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Principles Of Anesthesia I > Airway Equipment I (Exam II) > Flashcards

Airway Equipment I (Exam II) Flashcards

1
Q

Describe Face masks.

A
  • Allows gas administration to the pt from the breathing system without any apparatus in the pts mouth
  • Preoxygenation/De-nitrogenation
  • May be used for entire anesthestic
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2
Q

What indicators show successful ventilation?

A
  • Chest rise/fall
  • EtCO2
  • SpO2
  • Minimal air leak
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3
Q

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

A

20 - 25 cmH₂O

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4
Q

What connector size does a face mask have?

A

22 mm internal diameter

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5
Q

What is a concern to be aware of when using the One-handed Method for ventilation?

A

Excessive pressure can occlude facial artery
Excessive pressure can compress the Facial Nerve (CN VII)

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6
Q

When would you potentially use the Two-Handed Method?

A

In difficult to intubate/ventilate cases

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7
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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8
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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9
Q

When would mask straps be used?

A
  • After the patient is sedated and relaxed
  • If one-hand ventilation is difficult
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10
Q

What are most oropharyngeal airways (OPA) made of?

A

Plastic

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11
Q

How do oropharyngeal airways work?

A
  • Lift tongue & epiglottis away
  • ↓ Work of breathing during SV (spontaneous ventilation)
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12
Q

How is the correct oropharyngeal airway size checked?

A
  • Corner of mouth to angle of jaw or earlobe
    Bite portion must be firm enough that patient cannot close lumen by biting
    Size designated in millimeters
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13
Q

When inserting oropharyngeal airways, what reflexes should be depressed?

A

Pharyngeal and laryngeal reflexes

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14
Q

Where are bite blocks placed?

A

Between upper and lower teeth and gums
Used a lot during endoscopy.
(Prevents biting on ETT, bronchoscope, endoscope)

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15
Q

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

A

Nasopharyngeal

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16
Q

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

A

Nasopharyngeal airway (NPA)

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17
Q

When are Nasopharyngeal airways contraindicated?

A
  • Basilar skull fracture
  • Nasal deformity
  • Hx of severe epistaxis (not a complete contraindication)
  • Pregnancy (venous congestion)
  • Coagulopathy
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18
Q

How are Nasopharyngeal airways sized?

A

By outer diameter in the French scale

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19
Q

What’s more stimulating, insertion of an OPA or NPA?

A

OPA

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20
Q

How do you determine the appropriate size NPA?

A

Bony mandible or nostril to the external auditory meatus
(Lubricate thoroughly)

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21
Q

What are the possible complications of artifical airways?

A
  • Airway obstruction
  • Ulceration (nose, tongue, etc.)
  • Dental/oral damage
  • Laryngospasm
  • Latex allergy (older NPAs; green)
  • Retention/swallowing
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22
Q

Should an OPA be used in a prone or lateral decubitus patient?

A

No, because of the increased risk of ulceration
(Use rolled up 4x4s instead, if needed)

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23
Q

Who developed Supraglottic airways?

A

Dr. Archie Brain

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24
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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25
Q

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

A

Can be used for both

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26
Q

What is the difference between 1st and 2nd generation LMAs?

A

2nd gen has a lumen for a gastric tube

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27
Q

Describe features of the LMA Classic.

A
  • Shaped like a TT proximally
  • Elliptical mask distally
  • Inflatable cuff
  • Latex-free, reusable, disposable
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28
Q

Are LMA Classic’s MRI-safe?

A

Depends.
Can have a metal spring (not safe)
Can have a plastic spring (safe)

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29
Q

Where do LMA classic’s sit after insertion?

A

Sits in hypopharynx and surrounds the supraglottic structure

30
Q

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

A

LMA 1

31
Q

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

A

LMA 1.5

32
Q

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

A

LMA 2

33
Q

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

A

LMA 2.5

34
Q

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

A

LMA 3

35
Q

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

A

LMA 4

36
Q

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

A

LMA 5

37
Q

What size LMA is necessary for adults over 100kg?

