How should the patient be positioned for Mallampati?
Sitting upright
What is a Mallampati I ?
Uvula, hard and soft palate and pillars are all visible
What is Mallampati II?
Uvula is not fully visible
What is Mallampti III?
Can't see uvula but can see hard and soft palate (kind of subjective)
What is Mallampati IV?
You can only see the hard palate
What is the sniff position?
Neck flexed 35° on the torso
Head extended at the antlantooccipital joint to produce a 15° angle between the facial plane and the horizontal
The axis will all align together in this position
The three axes alignment theory is????
Looking at three axes and how the alignment best in the sniff position
How do we achieve optimal head position in the morbidly obese patient?
by supporting and elevating the shoulders and upper torso.
Horizontal alignment of the external auditory meatus with the sternal notch should be used as an end point for correct positioning
Do you need a pillow for proper head alignment in children?
No, they have big heads
True or false? In infants, you may need to use a shoulder roll to get proper head position
TRUE
What is the MOST important skill we have?
Bag/Mask ventilation! Ventilation is far more important than intubation
ASA Closed Claims Review Adverse Respiratory Events showed inadequate ventilation to be the cause most of the time
When/Where do difficult airway management situations occur the most?
During induction (66%)
4 "steps" of airway managment
ASSESS
PLAN
MANAGE
BACK-UP
Describe the grades of the Cormack and Lehane – Grading System for Direct Laryngoscopy
Grade 1 – no difficulty visualizing the VC
Grade 2 – only the posterior VC, or arytenoid cartilage, is seen
Grade 3 – only the epiglottis is seen
Grade 4 – no recognizable structures
Why do we use the Cormack and Lehane – Grading System for Direct Laryngoscopy
This classification allows interobserver comparison of the view of the glottis on direct laryngoscopy.
This grading system is pre-written on some of our anesthesia records.
If not, you should still note the grade in on the record.
This grading system is in common usage and would be very valuable to the next anesthesia provider if the pt. returns for another surgery.
The prevalence of difficult laryngoscopy appears to be __________ and is higher in the obstetric than the nonobstetric population.
~1-4%
According to the Cormack and Lehane – Grading System for Direct Laryngoscopy, Patients of grade __ and many pt’s with grade ___ view are difficult to intubate
4; 3
What are the 11 anatomical things we look for regarding a patients airway?
1) Length of upper incisors (long)
2) Relationship of maxillary and mandibular incisors during normal jaw closure (overbite)
3) Relationship of maxillary and mandibular incisors during voluntary protrusion of mandible
4) Intercisor distance (<3cm)
5) Visibility of uvula (Mallampti 3/4)
6) Shape of palate (high arch or narrow)
7) Compliance of mandibular space (stiff, indurated, occupied by mass, or non-resilent)
8) Thyromental distance (<3 fingers)
9) Length of neck (short)
10) Thickness of neck (thick)
11) ROM of head & neck (can't flex/extend neck well)