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JW: Principles of Anesthesia I > Airway Equipment (Exam III) > Flashcards

Airway Equipment (Exam III) Flashcards

1
Q

What pressure should the inflatable seal of a face mask be at?

A

20 - 25 cmH₂O

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2
Q

What connector size does a face mask have?

A

22 mm internal diameter

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3
Q

What risk factors are there for difficult mask ventilation?

A
  • Male
  • > 55 yo
  • Beard
  • Edentulous
  • OSA
  • BMI > 30 kg/m²
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4
Q

What are some options for overcoming a difficult mask ventilation?

A
  • Oral or nasopharyngeal airway
  • Two-handed technique
  • Cut the beard
  • Tegaderm
  • Difficult airway algorithm
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5
Q

What are most oropharyngeal airways made of?

A

plastic

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6
Q

How do oropharyngeal airways work?

A

Lift tongue & epiglottis away to ↓ work of breathing during SV (spontaneous ventilation)

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7
Q

How is the correct oropharyngeal airway size checked?

A

Corner of mouth to angle of jaw or earlobe

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8
Q

When inserting oropharyngeal airways, what reflexes should be depressed?

A

Pharyngeal and laryngeal reflexes

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9
Q

Where are bite blocks placed?

A

Between upper and lower teeth and gums

Used a lot during endoscopy.

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10
Q

Which artificial airway is preferred for patients w/ intact airway reflexes?

A

Nasopharyngeal

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11
Q

What airway is preferable for patients with loose teeth, oral trauma, gingivitis, or limited mouth opening?

A

Nasopharyngeal airway

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12
Q

When are Nasopharyngeal airways contraindicated?

A
  • Basilar skull fracture
  • Nasal deformity
  • Hx of severe epistaxis
  • Pregnancy
  • Coagulopathy
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13
Q

How are Nasopharyngeal airways sized?

A

By outer diameter in the french scale

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14
Q

What are the possible complications of airways?

A
  • Airway obstruction
  • Ulceration (nose, tongue, etc.)
  • Dental damage
  • Laryngospasm
  • Latex allergy
  • Retention/swallowing
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15
Q

Who developed Supraglottic airways?

A

Dr. Archie Brain

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16
Q

What airway is intermediate in invasiveness between a face mask and endotracheal tube?

A

Supraglottic airway (LMA, Laryngeal mask airway)

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17
Q

Are supraglottic airways used for spontaneous ventilation or positive pressure ventilation?

A

Either

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18
Q

Where do LMA classic’s sit after insertion?

A

Hypopharynx surrounding the supraglottic structure.

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19
Q

What LMA size is necessary for adults 50-70 kg?

A

LMA 4

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20
Q

What LMA size is necessary for children 30-50kg?

A

LMA 3

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21
Q

What size LMA is necessary for adults over 100kg?

A

LMA 6

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22
Q

What LMA size is necessary for adults 70-100kg?

A

LMA 5

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23
Q

What LMA size is necessary for neonates and infants up to 5kg?

A

LMA 1

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24
Q

What LMA size is necessary for infants/children between 10-20kg?

A

LMA 2

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25
Q

What LMA size is necessary for infants between 5-10kg?

A

LMA 1.5

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26
Q

What LMA size is necessary for children between 20-30kg?

A

LMA 2.5

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27
Q

What occurs with an LMA that is too small?

A

Leaking occurs during positive pressure ventilation

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28
Q

What occurs with an LMA that is too large?

A
  • Won’t seat on glottis
  • Sore throat
  • Pressure on nerves
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29
Q

What nerves might be compressed with an overly large LMA?

A
  • Lingual
  • Hypoglossal
  • Recurrent Laryngeal
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30
Q

Label the following steps of LMA insertion as true or false.

