Airway management






Evaluation of the airway

    1. History
    2. General examination
    3. Specific predictive tests
    4. Special investigations including interpretation of CT, MRI imaging and flow-volume loops; flexible nasendoscopy and imaging

Airway strategy for:

    1. High aspiration risk
    2. Predicted difficult direct laryngoscopy
    3. Predicted difficult mask inflation
    4. Known abnormal / narrowed tracheo-bronchial tree
    5. Unexpected difficult ventilation
    6. Unexpected difficult intubation
    7. Unexpected difficult intubation during rapid sequence induction
    8. can’t intubate / can’t oxygenate

Intubation

    1. Indications
    2. Selection of tube type (oral, nasal, armoured etc), diameter and length
    3. Methods of confirming placement of the endotracheal tube
    4. Laryngoscopy, intubation and its complications including oesophageal and endobronchial intubation

Alternative intubation strategy:

    1. Understanding of fibreoptic bronchoscopic techniques for airway management
      1. Oral and nasal intubation using fibreoptic bronchoscope
      2. Low skill fibreoptic intubation e.g. via laryngeal mask or specialised airway
      3. Blind and fibreoptic assisted intubation via the intubating laryngeal mask
    2. Elective trans-tracheal ventilation to aid difficult intubation
    3. Retrograde intubation – blind and fibreoptic assisted
    4. Specialised bougies and airway exchange catheters
    5. Use of the combitube or other supraglottic balloon device

Difficult intubation & dentition

Airway care, including tracheal intubation and clearance of secretions (in the critical care setting)

Airway control: recognition and correction of problems

Management of the shared airway

    1. Working with dental and oral surgeons and their use of mouth props and packs

Percutaneous cricothyrotomy and tracheostomy

Surgical approach to the airway – indications, techniques, conduct

Fibre-endoscopy skills to:

    1. visualise tracheo-bronchial tree
    2. confirm placement of single and double lumen tubes

Preoxygenation – techniques / purpose

Monitoring of ventilation by pressure changes, gas flows and capnography

Cricoid force:

    1. Indications
    2. Techniques
    3. Difficulties at intubation induced by Cricoid Force

Awake intubation :

    1. Indications
    2. preparation of patient
    3. topical anaesthesia
    4. nerve blocks
    5. Fibreoptic intubation through the nose and mouth with and without concurrent ventilation
    6. use with the compromised airway

Laryngoscopy, bronchoscopy

Placement and checking of double lumen tubes

Placement of bronchial blockers

The obstructed airway:

    1. Recognition
    2. Immediate treatment of acute obstruction
    3. Anaesthetic management of acute and chronic obstruction

Emergency cricothyrotomy

    1. needle
    2. surgical
    3. Landmarks
    4. Insertion of needle / purpose built cannula >4 mm ID
    5. Confirmation of position within trachea
    6. Fixation
    7. Pressures required for adequate gas flows
    8. Ventilation through cannula / catheter
    9. Complications

Extubation strategies – routine, predicted and unexpected difficulty, extubation in presence of full stomach

Extubation procedures to avoid laryngospasm

Complications of difficult airway management

Clinical review of patient to detect and treat complications of airway instrumentation.

Follow-up care of patient, documentation and patient information

CEACCP 2001: APRIL
Ralph S Vaughan
Predicting difficult airways

CEACCP 2005: APRIL
Rhona CF Sinclair and Mark C Luxton
Rapid sequence induction

CEACCP 2006: FEBRUARY
James English, Andrew Norris, and Nigel Bedforth
Anaesthesia for airway surgery

CEACCP 2003: AUGUST
P Sudheer and MR Stacey
Anaesthesia for awake intubation