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Sim Lab I > Airway Adjuncts/LMA > Flashcards

Airway Adjuncts/LMA Flashcards

1
Q

When to use a supraglottic airway ventilation?

A

-Primary means of managing a difficult airway
-Rescue ventilation
-Failed intubation
-Alternative to ETT, in elective sx pts
-Conduit to facilitate endotracheal intubation
-Difficult facemask ventilation

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2
Q

Predictors for difficult SAD placement

A

-Restrictive mouth opening
-Distortion in the upper airway anatomy
-Both upper and lower airway obstruction

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3
Q

Which important assessment tool is considered when introducing any airway adjuncts in to the mouth?

A

Interincisor gap <4cm/three fingerbreadths

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4
Q

What physiological conditions may cause difficulty with some SAD placements?

A

-Reductions in atlanto-occipital joint movement d/t conditions such as anklyosing spondylitis and RA
-Obstructions at the larynx, trachea, or below can reduce or completely block ventilation from a SAD

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5
Q

What could cause the disruption and distortion in the upper airway anatomy and may make SAD placement difficult and lead to ineffective ventilation from a compromised “seat and seal?”

A

Upper airway lesions, such as oropharyngeal

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6
Q

____________________ or __________________ require higher ventilatory pressures to facilitate adequate gas exchange within the lungs.

A

Bronchospasm or Acute respiratory distress syndrome

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7
Q

Conditions affecting the _______________ airway results in decreases in pulmonary compliance or increases in airway ____________ can cause peak airway pressures to rise.

A

Lower; resistance

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8
Q

Which factors determine the selection of an airway adjunct for airway management?

A

1) The need for airway control
2) The ease of laryngoscopy
3) The ability to use supralaryngeal ventilation
4) Aspiration risk
5) The pt’s tolerance for apnea

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9
Q

Which 2 devices are truly supraglottic that sit above or surround the glottis?

A

LMA, facemask

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10
Q

Why are LMAs well tolerated?

A

They follow the same pathway as the airway, unlike laryngoscopy

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11
Q

Examples of LMA variations?

A

Flexible
ProSeal
Supreme
Fastrach

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12
Q

In what ways can the LMA be used in General anesthesia?

A

BMV

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13
Q

How is the LMA sized?

A

Pt’s Kg

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14
Q

Step 1 in LMA classic insertion technique

A

Deflating the cuff and placing a water soluble lubricant on its posterior surface

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15
Q

Step 2 in LMA classic insertion technique

A

Insert the LMA midline, with the posterior surface pressed flat against the palate of the mouth

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16
Q

Step 3 in LMA classic insertion technique

A

Then advance with the index finger along the palatopharyngeal curve

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17
Q

Success rate on the first attempt

A

88-95%

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18
Q

What should be done if the LMA encounters resistance when it reaches the posterior pharyngeal wall?

A

It is typically due to the distal tip folding back as a result of aggressive posterior pressure
——->
Retract the airway and advance again, applying more upward pressure toward the top of the patient’s head.

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19
Q

What should you do if the continued resistance occurs when placing LMA?

A

Place the R index finger b/w the superior portion of the LMA and the palate and “flip the tip” back in to the normal position while advancing the device with the opposite hand.

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20
Q

What is the position when the LMA is properly placed?

A

Final resistance denotes placement of the LMA’s tip in the hypopharynx, and the black line on the tubing will be even with the upper lip

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21
Q

Where is the LMA sealed after the cuff is inflated?

A

Over the larynx

22
Q

What pressure should the LMA cuff not exceed?

A

60cmH20

23
Q

The ______________ opening at the base of the hypopharynx has no seal

A

Esophageal

24
Q

What happens if the LMA cuff is over inflated?

