Perioperative Management of Difficult Airway

Abstract

Introduction: It is widely recognized that the two most important tasks for anaesthetists are the management of a difficult airway and the maintenance of oxygenation. Problems related to difficult airways are known to be the primary cause of life-threatening anaesthesia-related accidents, they are one of the main sources of legal issues in the United Kingdom Défense Societies registries and in the American Society of Anaesthesiologists (ASA) closed claims. That is why difficult airway management is one of the most demanding duties for anaesthetists, and it provides a continuous challenge in addressing and solving potentially life-threatening problems. Although the incidence of the most critical situation in airway management, "cannot intubate, cannot oxygenate." is low at 0.0019-0.04%, its occurrence can have severe consequences and up to one-third of anaesthesia-related deaths are due to failure to intubate and ventilate including tracheal or oesophageal injury, aspiration, and sever hypoxemia, which can cause irreversible brain damage and lead to death.

Clinical Features of airway obstruction, respiratory arrest, Teaching post graduates basic airway manoeuvres like head-tilt/chin-lift.

Predictors of difficult airway Key parts of the examination of patients include neck mobility, mouth opening, teeth/jaw alignment, shorter horizontal distance, retrognathia, Mallampati score, thyromental distance. Specific tests like modified Mallampati, lemon test, Wilson score SARI score have been recommended as predictors Measurements of airway can help identify issues like limited neck extension, micrognathia.

Preparation of patients with difficult airway- airway management equipment ie airway cart It also covers basic airway adjuncts like oropharyngeal airways and nasopharyngeal airways. Finally, it introduces advanced airway devices like laryngeal mask airways and describes how to size them appropriately. Fibreoptic intubating bronchoscope Basic vital parameters monitor- Management of airway, to follow the ASA difficult airway algorithm strategy used for managing difficulties and management of complication arising out non intubations situations.