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Principles > Airway equipment > Flashcards

Airway equipment Flashcards

1
Q

Allows gas administration to the patient from the breathing system without any apparatus in patients mouth

A

Face Masks

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2
Q

Face masks are used for….

A

Preoxygenation/denitrogenation
May be used for entire anesthetic

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3
Q

Body of face masks

A

Transparent; see secretions, lip color, mist
Provides shape

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4
Q

Seal of face mask (airways pressure maintained)

A

Inflatable cushion
20 to 25 cm H2O with minimal leak

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5
Q

Connector size for face mask

A

22 mm internal diameter- female
Circular ring with prongs for straps

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6
Q

Difficult Mask Ventilation factors (6)

A

Male
Over 55
Beard
Edentulousness
OSA/snoring
BMI > 30 kg/m2

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7
Q

If having to Two-Handed Method/technique, what should happen?

A

ask for help

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8
Q

Overcoming Difficult Mask Ventilation ideas (4)

A

-Oral airway OR nasopharyngeal airway
-Two-handed technique
-Cut the beard
Tegaderm (over mouth)

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9
Q

Cant mask ventilate at all turns into….

A

Emergency adjunct (difficult airway algorithm)

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10
Q

if cant mask ventilate then dont….

A

dont give paralytic

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11
Q

Lifts tongue and epiglottis away from the posterior pharyngeal wall to relieve any obstruction and help open the airway

A

OroPharyngeal Airways (OPA)

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12
Q

OPAs hemodynamic effect

A

Decreases work of breathing during Spont Vent

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13
Q

Bite portion of the OPA must be——-

A

Bite portion must be firm enough that patient cannot close lumen by biting

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14
Q

Design and size of OPAs

A

plastic
color coded
Size designated in millimeters (up to 100 mm)

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15
Q

white OPAS dont have…

A

dont have hole in the front like the color coded opas. hole can be an insertion point for a scope

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16
Q

measurement markers for OPAs

A

Corner of mouth to the angle of the jaw or the earlobe

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17
Q

What reflexes should be depressed for OPA insertion?

A

Pharyngeal and laryngeal reflexes should be depressed

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18
Q

Placed between upper and lower teeth and gums

A

Bite Blocks

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19
Q

What device goes in place before anesthesia ?

A

bite block

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20
Q

Where are bite blocks used?

A

Endoscopy

Prevents biting on ETT, bronchoscope, endoscope

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21
Q

Device that is Tolerated in patients with intact airway reflexes

A

Nasopharyngeal Airways (NPA)

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22
Q

What is used to dilate the nasal cavity for nasal intubation?

A

Nasopharyngeal Airways (NPA)

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23
Q

When are NPAs preferable? (4)

A

Preferable with loose teeth, oral trauma, gingivitis, limited mouth opening

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24
Q

Contraindications for NPAs (5)

A

Basilar skull fracture
Nasal deformity
Hx of epistaxis
Pregnancy
Coagulopathy (chronic NSAID use)

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25
Q

Purpose of flange on NPA

A

flange at the end site outside the nose
Can get in the way of getting the nasal cannula to seat
Flange at outer end to prevent complete passage

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26
Q

what resembles a shortened tracheal tube

A

NPA

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27
Q

What is less stimulating than an OPA

A

NPA

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28
Q

How are NPAs sized

A

Sized by outer diameter in French scale

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29
Q

As french number increases______

A

diameter increases

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30
Q

Measurement points for NPA

A

Bony mandible or nostril to the external auditory meatus

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31
Q

Insertion of NPA

A

insert parallel to nasal floor
when proximal end/ beveled in the nasal passage it should come to rest ABOVE the epiglottis. shouldn’t be in the epiglottis or past the epiglottis. sh

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32
Q

Complications of Airways (Oral or Nasal) (6)

A

Airway obstruction (incorrect placement)
Ulceration of nose or tongue
Dental/oral damage
Laryngospasm
Latex allergy (some older NPAs usually green in color)
Retention/swallowing (mostly with npa)

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33
Q

Old NPAs are usually_____ and have what?

A

green and have latex

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34
Q

When is the best time to remove oral or nasal airways?

A

let them take it out.

