Lapsus Airway Management Edit2

7/21/2019 Lapsus Airway Management Edit2

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Airway Management Ayun Puji Lestari

I1A007081

Pembimbing:

dr. Rapto Hardian, Sp.An

Laporan asus



Anatomy



Equipment

! "ra# $ nasa# air%ay

! &a'e mas(

! L)A

! *sop+agea#-ra'+ea# 'ombitube

! -ra'+ea# tube

! Rigid #aryngos'ope



Equipment

! )aintain t+e opening air%ay

! A%a(e or #ig+t#y anest+etied patients may

'oug+ or e/en de/e#op #aryngospasm duringair%ay insertion i #aryngea# re#ees are inta't.

! 2asa# air%ay: ris( o epistais, s+ou#d not beused in basi#ar s(u## ra'ture, better to#eratedt+an ora# air%ay.

Oral & nasal airway



Face mask! &a'i#itate de#i/ery o oygen or o an anest+eti'

gas rom a breat+ing system to a patient by'reating an airtig+t sea# %it+ t+e patient3s a'e

! -ransparent mas(s

obser/ation o e+a#ed+umidiied gas and immediate re'ognition o /omiting

! 4#a'( rubber mas(s p#iab#e enoug+ to adapt

to un'ommon a'ia# stru'tures



! *e'ti/e /enti#ation re5uires bot+ a gastig+tmas( it and a patent air%ay.

! Improper a'e mas( te'+ni5ue de#ation ot+e anest+esia reser/oir bag %+en t+e adjustab#epressure#imiting /a#/e is '#osed indi'ating a

substantia# #ea( around t+e mas(.



The McCoy Laryngoscope Rigid Laryngoscope



LMA Combitube



Specialized laryngoscopic

blades

Flexible fiberoptic

bronchoscope



Kheterpal S. Han R, Tremper RK, et al. Incidence and Predictors of Difficult and Impossible MaskVentilation. Anest+esio#ogy 600 109:889;1



Spesific test for assessment

1. Re#ati/e to tongue<p+aryngea# sie )a##ampatti test

A. Anatomical criteria

Class I !isualization of the soft palate" fauces# u/u#a, anterior andt+e posterior pi##ars.Class II !isualization of the soft palate" fauces and u/u#a.Class III !isualization of soft palate and base of u/u#a.Class I! $nly hard palate is %isible& Soft palate is not /isib#e at a##.



6. At#anto o''ipita# joint =A"> etension

easibi#ity to ma(e sniing or )agi## position orintubation, measured by simp#e /isua# estimateor goniometer

?rade I : @ 9

?rade II : 66B?rade III : 1661?rade IC : D16



. )andibu#ar spa'ei. -+yromenta# =-)> distan'e =dii'u#t: D

inger or D 'm #ess dii'u#t: .9 'mnorma#: @,9 'm>

ii. Sternomenta# distan'e =dii'u#t intubation:D16 'm>

iii. )andibu#ar+yoid distan'e =2: B 'm< inger>

i/. Interin'isor distan'e = 2: B, 'm < more>



Lemon Airway Assessment-+e s'ore %it+ a maimum o 10 points is 'a#'u#ated by assigning 1

point or ea'+ o t+e o##o%ing L*)"2 'riteria:

L ' Loo( externally )facial trauma" large incisors" beard ormousta'+e, #arge tongue>

* ' *%aluate the +,+,- rule )incisor distance,+ finger breadt+s,+yoidmenta# distan'e inger breadt+s, t+yroidtomout+ distan'e6 inger breadt+s>

M ' Mallampati )Mallampati score . +/&

$ ' $bstruction )presence of any condition li(e epig#ottitis,

peritonsi##ar abs'ess, trauma>.0 ' 0ec( mobility )limited nec( mobility/

Patients in t+e dii'u#t intubation group +a/e +ig+er L*)"2 s'ores.1upta S" Sharma R" 2ain 3& AIR4A5 ASS*SSM*0T 6R*3ICT$RS $F 3IFFIC7LT AIR4A5& Indian J Anaesth 2005; 49 (4) 25!"2#2.



B. Direct laryngoscopy an fi!reoptic

!ronc"oscopy

1rade I 8 !isualization of entire laryngeal aperture&1rade II 8 !isualization of only posterior 'ommissure o #aryngea#

aperture.1rade III 8 !isualization of only epiglottis&1rade I! 8 !isualization of 9ust the soft palate&

?rade III and IC predi't dii'u#t intubation



#. $aiograp"ic assessment

1. S(e#eta# i#ms

6. &#uoros'opy ='ord mobi#ity, air%ay ma#a'ia,emp+ysema>

. "esop+agogram =in#ammation, oreign body,etensi/e mass or /as'u#ar ring>

B. E#trasonograp+y =anterior mediastina# mass,#ymp+adenopat+y, dierentiates 'yst rom

mass and 'e##u#itis rom ab'ess>9. F-<)RI ='ongenita# anoma#ies, /as'u#ar

air%ay 'ompression>

. Cideoopti'a# intubation sty#ets



Laporan %asus

2ama : -n. &

Emur : B ta+un

A#amat: omp#e( ayu -angi 6

Agama : Is#am

Inormed 'onsent: o(tober 6016

R) : 1016861



Anamnesis! e#u+an Etama

e#uar benjo#an di se#ang(angan sebe#a+ (anan

! RPS

Pasien menge#u+ (e#uar benjo#an seja( ta+un

yang #a#u, +i#ang timbu#. 4enjo#an mun'u# tiap (a#ipasien bersin. 1 bu#an tera(+ir benjo#an (e#uar dansu#it masu( (emba#i. Pasien merasa sangat nyerisaat (e#uar benjo#an. Pasien #a#u (e po#i beda+

