AIRWAY ADJUNCT AND

DIFFICULT AIRWAY
By Izwan Taufik
 AIRWAY ADJUNCT

• Equipment that being use to maintain airway.

• OROPHARYNGEAL
• NASOPHARYNGEAL AIRWAY
 OROPHARYNGEAL AIRWAY

• Inserted into the mouth and are used only on unconscious, unresponsive victims with no
gag reflex.
• STEPs:
1) SELECT THE PROPER SIZE – ANGLE OF MOUTH TO TRAGUS
2) OPEN THE VICTIM’S MOUTH – CROSS FINGER TRECHNIQUE
3) INSERT OPA
- Grasp the victim’s lower jaw and tongue and lift upward.
- Insert the OPA with the curved end along the roof of the mouth.
- As the tip approaches the back of the mouth, rotate it one-half turn (180 degrees).
- Slide the OPA into the back of the throat.
4) Ensure correct placement - flange should rest on the victim’s lips.
 NASOPHARYNGEAL AIRWAY
• The nasopharyngeal airway is a soft rubber or plastic uncuffed tube that provides a
conduit for airflow between the nares and the pharynx.
• Unlike the oral airway, it may be used in conscious or semiconscious persons (persons
with intact cough and gag reflex). The NPA is indicated when insertion of an OPA is
technically difficult or dangerous.
• Use caution or avoid placing NPAs in a person with obvious facial fractures.
• Steps :
1) SELECT THE PROPER SIZE - Measure the NPA from the victim’s earlobe to the tip of the
nostril. Ensure that the diameter of the NPA is not larger than the nostril.
2) LUBRICATE THE NPA - Use a water-soluble lubricant prior to insertion.
3) INSERT THE NPA -With the bevel toward the septum, advance the NPA gently following
the floor of the nose. If resistance is felt, do not force. If you are experiencing problems,
try the other nostril.
4) ENSURE CORRECT PLACEMENT - The flange should rest on the victim’s nostril.
 DIFFICULT AIRWAY

Difficult airway is defined as the clinical situation in which a

trained anaesthesiologist experiences difficulty with facemask
ventilation of the upper airway or difficulty with tracheal
intubation, or both.
Occurring in 6% of overall patient.
AIRWAY ANATOMY
 FIRST IMPRESSION
• Will I be able to mask ventilate?
• Will I be able to perform laryngoscopy, directly or indirectly?

• Will I be able to intubate this patient?

• Is there a significant aspiration risk?
• If I predict difficulty, should I secure the airway awake?

• How will the airway behave at extubation?

 POSSIBLE CANDIDATES

• Obese
• Polytrauma patient
• OMFS
• Burn
• Chronic illness – joint problems / genetic / rare disorders
 CLINICAL EXAMINATION

• Mouth opening <3FB

• MALLAMPATI score >3
• TMD <3FB
• Limited Neck ROM
• Short neck
• Receeding chin
 DIFFICULTY IN BAG MASK VENTILATION

• Mask ventilation is the most basic, and arguably most important, skill in airway
management.
• Types of patient: OBESE
1) Obesity
2) Bearded
3) Elderly
4) Snorer
5) Edentulous
 COMMON OBSTACLES

• Limited mouth opening

• Limited neck movement
• Obese
• Pregnancy
• Airway soiling
 STRATEGY IN MANAGING DIFFICULT
AIRWAY
1. Awake intubation
2. Video-assisted laryngoscopy
3. SGA for ventilation
4. Rigid laryngoscope blades of varying design and size
5. Fibreoptic guided intubation
 DIFFICULTY IN EXTUBATION

• Laryngeal oedema
THANK YOU!