  • Insert well lubricated w/ the cuff inflated
  • Hold like a pencil
  • Upward against the hard palate
  • Follow the anterior pharyngeal wall
  • Feel curve downward into airway then come to a stop.
A
  • Insert well lubricated w/ the cuff inflated (False, cuff should not be inflated)
  • Hold like a pencil (T)
  • Upward against the hard palate (T)
  • Follow the anterior pharyngeal wall (False, follow the posterior pharyngeal wall)
  • Feel curve downward into airway then come to a stop. (T)
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31
Q

What anatomic technique would one use for a difficult LMA insertion?

A
  • Jaw lift
  • Pull tongue forward
  • Slightly inflate balloon
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32
Q

How does an LMA Unique compare to an LMA classic?

A
  • Stiffer (made of PVC)
  • Less compliant cuff
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33
Q

What are the characteristics of an LMA Proseal?

A
  • Shorter than Classic
  • Reinforced w/ wire
  • Access to Esophagus for gastric tube
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34
Q

Which LMA type has no cuff to seal around the supraglottic opening?

A

I-gel LMA’s

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35
Q

Which LMA’s provide access to the esophagus through a built in opening?

A
  • LMA Proseal
  • I-gel LMA’s
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36
Q

What are the characteristics of I-gel LMA’s?

A
  • No cuff (non-inflatable anatomic seal)
  • Gastric channel
  • Can intubate through
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37
Q

What are the advantages of LMAs?

A
  • Easy and speedy placement
  • Improved hemodynamic stability
  • Reduced anesthetic requirements
  • No muscle relaxation needed
  • Tracheal intubation risks avoided
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38
Q

Which LMA allows for intubation through the LMA itself?

A

I-gel LMA’s (typically)

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39
Q

Would an LMA or an ETT be better for hemodynamic stability?

A

LMA

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40
Q

Would an LMA or ETT be better for protection from gastric regurgitation and aspiration?

A

ETT

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41
Q

Would an LMA or ETT be better for protection from Laryngospasm?

A

ETT

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42
Q

What size Mac blades are used for adult laryngoscopy?

A

3 and 4

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43
Q

What size Miller blades are used for adult laryngoscopy?

A

2 and 3

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44
Q

Which intubating blade style is generally better for smaller mouths and longer necks?

A

Miller

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45
Q

Which intubating blade shows more cervical spine movement with its use?

A

Mac

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46
Q

Which laryngoscopy blade is inserted into the vallecula?

A

Mac

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47
Q

What imaginary line is created when placing a patient in the sniffing position?

A

Horizontal line connecting external auditory meatus and sternal notch.

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48
Q

Is a laryngoscopy blade inserted into the right or left of the mouth?

49
Q

How much cervical flexion and head extension are present in the sniffing position?

A
  • 35° lower cervical flexion
  • 80-90° head extension
50
Q

How is the larynx displaced to provide a better intubating view?

A

BURP technique

Backward
Upward
Rightward
Pressure

51
Q

What laryngoscopic positioning is useful for obese patients?

A

Ramped Position

52
Q

What is a Shikani Optical Stylet?

53
Q

What are the disadvantages to the optical stylet?

A
  • Longer intubation time
  • No nasal intubations
  • No malleable stylet for precise directing.
54
Q

What are the benefits of the optical stylet?

A
  • Visualized trachea
  • ↓ sore throat incidence
  • ↓ c-spine movement
55
Q

What are the strongest predictors of failure of video laryngoscopy?

A

Presence of:

  • Surgical scar
  • Radiation changes
  • Mass
56
Q

What are overall limitations of video laryngoscopes?

A
  • Video system required
  • Limited portability
  • Can fail w/ anatomic abnormalities
57
Q

What is the most frequent anesthesia-related claim?

A

Dental injury

58
Q

Which teeth are most likely to be injured from laryngoscopy?

A
  • Upper incisors
  • Restored or weakened teeth
59
Q

What can help prevent dental injury?

A

Tooth protectors placed on upper teeth

60
Q

What objects can be swallowed during laryngoscopy?

