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

Airway Equipment II (Exam II) Flashcards

1
Q

What is a Shikani Optical Stylet?

A
  • Stainless steel, lighted stylet with malleable distal tip; design utilizes eye piece
  • Oxygen port for oxygen insufflation
  • Neutral position, inserted midline; available in adult and peds sizes
  • Stylet advanced into trachea; light pressure and tip anterior at all times to avoid injury
  • Can be used as a light wand, check ETT placement, or placement of double-lumen ETT
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2
Q

What are the 4 advantages of the optical stylet?

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
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3
Q

What are the disadvantages to the optical stylet?

A
  • Longer intubation time
  • Cannot be used with nasal intubation
  • Cannot be adjusted into a precise direction compared to a traditional malleable stylet
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4
Q

What are the different types of Video Laryngoscopes?

A
  • Glidescope
  • Co-Pilot
  • King
  • McGrath
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5
Q

What are the six advantages of Video Laryngoscopes?

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
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6
Q

What are the 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
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7
Q

What is the most frequent anesthesia-related claim?

A

Dental injury
(Particularly upper incisors or restored/weakened teeth)

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8
Q

What can help prevent dental injury?

A

Tooth protectors
(Placed on upper teeth)

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9
Q

How can cervical spinal cord injury occur during laryngoscopy?

A
  • Aggressive head positioning
  • Improper manual in-line stabilization
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10
Q

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

A
  • Abrasion/hematoma
  • Lingual/hypoglossal nerve injury
  • Arytenoid subluxation
  • Anterior TMJ dislocation
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11
Q

What objects can be swallowed during laryngoscopy?

A
  • Light bulbs
  • Tooth/teeth
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12
Q

What is the universal numbering system?

A

Accurate way to document specific teeth presence, absence, or damage

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13
Q

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

A
  • Internal diameter
  • Length
  • Configuration
  • Connectors
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14
Q

What are the 10 manufacturing requirements for ETT’s?

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
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15
Q

What aspect of ETT’s decrease kinking?

A

Internal and external walls are circular

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16
Q

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

A

Helps view the larynx

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17
Q

What is the purpose of the Murphy Eye?

A

Provides alternative pathway for gas flow

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18
Q

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

A
  • Facilitate surgery around head and neck
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19
Q

What are other advantages of RAE tubes?

A
  • Temporarily straightened during insertion
  • Increased tube diameter… increased distance from tip to curve
  • Easy to secure
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20
Q

What are disadvantages of RAEs?

A
  • Difficult to pass suction/scope
  • Increases airway resistance
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21
Q

Are RAE tubes ever straight?

A

Can be straightened if needed on insertion

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22
Q

What are alternative names for “armored” tubes?

A
  • Reinforced
  • Anode
  • Spiral embedded
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23
Q

What are the advantages of reinforced tubes?

A
  • Increased resistance of kinking and compression
  • Good for head, neck, and tracheal surgeries
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24
Q

What are the disadvantages of reinforced ETT’s?

A
  • Need a stylet or forceps
  • Difficult to use during nasal intubation
  • Cannot be shortened
  • Damaged when biting
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25
Q

Are Armored tubes MRI safe?

A

No, because they are comprised of metal

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26
Q

What are laser resistant tube made from?

A

Metal, silicone, or metal mixture

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27
Q

What is the purpose of a laser resistant ETT?

A

Reflection of CO₂ or KTP laser
(To prevent inadvertent fire/ignition)

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28
Q

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

A

Methylene Blue crystals (MB)
To see if the cuff has burst, as MB is not laser resistant

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29
Q

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

A
  1. Fill with saline solution to mix with MB
  2. Distal cuff first, then proximal cuff
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30
Q

Where are tube marking located?

A

On the bevel side above the cuff
(Read from pt side to the machine)

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31
Q

What are the 6 safety standards regarding ETTs?

A
  • The word oral or nasal or oral/nasal on the tube
  • 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
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32
Q

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

A

cuff
(Hernation would cause occlusion of tube)

33
Q

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

A
  • 18 - 25 mmHg
  • 8 - 10 mL of air
    (Excess pressure can cause necrosis)
34
Q

ETT cuff pressure should be monitored frequently if using _______.

A

N₂O (easy expansion & contraction)
(assess ~30 mins)

35
Q

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

A
  • Has a thin, compliant wall
  • Occludes the trachea w/o stretching the tracheal wall
  • ↑ area of contact, but cuff adapts shape to tracheal wall
36
Q

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

A
  • Easy to regulate pressure
  • Pressure to trachea won’t exceed mucosal perfusion pressure.
37
Q

What are 5 disadvantages of high-volume, low pressure ETT cuff?

A
  • Difficult insertion, may obscure view of tube tip and larynx
  • Can tear easily during intubation
  • Sore throat more likely
  • Won’t prevent fluid leakage
  • Easy to pass NGT, esophageal stethoscope around cuff
38
Q

What is a low-volume high pressure ETT cuff?

A
  • Small area of contact with the trachea
  • High pressure required to achieve seal
  • Distends and deforms trachea to circular shape
39
Q

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

A
  • Better protection from aspiration
  • Better visibility during intubation
  • Lower incidence of sore throat
40
Q

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

A
  • Pressure exerted on the trachea is greater than mucosal perfusion pressure
  • Needs replacement with low-pressure cuff if post-operative intubation is required.
41
Q

What factors can change cuff pressure?

A
  • N₂O usage (Increase)
  • Hypothermic cardiopulmonary bypass (Decrease)
  • Increases in altitude (Increase)
  • Coughing, straining, changes in muscle tone (Increase)
42
Q

What 5 factors will increase the risk of airway trauma from ETT insertion?

