Basics of Airway Management

Airway management is a fundamental skill in anesthesia and critical care, aimed at ensuring adequate ventilation and oxygenation. It involves assessing, maintaining, and securing the airway to prevent airway obstruction and respiratory failure. Here are the essential aspects of airway management:

1. Airway Assessment

Before any intervention, assess the patient’s airway to predict potential difficulties in mask ventilation, intubation, or airway maintenance.

• Key Examination Points:
  • Mallampati Classification: Visual inspection of the oropharyngeal structures.
  • Thyromental Distance: The distance between the thyroid notch and the mentum. A distance <6 cm suggests difficulty.
  • Neck Mobility: Reduced mobility may indicate challenges in aligning airway axes.
  • Inter-incisor Gap: A gap <3 cm indicates limited oral access.
  • Other Indicators: Obesity, facial trauma, or airway masses.

2. Airway Anatomy

Understanding the anatomy of the upper airway is critical.

The airway is divided into:

• Upper Airway: Nose, mouth, pharynx, larynx.
• Lower Airway: Trachea, bronchi, and lungs.

Key landmarks include the epiglottis, vocal cords, and glottic opening.

3. Basic Airway Management Techniques

A. Positioning

Proper patient positioning optimizes airway patency.

• Head-Tilt/Chin-Lift: Elevates the tongue off the posterior pharynx.
• Jaw Thrust: Useful in patients with suspected cervical spine injury.

B. Airway Adjuncts

• Oropharyngeal Airway (OPA): Prevents tongue obstruction in unconscious patients, and those with no gag reflex.

  

  Oropharyngeal airway measurement from the corner of the mouth to the angle of the mandible.

• Nasopharyngeal Airway (NPA): Useful when oral access is restricted or in semi-conscious patients.

  

  Nasopharyngeal airway measurement from tip of the nose to the tragus of the ear.

C. Bag-Valve-Mask (BVM) Ventilation

• Ensure a good seal with the mask.
• Use the “E-C clamp” technique to hold the mask and lift the mandible.
• Avoid excessive ventilation pressures to prevent gastric insufflation.

Bag-Valve-Mask (BVM) Ventilation

4. Advanced Airway Management

A. Endotracheal Intubation

• Direct or video laryngoscopy is performed to place a tube through the glottis into the trachea.
• Confirm tube placement using:
  • End-tidal CO2 (ETCO2) monitoring (gold standard).
  • Bilateral chest rise and auscultation.

B. Supraglottic Airway Devices (SGAs)

• Examples: Laryngeal Mask Airway (LMA), i-gel.
• Provide an effective airway when intubation or mask ventilation fails.

C. Surgical Airways

• Cricothyrotomy: Performed in emergency "cannot intubate, cannot ventilate" situations.
• Tracheostomy: Performed electively or in long-term airway management.