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LEAH FCP > Airway management > Flashcards

Airway management Flashcards

1
Q

Why do we need to secure an airway during anaesthesia?

A

Allows delivery of oxygen &inhaled anaesthetic gases

Prevents airway obstruction due to respiratory depression or loss of reflexes (all of which cause hypoxia)

Facilitates ventilation of patient

Protects airway from silent regurgitation

Helps in scavenging waste gases for environmental protection.

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2
Q

How do you select the correct endotracheal tube

A
  1. Palpate trachea to estimate diameter prior to intubation
  2. Choose 3 different sizes
  3. Measure tube from nares to point of shoulder
  4. Cut tubes to length to avoid intrathoracic placement
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3
Q

What are cuffed vs. uncuffed endotracheal tubes, and why are PVC/silicone preferred?

A

Cuffed: Prevent leakage & aspiration, inflated via pilot balloon

Uncuffed: Used in smaller patients to prevent tracheal damage

PVC/Silicone: More flexible & durable compared to red rubber tubes

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4
Q

What are the first steps in preparing for intubation of a cat?

A
  1. If tolerated, preoxygenate cat for 3 min using face mask or flow-by technique
  2. Administer IV induction drug
  3. Position cat in sternal recumbency & check for general muscle relaxation before assessing jaw tone
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5
Q

What are the techniques for positioning a cat for intubation?

A

Sternal or lateral recumbency:
- Extend head & neck using fingers or bandage around maxillary canines
- Gently pull tongue forward with fingers or dry swab

Dorsal recumbency:
- Use laryngoscope to lift mandible & tongue
- Enables visualisation of larynx without assistance but increases risk of regurgitation

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6
Q

How should lidocaine be applied during cat intubation?

A
  1. Use 1 ml syringe to drop ⩽0.2 ml of lidocaine onto arytenoid cartilages
  2. Wait 60–90s before proceeding

Avoid contact of syringe tip with arytenoid cartilages or vocal folds to prevent injury

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7
Q

What should you do if laryngospasm or resistance occurs during intubation?

A
  1. Stop the procedure
  2. Administer oxygen & assess anaesthetic depth
  3. Consider reapplying lidocaine after ensuring 60–90s have elapsed

Laryngospasm is usually self-limiting

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8
Q

How do you confirm correct endotracheal tube placement in a cat?

A

Observe arytenoid cartilages on either side of ETT

Check for condensation inside ETT with each breath

Ensure appropriate CO₂ waveform on capnograph

Palpate neck for 1 firm structure (trachea)
- If 2 tubes are felt, ETT is in oesophagus

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9
Q

How do you inflate the ETT cuff during intubation

A
  1. Inflate cuff in 0.5ml increments using 3ml syringe
  2. Stop inflating when no leak is heard at 16–18 cmH₂O circuit pressure

Use ETT cuff pressure measurement device for accurate inflation

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10
Q

What are the final steps after intubating a cat

A
  1. Secure ETT with gauze or tubing tied behind ears
  2. Attach to breathing circuit with oxygen flowing
  3. Check for heartbeat & assess mucous membrane colour
  4. Verify ETT placement with capnography or visual/physical signs (e.g., condensation or reservoir bag movement)
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11
Q

Describe equine ET tubes

A

Range from 14-30 mm

Cuffed

Gag required for intubation

Intubation without direct visualisation

Tube not cut to length

Lubricated

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12
Q

Describe equine intubation

A
  1. Induce anaesthesia & place horse in lateral recumbency
  2. Extend head & Insert gag
  3. Introduce tube to level of larynx
  4. Rotate & advance tube during inspiration (extend head further if difficult)
  5. Inflate cuff (tube is not usually secured)
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13
Q

What is Supraglottic airway device (V-gel)

A

Designed for cats, rabbits & dogs

Alternative to ET tubes; allows IPPV & airway protection

Ideal for short procedures & bronchoscopy

Channels to divert regurgitation can be incorporated

Always use capnography

(ETT remain gold standard)

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14
Q

Describe face masks as alternative to ETT

A

Available in range of sizes

Should cover nose & mouth
- not whole head
- avoid eyes

Beware of dead space
- choose the shape

Transparent masks preferable

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15
Q

Describe AMBU bags (self-inflating resuscitators)

A

Can use room air or connect oxygen

Essential in practice

Can connect to mask or ETT

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16
Q

What complications can arise from high pressure/low volume (red rubber) ETT cuffs?

