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Anaesthesiology > Airway Management > Flashcards

Airway Management Flashcards

1
Q

Why is rapid sequence induction done?

A

To minimise chance pulmonary aspiration in high risk individuals eg pregnancy

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2
Q

Name 6 features associated with difficult mask ventilation

A

BONESS
Beard
Obesity
No teeth
Extremes of age
Sleep apnea/ snoring
Severe prognathia, receding mandible, other facial deformities

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3
Q

Name 2 features associated with difficult insertion of laryngeal mask

A

• Limited access to mouth (inter-incisor distance <2,5 cm)
• intra-oral pathology eg Intra oral tumours

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4
Q

Name 4 features associated with difficult crico-thyroidotomy and tracheostomy

A

• Fixed flexion of neck eg ankylosing spondylitis, scaring
• deviation larynx and trachea
• Tissue overlying cricothyroid membrane and trachea eg fat, goitre, sepsis
• Devices overlying trachea eg surgical collar

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5
Q

Name 8 pre-operative clinical tests that can predict the ability of a successful laryngoscopy

A
  1. Inter-incisor gap ( <3 cm difficult)
  2. Protrusion of mandible- inability to protrude lower incisors in front of upper (retrognathia) - difficult.
  3. Mallampati score
  4. Flexion and extension craniocervical junction: > 90 degrees should be possible
  5. Thyromental distance (Patil’s test): <6 cm difficult.!
  6. Sternomental distance (Savva’s test): < 12,5 cm. difficult
  7. Mandibular space
  8. Neck circumference - thyromental distance (patil) ratio: obese >5 difficult
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6
Q

What must be done if high likelihood mask ventilation and direct laryngoscopy will be difficult?

A

Awake fibreoptic intubation

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7
Q

Name the steps of RSI ( 6)

A
  1. Preoxygenation with mask and 100% oxygen 3-5 minutes at high flow 6L/min, tight fitting mask
  2. Iv induction with drug with fast onset action eg propofol, sodium thiopental, ketamine
  3. As soon as patient loses consciousness, apply cricoid pressure on cricoid ring to occlude oesophagus posterior to it. (Sellick’s maneuver) (BURP - BACK UP RIGHT PRESSURE)
  4. Administer fast acting muscle relaxant. Either suxamethonium (30s) 1-1,5 mg/kg or rocaronium (60s) 0,6-1 mg/kg (modified RSI)
  5. Perform laryngoscopy, intubate trachea, inflate ETT cuff
  6. Verify correct position of ETT and then only stop cricoid pressure
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8
Q

Name 5 indications for RSI

A
  1. Emergency operation
  2. Unfasted patient
  3. Delayed stomach emptying: acute abdomen, hiatus hernia (regurgitation), pyloric stenosis, trauma
  4. Pregnancy
  5. Autonomic neuropathy: renal failure, diabetes mellitus, etc.
    (All these = risk aspiration)
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9
Q

Name 7 indications intubation in surgical procedures

A

• Protect airway
• maintain airway
• controlled ventilation (relaxants)
• surgery on head and neck (access)
. Longer procedures > 180 minutes
. Babies and small children
• non-supine positions

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10
Q

Name 6 ways correct placement of endotracheal tube can be checked

A

• See tube passing through cords
• 5 point auscultation
• bilateral chest movement
• press on chest and listen
• oximetry desaturation (late sign)
• capnography

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11
Q

Name 6 complications intubation

A

• sore throat
• incorrect placement
• trauma
• regurgitation/aspiration
• bronchospasm
• stress response - tachycardia, hypertension

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12
Q

Name 3 complications face mask air way management and SGA LMA

A

• Inflation stomach
• obstruction airway and for some, regurgitation
• pulmonary aspiration

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13
Q

Name 3 advantages to using face mask airway management

A

• inflatable cuff to make it fit better
• warm humid air easily seen to check if patient breathing
• foreign material can be seen easily

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14
Q

Name 4 indications facemask airway management

A

• Oxygenate hypoxic patient
• preeoxygenate before induction anaesthesia
• assisted manual ventilation during induction
• spontaneous or assisted ventilation for short procedures eg D and c, myringotomy insertion

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15
Q

Name 7 contraindications SGA LMA

A

Rroodds
• regurgitate and aspirate risk
• reach airway difficult/unable during surgery eg head and neck surgery
• other position than supine
• opening mouth restricted - inter-incisor distance <2.5cm
• Distorted upper airway eg tumour
• disrupted upper airway
• stiff lungs and must be ventilated during procedure

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16
Q

Optimal position for tracheal intubation?

