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1Principles of Anesthesia > Airway Equipment Pt2 (Exam 2) > Flashcards

Airway Equipment Pt2 (Exam 2) Flashcards

1
Q

Which teeth are most likely to be damaged from laryngoscopy?

A
  • Upper incisors
  • Restored or weakened teeth
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2
Q

What can help prevent dental injury?

A

Tooth protectors placed on upper teeth

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3
Q

What objects can be swallowed/aspirated during laryngoscopy?

A
  • loose Light bulbs (on some blades)
  • Teeth
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4
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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5
Q

How can cervical spinal cord injury occur during laryngoscopy?

A
  • Aggressive head positioning
  • Manual in-line stabilization
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6
Q

What nerves could be injured via laryngoscopy?

A
  • Lingual nerve
  • Hypoglossal nerve
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7
Q

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

A
  • Internal diameter
  • Length
  • Configuration
  • Connectors
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8
Q

What manufacturing requirements are there for ETT’s?

A
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9
Q

What aspect of ETT’s decrease kinking?

A

Round, circular structure

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10
Q

What is the purpose of the Murphy eye?

A

Provides alternative pathway for gas flow

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11
Q

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

A

Helps view Larynx

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12
Q

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

A

Facilitation of surgery around the head and neck

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13
Q

Are RAE tubes ever straight?

A

Can be straightened on insertion

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14
Q

What are disadvantages to RAE tubes?

A
  • Difficult to pass suction/scope
  • Increased airway resistance
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15
Q

What are alternative names for “armored” tubes?

A
  • Reinforced
  • Anode
  • Spiral-embedded
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16
Q

What are the benefits of reinforced tubes?

A
  • Prevention of kinking and compression
  • Good for head, neck, and tracheal surgeries
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17
Q

What are the disadvantages of reinforced ETT’s?

A
  • Need stylet or forceps
  • Difficult use in nasal intubation
  • Cannot be shortened
  • Damaged when bit
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18
Q

What are laser resistant tube made from?

A

Metal or silicone + metal mixture

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19
Q

What is the purpose of a laser resistant ETT?

A
  • Reflection of CO₂ or KTP laser beam
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20
Q

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

A
  • Methylene Blue saline solution
  • Cuff is not laser resistant and becomes apparent when ruptured cuff
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21
Q

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

A

Distal first, proximal last

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22
Q

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

A

cuff

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23
Q

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

A
  • 18 - 25 mmHg
  • 8 - 10 mL of air
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24
Q

ETT cuff pressure should be monitored frequently if using _______.

A

N₂O (diffusion expansion of cuff)

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25
Q

What are the characteristics of a high-volume, low pressure ETT cuff work? (3)

A
  • Thin, compliant wall
  • Occludes trachea w/o stretching the trachea
  • ↑ area of contact
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26
Q

What are advantages to a high-volume, low pressure ETT cuff? (2)

A
  • Easy to regulate pressure
  • Pressure to trachea is less than mucosal perfusion pressure. (doesn’t obstruct perfusion)
27
Q

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

A
  • Difficult insertion
  • more likely to tear
  • Sore throat more likely
  • may not prevent fluid leakage (aspiration)
  • NGT can slip past cuff
28
Q

What are the characteristics of a low-volume high pressure ETT cuff? (3)

A
  • Small area of contact
  • High pressure
  • Deforms trachea to circular shape
29
Q

What are advantages of a low-volume high pressure ETT cuff? (3)

A
  • Protects better from aspiration
  • Better visibility during intubation
  • Lower incidence of sore throat
30
Q

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

A
  • Exerts pressure greater than mucosal perfusion pressure
  • Needs replacement if post-operative intubation is required.
31
Q

What factors can change cuff pressure?

A
  • N₂O usage
  • Hypothermic cardiopulmonary bypass
  • Increases in altitude
  • Coughing, straining, changes in muscle tone
32
Q

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

A
  • Excessive force
  • Multiple attempts
  • Stylet outside tube
  • Skill, difficult airway
  • Degree of muscle relaxation
33
Q

What population is at greatest risk for inadvertent bronchial intubation?

