Airway

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Author:
esmond
ID:
255706
Filename:
Airway
Updated:
2015-06-29 11:24:11
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Airway
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Airway
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  1. Malampatti
  2. Cormack-Lehane
  3. Intravenous induction agents
    • Propofol
    • Adv quick onset
    • Disadv -ve inotropic effect, apnoea with unconciousness

    • Ketamine
    • Adv No apnoea, can give IM
    • Disadv HT,increased secretions,delirium
  4. Maintenance volatile anaesthetic agents
    • e.g. isofluorane(least noxious), sevfluorane
    • Adv maintain spontaneous respiration with unconciousness
    • Disadv slow onset, patient inability to tolerate smell of gas
  5. Adjuntives
    • Sedatives - e.g midazolam for anxiolytic
    • and amnesic effects , disadv = resp depression in larger doses or in synergy with opiods

    Opiods – analgesia, blunt sympathetic response to intubation, sedation

    Anti sialogogue – e.g glycopyrolate
  6. Paralytic agents
    -helps with intubation
    • Depolarising
    • eg succinylcholine
    • Adv fast onset, short, duration
    • Disadv rise on potassium, muscle fasciculation, prolonged effect if
    • psudocholinesterasee deficient, malignant hyperpyrexia.
    • Contraindications – known/suspected MH, increased intracranial pressure, increased intraoccular pressure, elevated potassium

    Non – depolarising

    • Slower onset
    • Rocuronium=fastest if Depolarising contraindicated, – 60 seconds onset, last 30 – 40 minutes,no reversal for 20-30 minutes
  7. Standard protocol
    • Monitoring/iv access
    • Preoxygenation
    • Induction
    • Positive pressure mask ventilation
    • If suucessful paralysing agent given
    • When paralysed intubation
  8. Rapid sequence induction
    • No mask ventilation
    • Induction agent
    • Paralytic agent
    • Cricoid pressure
    • Intubation
  9. Difficult airway
    • 1.Difficult tracheal intubation
    • 2. Difficult laryngoscopy
    • 3. Difficult mask ventilation
  10. Fiberoptic intubation
    • Premedication – eg midazolam
    • Anti sialogogue – e.g glycopyrolate
    • Local anaesthetic eg lignocaine
  11. RAE tube
    right angled endotracheal tube
  12. Airway protocol
  13. Aintree catheter intubation
    • Ventilating bougee(4.7 mm inner diameter) 
    • Able to pass FNE through
    • Pass through size 7mm+ ET tube

    • Standard LMA
    • Pass Aintree catheter on FNE through standard LMA into trachea.Tape prox aintree onto FNE.
    • Remove FNE
    • Remove LMA
    • Oxygenate if required
    • Railroad size 7+ ET tube over catheter.
    • Recheck position with FNE
    • Remove catheter

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