Airway Preparation and Equipment Flashcards
Airway equipment
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
Preoxygenation
- 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%
Positioning
Sniffing position helps align oral, laryngeal and pharyngeal axises
Morbid Obesity Positioning
May require a ramp
Positioning with unstable c-spine
must remain neutral
Requirements of Effective Bag Mask Ventilation
Sealed mask fit
Patent airway
Results: chest rise, end-tidal detection, condensation
Exceptions to Bag Mask
RSI & elective awake intubation
Deflated reservoir bag:
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*
Obstructed airway or tubing
high breathing circuit pressures w/
minimal chest movement and breath sounds
oral airways can improve this
One-handed face mask technique
Mask held with left hand and right hand is used to generate positive pressure by squeezing bag
Placement of hand for one-handed ventilation
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
Indications for two-handed face mask
Difficulty obtaining adequate mask seal or patent airway
anesthesia provider uses two hands to provide jaw thrust and create a a seal
Oral Airway
keep tongue from blocking airway
should reach base of tongue
may stimulate airway reflexes
Supraglottic Airway Devices
- used for spont breathing and ventilated patients during anesthesia
- can aid in intubation when both BMV and ETT have failed
SAD works:
connected to respiratory circuit or breathing bag
directing airflow to glottis, trachea and lungs
Examples of SADs
Esophageal-tracheal comitube
King laryngeal tube
LMA
LMA
wide-bore tube
proximal end connects to circuit
distal end attached to elliptical cuff that can be inflated through pilot
Placement of LMA
lubricated and blindly inserted into hypopharynx
once inflated forms a low-pressure seal around entrance to larynx
Considerations for LMA
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
Insertion of LMA
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)
Endotracheal Intubation
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
ETT sizing
Adult Male: 7.5
Adult Female: 7.0
Both are 24cm long
ETT valve
prevents air loss after cuff inflation
Pilot Balloon
gross indication of cuff inflation