A
  • Light bulbs
  • Teeth
61
Q

What structures (other than teeth) can be injured during laryngoscopy?

A
  • Abrasion/hematoma
  • Lingual/hypoglossal nerve injury
  • Arytenoid subluxation
  • Anterior TMJ dislocation
62
Q

How can cervical spinal cord injury occur during laryngoscopy?

A
  • Aggressive head positioning
  • Manual in-line stabilization
63
Q

What nerves could be injured via laryngoscopy?

A
  • Lingual nerve
  • Hypoglossal nerve
64
Q

What components of the tracheal tube will change resistance in the breathing system?

A
  • Internal diameter
  • Length
  • Configuration
  • Connectors
65
Q

What manufacturing requirements are there for ETT’s?

66
Q

What aspect of ETT’s decrease kinking?

A

Round, circular structure

67
Q

What is the purpose of the Murphy eye?

A

Provides alternative pathway for gas flow

68
Q

What is the purpose of the slanted bevel of an ETT?

A

Helps view Larynx

69
Q

What is a Ring-Adair-Elwin (RAE) tube used for?

A

Facilitation of surgery around the head and neck

70
Q

Are RAE tubes ever straight?

A

Only on insertion

71
Q

What are disadvantages to RAE tubes?

A
  • Difficult to pass suction/scope
  • Increased airway resistance
72
Q

What are alternative names for “armored” tubes?

A
  • Reinforced
  • Anode
  • Spiral-embedded
73
Q

What are the benefits of reinforced tubes?

A
  • Prevention of kinking and compression
  • Good for head, neck, and tracheal surgeries
74
Q

What are the disadvantages of reinforced ETT’s?

A
  • Need for stylet or forceps
  • Difficult use in nasal intubation
  • Cannot be shortened
  • Damaged when bit by the patient
75
Q

What are laser resistant tube made from?

A

Metal, silicone, or metal mixture

76
Q

What is the purpose of a laser resistant ETT?

A
  • Reflection of CO₂ or KTP laser
77
Q

What are the cuffs filled with in laser resistant ETT’s?

A
  • Methylene Blue saline solution
78
Q

How are the double cuffs of a laser resistant tube filled?

A

Distal first, proximal last

79
Q

The ETT _____ must not herniate over the murphy eye or bevel of the tube.

80
Q

What is the cuff pressure of an ETT?
How much air is this typically?

A
  • 18 - 25 mmHg
  • 8 - 10 mL of air
81
Q

ETT cuff pressure should be monitored frequently if using _______.

A

N₂O (easy expansion & contraction)

82
Q

How does a high-volume, low pressure ETT cuff work?

A
  • Thin, compliant wall
  • Occludes trachea w/o stretching the trachea
  • ↑ area of contact
83
Q

What are advantages to a high-volume, low pressure ETT cuff?

A
  • Easy to regulate pressure
  • Pressure to trachea won’t exceed mucosal perfusion pressure.
84
Q

What are disadvantages of high-volume, low pressure ETT cuff?

A
  • Difficult insertion
  • Can tear easily
  • Sore throat more likely
  • Won’t prevent fluid leakage
  • NGT can slip past cuff
85
Q

What is a low-volume high pressure ETT cuff?

A
  • Small area of contact
  • High pressure
  • Deforms trachea to circular shape
86
Q

What are advantages of a low-volume high pressure ETT cuff?

A
  • Protects from aspiration
  • Better visibility during intubation
  • Lower incidence of sore throat
87
Q

What are disadvantages of a low-volume high pressure ETT cuff?

A
  • Pressure greater than mucosal perfusion pressure
  • Needs replacement if post-operative intubation is required.
88
Q

What factors can change cuff pressure?

A
  • N₂O usage
  • Hypothermic cardiopulmonary bypass
  • Increases in altitude
  • Coughing, straining, changes in muscle tone
89
Q

What factors will increase the risk of airway trauma from ETT insertion?

