Airway Management in Anes. Practice

Question 1

what are the functions of airway?

Answer 1

physical protection from aspiration

lymphatic protection from microorganisms

conduction of O₂, CO₂, Anes. agents

air conditioning (heat, humidification)

Question 2

What is the anesthetists role re: the airway

Answer 2

Support the functions of the airway i.e…

continue physical protection, protect agains infection

support conduction

minimize heat loss and water vapor loss

Question 3

what is the importance of airway management

Answer 3

Provide anesthesia for surgery, protection, conduction, air conditioning.

Support resuscitation (protection, oxygenation, ventilation

Provide long-term respiratory care

Question 4

what can be used to support a patent airway?

Answer 4

physical maneuver - jaw thrust

Adjuncts - oral airway (OAW), nasal airway (NAW)

Question 5

Trace airflow through oral route? Nasal route?

Answer 5

a) Oral cavity > oropharynx > hypopharynx > glottis > vocol cords > larynx > trachea
b) Nasal cavity > nasopharynx > oropharynx > hypopharynx > glottis > vocol cords > larynx > trachea

Question 6

Tracheostomy vs laryngectomy

Answer 6

tracheostomy is opening made through neck into trachea through which patient can breathe … laryngectomy is removal of the larynx (or voice box)

there is a separation of the airway from the mouth, nose

Question 7

what happens to airway when tone and position is lost?

Answer 7

obstruction

base of tongue falls on posterior pharyngeal wall causing the obstruction

Question 8

what anatomic points are involved in the jaw thurst/face mask maneuver?

Answer 8

little finger — anterior pressure applied just behind angle of mandible, uses sliding component of Temporomandibular joint (TMJ) to move the mandible, hyoid bone, and attached structures

Middle and ring finger — grasp bony mandible to facilitate extension of atlantoocipital joint

Question 9

What mask points are involved with jaw thrust/face mask technique?

Answer 9

thumb and index finger on body of face mask (one hand technique)

thumbs only on body of mask when 2 handed technique is used

Question 10

How do you maintain a gas-tight seal?

Answer 10

press the mask down onto the face by using your thumb and index finger while pulling the mandible up with the middle and ring finger

Question 11

what are two types of oral airway?

Answer 11

guedel

berman

Question 12

What are the structural differences?

Answer 12

Guedel - central lumen

Berman - cental I beam, side air channels

Question 13

How do you size an Oral Airway (OAW)?

Answer 13

measure from the angle of the mandible to the corner of the mouth.

Question 14

How do you insert an OAW with minimum trauma?

Answer 14

using a tongue depressor, depress the tongue and insert the OAW with body curvature toward palate. the distal end of the OAW should be turned or inserted in a manner that does NOT scrape the palate

Question 15

contraindications for OAW

Answer 15

patient is conscious, has a gag reflex, or there is some foreign body blocking the airway

Question 16

how do you size a nasal airway (NAW)

Answer 16

flange of NAW at nare and extend body to the tragus (or external meatus)

Question 17

how do you insert a NAW with minimal trauma?

Answer 17

1. Lubricate thewith water soluble jelly/lubricant.
2. Place in the larger nostril with the bevel towards the nasal septum.
3. Be sure the NPA follows the curve of the floor of the nose.
4. When the right nostril is being used make sure the bevel faces the septum and insert until the flange rests against the nose. When using the left nostril you may need to have the bevel pointing upwards and turn 180 degrees when inserting. Again, the flange should rest on the nostril when fully inserted.

Question 18

what are contraindications for NAW?

Answer 18

pt is on anticoag. therapy

nasal trauma

Question 19

what are some anatomic considerations for insertion of a NAW?

Answer 19

penetration of base of skull into the brain

nasal concha

Question 20

What is the correct path for NAW insertion?

Answer 20

perpendicular to the long axis of the patient

Question 21

what are risks associated with NAWs and other instrumentation of the nasal passage?

Answer 21

mucosal trauma

turbinate fracture

epistaxis

acute sinusitis

failure to instrument

penetration of the base of skull

Question 22

What is the official name of the AMBU bag?

Answer 22

hand operated, self-inflating resuscitation bag

Question 23

Schematic of AMBU bag

Answer 23

Question 24

How are inspiratory and expiratory gas flows directed in hand-operated, self inflating bag?

Answer 24

inspiratory - gas flows from ventilatioin bag (bag deflates) through one way patient valve to patient

expiratory - gas from patient and is vented to atmosphere. The bag inflates, the negative pressure pulls ambient air in through the one way inlet/intake valve.

Question 25

what is the ID of a Face mask connection?

Answer 25

22 mm

Question 26

How do you size a face mask?

Answer 26

It should sit over the bridge of the patient’s nose with the upper
border aligned with the pupils. The sides should seal just lateral to
the nasolabial folds with the bottom of the face mask sitting between
the lower lip and chin.

Question 27

what part of the mask do you apply first to the patient’s face?

Answer 27

point of the mask to the bridge of the nose

Question 28

Which finger is applied first to the patient for face mask technique? Where?

Answer 28

little finger (pinky) just behind the angle of the mandible

Question 29

Name the airway

Answer 29

Guedel

Question 30

Name the airway

Answer 30

berman

Question 31

name the anesthesia face mask

Answer 31

rendell-baker-soucek face mask