A
  • Excessive force, repeated attempts
  • Keep the stylet inside tube (above Murphy eye)
  • Skill, difficulty of airway
  • Degree of muscle relaxation
  • Not using vasoconstrictors for nasal intubation and pre-dilating nasal passage
43
Q

When is inadvertent bronchial intubation most likely?

A
  • During emergencies
  • Especially with pediatric and female patients

Right main bronchus intubation most likely

44
Q

What causes a decreased distance to the carina?

A
  • Trendelenburg
  • Laparascopy
45
Q

Bronchial intubation will lead to _________.

A

Atelectasis

46
Q

At what distance should the ETT be secured at for males and females?

A
  • Male: 23 cm at the teeth
  • Female: 21cm at the teeth
47
Q

What are some ETT complications?

A
  • Dislodgement with instrumentation
  • Fluid accumulation above the cuff
48
Q

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

A
  • Young children 1- 4 y/o
  • Cricoid cartilage completely surrounds subglottic area
49
Q

When will upper airway edema be noticed usually?

A

Earliest: 1-2 hours post-op
Lastest: 48 hours post-op

50
Q

How can we avoid upper airway edema?

A
  • Avoid irriting stimuli - URI
  • Monitor anesthetic depth
51
Q

What is a vocal cord granuloma?

A

Mass on vocal cord from excess stimulation

52
Q

Who are vocal cord granuloma’s most common in?

A

Adults, especially females

53
Q

What 4 things can cause vocal cord granulomas?

A
  • Trauma
  • Large ETT
  • Infection
  • Excessive cuff pressure
54
Q

What are the 4 s/s of vocal cord granuloma?

A
  • Persistent hoarseness
  • Fullness
  • Chronic cough
  • Intermittent loss of voice
55
Q

How are vocal cord granuloma’s treated?

A

Laryngeal evaluation and vocal rest

56
Q

When would a bougie be indicated?

A
  • Blind intubation if glottic exposure is absent
  • ETT passage is difficult
    Advance gently, should feel clicking sensation across tracheal rings
57
Q

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

A

30 - 45°

58
Q

How is a bougie inserted?

A

Introduced with anterior positioning of the tip
(So we can feel the tracheal rings)

59
Q

When are Magill forceps used?

A

With nasal intubations
Should always be immediately available

60
Q

What can happen with use of Magill forceps?

A

Damage to tube cuff and lodged in murphy eye

61
Q

What are indications for lung isolation?

A
  • Thoracic procedures (Deflated lung increases safety profile and surgical exposure)
  • Control of contamination or hemorrhage
  • Unilateral pathology (Excludes fistulas, ruptured cysts or other issues with the disease lung while allowing unilateral ventilation)
62
Q

What should be known about the right mainstem?

A
  • Shorter, straighter, larger diameter
  • 25° takeoff from the trachea
  • Avg length 2.5 cm (from carina to takeoff)
  • RUL tracheal takeoff very close to the origin
63
Q

What should be known about the left mainstem?

A
  • 45° takeoff from the trachea
  • LUL tracheal takeoff more distal
  • Avg length 5.5 cm from carina to takeoff
64
Q

What size double lumen tubes are available for adults?

A

35, 37, 39, 41 Fr
(Adults are ODD)

65
Q

What size double lumen tubes are available for children?

A

26, 28, 32 Fr

66
Q

Which DLT do we primarily use?

A

Left DLT
(To avoid blockage of RUL bronchus)

67
Q

When would a right double lumen tube be utilized?

A
  • Left pneumonectomy
  • Left lung transplantation
  • Left mainstem bronchus stent placement
  • Left tracheo-bronchus disruption
68
Q

On insertion after the bronchial cuff passes the cords with a DLT what should you do?

A

Turn the DLT 90°

69
Q

Where should the blue bronchial cuff be located after proper placement?

A

Just below the carina in the appropriate bronchus

70
Q

How is the correct location of the bronchial balloon verified?

A

Fiberoptic scope

71
Q

What can occur if the bronchial cuff herniates over the carina?

A

Blockage of both main bronchi

72
Q

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

A

Clamping of the tracheal or bronchial connector
(Assess ability to block/clamp prior to surgery)

73
Q

What are complications of double lumen tube insertion?

A

Tube malposition (unsatisfactory lung collapse)
Bronchial lumen in wrong mainstem: reinsert
Tube too proximal in airway - correct with fiberoptic

Hypoxemia
Malpositioned tube: reinsert

Patient comorbidities
May need PEEP to dependent lung
Consider intermittent 2 lung ventilation

74
Q

When would a bronchial blocker be advised?

A

When a DLT is not advisable

75
Q

In what 6 instances would a double lumen tube not work? (and thus require the use of a bronchial blocker)

A
  • Nasal intubation
  • Difficult intubation
  • Patients with a tracheostomy
  • Subglottic stenosis (DLT are large)
  • Need for post-operative intubation
  • Single lumen tube already in place (Critically ill pt)
76
Q

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

A

Bronchial blocker

77
Q

What are some factors that cause difficulty with bronchial blockers?

A
  • Right upper lobe bronchus takeoff too high (May need to use DLT)
  • Tracheal bronchus
  • Fixation by staples during surgery
  • Perforation by suture needle or instrumentation
78
Q

If a patient has a Tracheal bronchus, what device would be indicated?

A

Can potentially use a bronchial blocker, but be prepared to switch to a DLT if necessary

Principles Of Anesthesia I (8 decks)

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