A

Tracheitis: Inflammation of trachea

Pressure necrosis: Tissue damage from excessive cuff pressure

Tracheal rupture: Rare but severe in extreme cases

17
Q

Why should the breathing system be disconnected when changing animals position?

A

To prevent trauma to trachea or airway caused by movement of ETT

18
Q

How can ETT cuff inflation cause complications, and how can this be minimized?

A

Overinflation can damage trachea

Inflate carefully using manometer or by adding air in 0.5 ml increments until no leaks are heard at 16–18 cmH₂O.

19
Q

What are the main functions of a breathing system during anaesthesia?

A

Connects patient to anaesthetic machine

Delivers oxygen & volatile anaesthetic agents (VAA) to patient

Removes CO₂ from expired gas

Provides means to ventilate patient

20
Q

Label

A
21
Q

What are the 2 types of breathing systems

A

Categorised by how they eliminate CO2 from expired gas

22
Q

What is the function of adjustable pressure limiting (APL) valves in breathing systems

A

Also known as pop-off valve or exhaust valve

Allows exhaled gases & fresh gases to leave breathing system when pressure exceeds valve’s opening threshold

23
Q

What is the purpose of corrugated tubing in a breathing system?

A

Increases flexibility & resistance to kinking

Can be smooth or corrugated on inside:
- Smooth inside reduces resistance to gas flow & prevents turbulence

24
Q

What is the function of a reservoir bag in a breathing system?

A

Acts as gas reservoir for patient

Provides visual cue of patient’s breathing pattern

Must have volume 3–4x tidal volume of patient to accommodate inspiration

25
Q

What are the features of a lack breathing system

A

Non-rebreathing system

Circuit factor (CF): 1

Patient size: >10 kg (mini Lack: 2–10 kg)

Advantages: More oxygen-efficient than T-piece or Bain

Not suitable for long-term IPPV

26
Q

Label the lack breathing system

A
27
Q

What are the features of a Bain breathing system?

A

Non-rebreathing system with coaxial arrangement (inner tube supplies fresh gas)

Patient size: 7–30 kg (mini Bain: <10 kg)

Circuit factor (CF): 2.5

Advantages: Excellent for IPPV

Higher fresh gas flow (FGF) than Lack

28
Q

What are the features of a T piece breathing system

A

Non-rebreathing system, suitable for small patients (<10 kg)

Circuit factor (CF): 2.5

Advantages: Low resistance, suitable for IPPV

Requires higher fresh gas flow compared to Lack

29
Q

How do you calculate fresh gas flow (FGF) for a breathing system?

A
  1. Calculate Minute Volume (MV):
    - MV = TV × RR (Tidal Volume = approx. 10 ml/kg, RR = ~20 bpm)
  2. Multiply MV × Circuit Factor × Patient Weight (kg)

Example: A 5 kg cat with T-piece → 5 × 2.5 × 0.2 = 2.5 L/min

FGF = MV x CF x Kg

30
Q

What are the features of a circle breathing system?

A

Removes CO₂ using soda lime (must be changed often)

Patient sizes:
- Adult: 10–150 kg.
- Paediatric: 2–100 kg.
- Large animals: 30–1000 kg.

FGF:
Initial: 100 ml/kg/min for 10–15 mins.
Maintenance: 10–15 ml/kg/min.

Advantages: Less pollution, better for IPPV.

31
Q

Label the circle breathing system

A
32
Q

When should the FGF be increased during anaesthesia in a circle breathing system?

A

To change volatile anaesthetic agent (VAA) concentration quickly

At end of anaesthesia to encourage washout of gases.

33
Q

What is IPPV

A

IPPV (intermittent positive pressure ventilation) is ventilating patient either manually (squeezing bag & opening/closing valve) or mechanically (via ventilator)

All breathing systems can be used for IPPV (short term)

34
Q

How do you ventilate a patient using IPPV?

A
  1. Close pop-off valve or depress button on top
  2. Slowly squeeze reservoir bag while observing patient’s chest rise
  3. Open pop-off valve to allow exhalation
  4. Chest will fall due to passive recoil
35
Q

What is the Humphrey ADE circle?

A

Versatile system: Can be used as non-rebreathing system for small patients & rebreathing system with soda lime for larger patients

Suitable for patients 2–100 kg

Compact, robust, easy to clean

Ideal for IPPV & low-flow anaesthesia

36
Q

What precautions are needed for small animals during anaeshesia?

A

Use smallest chamber possible

Ensure volatile anaesthetic agent (VAA) enters at bottom & scavenges from top

Injectable anaesthesia is preferred to avoid excitement during chamber induction.

LEAH FCP (49 decks)

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