airway equipment

Question 1

what must you have available and ready to use in every OR

Answer 1

suction
oral and nasal airways
face mask
laryngoscope handles and blades
multiple sizes of ETT with stylet, pilot balloon checked
O2 supply, ambu bag

Question 2

oral airway

Answer 2

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

Question 3

sizing of oral airways

Answer 3

size specified by overall length
small = 80 mm
medium = 90 mm
large = 100 mm

Question 4

when should we not use an oral airway

Answer 4

poor dentition maybe
lightly anesthetized - may provoke gag reflex, cough, vomiting, laryngospasm, bronchospasm
prone cases

Question 5

nasal airways

Answer 5

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

Question 6

nasal airway sizing

Answer 6

denoted by internal diameter in millimeters

from pt nare to earlobe or angle of jaw

Question 7

what is an advantage of nasal airways over oral airways

Answer 7

you can use them in lightly anesthetized patients

Question 8

contraindications for nasal airways

Answer 8

coagulopathy or hemorrhagic disorders
pregnancy
basilar skill fractures
nasal infections
deformities of nose
hx of nosebleeds that require treatment

Question 9

what is the correct size face mask

Answer 9

smallest mask that works is the correct size because

1. least dead space
2. easier to hold
3. less risk for eye injury

Question 10

why is the head tilt/chin lift maneuver not as useful in peds

Answer 10

hyperextension pushes posterior pharyngeal wall up against tongue and epiglottis

use jaw thrust instead

Question 11

what are the advantage of using a face mask

Answer 11

low incidence of sore throat
less anesthetic depth needed
no muscle relaxants necessary
cost efficient for short cases

Question 12

what are the disadvantages of using a face mask

Answer 12

hands are tied up
user fatigue
higher fresh gas flows often needed
more difficult in maintaining airway vs LMA
unprotected airway

Question 13

complications of using a face mask

Answer 13

dermatitis
nerve injury
aspiration
eye injury
movement of cspine 
lack of correlation between PaCO2 and ETCO2 d/t dilution from high FGF
environmental pollution

Question 14

laryngeal mask airway - LMA

Answer 14

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

Question 15

what is the max peak airway pressure for supraglottic devices

Answer 15

20cmH2O

Question 16

why choose an LMA

Answer 16

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

Question 17

components of LMA

Answer 17

15mm connector
curved airway tube
elliptical spoon shaped cuff mask
inflation pilot balloon and valve
aperture bars

Question 18

what are the aperture bars for on an LMA

Answer 18

to prevent epiglottis from obstructing airflow

Question 19

what is the maximum use per reusable LMA

Answer 19

40 times

Question 20

what is the LMA size based off of

Answer 20

patient weight in Kg

Question 21

adult LMA sizes and weight ranges and cuff volumes

Answer 21

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

Question 22

peds LMA sizes and weigh ranges and cuff volumes

Answer 22

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

Question 23

LMA inspection

Answer 23

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

Question 24

placement of LMA

Answer 24

• 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

Question 25

problems with LMA insertion

Answer 25

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

Question 26

why should you leave the LMA partially inflated when you remove

Answer 26

it will help remove secretions with it

Question 27

LMA contraindications

Answer 27

anyone at risk for aspiration
glottic/subglottic obstruction
supraglottic pathology
patients with fixed decreased pulmonary compliance
peak airway pressures >20cm

Question 28

adverse effects of LMA

Answer 28

aspiration of gastric contents
sore throat
laryngospasm
hypoglossal nerve injury
tongue cyanosis
vocal cord paralysis