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35
Q

who and when was the supraglottic airway made

A

Dr. Archie Brain in the 80s

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36
Q

Intermediate bridge between face mask and endotracheal tube

A

Supraglottic Airways

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37
Q

When can Suprglottic airways be used

A

Spont Vent (SV)
PPV

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38
Q

LMA classic mask shape

A

Elliptical mask distally

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39
Q

What is the proximal and distal shape of an LMA classic

A

Shaped like a Tracheally Tube proximally
Elliptical mask distally

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40
Q

Where does an LMA classic sit

A

Sits in hypopharynx and surrounds the supraglottic structure

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41
Q

What size syringe do you use for an LMA Classic and inflate pressure

A

at least a 20 ml to take out all the air out of the mask and need to inflate to an air pressure of 60 cmH20

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42
Q

LMA Classic mask inflation pressure

A

60cmH20

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43
Q

Sizing for LMA

A

go up by half size
smaller size = smaller pt

3456 = whole number.

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44
Q

What happens if you size too small for an LMA classic?

A

Gas leaks during positive pressure

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45
Q

Problems with too large of an LMA (3)

A

-Won’t seat over glottis
-Greater incidence of sore throat
-Possible pressure on lingual, hypoglossal, and recurrent laryngeal nerves

look for bulge in neck = too big

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46
Q

How to instert LMA?

A

Well lubricated; cuff down
Held like pencil
Upward against the hard palate
Follows the posterior pharyngeal wall
Smooth motion
Should feel it curve around downward in the airway then come to a stop

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47
Q

What happens when you inflate balloon of LMA?

A

When balloon inflated (if it has a balloon), neck bulges and LMA may “rise” up slightly

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48
Q

what to do For difficult LMA placement?

A

For difficult placement, jaw lift, pull tongue forward, slightly inflate balloon or may change to different technique

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49
Q

What is LMA unique made of?

A

Made of PVC

single use/ disposable

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50
Q

LMA unique vs LMA classic

A

Stiffer, cuff less compliant vs LMA Classic

Insertion same; resembles LMA Classic

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51
Q

What LMA has wire reinforcement?

A

LMA proseal

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52
Q

What is shorter than the Classic LMA?

A

LMA proseal

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53
Q

What is the special feature LMA proseals have?

A

Gastric access port-> esophaguss -> OGT -> decompress stomach.
wire reinforced

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54
Q

What has a Medical-grade thermoplastic elastomer

A

IGEL LMAS (NO CUFF)

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55
Q

IGEL LMAS (NO CUFF) features/ seals to

A

Noninflatable, anatomical seal of the pharyngeal, laryngeal, and perilaryngeal structures- prevent aspiration

Gastric channel

conduit for intubation

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56
Q

IGel has anatomical seal of the______

A

Noninflatable, anatomical seal of the pharyngeal, laryngeal, and perilaryngeal structures

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57
Q

Advantages of LMAs (5)

A

-Ease and speed of placement
-Improved hemodynamic stability- less stimulating then ETT
-Reduced anesthetic requirements
-No muscle relaxation needed
-Avoidance of some of the risks of tracheal intubation

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58
Q

Disadvantages of LMAs (3)

A

-Smaller seal pressures than ETTs
-No protection from laryngospasm
-Little protection from gastric regurgitation and aspiration
(First-generation= pre proseal)

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59
Q

What do the smaller seal presures with LMAs compared to ETT lead to?

A

ineffective ventilation and higher airway pressures are needed.

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60
Q

how can a laryngoscope be manufactured?

A

Manufactured as single piece or detachable blade/handle

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61
Q

What is the light source on a laryngoscope?

A

Light source is light bulb or fiberoptic

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62
Q

Where is the power for the light on a laryngoscope provided?

A

Handle: Provides power for light…. most use disposable batteries

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63
Q

Which hand is the laryngoscope held in?

A

left hand

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64
Q

What is formed when the blade and handle are ready to use?

A

Right angle

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65
Q

What part of the laryngcope is inserted into the mouth?

A

blade

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66
Q

sizing for laryngoscope blades

A

Different sizes; increasing number… increased size

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67
Q

Size of batteries for laryngoscope light

A

C size batteries
unscrews from bottom

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68
Q

tongue of the blade does what?

A

Tongue: manipulates and compresses soft tissue

69
Q

Tip of the blade does what?

A

Tip: directly or indirectly elevates epiglottis

70
Q

Mac can only go where?