RSEG E#in dan disaran(an untu( operasi.



isite 're operatif

! E : 4ai(

! 4atu(<pi#e(<demam : <<

! ?igi goyang<gigi pa#su : <

! R< H-<G)<asma : <<

! R< a#ergi ma(anan<obat : <

! R< operasi dengan ?A : ! )ero(o( : =ber+enti 1 minggu yg #a#u>



'emeriksaan Fisik

! eadaan umum: 4ai(

! esadaran: omposmentis

! ?FS : B9

! -G : 160<;0 mmHg

! 2 : 8B <menit

! RR : 60 <menit! 44 : B (g

! )a##ampati :



%esulitan (entilasi paa kasus



! Fer/i'a# spine dbn

! 2e'( anatomy t+i'( poor #eionetensionmobi#ity o t+e +ead on ne'(.

! )a##ampati '#assii'ation III

! &u## beard

2o! Gentition norma#

! Large tongue



)ntraoperatif

! Pet+idin, propoo# dan mus'#e re#a(san sd+diinje(si(anapnea (esu#itan /enti#asi

dengan a'e mas( saturasi turun pasangguede# =untu( memperta+an(an air%ay> saturasi tetap tida( mening(at pasang L)A.



Difficult Airway

! Gii'u#t air%ay : t+e '#ini'a# situation in %+i'+ a'on/entiona##y trained anest+esio#ogist

eperien'es dii'u#ty %it+ a'e mas( /enti#ationo t+e upper air%ay, dii'u#ty %it+ tra'+ea#intubation, or bot+.

Pra'ti'e guide#ines or management o t+e dii'u#t air%ay: An updated report by t+e Ameri'an So'iety o Anest+esio#ogists -as( &or'e on )anagement o t+e Gii'u#t Air%ay. A2*S-H*SI"L"? 600 ;8:16;77



Difficult (entilation=a> It is not possib#e or t+e anest+esio#ogist to pro/ide ade5uate a'e

mas( /enti#ation due to one or more o t+e o##o%ing prob#ems:inade5uate mas( sea#, e'essi/e gas #ea(, or e'essi/e resistan'e tot+e ingress or egress o gas.

=b> Signs o inade5uate a'e mas( /enti#ation:

1. absent or inade5uate '+est mo/ement,

6. absent or inade5uate breat+ sounds,

. aus'u#tatory signs o se/ere obstru'tion,

B. 'yanosis,

9. gastri' air entry or di#atation,

. de'reasing or inade5uate oygen saturation =Sp"6>,

7. absent or inade5uate e+a#ed 'arbon dioide,

8. absent or inade5uate spirometri' measures o e+a#ed gas #o%

;. +emodynami' '+anges asso'iated %it+ +ypoemia or +yper'arbia

=e.$., h%pertensi&n, ta'h%'ardia, arrh%thmia).Pra'ti'e guide#ines or management o t+e dii'u#t air%ay: An updated report by t+e Ameri'an So'iety o Anest+esio#ogists-as( &or'e on )anagement o t+e Gii'u#t Air%ay. A2*S-H*SI"L"? 600 ;8:16;77



'reict ifficult mask (entilation *OBESE+



Difficult intu!ation! ii'*lt int*+ati&n +as been deined by t+e need

or more t+an t+ree intubation attempts or

attempts at intubation t+at #ast @ 10 min.! Su'+ patients in stab#e 'ir'umstan'es 'an

usua##y to#erate 10 min o attempted intubation

%it+out ad/erse se5ue#ae.

Pra'ti'e guide#ines or management o t+e dii'u#t air%ay: An updated report by t+e Ameri'an So'iety o Anest+esio#ogists

-as( &or'e on )anagement o t+e Gii'u#t Air%ay. A2*S-H*SI"L"? 600 ;8:16;77



'reict ifficult intu!ation

a. Poor #eionetension mobi#ity o t+e +ead onne'(

b. A re'eding mandib#e and presen'e oprominent teet+

'. A redu'ed at#antoo''ipita# distan'e, a redu'ed

spa'e bet%een F1 and t+e o''iput.d. Large tongue sie re#ated more to t+e ratio o

t+e anterior #engt+ o t+e '+in or mandib#e



)f a ifficult airway is known or suspecte,

1. Inorm t+e patient =or responsib#e patient> o t+e spe'ia#ris( and pro'edures pertaining to management o t+edii'u#t air%ay

6. As'ertain t+at t+ere is at #east one additiona# indi/idua# %+o is immediate#y a/ai#ab#e to ser/e as an assistant indii'u#t air%ay management

. Administer a'e mas( preoygenation beore initiatingmanagement o t+e dii'u#t air%ay. -+e un'ooperati/e or

pediatri' patient may impede opportunities orpreoygenation

B. A'ti/e#y pursue opportunities to de#i/er supp#ementa#oygen t+roug+out t+e pro'ess o t+e dii'u#t air%ay

management



Difficult airway algorit"m



$etrograe intu!ation



T*RIMA :ASI;

Lapsus Airway Management Edit2

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