Airway Flashcards
Airway – Manage aspiration with LMA
[18A07] A 60-year-old man is anaesthetised for a rigid cystoscopy.
You notice bile stained fluid in his classic laryngeal mask airway (LMA) during the procedure.
Describe your management.
NAP4
N3Ai4Aw5An6
50% death ~ aspiration
Chemical pneumonitis
Aspiration pneumonia
Cause
1. Pt
- gastric content/delay emptying
- DM, preg, pain, opioid
- Oes dysmo
- -scleroderma
- LOS incom
- - HH, GORD, MO
Mx
1. Stable
- cric, sux 1/kg, RSI, ETT
- suction ETT
- vent 100%
2. Unstable
- O2 +++
- BMV/ETT with 100% O2
After AW secure:
- bronchospasm
- CXR
- bronch
- abandon sx
- NGT
- Once stable, plan ext
- - asym for 2 hrs = good
- sym + CXR = bad –> ICU, supp O2
Airway - preoxygenation
[15A15] Describe the physiological principles underlying preoxygenation prior to the induction of anaesthesia (50%).
Discuss the advantages and disadvantages of using a high inspired oxygen concentration (>80%) during maintenance of anaesthesia (50%)
Preoxy
FRC –> O2 –> safe apnoea time
O2 consump = 250mL/min
Additional technique
- HFNP = entrain O2
- head up = inc FRC
- CPAP/PSV
Hi O2 during maintenance
PROS
1. maintain O2 in FRC
CONS
1. Atelectasis - high FiO2 –> post op absorption atelectasis
2. O2 tox
3. inc risk of AW fire (laser)
4. Delayed recog of issue (endobronch intub)
Airway – equipment for difficult airway
[15A11]
List the essential equipment currently recommended to management a difficult airway in an adult patient (50%).
Justify supplementary items you would recommend (50%).
*PS55 min facility + PS56 equip to mx DA
PS56
1. Vent device
- OPA NPA
- SIB
- FM
2. SG device
- LMAs - proseal/classic
- iLMA - fastrach
3. Intub devices
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