airway dwi

7/25/2019 Airway Dwi

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M Dwi Satriyanto.

Department of Anesthesiology

Padjadjaran University, Hasan Sadikin Hospital

Bandng

A!"#A$ MA%A&'M'%(A!"#A$ MA%A&'M'%(

#hen yo )an*t +reath, nothing else matters#hen yo )an*t +reath, nothing else matters


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'sta+lishing A Patent Airway'sta+lishing A Patent Airway

Head tilt,Head tilt, -hin ift and /aw (hrst Manever-hin ift and /aw (hrst Manever

0ropharyngeal Airway0ropharyngeal Airway

%asopharyngeal Airway%asopharyngeal Airway

aryngeal Mask Airwayaryngeal Mask Airway

11(he a+ove do not prote)t against aspiration and(he a+ove do not prote)t against aspiration and

laryngospasmlaryngospasm


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Mask 2entilationMask 2entilation

-an Deliver A High 3!04-an Deliver A High 3!04

Avoids (he Potential (rama 0fAvoids (he Potential (rama 0f

!nt+ation!nt+ation

Does %ot Prote)t Against AspirationDoes %ot Prote)t Against Aspiration

May "eslt !n &astri) DistensionMay "eslt !n &astri) Distension

aryngospasm -an 0))raryngospasm -an 0))r

"e5ires Use 0f Both Hands"e5ires Use 0f Both Hands


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0ral6%asal !nt+ation0ral6%asal !nt+ation

Safe and -ommon Pra)ti)e in PatientsSafe and -ommon Pra)ti)e in Patients

Undergoing &eneral AnesthesiaUndergoing &eneral Anesthesia

Atramati) !nt+ation re5ires 7nowledge ofAtramati) !nt+ation re5ires 7nowledge of

Anatomy, Appropriate se of '5ipment, andAnatomy, Appropriate se of '5ipment, andDrgs 8Ms)le "ela9ants:Drgs 8Ms)le "ela9ants:


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Preoperative 'valationPreoperative 'valation

Patient HistoryPatient History

11 Prior History of Diffi)lt !nt+ationPrior History of Diffi)lt !nt+ation

11 (mor of Head and %e)k(mor of Head and %e)k

11 ArthritisArthritis

11 Pregnan)yPregnan)y

11 (rama 1 - Spine, 3ll Stoma)h(rama 1 - Spine, 3ll Stoma)h


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Preoperative 'valationPreoperative 'valation

Physi)al '9aminationPhysi)al '9amination

11 (onge verss Pharyngeal Si;e(onge verss Pharyngeal Si;e

11 Atlanto 1 0))ipital /oint '9tensionAtlanto 1 0))ipital /oint '9tension

-ervi)al Spine Mo+ility 8normal )m

11 Dental '9amination 8oose (eeth, Prostheses:Dental '9amination 8oose (eeth, Prostheses:


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(e)hni5e 3or 0rotra)heal !nt+ation(e)hni5e 3or 0rotra)heal !nt+ation

Preparation And '5ipment 8Always HavePreparation And '5ipment 8Always HaveS)tion Availa+le:S)tion Availa+le:

Head Position 1 Alignment 0f 0ral, Pharyngeal,Head Position 1 Alignment 0f 0ral, Pharyngeal,

and aryngeal A9esand aryngeal A9es -hoi)e 0f aryngos)ope And 'ndotra)heal (+e-hoi)e 0f aryngos)ope And 'ndotra)heal (+e

Possi+le %eed 3or Awake (ra)heal !nt+ationPossi+le %eed 3or Awake (ra)heal !nt+ation

11 Diffi)lt Airway AlgorithmDiffi)lt Airway Algorithm


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S ? S)ope 8aringoskop @ Stetoskop:

( ? (+e 8pipa jalan napas:

A ? Airway 8 Mayo:

( ? (ape 8plester:

! ? !ntrod)er 8Maindrain:

- ? -one)tor

S ? S)tion


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0rotra)heal !nt+ation0rotra)heal !nt+ation