A
  • Emergencies
  • pediatric
  • female

Right main bronchus

34
Q

What causes a decreased distance to the carina?

A
  • Trendelenburg
  • Laparoscopy
35
Q

Bronchial intubation can lead to _________.

A

atelectasis

36
Q

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

A
  • Male: 23 cm at the teeth
  • Female: 21 cm at the teeth
37
Q

Why is upper airway edema very dangerous in young children? What age group has highest incidence?

A
  • Young children 1- 4 y/o peak incidence
  • Dangerous because cricoid cartilage completely surrounds subglottic area and cannot expand
38
Q

When will upper airway edema be noticed usually?

A

Earliest signs at 1-2 hours to 48 hours post-op

39
Q

What is a vocal cord granuloma?

A

Mass on vocal cord from excess stimulation

40
Q

Who are vocal cord granuloma’s most common in? What can cause this?

A

Adults; females

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

41
Q

What are the s/s of vocal cord granuloma?

A
  • Persistent hoarseness
  • throat Fullness
  • Chronic cough
  • Intermittent loss of voice
42
Q

How are vocal cord granuloma’s treated?

A
  • Laryngeal evaluation and vocal rest
43
Q

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

A
  • Polyester base with resin coating
  • 30 - 45° distal end
44
Q

How is a bougie inserted?

A

Tip anterior

45
Q

What are Magill forceps primarily used for? What considerations should be made when using Magill forceps?

A
  • Primarily used with nasal intubations, directs tube into larynx
  • Possible damage to tube cuff or murphy eye lodgement can occur
46
Q

What are indications for lung isolation?

A
  • Thoracic procedures
  • Control of contamination or hemorrhage
  • Unilateral pathology
47
Q

What are characteristics of the right mainstem?

A
  • Shorter, straighter, larger diameter
  • 25° takeoff from trachea
  • 2.5 cm length avg from carina to takeoff
48
Q

What are characteristics of the left mainstem?

A
  • Longer, more narrow
  • 45° takeoff from trachea
  • 5.5 cm length avg from carina to takeoff
49
Q

What size double lumen tubes are available for adults?

A

35, 37, 39, 41 fr (odd)

50
Q

What size double lumen tubes are available for children?

A

26, 28, 32 Fr (even)

51
Q

When would a right double lumen tube be utilized?

A

For left-sided lung surgeries

(Right sided DLT ventilates the right lung)

52
Q

What occurs after the bronchial cuff passes the cords?

A

ETT is turned 90°

to direct towards one side

53
Q

Where is the blue bronchial cuff located when a DLT is placed?

A

Just below the carina in the appropriately blocked bronchus, ensure doesn’t herniate over the carina

54
Q

How is the correct location of the bronchial balloon verified?

A

Fiberoptic scope

55
Q

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

A

Clamping of the tracheal or bronchial connector

56
Q

What are complications of double lumen tube insertion?

A
  • Tube malposition (w/ unsatisfactory lung collapse)
  • Hypoxemia
57
Q

When would a bronchial blocker be advised?

A

When a double lumen tube cannot be used

58
Q

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

A
  • Nasal intubation
  • Difficult intubation
  • Tracheostomy
  • Subglottic stenosis (DLT are large)
  • Need for post-operative ventilation
  • Single lumen tube already in place
59
Q

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

A

Bronchial blocker (cannot do this with a DLT)

60
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
61
Q

Label each section of the ETT

A
62
Q

Tube markings on an ETT provide tube ID size in ___ and graduated length markings in ____ from ___ side.

A

Tube markings on an ETT provide tube ID size in mm and graduated length markings in cm from patient side.

63
Q

What are some examples of surgeries that would utilize a right DLT?

A
  • left pneumonectomy
  • left lung transplant
  • left mainstem bronchus stent in place
  • left tracheo-bronchus disruption
64
Q

How can hypoxemia with a DLT be potentially resolved?

A
  • malpositioned tube - reinsert
  • may need more PEEP to dependent lung
  • may need intermittent 2 lung ventilation

1Principles of Anesthesia (26 decks)

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