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ASA -Guidelines for management of difficult airway

Discussion in 'Anesthesiology' started by ALTorGT, Mar 3, 2007.

  1. ALTorGT

    ALTorGT Senior Member 7+ Year Member

    Feb 25, 2003
    1) Prominent overbite of maxillary incisors
    -overbite means recessed lower mandible, which means less room for tongue = less room for you to see
    -big incisors/beaver teeth = get in way of your view because you wont be able to line your blade up properly = increased possiblity of broken teeth

    2) During voluntary protrusion, patients cannot bring mandibular incisors anterior to maxillary
    Think about when you lift up and away with your laryngoscope. That action TRANSLATES the jaw forward opening up the posterior pharynx and allowing you to get a better view of the larynx. If you person cant translate their jaw forward = less room for you to manuver with = crappier view

    3) High arched palate or narrow
    High arched, dunno. Unless it is associated with some other sort of anomaly. Narrow = less room.

    4) Compliance of mandibular space (what is the mandibular space?)
    If you grabbed my lower jaw and ripped it out, tongue (the whole thing to the thyroid notch)and all, everything lying inbetween the two halves of the mandible to the thyroid notch is the mandibular space. This is all the soft tissue you must manuver around in order to get your view.

    5) Thickness of neck...i can understand short necks..but why thickness?
    Big thick neck probably correlates with a LOT of soft tissue on the inside. Soft tissue LOVES to collapse when you put the patient to sleep.

    Grab any anesthesia book and check out the 3 axis of the airway (oral, pharyngeal, laryngeal). That will lead to a nice simple understanding of some of the anatomic barriers you must try and overcome in order to get a view (i.e. the sniffing position and a ramp for phatties in order to get their head higher than their chest.). Some studies suggest that the sniffing position doesn't make all that much difference if an airway is difficult.
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  3. VentdependenT

    VentdependenT You didnt build thaT Physician Moderator Emeritus 10+ Year Member

    Oct 3, 2003
    WHoops, sorry ALTorGT. I accidently put my answer into your original post. My apoligies.
  4. ALTorGT

    ALTorGT Senior Member 7+ Year Member

    Feb 25, 2003
    how does ramping the fatties head help? because if the fatties chin is below the fatties chest, it still shouldnt interfere with head extension should it?
  5. Noyac

    Noyac ASA Member SDN Advisor 10+ Year Member

    Jun 20, 2005
    Some folks swear by it. Personally, I don't bother with it. It is supposed to get the weight of the breast if female away from the neck and to give a theoretically better angle to the 3 axis'. I mostly rely on strength if needed:eek: (scarry but true).
  6. ALTorGT

    ALTorGT Senior Member 7+ Year Member

    Feb 25, 2003
    if the breasts fall away from the neck, how does that help with better visualisation. the way i see it, if the breasts fall onto the neck, its a bit of BURP.

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