A

It can open the upper esophageal sphincter, or potentially cause posterior cricoarytenoid muscle fatigue

25
Q

Alternative technique #1 for LMA placement

A

Introduced into the mouth with the opening initially facing the palate, advanced til it reaches the oropharynx, rotate 180 degrees counterclockwise, then advance to final position

26
Q

Alternative technique #2 for LMA placement

A

Partial or fully inflate the LMA cuff with air before insertion

27
Q

Alternative technique #3 for LMA placement

A

Guided technique using an Eschman stylet (bougie) or a laryngscope to facilitate placement

28
Q

Which LMA is a variation of the LMA classic that utilizes a smaller diameter wire-inforced barre?

A

LMA Flexible

29
Q

Indications of LMA Flexible

A

-Sx on the mouth, pharynx, face, or jaw, or any other procedure in which the head may be moved
-When drapes cover the patient’s face and head
-If the barrel cannot be secured at the midline

30
Q

2nd gen SAD benefits

A

1) Attempts to reduce aspiration risk with additional channel
2) Reinforced tips that prevents folding
3) Better cuff seals with higher ventilation pressures
4) More rigid to prevent rotation and easier insertion

31
Q

Examples of 2nd Gen SAD

A

LMA ProSeal (PLMA)
LMA Supreme
AuraGain

32
Q

What is considered a 2nd Gen SAD, but is primarily used in the prehospital setting, and is not suitable as a conduit for TI?

A

King LTS-D

33
Q

PLMA modifications compared to the LMA Classic

A

1) Large and deeper bowl w/ no grill
2) Posterior extension of the mask cuff
3) A gastric drainage tube, existing at the mask tip
4) Bite block
5) Anterior pocket for seating an introducer or finger during insertion

34
Q

What is the benefit of the esophageal gastric drain tube on a PLMA?

A

Allows the practitioner to identify misplacement and decompress the patient’s stomach of air or solid contents, and may vent regurgitated stomach contents

35
Q

In the PLMA, airway seal is improved by __________, allowing peak ventilation pressures up to ___________cmH20 (versus the 20cmH20 with the LMA Classic.

A

50%; 28-30cmH20

36
Q

When has the PLMA been used?

A

Lap Sx (controversial)
Obese
ICU
Trauma
Difficult Airway populations

37
Q

What SAD is a disposable version of the PLMA?

A

LMA Supreme

38
Q

Peak ventilation pressures were slightly _________ in LMA Supreme when compared to PLMA.

A

Lower

39
Q

This device occupies the entire hypopharynx and laryngopharynx

A

i-gel mask

40
Q

T/F: The i-gel creates a noninflatable anatomical seal of the perilaryngeal structures while avoiding compression trauma, relies on contact with anatomical structures to create and effective seal for ventilation.

A

True

41
Q

T/F: The channel of the i-gel CANNOT be used as a conduit for intubation under fiberoptic guidance.

A

False; It can be used

42
Q

Proper placement of the i-gel provides what?

A

A good seal and effective ventilation

43
Q

Benefits of the i-gel

A

Ease of insertion
High seal pressures
Lower incidence of sore throat

44
Q

AuraGain key features

A

Gastric access port
Intubating capabilities
Bite block

45
Q

AuraGain capabilities

A

Similar airway pressures
Ease of insertion
Successful insertion in children

46
Q

What makes King LT different from other SADs?

A

It does not have a mask that covers the laryngeal opening.

One time use, with a double lumen tube with a large oropharyngeal balloon and a smaller esophageal balloon.

47
Q

T/F: A single pilot balloon is used to inflate both balloons in the King LT when the device is situated in the airway.

A

True

48
Q

What is the purpose of the large oropharyngeal balloon of the King LT?

A

-Isolates the oropharynx and nasopharynx from above
-Lifts the base of the tongue

49
Q

What is the purpose of the distal esophageal balloon of the King LT?

A

It sits at the esophageal inlet and isolates the esophagus from below, providing a high-pressure esophageal seal

50
Q

The King LT model has the capacity to achieve a ventilatory seal of _______cm H20 or higher.

A

30cmH20

Sim Lab I (3 decks)

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