Patient*s Head At (he evel 0f (he iphoidPatient*s Head At (he evel 0f (he iphoid

Sniffing PositionSniffing Position

aryngos)ope !naryngos)ope !n LEFTLEFTHandHand

0pen Moth0pen Moth

Hold (ra)heal (+e !n "ight Hand ike A Pen)ilHold (ra)heal (+e !n "ight Hand ike A Pen)il


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li i f h l


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-ompli)ations 0f 0rotra)heal-ompli)ations 0f 0rotra)heal

!nt+ation 8Dring:!nt+ation 8Dring:

Dental And 0ral Soft tisse (ramaDental And 0ral Soft tisse (rama

Hypertension And (a)hy)ardiaHypertension And (a)hy)ardia

-ardia) Dysrhythmias And Myo)ardial !s)hemia-ardia) Dysrhythmias And Myo)ardial !s)hemia

AspirationAspiration

-orneal Damage-orneal Damage

li i f h l- li i 0f 0 h l


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-ompli)ations 0f 0rotra)heal-ompli)ations 0f 0rotra)heal

!nt+ation 8!nt+ated Patient:!nt+ation 8!nt+ated Patient:

(ra)heal (+e 0+str)tion(ra)heal (+e 0+str)tion

'ndo+ron)hial !nt+ation'ndo+ron)hial !nt+ation

BarotramaBarotrama A))idental Dis)onne)tA))idental Dis)onne)t

(ra)heal M)osa !s)hemia(ra)heal M)osa !s)hemia

A))idental '9t+ationA))idental '9t+ation

! di A d d l d! di A d d l d


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!mmediate And delayed!mmediate And delayed

-ompli)ations 0n '9t+ation-ompli)ations 0n '9t+ation

aryngospasmaryngospasm

AspirationAspiration

PharyngitisPharyngitis aryngeal 0r S+glotti) 'demaaryngeal 0r S+glotti) 'dema

2o)al -ord Paralysis2o)al -ord Paralysis

Arytenoid -artilage Dislo)ationArytenoid -artilage Dislo)ation


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Alternatives (o 0rotra)healAlternatives (o 0rotra)heal

!nt+ation Under Anesthesia!nt+ation Under Anesthesia

Awake 0rotra)heal !nt+ationAwake 0rotra)heal !nt+ation

%asotra)heal !nt+ation%asotra)heal !nt+ation

11 Awake Blind %asalAwake Blind %asal11 %asotra)heal !nt+ation After !nd)tion%asotra)heal !nt+ation After !nd)tion

!nt+ation #ith 3i+eropti) Bron)hos)ope!nt+ation #ith 3i+eropti) Bron)hos)ope

11 Awake verss Under AnesthesiaAwake verss Under Anesthesia

11 0rotra)heal verss %asotra)heal0rotra)heal verss %asotra)heal "etrograde !nt+ation"etrograde !nt+ation


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2erifi)ation 0f -orre)t (+e Pla)ement2erifi)ation 0f -orre)t (+e Pla)ement

Symmetri) -hest MovementSymmetri) -hest Movement

Symmetri) Breath SondsSymmetri) Breath Sonds

'nd tidal -ar+on Dio9ide'nd tidal -ar+on Dio9ide

11 &reater (han


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-on)lsion-on)lsion

Airway management is an e9tremely important aspe)t ofAirway management is an e9tremely important aspe)t of

the pra)ti)e of anesthesiology and )riti)al )arethe pra)ti)e of anesthesiology and )riti)al )are

A firm +asis in airway anatomy is neededA firm +asis in airway anatomy is needed

Skills s)h as mask ventilation, endotra)heal int+ation,Skills s)h as mask ventilation, endotra)heal int+ation,MA pla)ement are ne)essaryMA pla)ement are ne)essary

!n the )ase of a diffi)lt airway, a logi)al algorithm and!n the )ase of a diffi)lt airway, a logi)al algorithm and

airway e5ipment assist the physi)ian in safely managingairway e5ipment assist the physi)ian in safely managing

the sitationthe sitation


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(hank $o(hank $o


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