Airway equipment

Question 1

Indication for jaw thrust instead of head-tilt chin-lift?

Answer 1

Significant trauma with potential spinal involvement

Question 2

How to measure oropharyngeal (Guedel) airway

Answer 2

Angle of the mandible to front teeth (hard-to-hard)

Question 3

How to measure oropharyngeal (Guedel) airway

Answer 3

Angle of the mandible to front teeth (hard-to-hard)

Question 4

How to insert Guedel in adults?

Answer 4

Insert into the patient’s mouth upside down, pass to the back of the throat and rotate 180 degrees to fit behind the tongue base.

Question 5

How to insert Guedel in children?

Answer 5

Inserted the right way up (i.e. not upside down).

Question 6

Issues with Guedel airways

Answer 6

1. Induce gag reflex (not tolerated in conscious/semi-conscious patients)
2. Can cause damage to mucous membranes of oral cavity

Question 7

How to measure nasopharyngeal airway (NPA)?

Answer 7

From tragus to tip of nose (soft-to-soft)

Question 8

Where should the tip of the NPA sit?

Answer 8

Just above the epiglottis

Question 9

Indication for NPA

Answer 9

Necessity to bypass obstructions in the mouth, nose, nasopharynx or base of the tongue

Question 10

Contraindication to NPA

Answer 10

Skull base fracture

Question 11

What are supraglottic airways (SGA)?

Answer 11

Group of devices that sit abutting the larynx, above the vocal cords
E.g. Laryngeal mask airway, iGel

Question 12

Issues with supraglottic airways?

Answer 12

1. Don’t protect against aspiration
2. Should not be used if there is poor mouth opening, pharyngeal pathology or obstruction at/below the level of the larynx.

Question 13

Complications of supraglottic airways

Answer 13

Gastric insufflation, aspiration, laryngospasm and partial airway obstruction

Question 14

SGA: LMA (Laryngeal mask airway)

Answer 14

• Reusable
• Silicone rubber tube with elliptical, spoon-shaped mask designed to fit over the larynx; inflatable mask rim forms a low-pressure seal over the laryngeal inlet
• Proseal LMA - has additional inflatable segment –> greater seal + gastric port for drainage of gastric secretions.

Question 15

SGA: iGel

Answer 15

• SIngle use SGA
• Non-inflatable thermoplastic elastomer; creates seal around larynx and peri-laryngeal structures when warmed to body temperature

Question 16

How to insert supraglottic airway?

Answer 16

Patient supine, neck flexed and head extended at the atlanto-occipital joint.
The tube is inserted blind into the patient’s mouth and guided over the tongue until resistance is encountered.
The tube can then be connected to a ventilation device and airway patency confirmed with chest movement, fogging of the tube and a CO2 trace.
If there is no CO2 trace present, the airway is not patent and must be removed or adjusted.