Give 100 % oxygen

• Give 100 % oxygen - if there is severe hypoxia summon help
• Anaesthesia may need to be deepened
• In some cases paralysis may be appropriate
• Apply CPAP (continuous positive airway pressure) and or attempt manual ventilation with PEEP (positive end expiratory pressure)

Airway clearing manoeuvres

Chin lift, jaw thrust and head positioning may clear the airway, even with an LMA in place.

Exclude problems with the anaesthetic circuit

Detach the circuit completely and use a self inflating bag (or mouth ventilation) to determine whether the obstruction is in the airway or the anaesthetic circuit.

Clear the airway

Management is dependent on whether or not an airway adjunct is already in place:

1. If no anaesthetic airway: insert Guedel or LMA
2. If the LMA is in place: remove and re-oxygenate
3. An LMA (or tracheal tube) may then be replaced once a problem with the device is excluded

Examine chest

1. Confirm bilateral chest movement and bilateral breath sounds
2. Exclude laryngospasm, bronchospasm, pneumothorax and pulmonary aspiration

Tracheal access (CICV situation)

If the airway cannot be cleared, and both mask ventilation and intubation are not possible, this is a ‘can’t intubate, can’t ventilate’ situation (CICV).

Insert (or reinsert) an LMA and plan for direct tracheal access. For further information refer to the session: Block 1 / Airway care / Airway management / Management of failed intubation.