Airway Emergencies - unexpected difficult airway
Helpful Hints

* Always perform a full airway assessment on every patient requiring anaesthesia, even if the plan is spont vent GA or regional anaesthesia. Algorithms should be learnt, taught and practised.
* Correctly performed pre-oxygenation gives you time to hopefully get out of trouble
* Most important factor indicating success/ failure is anaesthetist. He/she should be familiar with an array of airway instruments Techniques that have been practised regularly will have a higher success in an emergency

What To Do

* Don’t panic, give clear instructions
* CALL FOR HELP
if you can’t ventilate
if you are inexperienced in managing difficult airways
* Always consider waking patient up if this is possible
* Avoid multiple laryngoscopies by more experienced anaesthetists
* Do what you have rehearsed
* Do not try and use equipment that you have never used before

Improve Conditions for Intubation

* Position ‘sniffing the morning air’
* Jaw thrust/ tongue retraction
* Cricoid pressure- do yourself with right hand to obtain best view
* BURP- Backward upward right pressure on thyroid cartilage may bring posterior larynx into view

Blade choice

* MacIntosh for limited oropharyngeal space
* Straight blade for
anterior larynx
large protruding incisors where blade can be introduced into side of mouth
large floppy epiglottis
* McCoy blade produces elevation of epiglottis and may produce a better view in patient with anterior larynx
* Left handed blade for right sided tongue pathology

Improve Equipment for Intubation

* Introducer into ETT with hockey stick bend at distal end
* Gum elastic bougie used as a guide over which ETT is introduced
* Cook ventilating catheter also used as guide but allows ventilation through narrow lumen
* Smaller ETT may be appropriate
* Assistant to apply jaw thrust hopefully opening up larynx