Airway Management Flashcards
What steps should be taken if having difficulty with BMV?
- reposition head and neck into a sniffing position
- If tongue or airway soft tissue is cause of obstruction, place an oral airway
- If ventilation still inadequate, anesthetist should preform two-handed mask ventilation
What are the hallmark signs of an upper airway obstruction in the unanesthetized patient?
- hoarse or muffled voice
- difficulty swallowing secretions
- stridor
- dynes
What are signs of lower airway obstruction?
- high peak airway pressures
- low tidal volumes
- impaired ventilation
What is a predictor of difficult mask ventilation?
- obstructive sleep apnea
- snoring
*significant obesity has been identified as a potential risk factor of difficult BMV
What is direct laryngoscopy?
The process of airway instrumentation with a laryngoscopes in order to acquire direct line of sight with the laryngeal opening.
Preformed prior to placing the ET tube. First step of intubation procedure
What is direct tracheal intubation?
The process of placing an ET tube into the trachea proximal to the carina
What is ASA definition of “difficult to ventilate”
-when signs of inadequate ventilation can not be reversed by mask ventilation or the patient’s oxygen saturation can not be maintained above 90% with mask ventilation.
Definition of difficult to incubate
-a trained anesthesia provider, using conventional laryngoscopy, requires more than 3 attempts or more than 1 0 minutes to complete tracheal intubation.
What percentage of difficult airways are picked up with proper pre-op veal?
15-50%
What are causes of difficult intubation not related to the patien?
- Inadequate pre-op assessment
- malfunctioning equipment
- not skilled anesthetist
- experienced assistance
What is the Lemon Law?
-Look externally
- Evaluate the 3-3-2 rule
- Mallampati
- Obstruction?/Obesity
- Neck mobility
What is the 3-3-2 Rule?
3: minimal distance the mouth should open
3: distance from the tip of mandible to the laryngeal cartilage
2: distance from the floor of the mouth to the prominence of the laryngeal cartilage
*measured in finger
What angle is used to measure neck mobility?
Atlanto-occipital angle
What is the thyro-mental distance?
Measure from upper edge of thyroid cartilage to chin with head fully extended
A short distance = an anterior larynx
> 7cm is usually easy intubation
<6cm is difficult airway
What does the BONES acronym assess for?
Is mask ventilation going to be difficult
Beard Obesity No teeth Elderly Snoring
How do you know if Laryngeal visualization is going to be difficult?
Defined by 4 D’Souza
Disproportion
Distortion
Dismobility
Dentition
What is an awake intubation?
The patient needs to be intubated awake,there is significant risk of complications if sedatives and/or muscle relaxants are administered prior to airway control.
What is a “Quick Look”?
The pt may be sedated for an attempt at direct
laryngoscopy WITHOUT muscle relaxation
Quick Look
There is some risk of failed laryngoscopy but a low rink of
failed mask ventilation.
What is induction and paralysis?
The patient may be induced and paralyzed in this case as the patient is assessed as having a low risk of difficult laryngoscopy and/or mask ventilation
What are 3 possible options for intubation following an airway assessment?
- awake intubation
- quick look
- induction and paralysis
What are 2 techniques for pre-oxygenation?
- Tidal volume breathing (TVB) of oxygen for 3-5min
- Deep breaths (DB) 4x within 0.5min
*Both equally effective in increase atrial oxygen tension (PaO2)
Why does a failed intubation happen?
- no critical discussion with colleagues about proposed mgt plan
- no request for experienced help
- exaggerated idea of personal ability
- Ill-conceived plan A or plan B
- Poorly executed plan A or B
- persisting with plan A too long
- starting the resume plan too late
- not involving, and preparing surgical colleagues
What are some tools that can be used during a difficult intubation
- LMA/SGA
- different blades
- fiber optic intubation
- blind oral/nasal intubation
Invasive airway access
- jet ventilation
- percutaneous intubation
- retrograde intubation
- surgical airway
What are supraglottic airways?
LMAs main ones used. Above vocal cords
What are some challenges with an unexpected difficult airway?
- Experienced help may not be immediately available
- Special equipment may not be immediately available
- A general anesthetic has usually been administered
- A long acting relaxant may have been given
- Backup airway management plans may be poorly thought out
What should an airway strategy include?
- Standard airway strategy
- Anticipated difficult airway strategy
- Failed or unanticipated difficult airway strategy
What are criteria fro tracheal extubation?
- acceptable hemodynamic status
- normothermia
- ability to maintain a patent airway
- adequate muscle strength
- adequate respiratory mechanics
- ability to maintain adequate oxygenation
