Airway

Question 1

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.

Answer 1

1. Severity
2. Appr Obs
3. Appr Rx

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

Question 2

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%)

Answer 2

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)

Question 3

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%).

Answer 3

*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
-

Question 4

Which PS?

[15A11]

List the essential equipment currently recommended to management a difficult airway in an adult patient (50%).

Justify supplementary items you would recommend (50%).

Answer 4

PS56 - GL on equip to mx diff AW

PS55 - recomm min fac

A) Essential - PS56
1. VENT device
a) OPA 3-6, NPA 6-8
b) Self-infl bag
c) FMs

3. 2. SGA
      a) LMAs 3-5 proseal/classic
      b) iLMA - fastrach
4. Intubation
   a) handles
   b) blades
   c) introducer/bougie
   d) ETT
   e) ETT cuff syringe
   f) VL, special blade, AWEC, special ETT
   flexibroch 2.2mm scope fit 3.0mm ETT

+ Surgical AW - crico
+ Confirm intub –> CO2 det/capno; oseophageal intubation detector

B) Supplementary
- FIBREOPTIC
- suga
- comittube
- retrograde
- rigid bronch

Question 5

Describe the indications for and method of managing the airway during maxilla-facial surgery with a nasal endotracheal tube

Indications / CI rel/con / method /

Answer 5

Ind
1. Dental
2. Intra-oral - mandib
3. Oropharyngeal
4. AFOI with c spine
5. Intraoral mass
6. Limited MO
7. Angiooedema tongue

Abs CI:
1. Mid face instab
2. Coag
3. Susp BOS # / epiglottitis

GC notes