A
  • Excessive force
  • Multiple attempts
  • Stylet inside tube
  • Skill
  • Degree of muscle relaxation
90
Q

When is inadvertent bronchial intubation most likely?

A

W/ pediatric female patients

Right main bronchus

91
Q

What causes a decreased distance to the carina?

A
  • Trendelenburg
  • Laparascopy
92
Q

Bronchial intubation will lead to _________.

A

atelectasis

93
Q

What should the ETT be secured at for males and females?

A

Male: 23 at the teeth
Female: 21 at the teeth

94
Q

In what patient population upper airway edema most likely to occur?
Why is this?

A
  • Young children 1- 4 y/o
  • cricoid cartilage completely surrounds subglottic area
95
Q

When will upper airway edema be noticed usually?

A

1-2 hours to 48 hours post-op

96
Q

What is a vocal cord granuloma?

A

Mass on vocal cord from excess stimulation

97
Q

Who are vocal cord granuloma’s most common in?

A

Adult females

(Trauma, large ETT, infection, excessive cuff pressure)

98
Q

What are the s/s of vocal cord granuloma?

A
  • Persistent hoarseness
  • Fullness
  • Chronic cough
  • Intermittent loss of voice
99
Q

How are vocal cord granuloma’s treated?

A
  • Laryngeal evaluation and vocal rest
100
Q

What is the angle at the distal end of a bougie?

101
Q

How is a bougie inserted?

A

Tip anterior

102
Q

What should be known about Magill forceps?

A
  • Primarily used with nasal intubations
  • Possible damage to tube cuff or murphy eye lodgement can occur
103
Q

What are indications for lung isolation?

A
  • Thoracic procedures
  • Control of contamination or hemorrhage
  • Unilateral pathology
104
Q

What should be known about the right mainstem?

A
  • Shorter, straighter, larger diameter
  • 25° takeoff from trachea
  • 2.5 cm length
105
Q

What should be known about the left mainstem?

A
  • 45° takeoff
  • 5.5 cm length from carina to takeoff
106
Q

What size double lumen tubes are available for adults?

A

35, 37, 39, 41 fr

107
Q

What size double lumen tubes are available for children?

A

26, 28, 32 Fr

108
Q

When would a right double lumen tube be utilized?

A

For left-sided lung surgeries

109
Q

What occurs after the bronchial cuff passes the cords?

A

ETT is turned 90°

110
Q

Where is the blue bronchial cuff located?

A

Just below the carina in the appropriately blocked bronchus

111
Q

How is the correct location of the bronchial baloon verified?

A

Fiberoptic scope

112
Q

How is a lung isolated with a double lumen tube in place?

A

Clamping of the tracheal or bronchial connector

113
Q

What are complications of double lumen tube insertion?

A
  • Tube malposition (w/ unsatisfactory lung collapse)
  • Hypoxemia
114
Q

When would a bronchial blocker be advised?

A

When a double lumen tube cannot be used

115
Q

When would a double lumen tube not work? (and thus require the use of a bronchial blocker)

A
  • Nasal intubation
  • Difficult intubation
  • Tracheostomy
  • Subglottic stenosis (DLT are large)
  • Need for post-operative ventilation
  • Single lumen tube already in place
116
Q

What would be used to block a specific segment of a lung? (not the entire mainstem and thus lung)

A

Bronchial blocker

117
Q

What are some factors that cause difficulty with bronchial blockers?

A
  • Right upper lobe bronchus takeoff too high
  • Tracheal bronchus
  • Fixation by staples during surgery
  • Perforation by suture needle or instrument
118
Q

What are the characteristics of I-gel LMA’s?

A
  • No cuff (non-inflatable anatomic seal)
  • Gastric channel
  • Can intubate through

JW: Principles of Anesthesia I (61 decks)

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