Airway management 3 Flashcards
Which intervention demonstrates the MOST accurate understanding of inflating the cuff on the endotracheal tube?
a. assess the pressure inside the pilot balloon with your fingers
b. add 10 mL air to the pilot balloon
c. attach a manometer to the pilot balloon
d. attach a syringe to the pilot balloon to create a minimal occlusive pressure
c. attach a manometer to the pilot balloon
If glottic visualization is difficult during direct vision laryngoscopy, the ________ may improve your view
BURP maneuver (backward, upward, and rightward pressure on the thyroid cartilage)
When using an endotracheal tube, tracheal ischemia can occur if
the cuff pressure exceeds tracheal mucosal perfusion pressure
The cuff pressure of the endotracheal tube should be less than
25 cmH2O
Monitoring cuff pressure with _________ is the best method to reduce the risk of tracheal ischemia
manometer
The ___________ is a small hole on the opposite side of the bevel
Murphy eye
The purpose of the Murphy eye is to
provide an alternate passage for air movement in case the tip of the ETT becomes occluded or abuts the tracheal wall
What is the depth placement for a pediatric ETT?
Depth placement= internal diameter x 3
What is the ETT size without a cuff for pediatric formula?
(age/4)+4
What is the ETT size with a cuff for peds?
(age/4)+3.5
What are the two types of cuffs?
low volume, high-pressure
high volume, low pressure
What type of cuff is more common?
high volume low pressure- nearly all tubes in modern practice use this except…. red rubber tube, silicon tube for LMA fastrach, & bronchial balloon on a double lumen ETT
What are the benefits of using a low volume, high pressure cuff?
better protection against aspiration
lower incidence of sore throat
easier visualization during intubation
What are the benefits to using a high volume, low pressure cuff?
cuff pressure closely resembles the pressure exerted on the trachea
What are the risks of using a low-volume, high pressure cuff?
prolonged intubation–>tracheal ischemia
What are the risks of using a high-volume, low-pressure cuff?
adding too much air to the cuff or using N2O–> tracheal ischemia
easy to pass things around the cuff
protection against aspiration isn’t as good
The ____________ is another type of high-volume, low-pressure cuff
microthin cuff
Benefits of the microthin cuff include
lower pressure on the tracheal mucosa
better protection against liquid aspiration
Ways to minimize cuff pressure includes:
use a manometer
fill the cuff with the same O2/N2O mixture that you will use during the case (assuming you use N2O)
fill the cuff with water or saline (provides a more stable cuff pressure but takes longer to deflate- Bad! if airway fire)
use an ETT with a Lanz pressure-regulating valve
Which findings are MOST strongly associated with difficult video-assisted laryngoscopy? (select 2)
a. history of neck radiation
b. mandibular protrusion score of 3
c. obesity
d. Mallampati 4 classification
a. history of neck radiation
b. mandibular protrusion score of 3
Video laryngoscopes can be classified as
non-channeled or channeled designs
Non-channeled designs include
Glidescope, C-Mac, & McGrath
Channeled designs include
Airtraq Avant, King vision
Some video laryngoscopes have an option for an ____________ that facilitates glottic exposure of amore anterior glottic opening
acute-angle blade
Examples of acute angle blades include
Glidescope LoPro
C-Mac D-blade
McGrath X blade
Key benefits of video laryngoscopes include
usefulness for failed or difficult intubation
less cervical spine movement
decreased SNS response (possibly)
external screen so other providers can see what you see
The greatest risk with video laryngoscopy may be
pharyngeal injury
The risk of pharyngeal injury can be prevented by
directly watching the ETT as it’s inserted into the oropharynx and only viewing the screen after the tip of the ETT passes beyond your line of sight
A channeled video laryngoscope integrates a channel for the
endotracheal tube into the device
External interferences can prevent a good view on the screen such as
fog, secretions or blood
Predictors of difficult video laryngoscope include
neck pathology (radiation, tumor or surgical scar)
short TMD
limited cervical motion
thick neck
class 3 upper lip bite test
In patients with multiple predictors of difficult VAL, you should consider
awake fiberoptic intubation
Factors not associated with difficult VAL include
high MP score & obesity
The ________ is the most commonly used supraglottic airway
LMA
The LMA can be used as a
primary airway
rescue during difficult airway management
conduit for tracheal intubation
The max PPV pressure with a LMA is
20 cmH2O
The max cuff pressure with a LMA is
60 cm H2O
The most common cause of nerve injury with LMA is
cuff overinflation
What nerves are at highest risk of injury with a LMA
lingual, hypoglossal, & recurrent laryngeal nerves
Suppose the cuff pressure exceeds 60 cmH2o and you can’t get a good seal, the LMA is
improperly positioned
the patient is inadequately anesthetized
or there’s a partial or complete laryngospasm
The two aperture bars across the LMA’s orifice
prevent the epiglottis from obstructing the airway tube
Other risk factors for nerve injury from LMA include
using an LMA that is too small, lidocaine lubrication or traumatic insertion
Cuff overinflation with an LMA increases the risk of
sore throat and pharyngeal necrosis
What is the patient size, cuff inflation, and largest ETT that fits through a LMA 1?
<5 kg
5 mL inflation
3.5 ETT
What is the patient size, cuff inflation and largest ETT that fits through a LMA 1.5?
5-10 kg
7 mL inflation
4.0 ETT
What is the patient size, cuff inflation, and largest ETT that fits through a LMA 2?
10-20 kg
10 mL inflation
4.5 ETT
What is the patient size, cuff inflation, and largest ETT that fits through a LMA 2.5?
20-30 kg
14 mL inflation
5.0 ETT
What is the patient size, cuff inflation, and largest ETT that fits through a LMA 3?
30-50 kg
20 mL inflation
6.0 ETT
What is the patient size, cuff inflation, and largest ETT that fits through a LMA 4?
50-70 kg
30 mL inflation
6.0 ETT
What is the patient size, cuff inflation, and largest ETT that fits through a LMA 5?
70-100 kg
40 mL inflation
7.0 ETT
What anatomic structures does the LMA abut?
base of the tongue- proximal end
piriform sinus- sides
upper esophageal sphincter- distal end
The four LMA variations include
LMA ProSeal
LMA Fastrach
LMA C-Trach
LMA flexible
The LMA Proseal features a
gastric drain tube, a larger mask, and a built-in bite block
The max PIP for PPV with a LMA ProSeal is
<30 cmH2O
The _____________ is a disposable version of the ProSeal
LMA supreme
The LMA Fastrach is an
intubating LMA
can be removed after intubation or can remain in place throughout the procedure
The LMA C-Trach is very similar to the
Fastrach but it includes a camera so you can visualize intubation
The LMA flexible has a
flexible airway tube
is wire-reinforced
useful for head and neck surgery
