2025 Airway Management Exam 2 Flashcards
Lectures (3): Airway Management and Equipment
Airway Basics: What Does the Human Airway Do
Protection
Physical protection from aspiration
Lymphatic protection from microorganisms
Conduction
O2 in
CO2 out
Anesthetic gases and vapors
Air conditioning
Heat
Humidification
Anesthesia and Airway: What do we do to the Human Airway
Protection
Continue physical protection from aspiration
Not compromise protection from microorganisms
Conduction
Support O2 in
Support CO2 out
Supply and remove anesthetic gases and vapors
Air conditioning
Minimize heat loss
Minimize water vapor loss
Supportive Oxygen Therapy
Low flow devices
Nasal cannulas
Simple face masks
Partial rebreathing masks
Nonrebreathing masks
Tracheostomy collars
Depend on room air entrainment to meet the patient’s peak inspiratory and minute ventilatory demands
With changes in VT, RR, O2 reservoir FiO2 can vary dramatically
Nasal Cannula
For every 1L/min of O2 = 4% Increase in O2%
FiO2 of 24-44%
Anesthesia (Monitored Anesthesia Care)
Need a gas sampling line to monitor for spontaneous respirations
2 Variations Essentially
Nasal Cannula without CO2 monitoring
Nasal Cannula sampling line (CO2 monitoring)
Used when patient under anesthesia is asleep, common would be during MAC, make sure they are breathing
A lot of providers will just jump to mask if have to go more than 4 L/min in fear of drying out patients nose
Face Masks
Simple
FiO2 35-60% (6-10L/min)
Partial rebreathing
FiO2 60-90% (6-10L/min)
Non rebreathing
FiO2 Almost 100% (10-15L/min)
Venturi Mask
24-50% (Variable)
Simple Mask
FiO2 35-60% (6-10L/min)
Some providers prefer to use a simple mask post surgery when delivering patient to PACU… can see the fog to know they are breathing
Partial Rebreathing Mask
FiO2 60-90% (6-10L/min)
Nonrebreathing Mask
FiO2 Almost 100% (10-15L/min)
Rebreather Mask Function
Rebreather Mask Diagram
High Flow Devices
Have flow rates and reservoirs large enough to provide the total inspired gases reliably
Flows in excess of 30-40 L/min (or 4x minute volume)
Venturi masks, aerosol masks, and T-pieces powered by air-entrainment nebulizers or air oxygen blenders
Ability to deliver predictable, consistent, and measurably high and low FiO2s despite ventilatory pattern
Venturi Mask
24-50% (Variable)
Provides predictable and reliable FIO2 values of 24-50% (independent of patient’s respiratory pattern)
Air entrainment based on Bernoulli principle
Rapid velocity of gas moving through a restricted orifice
Fixed FiO2 model (color coded)
OR
Variable FiO2 model (graded adjustment)
Venturi Effect
Potential Passageways for Relieving Obstruction
Oral route
Obstruction from tongue (common), obese (there excess fat tissue collapsing into back of throat)
Nasal route
Obstruction from trauma typically (broken nose)
Airway During Anesthetic
Airway Obstruction: Oral
Obstruction relieved by:
Repositioning the head
Displacing the mandible anteriorly
How to Support Airway
Physical maneuver
Jaw thrust
Head Tilt/Chin lift
Adjuncts for physical support
Oral airway (OPA)
Nasal airway (NPA)
Oropharyngeal Airway (OPA) Basics
Two types of OPAs
Guedel
Body
Central lumen
Flange
Berman
Body
Central I beam
Side air channels
Flange
What are the structural and functional differences between them?
How do you size an OPA?
How do you insert an OPA with minimum trauma?
What purpose does a tongue depressor serve for OPA insertion?
What are the contraindications for using an OPA?
When do you remove an OPA?
Indications – OPA
Airway maintenance in the sedated and unconscious patient
Protects an endotracheal tube (ETT) from being bitten and occluded
This puts patient at risk for front tooth damage and also tongue swelling if left in place for a long period of time
Facilitates airway suctioning
OPA: Sizing
General Sizing
Flange at corner of mouth
Tip at angle of mandible
Most woman are: 9 or 90
Most men are: 10 or 100
Adult Sizes
Large: 100 mm flange to tip
(Guedel 5)
Medium: 90 mm flange to tip (Guedel 4)
Small: 80 mm flange to tip (Guedel 3)
Child Sizes
Lengths: 40-80 mm (Guedel
sizes 000 to 3)
OPA: Insertion (2 Ways) and Removal
Use a tongue depressor to pull tongue forward in the mouth (not required)
OR
can Insert upside-down and rotate 180° (but this risks tooth and/or palate damage)
Removal
Typically removed as they are waking up or start grabbing at it
OPA Complications
Oral airway too short
Pushes tongue into airway
Oral airway too long
Obstructs larynx by forcing down epiglottis
Vomiting and laryngospasm in the awake patient
Nasopharyngeal Airway (NPA)
What are the structural and functional components of NPAs?
How do you size a NPA?
How do you insert a NPA with minimum trauma? What are the contraindications for using a NPA?
What are the anatomic
Considerations for insertion of a NPA?
When do you remove a NPA?
Indications
Airway maintenance
Oral airway placement difficult
Semiconscious patient not tolerating OPA
Dilation of nasal passage for nasal intubation
NPA: Sizing
Airway diameter should not be too large
Should not blanche the nasal ala
Length: Tip of the nose to the tragus of the ear
Adult
Large: 8-9 mm Internal Diameter (I.D.), 34 fr
Medium 7-8 mm Internal Diameter (I.D.), 30 fr
Small 6-7 mm Internal Diameter (I.D.), 28 fr
Child
Diameters: 12F (~3mm ETT) to 36F
Alternatively may use a shortened ETT
French size / 3 = Diameter in millimeters
Bag/Valve/Mask (BVM)
Every Anesthesia Machine needs an Ambu bag with the machine
Face Masks for BVMs
Resuscitation
Malleable, transparent body
22 mm connection
Air-cushion seal
No retaining ring
Anesthesia
Opaque body or
Transparent body
22 mm connection
Air-filled seal
Retaining ring
How to BVM
Mask is pressed against nasal bridge with thumb.
Ensure that there is no pressure on the eyes
Index finger exerts downward pressure on the base of the mask over the chin.
Little finger should engage the angle of the mandible.
How to BVM Picture
Suction Devices
Suction Saves Lives
Oral secretions
Bloody secretions
Yankauer suction tips
Gentle curve to fit airway
Multiple holes at tip
Suction Catheters and Canisters