A

Flex base of neck with pillow, extend at c1 c2
After excluding neck injury!

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17
Q

Name 4 clinical features predicting difficult intubation

A

4 D’s
Disproportion
Distortion eg micrognathia
Dysmobility
Dentition
Hair piece, obesity

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18
Q

Describe mallampati classification

A

• Class 1: uvula, faucal pillars, soft palate visible
• class 2: faucial pillars and soft palate visible
. Class 3: soft and hard palate visible
• class 4: hard palate visible only

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19
Q

Name the 3 types of supraglottic air ways

A

• First generation: classic LMA (simple airway conduit)
• second generation: proseal LMA (reduce risk aspiration)or combitube - has suction port
• intubating LMA:fastrach (conduit for placement ett)

20
Q

Name device in picture 57

A

First generation SGA: Classic LMA

21
Q

Name device in picture 58

A

Second generation SGA: proseal supreme LMA or combitube

22
Q

Name device in picture 59

A

Intubating LMA:fastrach

23
Q

Minimum oxygen concentration is FGF mixture shouldn’t be less than?

A

30%

24
Q

Classify picture 70

A

Cormack lehane grade 1: full view of glottis

25
Q

Classify picture 71

A

Cormack Lehane grade 2: partial view of glottis or arytenoids

26
Q

Classify picture 72

A

Cormack Lehane grade 3: only epiglottis visible

27
Q

Classify picture 73

A

Cormack Lehane grade 4: neither glottis nor epiglottis visible

28
Q

What is classification on picture 74 called?

A

Cormack Lehane

29
Q

Dose of suxamethonium for RSI?

A

1-1,5 mg/kg

30
Q

Dose of rocaronium for RSI?

A

0,6-1 mg/kg

31
Q

Define respiratory failure in terms of PAO2

A

<60 mmHg

32
Q

How is front of neck access (fona) achieved as a last resort for airway management

A

Cricothyroidotomy (surgical or needle) with tracheostomy

33
Q

How do pre-oxygenation? (4)

A

• Tight fitting mask
• 100% oxygen
• 3-5 minutes
. High FGF (fresh gas flow)

34
Q

Normal end tidal co2?

A

35-45 mm hg

35
Q

When use intubating LMA?

A

Emergency, allows blind intubation. Especially when intubation difficult eg C spine injury
Useful between attempts of intubation and before intubation to have airway

36
Q

Classify picture 78

A

Mallampati class 1: uvula, faucial pillars, soft palate visible.

37
Q

Classify picture 79

A

Mallampati class 2: faucial pillars, soft palate visible

38
Q

Classify picture 80

A

Mallampati class 3: soft and hard palate visible

39
Q

Classify picture 81

A

Mallampati class 4: only hard palate visible

40
Q

Label picture 95

A

See picture 96

41
Q

Label picture 97

A

See picture 98

42
Q

How should extubation be performed in patient at high risk aspiration? (2)

A

• Fully awake, MAC < 0,3
• extubate fully reversed if used rocaronium - tof 0,9 or 90%

43
Q

How calculate fi02 from Pa02?

A

Pa02= fi02 x 500

44
Q

Describe how to assess airway difficulty (5)

A

Lemon
. Look externally: bones
• evaluate: 3-3-2
- can pt fit 3 fingers between incisors
-Is mandible length 3 fingers from the mentum to the hyoid
- distance from hyoid to thyroid 2 fingers
• mallampati
• obstruction or obesity: epiglottis, tumours, Ludwig’s angina, neck haematoma,foreign body, thermal injury can compromise airway management
• neck mobility: ability to extend, affected by trauma cervical collar, elderly, arthritis

45
Q

Name 9 risk factors for bronchospasm

A

• Atopy
• smoking, COPD
• occupational exposure: fumes, chemicals, smoke
• recent lower respiratory tract infection
• use of iv contrast media.
• use cholinergic drugs eg neostigmine
• use of histamine releasing drugs eg atracurium, morphine
• iatrogenic airway irritation and trauma
• use of beta blockers for other chronic conditions

46
Q

Name 8 classes pharmacological agents that may be useful in treating bronchospasm

A

• Beta 2 stimulants: salbutamol
• corticosteroids
• volatiles
• NMDA receptor antagonists: ketamine, mgs04
• anti-muscarinics
• methylxanthines: aminophylline
• leukotriene antagonists
• lignocaine (sodium channel blocker)

Anaesthesiology (24 decks)

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