A

into the vallecula

71
Q

Most alterations in larygoscope change the _________ and there are differences as noted in how they are used

A

Most alterations change the angle from tongue to handle and there are differences as noted in how they are used

72
Q

Macintosh blade sizes useful for adults

A

3 and #4 useful for adults

73
Q

Has been shown to cause greater cervical spine movement

A

Macintosh blades

74
Q

Makes intubation easier because blade requires adequate mouth opening due to blade size

A

Macintosh blades

75
Q

Tongue is straight with slight upward tip

A

Miller blades

76
Q

Miller blade size for adults

A

2 and #3 for adults

77
Q

Blade that Force, head extension, and cervical spine movement is less

A

Miller blades

78
Q

Blade that is Great for smaller mouths and longer necks

A

Miller blade

79
Q

If miller blade is inserted too far ______-

A

If blade inserted too far, it elevates larynx or esophagus

80
Q

If miller blade is withdrawn too far____

A

If withdrawn too far, epiglottis flips down and covers glottis

81
Q

“Sniffing” position

A

Optimal position
35 degree lower cervical flexion; 80 to 90 degree head extension at the atlanto-occipital level
Create an imaginary horizontal line connects the external auditory meatus and sternal notch

82
Q

Advancing the blade process

A

Right hand opens mouth (“scissor”) to keep the lips free to accommodate blade insertion
Blade inserted on right side of mouth
Advance blade, keeping tongue to left and elevated
Epiglottis comes into view

83
Q

Difficult airways interventions

A

Flexible fiberoptic scope or video largyngoscope
Maintain a neutral position and use of an OPA
Can be awake or “asleep”

84
Q

How to displace larynx

A

BURP
Backward
Upward
Rightward
Pressure

85
Q

How to make a ramped position

A

Troop Elevation Pillow
Folded blankets

86
Q

What does a ramped position create?

A

Create an imaginary horizontal line connects the external auditory meatus and sternal notch

87
Q

Stainless steel, lighted stylet with malleable distal tip; design utilizes eye piece

A

Shikani Optical Stylet

88
Q

What is the oxygen port on an Shikani Optical Stylet used for?

A

Oxygen port for oxygen insufflation

89
Q

Shikani Optical Stylet allows the patient to…..

A

maintain a Neutral position, inserted midline; available in adult and peds sizes

90
Q

Shikani Optical Stylet insertion

A

Stylet advanced into trachea; light pressure and tip ANTERIOR at all times to avoid injury

91
Q

Can be used as a light wand, check ETT placement, or placement of double-lumen ETT

A

Shikani Optical Stylet

92
Q

Optical Stylet Advantages (4)

A

-Easy to use for routine and difficult intubations
-Trachea is visualized, esophageal intubation should not occur
-Decreased incidence of sore throat
-Results in less c-spine movement over conventional laryngoscopy

93
Q

Optical Stylet DISADVANTAGES (3)

A

-Longer intubation time
-Cannot be used with nasal intubation (Because its not flexible)
-Cannot be adjusted into a precise direction compared to a traditional malleable stylet

94
Q

Video Laryngoscopes types (4)

A

Glidescope, Co-Pilot, King, and McGrath

95
Q

Advantages of video laryngoscopes (6)

A

-Magnified anatomy
-Some scopes have curved/straight blades to mimic laryngoscopes
-Operator and assistant can see
-May result in decreased c-spine movement
-Further distance from infectious patients
-Demonstrates correct technique in legal cases

96
Q

Limitations of video laryngoscopes

A

Requires video system
Portability varies
Strongest predictors of failure: altered neck anatomy with presence of a surgical scar, radiation changes, or mass

97
Q

Most frequent anesthesia-related claim

A

Dental injury

98
Q

Teeth Most likely damaged

A

Upper incisors
Restored or weakened teeth

99
Q

Tooth protectors

A

Placed on upper teeth during DL
Protects from the blade causing direct surface damage
Does not guarantee safety from dental trauma

100
Q

Damage to other structures during laryngocopy (4)

A

-Abrasions/hematomas
-Lingual &/or hypoglossal nerve injury (caused by increased pressure or stretching nerve)
-Arytenoid subluxation
Anterior TMJ dislocation

101
Q

Lingual nerve injury will result in…..

A

sensation problems with tongue and pain. not always immediate

102
Q

How to know if someone has a hypoglossal nerve injury

A

when tongue stuck out = deviates to the side.

side that deviates that side will be scalloped or wrinkled

103
Q

Things that contribute to the changes in resistance in the breathing system are______ (4)

A

Internal Diameter of tube
Tube length- shorter = less resistance
Configuration changes
Connectors

104
Q

ETT manufacturing requirements (10)

A

-Low cost
-Lack of tissue toxicity
-Easy sterilization (unless disposable)
-Non-flammability
-Smooth, non-porous surface to prevent secretion buildup, allow passage of suction catheter or bronchoscope and prevent trauma
-Sufficient body to maintain its shape
-Sufficient wall strength
-Conforms to patient anatomy
-Lack of reaction with anesthetic agents and lubricants
-Latex-free

105
Q

What decreases kinking in tracheal tubes?

