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Anesthesia Concepts 1 > Airway Preparation and Equipment > Flashcards

Airway Preparation and Equipment Flashcards

1
Q

Airway equipment

A 
oxygen source
bag/mask
laryngoscopes (direct and video)
several ETTs/stylet/bougies
other airway devices (oral, nasal, supraglottic)
suction 
pulse ox, co2 monitor, EKG, NIBP
Tape
IV access
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2
Q

Preoxygenation

A
  • increases body oxygen stores to delay arterial hemoglobin desaturation during apnea
  • desirable in all patients
  • recommended before extubation r/t hypoventilation, hypoxemia, loss of airway patency
  • Goal: end-tidal oxygen concentration of 90%
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3
Q

Positioning

A

Sniffing position helps align oral, laryngeal and pharyngeal axises

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4
Q

Morbid Obesity Positioning

A

May require a ramp

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5
Q

Positioning with unstable c-spine

A

must remain neutral

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6
Q

Requirements of Effective Bag Mask Ventilation

A

Sealed mask fit
Patent airway
Results: chest rise, end-tidal detection, condensation

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7
Q

Exceptions to Bag Mask

A

RSI & elective awake intubation

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8
Q

Deflated reservoir bag:

A

suggest a POOR mask seal

  • use little finger to bring mandible towards the face mask*
  • can use face-straps but risk for trigeminal or facial nerve injury*
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9
Q

Obstructed airway or tubing

A

high breathing circuit pressures w/
minimal chest movement and breath sounds
oral airways can improve this

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10
Q

One-handed face mask technique

A

Mask held with left hand and right hand is used to generate positive pressure by squeezing bag

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11
Q

Placement of hand for one-handed ventilation

A

Thumb &index finger: applies downward pressure
Middle &ring finger: grasp mandible and extend the atlantooccipital joint
Little finger: placed under angle of jaw and used to thrust anteriorly

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12
Q

Indications for two-handed face mask

A

Difficulty obtaining adequate mask seal or patent airway

anesthesia provider uses two hands to provide jaw thrust and create a a seal

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13
Q

Oral Airway

A

keep tongue from blocking airway
should reach base of tongue
may stimulate airway reflexes

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14
Q

Supraglottic Airway Devices

A
  • used for spont breathing and ventilated patients during anesthesia
  • can aid in intubation when both BMV and ETT have failed
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15
Q

SAD works:

A

connected to respiratory circuit or breathing bag

directing airflow to glottis, trachea and lungs

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16
Q

Examples of SADs

A

Esophageal-tracheal comitube
King laryngeal tube
LMA

17
Q

LMA

A

wide-bore tube
proximal end connects to circuit
distal end attached to elliptical cuff that can be inflated through pilot

18
Q

Placement of LMA

A

lubricated and blindly inserted into hypopharynx

once inflated forms a low-pressure seal around entrance to larynx

19
Q

Considerations for LMA

A

requires anesthetic depth and muscle relaxation > than oral airway
NOT a secure airway
does NOT protect against gastric regurgitation
positive pressure not the exceed 20mmHG

20
Q

Insertion of LMA

A

Select appropriate size and check for leaks
The leading edge of the deflated cuff should be wrinkle free and facing away from the aperture.
Lubricate only the back side of the cuff
Ensure adequate anesthesia
Place pt in sniffing position
Use your index finger to guide the cuff along the hard palate and down into the hypopharynx until an increased resistance is felt. The longitudinal black line should always be pointing directly cephalad (ie, facing the patient’s upper lip).
Inflate with the correct amount of air
Ensure adequate anesthetic depth during patient positioning
Obstruction after insertion is usually due to a down-folded epiglottis or transient laryngospasm
Avoid pharyngeal suction, cuff deflation, or laryngeal mask removal until the patient is awake (eg, opening mouth on command)

21
Q

Endotracheal Intubation

A

ETTs are often used to for GA and ventilation
A stylet can be used prior to insertion to adjust the shape of the ETT
The ETT end is beveled to aid visualization during intubation
ETT size selection if based on maximizing airflow and minimizing airway trauma

22
Q

ETT sizing

A

Adult Male: 7.5
Adult Female: 7.0

Both are 24cm long

23
Q

ETT valve

A

prevents air loss after cuff inflation

24
Q

Pilot Balloon

A

gross indication of cuff inflation

25
Q

ETT Cuff

A

tracheal seal, permits positive pressure ventilation and reduce likelihood of aspiration

26
Q

2 types of ETT cuffs

A

High pressure

Low pressure

27
Q

High pressure ETT cuff

A

associated with ischemia damage to tracheal mucosa

less suitable for long intubations

28
Q

Low-pressure ETT cuff

A

increase likelihood of sore throat, aspiration, spontaneous extubation, difficult insertion

29
Q

ETT sizing infant/child

A

Full term infant 3.5 diameter 12 cut length

Child 4+ age/4 diameter 4+ age/2 cut length

30
Q

Mac

A

curved blade

placed into vallecula

31
Q

Miller

A

straight blade

lifts epiglottis

32
Q

Flexible Fiberoptic Scope

A
  • coated glass fibers that transmit light and images of vocal cords
  • aspiration channel for suctioning, oxygen or instillation of local anesthetics (for an awake intubation)
  • dials to help maneuver the scopes tip through the vocal cords
33
Q

Use of FOS

A
  • unstable cspine, poor mouth opening or upper airway abnormalities
  • asleep or awake intubation
  • oral or nasal tubes

Anesthesia Concepts 1 (5 decks)

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