Airway management

• Outlines


  • Artificial Airway Indications
  • Oropharyngeal Airways
  • Nasopharyngeal Airways
  • Laryngeal Mask Airway
  • Anatomy of the airways
• Artificial airway


  Required when the patient's natural airway can no longer perform its proper function
• Conditions requiring management of the airway


  • Impending or actual airway compromise
  • Respiratory failure
  • Need to protect the airway
• Indications for artificial airway


  • Excessive secretions
  • Application of Positive Pressure Ventilation
  • Persistent apnea
  • Cardiopulmonary arrest
  • Upper airway obstruction (partial or complete)
  • Massive uncontrolled upper airway bleeding/Massive hemoptysis
  • Absence of airway protective reflexes
• Types of Artificial Airways


  • Pharyngeal
  • Oropharyngeal
  • Nasopharyngeal
  • Endotracheal
  • Orotracheal
  • Nasotracheal
  • Tracheostomy
  • Alternative Supraglottic
  • Retroglottic
• Oropharyngeal Airway (OPA)


  Lie between the base of the tongue and the posterior wall of the pharynx and separates them
• Oropharyngeal Airway (OPA)


  • Can help restore airway patency, maintain adequate ventilation when using a bag-mask device, facilitate suctioning, help with patient biting oral tubes (biting blocker)
  • Must only be used on the unconscious patients
  • Should never be taped in place
• Oropharyngeal Airway Types


  • Guedel airway
  • Berman airway
• Oropharyngeal Airway Size selection


  From the corner of the patient's mouth, to the angle of the jaw
• Oropharyngeal Airway Insertion


  1. With tongue depressor

  2. Jaw lift

  3. Proper insertion - The tip lies at the base of the tongue above the epiglottis, with the flange portion extending outside the teeth
• Complications of Oropharyngeal Airway


  • Provoke a gag reflex, vomiting, or laryngeal spasm, if used with conscious or semiconscious patient
  • Roof of mouth may be lacerated upon insertion
  • Contraindicated when there is trauma to the oral cavity or the mandibular or maxillary areas of the skull
  • These airways should never be placed when either a space-occupying lesion or a foreign body obstructs the oral cavity or pharynx
• Nasopharyngeal airways (NPA)


  • Lie between the base of the tongue and the posterior wall of the pharynx
  • It is made of soft rubber which is easy to be inserted
  • It is tolerated by semi/conscious patients
  • It facilitates nasotracheal suctioning
• Hazards of Nasopharyngeal airways


  • Aspiration if too small
  • Nasal irritation
  • Brain injuries
• Indications and Contraindications of Nasopharyngeal airways


  • Generally, is indicated when placement of an oropharyngeal airway is impossible
  • It is used when the jaws of a victim cannot be separated, as may occur with seizures
  • It should not be used when there is trauma to the nasal region or when space-occupying lesions or foreign objects block the nasal passages
  • Because the nasal passageway in children and infants is small, the use of nasal airways is generally limited to adults
• Nasopharyngeal airways Size selection


  From the patient's earlobe, to the tip of the nose
• Parts of Nasopharyngeal airways


  • A is the flange
  • B is the hollow cannula
  • C is the bevel
• Nasopharyngeal airways Insertion


  Proper insertion - The tip lies at the base of the tongue above the epiglottis, with the flange portion extending outside the teeth
• Laryngeal Mask Airway (LMA)


  • Consists of a short tube and a small mask that is inserted deep into the oropharynx
  • The open surface of the mask faces the laryngeal opening, and the tip of the mask is just above the esophageal sphincter
  • The short tube has a 15-mm adapter that can be connected to a manual resuscitator bag
  • A small tube is used to inflate a cuff when the device is in place
• Laryngeal Mask Airway Uses


  • Alternative to a face mask during surgery when tracheal intubation is not necessary
  • In emergencies when endotracheal intubation cannot be accomplished after several attempts
  • Unavailability of personnel trained in ET intubation
  • Elective surgical procedures
• Laryngeal Mask Airway


  • Insertion is simple, can be done blindly, and is easy to teach and learn
  • It provides a patent airway that is usually superior to that obtained with an oral or nasophrayngeal device
  • It dose not requie airway manipulatin or extreme head postioning and minimizes the flexion and extension of cervical spine
  • It eliminate the need to place a foreign body in the patient's trachea and causes less bronchospasm and coughing in pt with asthma and irritable airways
• Laryngeal Mask Airway Sizes


  • LMAs are available in all sizes and can be used in patients of all ages
• Laryngeal Mask Airway Insertion

  Mask must be lubricated and cuff fully deflated
• Laryngeal Mask Airway Advantages


  • It can be quickly and easy to be inserted
  • No special equipment necessary
  • It ventilates equally as well as an ET tube
  • Can intubate without removing LMA
  • There is less gastric insufflation than with bag-mask ventilation
  • There is no risk of esophageal intubation
  • There is less risk of trauma to the airway than with ET intubation
  • less stimulation to the larynx and quick recovery from postoperative sore throat
• Laryngeal Mask Airway Disadvantages and Limitations


  • Can't be used with semi/conscious patients
  • If ventilating pressure ">20" cm H2O" needed, gastric distention may occur
  • Short term use
  • Aspiration not avoided
  • Can't provide high ventilation pressures if needed
• Intubating Laryngeal Mask Airway


  • Designed to align the glottis with the LMA and allow blind endotracheal intubation through the hollow channel of the LMA
  • Requires training and practice
• Areas of focus


  • Establishing artificial airways
  • Oropharyngeal Airways
  • Nasopharyngeal Airways
  • Laryngeal Mask Airway
• Reference - Chapter 37 + 38