What is difficult intubation, its types and management? [Mind map notes]

 

What is difficult intubation?

The inability of trained anaesthetist to intubate airway in more than three attempts or within 10 minutes will be consider as the difficult intubation.

We often confuse difficult intubation with difficult airway or difficult ventilation though these are different from each other lets briefly define these terms also. 

what is Difficult airway:

The clinical situation in which a trained anaesthetist is experiencing difficulty in mask ventilation, difficult with tracheal intubation or with both  is called as difficult airway 

what is Difficult ventilation:

The inability of trained anaesthetist to maintain the oxygen saturation more than 90% using a face mask for ventilation with 100% inspired oxygen, provided that the pre-ventilation oxygen saturation was within the normal range.

Now lets talk about the types of the difficult intubation with its mind maps at the end of this article.

Types of difficult intubation 

there are two types of difficult intubation 

1. Anticipated difficult intubation
2. Non anticipated difficult intubation

Anticipated difficult intubation:

As its name indicates in this type of intubation we are aware of the difficult airway and so the difficult intubation and accordingly we manage the patient with very much little chance of facing difficulty and airway loss.

Management of anticipated difficult airway:

There are five plans to manage this type of airway patients 

Plan A:

Do awake intubation either fibre-optic or with local spray and gel

Plan B:

Go for Blocks which includes, Superior laryngeal & glossopharyngeal nerve blocks#

Plan C:

If still did not managed then go for Regional anaesthesia l i.e lumbar puncture 

Plan D:

If regional also not working then go for insertion of  laryngeal mask airway (LMA)

Plan E:

Last option for anticipated difficult intubation management is to do tracheostomy, here choose cricothyroidotomy and its better than tracheostomy because it takes less time with ow bleeding chances.

Non anticipated difficult intubation:

In this type of intubation we are unaware of the difficult airway or intubation preoperatively and the difficulty has been faced during intubation.

Management plans of the Non anticipated difficult intubation:

There are three plans of management for this kind of intubation patients

Plan A:

If the mask ventilation in these types of patient is possible then do the following things

Mask ventilation

1. Change patient position
2. Use LMA, stylet, or buggy
3. Attempts up to maximum 4 times
4. Change the person who is doing intubation (anaesthetist)

Plan B:

Use LMA or intubating LMA

Plan C:

In this plan you have to check if the  mask ventilation is working so revert to the mask ventilation  and do the whole surgery with mask ventilation.

Or

Postpone the surgery if any of the above measures fails.

Here is the mind map of difficult intubation types and its management