Airway Management & Intubation Equipment

Question 1

Anesthesia Defined

Answer 1

total lack of awareness or a lack of awareness of a part of the body

Question 2

GA Induction Sequence

Answer 2

Monitor application, pre-oxygenation, induction agents given, airway support through masking, LMA or ETT placement

Question 3

Pre-Oxygenation

Answer 3

Increasing apnea threshold by filling FRC with oxygen

Question 4

Functional Residual Capacity

Answer 4

Lung volume at end of normal exhalation- about 2.5 liters

Question 5

Residual Volume

Answer 5

1.25-2 Liters

Question 6

Tidal Volume

Answer 6

0.5-0.6 Liters

Question 7

Expiratory Reserve Volume

Answer 7

1.25 liters

Question 8

Vital Capacity

Answer 8

3.5-5.5 Liters

Question 9

Total Lung Capacity

Answer 9

6 liters

Question 10

Typical Mask Induction Sequence

Answer 10

Place monitors (sometimes just pulse ox), N2O then add Sevo, gentle mask ventilation until IV placed (patients susceptible to obstruction, laryngospasm & bradycardia during this time), airway placement after IV placed (if no IV MUST have backup plan)

Question 11

What causes a Laryngospasm**

Answer 11

Mediated by the superior laryngeal nerve in response to irritating glottic or supraglottic stimuli such as presence of food, blood, vomit or airway secretions. Occurs most frequently with light anesthesia upon induction or emergence.

Question 12

What happens during a laryngospasm**

Answer 12

False cords and epiglottic body come together firmly and allow no air flow and no vocal sound

Question 13

Laryngospasm treatment***

Answer 13

Forward displacement of jaw, apply positive pressure with 100% oxygen, potentially give succinylcholine (0.1-1mg/kg) and re-intubate, let hypercarbia and hypoxia develop and it may break

Question 14

Rapid Sequence Induction indications

Answer 14

Full stomach, severe GERD, anticipated difficult mask/intubation

Question 15

Rapid Sequence Induction steps

Answer 15

Pre oxygenate up to 5 minutes, IV anesthetic, rapid-onset NMBA (succ), cricoid pressure, intubate, release cricoid after confirmation of ETT placement

Question 16

Modified Rapid Sequence Induction

Answer 16

may mask with gentle pressure while maintaining cricoid pressure, if you need extra oxygenation or feel the need to see if patient has good mask airway

Question 17

Basis of Cricoid Pressure

Answer 17

Pressure on the front of the cricoid cartilage is transmitted to posterior lamina, occludes esophagus by compression against vertebral bodies

Question 18

Cricoid Disadvantages

Answer 18

Reduces tone of lower esophageal sphincter- risk of regurgitation from stomach to esophagus increases, impair insertion of laryngoscope, degrade view of larynx, impede passage of tube, cause airway obstruction, fracture, rupture of esophagus

Question 19

Mallampati Classes

Answer 19

Class 1 - visualize pillars, uvula, hard palate, soft palate. Class 2- visualize some pillars, portion of uvula, hard palate, some soft palate.
Class 3- visualize little bit of pillar, hard palate, maybe part of soft palate/uvula
Class 4- only see hard palate

Question 20

Mallampati Grades

Answer 20

Grade 1- see epiglottis, vocal cords, everything
Grade 2- see posterior arytenoids, epiglottis, part of cords
Grade 3- see epiglottis
Grade 4- cant even see epiglottis

Question 21

How to optimize visualization

Answer 21

“OPT” have oral, pharyngeal & trachea in line in sniffing position

Question 22

Curved blade intubation

Answer 22

Curved blade goes into vallecula- upward force brings posterior pharynx & vocal cords into view- displaces tissue & tongues and visualizes cords

Question 23

Straight blade intubation

Answer 23

Deliberately direct blade to right paraglossal space, no tongue should be present to right of blade, direct blade medially, trap epiglottis under blade tip, rock blade slightly backward

Question 24

Adult sizing for ETT (circumference)

Answer 24

Usually about 7.0-9.0 mm

Question 25

Children sizing for ETT

Answer 25

Age divided by 4 + 4 (If you have a 5 year old -- 5/4 + 4 = 5)

Question 26

Children depth of ETT

Answer 26

ETT size x 3

Question 27

Poiseuille's Law

Answer 27

Resistance increases as radius decreases by radius^4

Question 28

Microlaryngoscopy Tube

Answer 28

Small diameter, longer ETT

Question 29

When would you not use PVC ETT?

Answer 29

Laser surgeries! It is flammable. Use Laser-Shield (aluminum wrapped, silicone based tube & cuff)

Question 30

RAE ETT

Answer 30

Ring, Adair & Edwin- used for nasal intubation or oral intubation

Question 31

Nasal intubation insertion

Answer 31

Place ETT in warm saline, mix afrin with 2% lidocaine jelly, dilate nasal passage with nasal trumpets lubricated with above solution, uce McGill forceps to guide tube (usually need external laryngeal manipulation)

Question 32

Complications of supraglottic airway

Answer 32

sore throat, trauma, nerve injury including hypoglassal (vocal cord paralysis, excessive high cuff pressures, N2O use), gastric distention/aspiration

Question 33

Complications of ETT

Answer 33

Sore throat, vocal cord damage, cuff pressure erosion of mucosa (N2O use), damage to teeth/mouth with DL, bronchial irritation/spasm, pneumothorax/barotrauma, aspiration, esophageal intubation

Question 34

Contraindications to supraglottic airway

Answer 34

Prone position, obesity, severe lung disease, pregnancy, laparoscopic surgery, GERD, full stomach, long case, need for postoperative ventilation, maliampati score of III or above, trismus, limited mouth opening, airway pressure above 40 cmH2O

Question 35

ASA Difficult Airway Algorithm

Answer 35

1) Assess likelihood & clinical impact of difficult ventilation/intubation/patient cooperation/tracheostomy 2) Actively pursue opportunities to deliver supplemental oxygen throughout process 3) Consider relative merits and feasibility of basic management choices (awake, attempts, etc) 4) Develop primary & alternative strategies-- awake intubation versus intubation attempts after induction of general anesthesia. 5) If after induction of GA & attempts unsuccessful-- consider calling for help, returning to spontaneous ventilation & AWAKENING THE PATIENT**, face mask ventilate, consider LMA

Question 36

Rigid Fiberoptic Laryngoscopes - names & use

Answer 36

Bullard or Upsher, use to elevate jaw without extension of neck and useful with small mouth opening

Question 37

Bougie use

Answer 37

If you can only see posterior arytenoids

Question 38

Video laryngoscope name & use

Answer 38

Airtraq, CMAC provides wide-angle view