A

Internal and external walls circular

106
Q

What end of tracheal tube can be shortened?

A

machine end

107
Q

What does the slanted bevel of the tracheal tube do?

A

Helps view larynx

108
Q

What on the tracheal tube Provides an alternate pathway for gas flow?

A

Murphy eye

109
Q

Ring-Adair-Elwin (RAE) Tube advantages (4)

A

-Facilitate surgery around head and neck
-Temporarily straightened during insertion
-Increased tube diameter… increased distance from tip to curve
-Easy to secure

110
Q

magills forceps and murpys eye

A

for nasal intubation as the patient end entered the nasal cavity and use the magills to direct to trachea, the forceps can get caught in the Murphys eye

111
Q

Also called “reinforced” or “anode” or “spiral embedded” tubes

A

Armored Tubes

112
Q

Advantages of armored tubes

A

Useful when tube is likely to be bent or compressed
Resistance to kinking and compression
Head, neck, tracheal surgeries

113
Q

Disadvantages or armored tubes

A

Need a stylet or forceps
Difficult to use during nasal intubation
Cannot be shortened
Damaged when biting

114
Q

Laser-Resistant Tubes are made of….

A

Metallic or silicone and metal mixture

115
Q

Laser-Resistant Tubes reflect what laser beams

A

CO2 or KTP laser

potassium titanyl phosphate (KTP)

116
Q

Laser-Resistant Tubes cuffs contain…..

A

Cuffs contain methylene blue crystals
Saline
cuffs are Not laser resistant

117
Q

Laser-Resistant Tubes double cuffs fill with and sequence

A

Double cuffs
Fill with methylene blue saline solution
Distal cuff first, then proximal cuff

118
Q

Purpose of methylene blue in laser resistance tube cuffs

A

methylene blue seen = cuff is leaking

119
Q

What side are ETT markings on

A

On bevel side above the cuff

120
Q

How are tube makings read

A

Read from pt side to machine side (cm)

121
Q

Tube marking safety standards (6)

A

-The word oral or nasal or oral/nasal
-Tube size in ID in mm
-Name of manufacturer
-Graduated markings in centimeters from patient end
-Cautionary note… single use only if disposable
-Radiopaque marker at patient end

122
Q

What are Radiopaque marker at patient end used for

A

see position on x ray

123
Q

normal ETT cuff pressure and mls

A

Cuff pressure = 18 - 25 mm Hg; usually 8 - 10 mL of air

124
Q

ETT cuffs should not …….

A

Must not herniate over murphy eye or bevel of tube

125
Q

measuring cuff pressure with manometer is recommended when….

A

Monitor cuff pressure frequently if using nitrous as this causes cuff inflation/expansion

126
Q

High-volume, Low-pressure Cuff features

A

Thin compliant wall
Occludes trachea without stretching tracheal wall
Area of contact larger but cuff adapts shape to tracheal wall shape

127
Q

advantages of High-volume, Low-pressure Cuff (2)

A

-Easy to regulate pressure
-Pressure applied to trachea less than mucosal perfusion pressure

128
Q

Disadvantages of High-volume, Low-pressure Cuff (5)

A

More difficult to insert, may obscure the view of the tube tip and larynx
Cuff is more likely to be torn during intubation
More likely to have a sore throat (covering more of the wall)
May not prevent fluid leakage
Easy to pass NGT, esophageal stethoscopes around cuff

129
Q

Low-volume, High-pressure Cuff features

A

Has small area of contact with trachea
Requires large amount of pressure to achieve a seal
Distends and deforms the trachea to a circular shape

130
Q

Advantages of Low-volume, High-pressure Cuff (3)

A

-Better protection against aspiration
-Better visibility during intubation
-Lower incidence of sore throat

131
Q

Disadvantages of Low-volume, High-pressure Cuff (2)

A

-Pressure exerted on trachea probably above mucosal perfusion pressure
-Should be replaced with a low-pressure cuff if postoperative intubation is required

132
Q

causes of Changes in Cuff Pressure (4)

A

-Use of nitrous
-Hypothermic cardiopulmonary bypass (decrease cuff pressure)
-Increases in altitude
-Coughing, straining, and changes in muscle tone

133
Q

Why does hypothermia decrease cuff pressure

A

cold induced vasoconstriction/ contraction of microvasular -> dilating

134
Q

What can cause ETT trauma (3)

A

-Excessive force, repeated attempts
-Varies with skill, difficulty of airway, and amount of muscle relaxation
-Keep stylet INSIDE tube
-Use vasoconstrictors for nasal intubation and pre-dilate nasal passage

135
Q

Inadvertent bronchial intubation
seen commonly in….

