Airway management
There are several things which must be taken into account regarding airway management during perioperatively:
- What is the patient’s body shape and airway anatomy? Will it make intubation difficult?
- Has the patient fasted?
- Are muscle relaxants needed?
- Will the surgery influence the anaesthesia somehow?
If the patient hasn’t fasted before surgery, for example during an emergency, the stomach is regarded as full, and rapid-sequence intubation (RSI, also called crash induction) and the Sellick-manoeuvre is needed. The Sellick-manoeuvre involves placing pressure on the cricoid cartilage to compress the oesophagus and prevent aspiration.
- All equipment which will be and may be necessary are prepared
- The patient is preoxygenated with 100% oxygen
- The Sellick-manoeuvre is applied
- Anaesthesia and paralysis is induced simultaneously with succinylcholine and an IV anaesthetic
- The patient is rapidly intubated after step 3
- The Sellick-manoueuvre is stopped
Mask ventilation is avoided, as this would increase the risk of aspiration.
Airway devices
An airway can be maintained with various tools:
- Face mask
- Nasopharyngeal (Wendl) tube
- Oropharyngeal (Guedel) tube
- Combitube
- Laryngeal mask
- I-gel tube
- Endotracheal tube (ET)
- Coniotomy – if mask ventilation and intubation fails (difficult airway)
The most frequently used airway is the ET tube. Signs of a successful intubation include:
- Direct visualisation of the tube passing between the vocal cords
- Auscultation of breathing sounds bilaterally
- Observation of chest movements