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Principles > Airway Management > Flashcards

Airway Management Flashcards

1
Q

What is not required for an LMA

A

NMB agents

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2
Q

What is not required for rapid sequence induction

A

Ventilation

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3
Q

First maneuvers that can be used if patient is snoring and airway obstruction is suspected

A

First - chin tilt
Second - jaw thrust
Can turn head to side
And then last place oral or nasal airway

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4
Q

Placing oral airway can stimulate what reflex

A

Gag reflex
CN IX - afferent (sensory)
CN X - efferent (motor)

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5
Q

How to estimate size of oral airway for patient

A
  • Estimate by holding next to patients mouth

* Tip should rest cephalad to angle of the mandible

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6
Q

Measurements of oral airway

A

8,9,10
80mm
90mm
100mm

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7
Q

Too small of an oropharyngeal airway may cause

A

Tongue to kink and force part of it against the roof of the mouth, causing obstruction

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8
Q

Too large oropharyngeal airway may cause

A

beyond epiglottis and displaces epiglottic posteriorly and can also traumatize larynx

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9
Q

Purpose of oropharyngeal airway

A

lift the tongue and epiglottis away from posterior pharyngeal wall and prevent them from obstructing the space above the larynx.

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10
Q

Other uses for oropharyngeal airway

A

With emergence to prevent biting of tube of tube and negative pressure pulmonary edema
Can be used for neuro monitoring with motor evoke potentials to prevent biting of tongue

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11
Q

Where does nasal airway sit

A

o Pharyngeal end should sit below the base of the tongue and above the epiglottis (same as oral airway)

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12
Q

Nasal airway can be preferred airway in a patient with…

A

poor dentition

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13
Q

What do we want to adminster into nares before nasal instrumentation

A

Some type of vasoconstrictor since GA can cause vasodialtiona and engorgement which can lead to excessive bleeding

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14
Q

Contraindications for patients to have nasal airway

A 
Patients that are anticoagulated
Patients with basilar skull fracture
Nasal pathology
Sepsis
Deformity of the nose or nasopharynx 
History of nosebleed requiring medical treatment
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15
Q

Sizing of nasal airway

A

Distance from the nares to the meatus of the ear

Should be approximately 2-4 cm longer than oral airways

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16
Q

When inserting a nasal airway where should to tip of the bevel be

A

Towards the septum to avoid turbinates

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17
Q

Can facilitate delivery of oxygen or anesthetic agent from breathing system to a patient by creating an air tight seal with the patient’s face

A

Face Mask

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18
Q

Internal diameter of the face mask orofice is…

A

22mm

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19
Q

Complications of head straps attached to retaining hooks of face mask

A

Corneal abrasions from straps close to eyes

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20
Q

Laryngeal Mask Airway is also known as

A 
Supraglottic airway (SAD)
ABOVE the glottis and not through the cords
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21
Q

LMA can protects larynx from oral secretions but not…

A

Gastric contents

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22
Q

Where does the LMA rest when fully inserted?

A

Against the upper esophageal sphincter when fully inserted (cricopharyngeus muscle)

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23
Q

Which side of the LMA is water based lubricant placed?

A

Posterior

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24
Q

Proper orientation of LMA

A

Midline insertion

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25
Q

What should INTRACUFF pressure not exceed for an LMA?

A

60 cm H2O

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26
Q

What should peak ventilator pressures not exceed for LMA?

A

APL not to exceced 20 cm H2O

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27
Q

What happens when APL exceeds 20 for an LMA?

A

Gastric insufflation

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28
Q

Successful insertion of an LMA depends on

A

Inflation of the balloon and ventilation with no leak (meaning there is an adequate seal)

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29
Q

Contraindications for an LMA include…

A
  • Pharyngeal pathology (abscess)
  • Pharyngeal obstruction
  • Full stomach
  • Low pulmonary compliance requiring high peak inspiratory pressures
  • Any procedure where patient needs to be paralyzed cannot use LMA
  • Also want to consider position
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30
Q

Sizing of an LMA is indicated by patient

A

Weight in kg

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31
Q

As size of LMA increases what else increases

A

Amount of air

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32
Q

Males usually what size LMA

A

5 or 6

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33
Q

Females usually use what size LMA

A

3,4,5

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34
Q

Part of difficult airway algorithm
Assistive device for intubation – not meant to be used for duration of procedure just a conduit for which we perform intubations

