Airway Management and Technique

Introduction

Airway management is the art of examining, planning, and utilizing various medical procedures and devices. These operations are recommended for patients with airway obstruction, respiratory failure, or need to protect their airways because of the danger of aspiration during general anesthesia. The basic airway exercises consist of positioning, more oxygen, and bag-mask ventilation with or without adjuncts. These are the most crucial first step. Advanced airway devices are often needed for patients with substantial or persistent airways.

Additionally, endotracheal intubation is a tube placed into the trachea orally or nasally to enable gas exchange, frequently by mechanical ventilation. With the use of a laryngoscope, the tube can be positioned for direct viewing or using laryngoscopy with video assistance. Although hypoxia is one of the most typical endotracheal intubation side effects with hypotension, airway obstruction, and esophageal intubation. In an emergency, surgical airways are employed. However, individuals having surgical airways are susceptible to an abrupt loss of the airway due to tube displacement or secretion obstruction.

What Is the Airway Technique to Maintain Oxygenation?

The assessment, planning, and sequence of medical interventions necessary to preserve or restore a person's ventilation or breathing are called airway techniques. Air can enter the lungs from the nose and mouth by keeping the airway open. Lack of airway control in some circumstances might result in hypoxia (decreased oxygen level in the body), which is potentially fatal.

When Is the Management of the Airway Required?

The tongue or foreign objects restricting the airway are the most frequent causes of airway blockage. It may also result from an airway injury, increased blood and secretions (such as saliva and mucus), or airway inflammation.

Respiratory failure, decreased level of consciousness, abrupt change in mental status, active choking, or penetrating trauma are some specific clinical symptoms that may point to the necessity for airway management. Depending on the clinical situation, several forms of airway management may be used.

What Are the Techniques Used in Airway Management?

Artificial airway management is done by various medical devices which are used to keep or open a person's airway under surgical intervention. The technique involved in the management of the airway include:

1. Oropharyngeal Airway (OPA):

When a person is not responding, the OPA is usually used. Besides preventing the tongue from blocking the epiglottis, a little flap in the throat, the OPA is a medical device that is used to maintain or open a person's airway.

2. Nasopharyngeal Airway (NPA):

To maintain an open airway, a tube called the NPA is inserted through the nasal passage. NPAs are more tolerable than OPAs and may be used when using OPAs is challenging, such as when a person's jaw is clamped or the person is awake.

3. Endotracheal Airway (ETA):

A plastic tube called an ETA is placed in the trachea or windpipe through the mouth. A ventilator is then attached to the ETA, which mechanically pumps oxygen into the lungs.

4. Basic Airway Management:

• Basic airway management can be performed independently or in conjunction with additional airway management procedures to treat mild airway blockages like choking. Basic airway care uses non-invasive methods without the aid of specialized medical apparatus. Examples of techniques to remove foreign body airway obstruction include chest compressions, abdomen thrusts, and back blows. These techniques may be employed individually or together. As chest compressions might provide larger airway pressures to clear the obstruction, in some situations, if the patient is unresponsive to these treatments, they may need cardiopulmonary resuscitation (CPR).

• Basic airway control techniques also include the head-tilt/chin-lift and jaw-thrust. These techniques are used to avoid airway obstruction in unconscious people by keeping the tongue from obstructing the upper airway. In people who are at risk for cervical spine damage or injury to the upper spine in the neck, the head-tilt/chin-lift is not advised. On the other hand, the jaw-thrust technique is appropriate when a cervical spine injury is suspected.

• Bag valve mask ventilation may be necessary for situations where there is insufficient ventilation, which can be brought on by difficulty breathing or obstruction of the airway. Positive pressure, a type of intervention, is used to force air into the person's chest. Although, the patient must be carefully monitored during bag valve mask ventilation to ensure their chest rises with each breathing cycle.

5. Advanced Airway Management:

• Advanced airway management techniques may be used once a clear airway has been created utilizing basic management techniques. Advanced airway management entails the use of invasive procedures, specialized medical equipment, and techniques used to open and maintain an airway in sedated patients. The laryngeal mask airway (LMA), the most popular device, is used to temporarily maintain an open airway during anesthetic administration or as an immediate life-saving intervention in a complicated airway situation. A difficult airway requires three or more attempts, each requiring more than ten minutes to establish.

• OPAs or NPAs are additional advanced airway approaches that can be utilized to keep the airway open in people who are completely unconscious. However, neither type of airway device will shield the trachea from respiratory secretions or an upsurge of stomach contents. Both types of airway devices will keep the tongue from obstructing the airway and offer enough breathing or regurgitation.

6. Surgical Intervention for Airway Management:

• The cricothyroid membrane, which joins the thyroid and cricoid cartilages of the larynx in emergency settings, is removed during cricothyrotomy surgery. A tracheostomy tube is inserted into the incision to create a working airway. This can be verified by listening to the lungs for breath sounds and by observing the chest expansion and contraction.

• A tracheostomy is an alternative surgical technique in which a neck incision is performed to place a breathing tube into the trachea.

Conclusion

A person may require basic or complex forms of airway control, depending on their clinical presentation. Advanced airway management procedures, on the other hand, require special medical equipment like OPAs, NPAs, and ETAs and are invasive. Basic airway management techniques are non-invasive. Another method for preventing insufficient ventilation, which can be caused by poor breathing or airway obstruction, is bag valve mask ventilation. The most efficient and often employed technique for airway control is RSI (rapid sequence intubation), which includes ETI (endotracheal intubation) and drugs that cause unconsciousness and muscular relaxation.