22. Nasal Intubation Flashcards
where does the pituitary gland sit
in the sphenoid bone
what causes increased bleeding in the nasal cavity
adenoid pad
(very vascular)
nasal intubation indications
oral not available
- jaw wired shut
- severe oral cavity swelling
impedance
- dental surgery
- OMFS surgery
better tolerated in extended care
why are nasal intubations better tolerated for extended care pts?
decreases sedation requirements
nasal intubation absolute contraindications
epiglottitis
midface instability
hx of basal skull fracture/surgery
bleeding disorders
choanal atresial
basal skul fractures/surgeries
pituitary tumors
meningiomas
chordomas
trigeminal neuralgia surgery
bleeding disorders
thalassemia
anti-coagulants
choanal atresia
failure for nare to open
nasal intubation relative contraindications
obstruction of nasal airway
-lg polyps
- foreign bodies
recent nasal surgery
frequent epistaxis
epistaxis
nose bleeds
prolonged nasal intubation: issues
nasal damage
local abscesses
otitis media (cant drain ears)
sinusitis
nasal intubation complications
epistaxis
fractured turbinate
avulsed nasal polyps
septal abscess
avulsed adenoids
bacteremia
nasal intubation equipment
magic forceps
nasal RAW endotracheal tube
red robinson catheter
warming (towels/saline)
laryngoscope
why do you need to warm nasal tubes
tubes are stiff
need to make more pliable
nasal dilators
28Fr
30Fr
32Fr
34F
work up sequentially
increase diameter of Nasal Rae
increase length of nasal Rae
nasal rae sizing limiting factor
overall diameter
preformed bend (RAE)
which nasal rae tubes can be inserted deeper?
larger diameters
what should you do prior to rolling pt back for nasal intubation?
vasoconstrict both nares
nasal vasoconstrictors
1% phenylephrine
afrin/oxymetazoline
4% cocaine pledget
epinephrine pledget
which nasal vasoconstrictor provides analgesia?
4% cocaine pledget
most common nasal vasoconstrictors
pehnylephrine
afrin
nasal rae insertion
along floor of nasal passage
perpehndicular to face
bevel directed laterally
which way is bevel during nasal rae insertion
bevel directed laterally
why do we need to cover the murphy eye during nasal intubation?
murphy eye causes scraping, bleeding, trauma
how do you direct the nasal Rae into glottic opening?
use the magil forceps
what do you need to be cautious off when using magil forceps?
do not grab onto the tube cuff
it could tear
securing nasal rae
pad connector
dont fishhook nare
tape circumferential
fishhooking the nare can cause
cut off blood flow
blanching tissue
tissue necrosis
head flexion with nasal rae
pushes NETT deeper into trachea
risk mainstem or carina stimulation
head extension with nasal rae
withdraws NETT out of trachea
risk tube popping out of airway
retrograde intubation
place needle through cricothyroid membrane
thread seldingwire through neck and out of mouth
place arndt catheter over seldingwire
remove selding wire
ETT over catheter
remove catheter
retrograde intubation requires
time
proper MV
definitive pre-ox
jet ventilation indications
removal of foreign bodies
evaluation of airway dynamics
removal of lesions
jet ventilation limitations
airway pollution (open airway)
no end-tidal measuring
possible loss of airway
limits ability to multitask
jet ventilation anesthetics
TIVA only
when is jet ventilation used?
typically with rigid bronchoscope
types of jet ventilation
supraglottic
subglottic
supraglottic jet ventilation
air introduced above glottic opening
rigid bronchoscope accessory port
subglottic jet ventilation
typically emergency only
small catheter intriduced through glottic or through cricothyroid membrane
jet ventilator hooks up to what air supply?
wall supply
DISS
50 psi
what should you ask surgical team about prior to starting jet ventilation?
ask to see the O2 jet adapter
do you use an ETT or LMA prior to jet ventilation
LMA (typically Igel) w/100% FiO2
jet ventilation handle squeeze frequency/duration
8 times/min
duration <1 second
jet ventilation pressure
15 psi (ideal)
25-50 psi may be needed
depends on level of compliance
how do you verify adequate pressure during jet ventilation
watch for chest rise
ventilation includes
O2 IN
CO2 OUT
do you paralyze during jet ventilation
yes
what are common symptoms post-jet ventilation?
coughing
irritation
treat w/narcotics and humidified air