A

LMA Fastrach

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35
Q

Advantages of LMA over FMV

A
  • Hands-free operation
  • Better seal in bearded patients
  • Less cumbersome in ENT surgery
  • Often easier to maintain airway
  • Protects against airway secretions
  • Less facial nerve and eye trauma
  • Less operating room pollution
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36
Q

Disadvantages of LMA over FMV

A
  • More invasive
  • More risk of airway trauma
  • Requires new skill
  • Deeper anesthesia required
  • Requires some TMJ mobility
  • N2O diffusion into cuff – can lead to SLN and Glossopharyngeal injury due to hyperinflation over long period of time
  • Multiple contraindications
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37
Q

Delivers anesthetic gas directly into trachea and allows most control of ventilation and oxygenation

A

Endotracheal tube

38
Q

When inserting a stylet we do not go past what on the ETT

A

Murphy’s eye

39
Q

Murphy tubes (standard) have this to decrease risk of occlusion should the distal tube opening abut the carina or trachea

A

Murphy’s eye

40
Q

Resistance to airflow depends primarily on tube….

A

Diameter, but is also affected by length and curvature

41
Q

Tracheal tube size is usually designated by…

A

Internal diameter of tube in mm

42
Q

Valve on ETT prevents

A

Air loss after cuff inflation

43
Q

Provides gross indication of cuff inflation

A

Pilot balloon

44
Q

Cuff is more narrow so it has a smaller surface area contact within the trachea and has a higher potential for tracheal mucosal ischemia

A

Low volume HIGH pressure cuff

45
Q

Small area contact with the trachea, but distends the trachea and distorts it to a circular shape- therefore disadvantage is higher risk of ischemic damage to tracheal wall mucosa

A

Low volume, HIGH pressure cuff

46
Q

More volume but the cuff will contact the trachea over a larger surface area. Maintains pressure at lower seal so less potential for tracheal mucosa ischemia.

A

High volume, LOW pressure

47
Q
  • As the cuff continues to inflate, the area of contact becomes larger and cuff adapts itself to the tracheal surface conforming to tracheal lumen
  • Reduces the risk of significant cuff-induced complications following prolonged intubation
A

High volume , LOW pressure

48
Q

Flexible, spiral wound, wire-reinforced TTs resist kinking and may prove valuable in some head & neck surgical procedures or in prone position

A

Armored tubes

49
Q

Small tube diameter but still has a long or regular length.

A

Microlaryngeal tubes

50
Q

Types of preformed tubes

A

RAE - nasal and oral

51
Q

Placed in nose so sits in airway and top comes out of nose and over pts head.

A

RAE nasal airway

52
Q

Preformed ETT that sits in trachea and projects downward away from face

A

RAE oral airway

53
Q

Used for lung isolation procedures such as one lung ventilation

A

Double lumen endobronchial tubes

54
Q

Tube that connects to special monitor to allow CO and potentially other parameters

A

ECOM

55
Q

Tube that allows intraoperative monitoring of EMG activity of the laryngeal musculature during surgery

A

EMG

56
Q

tube sits in trachea and vocal cords come in contact with monitoring plates
•As we are doing thyroidectomy’s – parathyroidectomies, anterior cervical discectomy infusions
•ANYTHING in neck where we are worried about integrity of nerves, we will use a NIM tube

A

NIM (nerve integrity monitor)

57
Q

Trachea reaches adult size at what age

A

14

58
Q

Insertion depth of ETT for women

A

approx 21 cm at lip

59
Q

Insertion depth of ETT for men

A

approx 23 cm at lip

60
Q

Ideal internal diameter of ETT for women

A

7.0-8.0 mm

61
Q

Ideal internal diameter of ETT for men

A

8.0-9.0 mm

62
Q

Formula for pediatric ETT size

A

4 + (age/4)

63
Q

Formula for pediatric ETT depth of insertion

A

14 + (age/2)

64
Q

Advantages of LMA to Endotracheal intubation

A
  • Less invasive
  • Useful in difficult intubations
  • Less tooth & laryngeal trauma
  • Less laryngospasm & bronchospasm
  • Does not require muscle relaxation
  • No risk of esophageal or endobronchial intubation
65
Q