A

Emergencies; pediatric and female pts

peds and female = shorter to carina and R mainstem is shorter distance

136
Q

bronchial intubation can lead to….

A

atelectasis

137
Q

Distance to carina decreases with ………

A

Trendelenburg and laparoscopy

138
Q

Securing ett positions

A

Approx 21 cm mark at teeth - female
23 cm at teeth - male

139
Q

Reason why R mainstem bronchus is intubated more often

A

shorter
straighter - (L = 45 degree angle)

140
Q

Fluid accumulation above the cuff can lead to_______

A

Inadvertent bronchial intubation

141
Q

Where can upper airway edema happen?

A

Anywhere along path of tube

142
Q

Upper airway edema is dangerous in young children because_______
and peak incidence

A

Dangerous in young children (cricoid cartilage completely surrounds subglottic area)
more anterior
Peak incidence between 1-4 y/o

143
Q

Earliest signs of upper airway edema

A

Earliest signs 1-2 hrs postop to 48 hours postop

144
Q

How to avoid upper airway edema

A

Avoid irritating stimuli - URI, anesthetic depth

145
Q

Vocal cord granuloma is common in….

A

Common in adults; females

146
Q

s/s of vocal cord ganuloma (4)

A

S/S: Persistent hoarseness, fullness, chronic cough, intermittent loss of voice

147
Q

treatment for vocal cord granuloma

A

Treatment: laryngeal evaluation, voice rest

148
Q

Causes of vocal cord granuloma (4)

A

Trauma, ETT too large, infection, and excessive cuff pressure

149
Q

Bogies are made of….

A

Polyester base with resin coating

150
Q

bougies angle

A

Distal end angled 30-45 degrees

151
Q

How is bougies introduced

A

Introduced with anterior positioning of the tip

152
Q

reasons to use bougies

A

Blind intubation if glottic exposure is absent
ETT passage is difficult

Advance gently
Feel clicking sensation across tracheal rings

153
Q

what are magill forceps used for

A

Used primarily with nasal intubations
Should be immediately available
Directs tube into larynx
Possible damage to tube cuffs and lodged in murphy eye

154
Q

Right mainstem features

A

Shorter, straighter, larger diameter
25 degree takeoff from trachea
Larger diameter
RUL tracheal takeoff very close to origin
Avg length 2.5 cm from carina to take-off

155
Q

Left mainstem features

A

45 degree takeoff from trachea
LUL tracheal takeoff more distal
Avg length 5.5 cm from carina to take-off

156
Q

Indications for Lung Isolation (3)

A

Thoracic procedure
Control of contamination or hemorrhage
Unilateral pathology

157
Q

Double- lumen tubes adult sizes

A

35, 37, 39, 41 Fr

158
Q

Double-Lumen Tubes peds size

A

Pediatric sizes: 26, 28, 32 Fr

159
Q

Primarily we use _____ DLT

A

left

160
Q

When is a Right DLT used (4)

A

Left pneumonectomy, left lung transplantation, left mainstem bronchus stent in place, left tracheo-bronchus disruption

161
Q

Once the bronchial cuff of double lumen tube is placed past the cords what is the next step?

A

the tube is turned 90 degrees
Bronchial portion points toward the appropriate bronchus

162
Q

___bronchial cuff is just below the____ in the appropriate bronchus

A

Blue bronchial cuff is just below the carina in the appropriate bronchus

163
Q

DLT Complications

A

Tube malposition
Hypoxemia

164
Q

what can cause Unsatisfactory lung collapse

A

Bronchial lumen in wrong mainstem - reinsertion
Tube too proximal in airway - correct with fiberoptic

165
Q

What can cause Hypoxia with DLT? (2) and 2 solutions

A

Malpositioned tube- reinsertion
Patient comorbidities
-May need PEEP to dependent lung
-Consider intermittent 2 lung ventilation

166
Q

When DLT is not advisable (7)

A

-Nasal intubation
-Difficult intubation
-Patients with tracheostomy
-Subglottic stenosis
-Need for continued postoperative intubation
-If a single-lumen tube is already in place
-Critically ill pts

use bronchial blocker instead

167
Q

Can block a segment of lung without isolating entire lung

A

Bronchial-Blockers
Cannot be done with DLT

168
Q

Difficulties with Bronchial-blockers (4)

A

-Right upper lobe bronchus takeoff is high
-Tracheal bronchus
-Fixation by staples during surgery
-Perforation by suture needle or instrumentation

Principles (34 decks)

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