الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Tracheal intubation is a common procedure usually accomplished easily in anaesthetic practice . The incidence of difficult intubation in general anaesthetic practice van between 1-3 %
( King and Adams, 1990 )
obste ric cases the incidence of failed intubation is eight times higher than in other surgical procedures ( Samson and Young, 1987 )
Passing an oral endotracheal tube depends on getting the oral pharyngeal d laryngeal axis in one plane . Flexion of the neck and extension of he head at Atlanto-occipital joint ( sniff position ) , as well as liftin the tongue upwards serves for the align of the oral ,pitaryrgeal tu d laryngeal axis lie in one plane,so passage of the endotracheal ti Abe becomes possible (otto 1989 )
Difficult in managing the airway is the most important cause of major anaesthetic . related morbidity and mortality ( Bellhouse 1988).
Sucess in management of difficult airway begins with recognizing the potential problem preoperatively (Slullampati eta11985 ).
Many anatomical abnormalities and/or pathological conditions make endotra4heal intubation difficult. The anatomical abnormalities such as . a short muscular neck receding mandibule obtuse mandibular angle,poor mobility of the temporo-mandibular joint result in poor opening of the mouth.The pathological conditions which may leads to difficult tracheal intubation may be congenital neoplastic or inflammatory e.g. . tuniours,abscess . burns etc.
(cormack and lehane 1989 ) .
If an airway is recognized to be difficult ,endotracheal intubation
is better performed awake by one of the following techniques :-.Awake blind nasotracheal intubation .
. Awake tiberoptic (aral or nasal ) intubation
.Awake retrograde intubation technique .
For an awake intubaten to be successful it is absolutely essential that the patient must be properly prepared (when , 1991).
In the patient which is already anaesthetized and/or paralized and intubation is found to he difficult or the patient refuses to be intubated awake , the airway must be maintained by mask ventilation to maintain gas exchange (Benumof, 1991).
In rare cases it is impossible neither to intubate nor to ventilate the lungs , consequently , unlace there is an alternative ventilation method inunediately available such as laryngeal mask airway ( LMA ) or oesophageal.tracheal combitube(OTC).transtracheal jet ventilation or tracheostomy life threatening hypoxia may follow (Benumof ,1989 ).
After several attempts at intubation it may be best to awaken the patient or use of face mask or laryngeal mask airway and if all methods failed a semi-elective tracheostomy or cricothyrotomv may be
needed (benumot1991 ).
It has to be mentianed that repeated attempts at intubation in cases of difficult intubation should be avoided becouse progressive development of laryngeal oedema and haemorrage will occur and the ability to ventilate the lungs via mask may be lost ( Benumof , 1991).
Certain precautions should also taken during extuhation in patients with difficult intubation. Because of airway maintaining and reintubation may he difficult.So extubation over a Jet stylet is the ideal methods for ex-tubation ( Benumof , 1991 ) .
As the anaesthesiologist becomes able to manage the difficult airway, this will dramatically decrease respiratory related mortality and morbidity (King and Adams, 1990 ).