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airway management
Anesthesiology airway management content, including the anatomy of the airway, Causes that affect airway patency, Supraglottic airway management methods, etc.
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airway management
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airway management
anatomy of airway
Upper respiratory tract
Mouth, pharynx, nose, throat
The mucous membrane in the anterior superior area of the nasal septum is an area prone to bleeding.
Nasopharynx: enlarged tonsils
Oropharynx: Tongue falls behind
lower respiratory tract
Trachea, bronchi, branching bronchi within the lungs
Causes that affect airway patency
Discharge, bleeding, and foreign bodies
Often causing incomplete respiratory obstruction
Characteristic manifestations: Inspiratory dyspnea; phlegm and/or high-pitched wheeze
Treatment method: suction with a suction device; assisted removal with hands or instruments; suction or removal under direct laryngoscopy.
Tongue drop (most common)
clinical manifestations
Incomplete obstruction: snoring, laryngeal drag
Complete obstruction: snoring disappears, abnormal breathing occurs, oxygen saturation decreases, and cyanosis
Treatment principles: For mild cases, the head tilt to one side may be relieved; chin lifting method with one hand or mandibular support method with both hands; if necessary, place an oropharyngeal or nasopharyngeal airway
laryngospasm
Characteristic manifestations: Inspiratory dyspnea, accompanied by dry cough and high-pitched throat sounds
Bronchospasm
Reasons: Allergy, reflux and aspiration of gastric contents, excessive secretions, strong irritation of tracheal mucosa
Clinical manifestations: significantly prolonged expiration time, scattered wheezing in both lungs, and cardiac arrhythmia
Treatment method: Oxygen inhalation or anesthesia machine mask assisted oxygen supply, antispasmodic drug treatment
Ventilation disorders caused by residual effects of drugs
Treatment method: Assist breathing with a simple breathing bag or anesthesia machine mask; control breathing with endotracheal intubation
Supraglottic airway management methods
Processing principles
Choose a method that is simple, effective, safe, and familiar to the operator
Basic methods to maintain airway patency
mandibular support method
Use of oropharyngeal airway
Use of nasopharyngeal airway
mask ventilation
Indications
A short general anesthesia operation without the risk of reflux and aspiration of gastric contents
Pre-oxygenation and denitrification before tracheal intubation
Assist or control breathing in emergency situations
Precautions
Effect judgment: airway resistance, ups and downs of the chest
Adjuvant measures: Oropharyngeal or nasopharyngeal airway
Complications: gastric distension and reflux and aspiration (the most serious); soft tissue injuries around the eyes, mouth, and nose
laryngeal mask ventilation
advantage
Easy to learn, easy to operate, and quick to install
It causes little irritation to the patient and has a light response to intubation. It is suitable for patients with hypertension, coronary heart disease, etc.
Fewer postoperative complications
Indications
Quickly establish an emergency airway, such as when lying on your side or prone
When the effect of neuraxial anesthesia is not satisfactory and it is necessary to combine it with light general anesthesia
Disadvantages and contraindications
(1). There is a possibility of aspiration. For people who are at greater risk of aspiration
(2). The laryngeal mask is resistant to high airway pressure and may cause insufficient ventilation in patients with increased airway resistance.
(3). Not applicable to conscious patients in the emergency room
(4). Too shallow anesthesia can lead to laryngospasm
(5). Damage to the supraglottis or hypopharynx
high frequency jet ventilation
Indications: acute respiratory failure emergency; bronchopleural fistula; bronchoscopy or airway surgery; emergency difficult airway
Subglottic airway management methods
tracheal intubation
It is the most accurate and reliable method to connect the artificial airway with the natural airway and control the airway.
Indications
Keep airway open
General anesthesia requiring intubation
Treatment of airway obstruction and dyspnea
cardiopulmonary cerebral resuscitation
First aid for severe hemoptysis
Unilateral lung lavage treatment
Preparation before intubation
Intubation method
transoral photopic endotracheal intubation
Pre-oxygenation
Intubation position
Intubation operation method
Determination of endotracheal tube position
Direct vision of the inferior duct entering the glottis
When pressing the chest, there is airflow from the catheter port
During artificial ventilation, symmetrical rise and fall of the bilateral thorax can be seen, and clear alveolar breath sounds can be heard during auscultation of both lungs.
If you use a transparent catheter, the wall of the tube will be clear when you inhale, and an obvious "white mist"-like change will be visible when you exhale.
If the patient is breathing spontaneously, the breathing bag will expand and contract with breathing after being connected to the anesthesia machine.
If you can monitor the partial pressure of end-tidal CO2 (PETCO2), it will be easier to judge. If there is a display, you can confirm it is correct.
Nasotracheal intubation
Indications: cervical spine instability, mandibular fracture, oropharyngeal infection, etc.
Features: The technical requirements and trauma are relatively large, and it can easily cause nose bleeding.
Operational points
Topical anesthesia and 3% ephedrine solution intranasally
The catheter is inserted vertically to conform to the shape of the inferior meatus.
Adequate lubrication of the catheter and nasal cavity
Intubation forceps can be used to assist in intubation
Common complications of tracheal intubation
Injuries caused by endotracheal intubation
Poor endotracheal tube or tracheostomy tube
Excessive phlegm or phlegm scab
Inadvertent one-lung ventilation due to too deep catheter
tracheostomy
Routine and emergency tracheostomy
cricothyroidotomy or puncture
It is simpler, faster and has fewer complications than tracheotomy.
Combined tracheo-esophageal catheter
bronchial intubation
Inserting a bronchial tube into a unilateral main bronchus
Purpose: Separate the lungs on both sides and ventilate them separately to protect the healthy lung and improve the exposure of the surgical field.
Usage: Hemoptysis, pulmonary infection, bronchoalveolar lavage, lung surgery
Management of difficult airway
Including: difficulty in mask ventilation, difficulty in direct laryngoscope intubation
Processing principles
Patients with a known difficult airway prior to intubation
Try to choose awake intubation and use appropriate intubation techniques
Patients under general anesthesia, comatose and unable to breathe spontaneously
Use other intubation techniques when the mask ensures adequate ventilation.
Difficulty intubating Patients with difficulty in mask ventilation
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