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9 Cards in this Set
- Front
- Back
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Prediction/grade of difficult mask ventilation |
Difficult mask ventilation ≥ 2 of: BMI; age >55; malesex; OSA/snoring; beard; edentulous – 70% sensitivity/specificity· Grading of difficulty of mask ventilation (Kheterpal et al) o Grade 1 – simple maskventilation o Grade 2 – airway adjunctreqd o Grade 3 – Difficult – 2providers, inadequate or unstable – risk 2-5% o Grade 4 – impossible – risk0.1% |
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Cormack-Lehane |
Cormack-Lehane Grade Grade 1 – Fullview of glottis Grade 2 – Partialview Grade 3 –Epiglottis only Grade 4 – no laryngeal structure visible Cook’sModification 2a – partial cords 2b – aretynoids/cunieform only 3a – epiglottis able to lift from posterior pharyngealwall 3b - epiglottis adeherent to posterior wall |
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Wilson score |
0-2 points x5 = 10 max Weight - <90 / 90-110 / >110 H&N mobility deg - >90 / 90 / <90 Mandiblular mobility* > 0 / 0 / <0 Retrognathia none/mod/sev Upper teeth prominence none/mod/sev Sens 50 Spec 90 Mandibular mobility 0 point = MO > 5cm plus lower teeth beyond upper 1 = MO <5cm or lower at upper 2 = MO <5cm and lower behind upper (no subluxation) |
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Conditions associated with difficult airway |
Anatomical Congenital - midface or mandibular hypoplasia (Pierre-Robin, Treacher Collins, Apert, Downs), restricted neck movement (Kippel-Fiel) Acquired - - obesity - infection - trauma, bleeding, oedema - spine (RA, AS, fusion) - mass (oropharynx, pharynx or larynx, external e.g. tracheal) - abscess - radiotherapy - foreign body - burns - acromegaly Physiological - cardiac - respiratory - pregnancy - GI/reflux - psychological/behavioural |
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Sens/Spec airway tests |
MP sens 50 spec 80 TMD 20 / 94 MO 20/ 97 Combination MP/TMD 81 / 97 Wilson 50 / 90 |
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Airway assessment measurements |
MO/IID <3 difficult ETT < 2.5 difficult LMA TMD (Patil) normal > 6.5 or 7cm; 75% difficult intubations < 6cm Sternomental (Saava) <12.5cm Cervical extension <90 degrees (chin below occiput) OR - change of angle of >35 degrees (from erect/front facing, then look upwards) Mandibular protrusion - A normal (lower teeth beyond upper) B&C difficult (lower teeth at or behind upper) 3-3-2 (Lemon score) 3 of patients fingers between incisors hyo-mental 3 fingers hyo-thyroid 2 fingers |
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Sensory supply of airway |
Nasal - Anterior - V1 (anterior ethmoidal, from nasociliary) - Posterior - V2 (greater & lesser palatine) Oral - Floor of mouth and anterior tongue - V3 (lingual); VII for taste (chorda tympani) - Posterior 1/3 of tongue - IX and X - Buccal mucosa - V2 branches and V3 (buccal nerve) - Palate - V2 (greater/lesser palatine, nasopalatine) Pharynx - IX to pharyngeal surface of epiglottis Larynx & trachea - X - superior laryngeal nerve (internal branch) - posterior epiglottis, larynx except: - recurrent laryngeal nerve - vocal cords and trachea |
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Anaesthesia for AFOI |
Adults - 8-9mg/kg topical or 3mg/kg block Children - 4mg/kg lignocaine (Frank Shann) Options: Topical - spray as you go, nebulise, atomise Blocks - pterygeopalatine ganglion - cotton swab to middle turbinate - peristyloid (IX) (5mL 2%) - superior laryngeal n - drag hyoid towards you, contact hyoid, pierce thyrohyoid membrane (2mL 2% x2) - recurrent laryngeal - trans cricothyroid (topical) |
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Nasal intubation - I/CI |
Indications Surgical – oral/dental – visualisation or dentalocclusion Patient – limited mouth opening (usingfibreoptic) Other - ?blind nasal intubation, prolongedintubation (especially in children) Contraindications Base of skull injury (CSF leak, confirmedethmoidal fracture) Bleeding (epistaxis, coagulopathy) Non-patent nasal passage Patient refusal |
