Airway Maintenance Without Airway Device

Airway Maintenance Without Airway Device

Although the potential causes of airway obstruction are many including anesthesia, the following initial airway clearing maneuvers are appropriate to try in most

Patients Head Tilt and Chin Lift Maneuver

The simplest way of ensuring an open airway in an unconscious patient, there by lifting tongue from the back of the throat (Figure 5.1).

Figure 5.1 head tilt

Head Tilt

The patient's head is tilted backwards at the atlanto-occipital joint on the neck and the neck is hyper extended (Figure 5.1). This maneuver is contraindicated in the presence of possible cervical injury. After the head is extended, functional obstruction is alleviated as the epiglottis and tongue are elevated off the posterior pharyngeal wall

Figure 5.2 Chin Lift: Place two fingers under the bony portion of the lower jaw, near the chin, and push the patient's chin upward with moderate pressure. The head tilt and chin lift maneuver are often done collectively.

Figure 5.3 Jaw thrust. It is done by placing fingers at the angle of the jaw and pull gently up and out. The procedure moves away obstructing tongue from both the palate and the posterior pharyngeal wall to obtain a patent airway in an unconscious patient. This is easy to understand because the tongue is anchored to the mandible lifting the mandible lifts the tongue. The jaw thrust without head tilt is the technique of choice for a patient with a suspected neck injury since it causes the least amount of movement in the cervical spine. When using a chin lift or jaw thrust, it is important to ensure that your patient is exchanging air adequately.

If inability to ventilate with a face mask despite proper positioning, jaw thrust, and a good mask seal, this may be caused by laryngeal spasm in response to light anesthesia or by soft-tissue upper airway obstruction resulting from deepening anesthesia and the onset of muscle relaxation. If an assessment suggests simple supraglottic obstruction, insertion of oro pharyngeal airway to separate soft tissues from the posterior pharyngeal wall is a logical next step. Success confirms that the soft tissue had been obstructing the airway, whereas persisting or worsening obstruction often is indicative of active closure of the larynx that may be relieved by administering muscle relaxants or deepening the anesthetic depth with intravenous agents. The anesthetist should minimize the trap created by the pathologic causes of obstruction that may be worsened by the loss of muscle tone.
Last modified: Tuesday, 15 November 2016, 11:15 AM