airway equipment Flashcards
what must you have available and ready to use in every OR
suction oral and nasal airways face mask laryngoscope handles and blades multiple sizes of ETT with stylet, pilot balloon checked O2 supply, ambu bag
oral airway
follows curvature of tongue and lifts tongue and epiglottis away from the posterior pharyngeal wall, preventing obstruction
bite portion is between teeth and lips, with phalange outside of lips
sizing of oral airways
size specified by overall length
small = 80 mm
medium = 90 mm
large = 100 mm
when should we not use an oral airway
poor dentition maybe
lightly anesthetized - may provoke gag reflex, cough, vomiting, laryngospasm, bronchospasm
prone cases
nasal airways
artificial airway that passes through nose, goes behind tongue and rests above epiglottis
- used to relieve upper airway obstruction
- facilitates pharyngeal suctioning
- nasal dilation for nasal intubation
- fiberoptic guide
nasal airway sizing
denoted by internal diameter in millimeters
from pt nare to earlobe or angle of jaw
what is an advantage of nasal airways over oral airways
you can use them in lightly anesthetized patients
contraindications for nasal airways
coagulopathy or hemorrhagic disorders pregnancy basilar skill fractures nasal infections deformities of nose hx of nosebleeds that require treatment
what is the correct size face mask
smallest mask that works is the correct size because
- least dead space
- easier to hold
- less risk for eye injury
why is the head tilt/chin lift maneuver not as useful in peds
hyperextension pushes posterior pharyngeal wall up against tongue and epiglottis
use jaw thrust instead
what are the advantage of using a face mask
low incidence of sore throat
less anesthetic depth needed
no muscle relaxants necessary
cost efficient for short cases
what are the disadvantages of using a face mask
hands are tied up user fatigue higher fresh gas flows often needed more difficult in maintaining airway vs LMA unprotected airway
complications of using a face mask
dermatitis nerve injury aspiration eye injury movement of cspine lack of correlation between PaCO2 and ETCO2 d/t dilution from high FGF environmental pollution
laryngeal mask airway - LMA
supraglottic airway device designed to secure the airway by providing a circumferential seal around the laryngeal inlet with an inflatable cuff
allows for spontaneous or assisted ventilation
what is the max peak airway pressure for supraglottic devices
20cmH2O
why choose an LMA
alternative to vent through face mask - allows for hands free vent
facilitates ventilation and passage of an ETT in a difficult airway
aid in vent during fiberoptic bronch
preferred device to manage difficult airway when conventional ventilation and intubation attempts fail
components of LMA
15mm connector curved airway tube elliptical spoon shaped cuff mask inflation pilot balloon and valve aperture bars
what are the aperture bars for on an LMA
to prevent epiglottis from obstructing airflow
what is the maximum use per reusable LMA
40 times
what is the LMA size based off of
patient weight in Kg
adult LMA sizes and weight ranges and cuff volumes
3 - 30-50kg - max vol: 20cc - test: 30cc
4 - 50-70kg - max vol: 30cc - test: 45cc
5 - 70-99kg - max vol: 40cc - test: 60cc
6 - >100kg - max vol: 50cc - test: 75cc
peds LMA sizes and weigh ranges and cuff volumes
1 - <5kg - max vol: 4cc - test: 6cc
1.5 - 5-10kg - max vol: 7cc - test: 10cc
2 - 10-20kg - max vol: 10cc - test: 20cc
2.5 - 20-30kg - max vol: 14cc - test: 21cc
LMA inspection
test integrity of cuff by overinflating briefly
inflate cuff with recommended amount and ensure it holds for 2min
check pilot balloon - should be elliptical in shape
*spherical = loss of integrity
deflate cuff to ensure surface is smooth
check 15mm connector for tight fit with circuit
placement of LMA
- lubricate posterior surface of cuff
- airway reflexes must be obtunded before insertion
- absence of response to jaw thrust is a good sign
- optional - assessment of ability to manually ventilate
- assure mask is fully deflated
- hold LMA like a pencil as close to cuff as possible
- place tip of LMA against inner surface of upper teeth and press mask tip against hard palate to flatten it out
- slide mask posteriorly following the angle of the hard palate until the pharyngeal cavity
- continue advance until you can’t reach anymore
- pull out your hand and press downward to ensure that it is fully inserted
- inflate mask with appropriate amount of air
- mask will rise slightly as it fits into hypoharynx so don’t touch it while you inflate
- attach to circuit, assess ventilation, secure and place bite block
problems with LMA insertion
failure to press mask against hard palate when advancing into pharynx or inadequate lubrication can cause tip of mask to fold over on itself, compromising seal
if this has flipped and you continue advancing, you will push epiglottis down and obstruct the airway
why should you leave the LMA partially inflated when you remove
it will help remove secretions with it
LMA contraindications
anyone at risk for aspiration glottic/subglottic obstruction supraglottic pathology patients with fixed decreased pulmonary compliance peak airway pressures >20cm
adverse effects of LMA
aspiration of gastric contents sore throat laryngospasm hypoglossal nerve injury tongue cyanosis vocal cord paralysis
