Airway highlights II- in class need to know

Question 1

How long can propofol stay out at room air once opened?

Answer 1

6 hours

Question 2

Steps to preparing the ET tube

Answer 2

test the cuff by attaching the syringe to the pilot balloon

insert stylet

Question 3

How do you prepare an LMA?

Answer 3

water soluble lubricant

test at 1.5 times fill

Question 4

Describe how to place an LMA.

Answer 4

have some air in cuff
hold like a pencil
slide along roof of the mouth
sit in place
inflate the cuff and allow it to seat
attach circuit

Question 5

What is a key difference when using an LMA versus an ET tube?

Answer 5

don’t give NMBD

Question 6

Another name for a fastrack LMA is

Answer 6

an intubating LMA

an ET tube can be passed through it

Question 7

How can you tell if an LMA is not seated properly?

Answer 7

get a headache because volatile anesthetics are leaking out
hear air leak
stomach gurgling
reservoir might be emptying too much or collapsed

Question 8

If your LMA is not seated properly, you should

Answer 8

turn off the gas
try to reposition
remove & start again

Question 9

The LMA is considered a

Answer 9

supraglottic mask

Question 10

What might indicate your ET tube is malpositioned?

Answer 10

air in stomach
no continuous ETCO2
no chest rise and fall
low O2 sats
no sustained condensation in the tube
gastric contents in tube- suction them out if you have time

Question 11

How does the ET tube move during positioning?

Answer 11

“the hose follows the nose”
tube goes up if head goes up
tube goes down if head goes down
any time there is a positioning change you need to reassess breath sounds

Question 12

When we attempt to mask ventilate and we cannot, the appropriate steps are

Answer 12

oral airway, reposition, two-handed mask ventilation
if still cannot ventilate by an experienced provider patient and situation should be assessed (wake them up and reschedule or take a look and try to intubate them deep)

Question 13

When might a nasal intubation be considered?

Answer 13

oral surgeries, jaw wired shut

Question 14

When performing a nasal intubation it is necessary to

Answer 14

discuss plan with the patient
assess which nare patient can breath out of better and use neosynephrine to constrict blood vessels in nare
Take small NP tube and roll in lubricant put in and wait 1-2 minutes- utilize 3 different size tubes to dilate nostril

Question 15

Important notes regarding nasal intubation:

Answer 15

do not use stylet
Magill forceps are needed
advance until you feel resistance and stop
when securing be careful not to tape too tight and cause pressure injury

Question 16

Extubation criteria include:

Answer 16

vital capacity >15 mL/kg, follows commands (might be impacted by developmental level), peripheral nerve stimulator (want 4/4 twitches & sustained tetany for 5 sec.), head lift, breathing on own, TV > 6mL/kg

Question 17

When would we not extubate the patient?

Answer 17

during stage 2 of anesthesia

Question 18

Reasons why you would want to extubate a patient while deep:

Answer 18

depends on type of surgery (don’t want coughing because it stirs up bleeding), patient and comorbidities, body habitus, ease of securing first airway (if difficult want them awake)

Question 19

When might a retrograde wire intubation be indicated?

Answer 19

a bloody airway

Question 20

How is a retrograde wire intubation performed?

Answer 20

find landmark- aiming to find cricothyroid membrane
thyroid- just inferior to cartilage & feel cricoid ring at C6
enter at 45 degree angle cephalad
use 3 cc syringe and aspirate air
remove needle, leaving angiocath & thread J-wire
take clamp and clamp J wire on skin side
use push-pull method to thread ET tube

Question 21

How long does a cricothyrotomy last?

Answer 21

10 minutes; call ENT when decision is made to perform

Question 22

When you have a difficult airway it is important to

Answer 22

drop an OG tube because it may have inadvertently put air in the stomach

Question 23

The superior laryngeal nerve is composed of

Answer 23

two branches
internal- sensory
external- motor
innervates above the cords

Question 24

What lines up the pharyngeal and laryngeal axis?

Answer 24

PiLlow

Question 25

How do you know if your axes are lined up?

Answer 25

sternal notch and external meatus