A

LMA 6

38
Q

What occurs with an LMA that is too small?

A

Gas Leaks during PPV

39
Q

What occurs with an LMA that is too large?

A
  • Won’t seat over the glottis
  • Sore throat
  • Pressure on nerves
40
Q

What nerves might be compressed with an overly large LMA?

A
  • Lingual
  • Hypoglossal
  • Recurrent Laryngeal
41
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)
42
Q

T/F
When inflating the LMA balloon (if present), the neck bulges and the LMA “rises” up slightly

A

True

43
Q

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

A
  • Jaw lift
  • Pull tongue forward
  • Slightly inflate balloon
    (Or change to another technique)
44
Q

How does an LMA Unique compare to an LMA classic?

A
  • Made of PVC
  • Stiffer, less compliant cuff
  • Single use, disposable
45
Q

What are the characteristics of an LMA Proseal?

A
  • Wire reinforced
  • Shorter than LMA Classic
  • Access to Esophagus for OGT
46
Q

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

A

IGEL LMA

47
Q

What are the characteristics of IGEL LMA’s?

A
  • Medical-grade thermoplastic elastomer
  • No cuff (non-inflatable anatomic seal)
  • Gastric channel
  • Conduit for intubation
48
Q

What makes the IGEL LMA unique?

A

Anatomically seals off the pharyngeal, laryngeal, and perilaryngeal structures

49
Q

What are the five advantages of LMAs?

A
  • Easy and speedy placement
  • Improved hemodynamic stability
  • Reduced anesthetic requirements
  • No muscle relaxation needed
  • Tracheal intubation risks avoided
50
Q

What are the disadvantages of LMAs?

A

Smaller seal pressures compared to ETTs
No protection from laryngospasm
Little protection from gastric regurgitation and aspiration
(Greater incidence in 1st vs 2nd generation)

51
Q

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

A
  • LMA Proseal
  • IGEL LMA’s
52
Q

Which LMA provides the best protection against gastric regurgitation and aspiration?

A

IGEL LMA

53
Q

Which LMA allows for intubation through the LMA itself?

A

IGEL (Typically)

54
Q

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

A

LMA

55
Q

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

A

ETT

56
Q

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

A

ETT

57
Q

What size Mac blades are used for adult laryngoscopy?

A

3 and 4

58
Q

What size Miller blades are used for adult laryngoscopy?

A

2 and 3

59
Q

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

A

Miller

60
Q

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

A

Mac

61
Q

Which laryngoscopy blade is inserted into the vallecula?

A

Mac

62
Q

Which laryngoscopy blade makes intubation easier because the blade requires adequate mouth opening due to blade size?

A

Mac

63
Q

Describe the Epiglottic view with the Mac blade.

A
  • Visualize the epiglottis
  • Tip advanced into the vallecula
  • Pressure is applied at right angle of blade & handle to move base of tongue and epiglottis forward
  • Can be used like Miller to elevate the tip of the epiglottis
64
Q

Describe the Epiglottic view with the Miller blade.

A
  • Blade lifts the epiglottis
  • If blade is inserted too far, it elevates the larynx or esophagus
  • If withdrawn too far, epiglottis flips down and covers the glottis
  • Can be used like a Mac to insert into the vallecula
65
Q

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

A

Horizontal line connecting external auditory meatus and sternal notch.

66
Q

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

A

Right side

67
Q

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

A

35° lower cervical flexion
80-90° head extension

68
Q

What techniques can be used for difficult intubations?

A
  • Flexible fiberoptic scope or video laryngoscope
  • Maintain neutral position and use an OPA
  • Awake or “Asleep” intubation
69
Q

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

A

BURP technique

Backward
Upward
Rightward
Pressure

70
Q

What laryngoscopic positioning is useful for obese patients?

A

Ramped position
(Troop elevation pillow or folded blankets)

Principles Of Anesthesia I (8 decks)

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