Disavantages of LMA over Endotracheal intubation

A
  • Risk of GI aspiration
  • Less safe in prone or jackknife positions
  • Unsafe in morbidly obese
  • Limits maximum PPV
  • Less secure airway
  • Greater risk of gas leak & pollution
  • Can cause gastric distention
66
Q

Instrument used to examine the larynx & facilitate intubation of the trachea

A

Laryngoscope

67
Q

Type of curved blade

A

Mac

68
Q

Types of straight blades

A

Miller, Wisconsin, Phillips

69
Q

Typical size of MAC blade for adults

A

3 or 4

70
Q

Typical MAC size blade for pediatrics

A

2 or 2 if really small

71
Q

Preferred blade for pediatric patients

A

Straight blade

72
Q

Miller size used for pediatric patients

A

0 and 1

73
Q

Most frequently used Miller size blade for adults

A

2

74
Q

Which side do we enter the mouth with the laryngoscope

A

Right side and then scoop tongue to left

75
Q

Video laryngoscopy utilizes what type of blade

A

curved

76
Q

is video laryngoscopy direct or indirect laryngoscopy

A

Indirect

77
Q

•Illumination device and microvideo camera on laryngoscope blade
oGlottic visualization- indirectly accomplished

A

Video laryngoscopy

78
Q

How can we align the three axes in order to achieve better visualization during laryngoscopy

A

Place pillow under head
Sniffing position

May even need to reverse trendelenberg for larger patients

79
Q

Gold standard to confirm placement of ETT

A

Visualization of placement through the vocal folds
Sustained detection of exhaled CO2
•Capnography for 3 consecutive breaths

80
Q

Other indicators for confirmation of proper intubation placement

A 
Equal bilateral breath sounds
Negative abdominal sounds
Visualization of chest excursion
Observation of condensation in ETT
Lighted stylets
Fiberoptic bronchoscope identification of tracheal rings
Chest x-ray
81
Q

What 3 things should you have in your emergency back up equipment

A

LMA, ambu bag, Gum elastic bougie or Eschmann stylet

82
Q

60 cm in length with a 40 degree bent distal tip

oUsed with glottis opening is difficult to visualize ( Cormack and Lehane grade II-III)

A

Eschmann Stylet (Gum elastic bougie)

83
Q

Insertion of bougie is placed..

A

Through glottic opening, advanced to 25cm at lip, and then held in place (by another provider), ETT inserted over stylet and advanced into trachea

84
Q

With an ETT in place can you have a laryngospasm?

A

No

85
Q

S/s of laryngospsm

A

Initially stridor then complete obstrucion

86
Q

Larsons maneuver

A

Head tilt jaw thrust with fingers behind jaw and use significant amount of pressure to break laryngospasm

87
Q

Treatment for laryngospasn

A
  1. Remove stimulus
  2. 100% O2 and positive pressure ventilation (close off APL valve >20)
  3. Provide open clear airway (placement of oral airway)
  4. Larsons maneuver
  5. Deepen anesthesia with Propofol
  6. Succs for refractory unresponsive Laryngospasm (1cc or 20mg)
88
Q

Before extubation we must ensure that…

A

oMuscle relaxants are fully reversed
oAll secretions & foreign material have been suctioned
oPatient has resumed spontaneous ventilation
oThe airway will remain clear and unobstructed after the ETT is removed
oPatient is breathing/being ventilated with 100% O2

89
Q

Bronchospasm intraoperatively is mostly due to what

A

Anaphylactic reaction - Epi, steroids, Pepcid, Benadryl

90
Q

Treatment for bronchospasm

A

Bronchodilator (B2), ketamine, steroids, Epi

91
Q

Negative pressure pulmonary edema usually happens in what patient population

A

Young muscular males

92
Q

Due to forceful inspiratory effort in the presence of a closed glottis or upper airway obstruction
oNegative intrathoracic pressure is transmitted to the alveoli which are unable to expand owing to the more proximal obstruction and fluid is entrained from pulmonary capillary beds

A

Negative Pressure pulmonary edema

Principles (4 decks)

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