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SRNA4TopicsAnesthesia > APEX: AIRWAY MANAGEMENT and Review exam > Flashcards

APEX: AIRWAY MANAGEMENT and Review exam Flashcards

1
Q

Mallampati score measure what?

A

Size of the tongue relative to the volume of the mouth

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2
Q

Mallampati exam helps predict

A

Difficulty of ET intubation

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3
Q

Mallampati exam perform with the patient

A

Sit upright
Extend neck
Open mouth
Stick out tongue

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4
Q

Class I airway you can visualize the

A

Tonsillar pillars

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5
Q

The more space the tongue occupies,

A

The less space is there to work

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6
Q

Higher mallampati score

A

More difficult intubation

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7
Q

is mallampati a good predictor?

A

By itself mallampati is a poor predictor of a difficult airway.

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8
Q

Mnemonic to remember Mallampati Class

A

PUSH

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9
Q

Class I Mallampati you can see

A

Pillars , Uvula, Soft palate, Hard palate

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10
Q

Class II Mallampati you can see

A

Uvula, Soft palate, Hard Palate

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11
Q

Class III Mallampati you can see

A

Soft palate and Hard palate

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12
Q

Class IV Mallampati you can see

A

Hard palate

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13
Q

What affects your ability to align the axes

A

Patient’s ability to open the mouth

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14
Q

What are the axes you are trying to align?

A

Pharyngeal
Oral
Laryngeal

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15
Q

Small inter-incisor gas creates

A

Acute angle between the oral and glottic opening increasing the difficulty of intubation

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16
Q

what is a normal inter-incisor GAP

A

2-3 fingerbreaths or 4cm

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17
Q

Longer incisors and the inter-incisor gap

A

Reduce the gap

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18
Q

What increase the risk of dental damage

A

Buck teeth.

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19
Q

Mandibular protrusion test assesses the function of

A

the TMJ

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20
Q

When performing the mandibular protrusion test, the patient is asked to

A

SUBLUX THE JAW and the position of the lower incisors is compared to the position of the upper incisors

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21
Q

A class 3 mandibular protrusion meaning

A

More difficult laryngoscopy

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22
Q

To expose the glottic opening you must

A

Displace the tongue into the Submandibular space (radiation, tumor make this more difficult)

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23
Q

What are the border of the submandibular space:

A

Superior
Inferior
Lateral

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24
Q

Superior border of the submandibular space is

A

Mentum

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25
Q

Inferior border of the submandibular space is

A

Hyoid

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26
Q

Lateral border of the submandibular space is

A

Either side of the neck.

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27
Q

How is the thyromental distance helpful?

A

Estimate the size of the submandibular space.

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28
Q

Where is the thyromental distance measured?

A

Thyroid cartilage to the TIP of the mentum

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29
Q

Thyromental distance less than ________ or greater than makes laryngoscope more difficult

A

6 cm ( 3 fingerbreaths) and greater than 9cm

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30
Q

TMD less than 6cm seen with

A

Mandibular hypoplasia

Small submandibular space

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31
Q

TMD more than 9cm seen with

A

Larynx is more caudal

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32
Q

Mandibular protrusion test is a

A

Upper lip bite test.

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33
Q

MPT class I

A

Patient can move lower incisors past upper incisors and bite the vermillion of the lip (where lip meets facial skin)(

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34
Q

MPT CLass II

A

Patient can move Lower incisors in line with upper incisors.

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35
Q

MPT Class III

A

Patient cannot move lower incisors past upper incisors. Indicating difficult intubation

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36
Q

The ability to place the patient in a sniffing position is highly dependent on the mobility of what joing?

A

Atlanto-occipital joint

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37
Q

What is a normal atlanto occipital joint flexion and extension ?

A

90-165 degrees

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38
Q

Normal Atlanto occipital joint extension

A

35 degrees

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39
Q

At what degree of extension of the atlanto-occipital joint is laryngoscopy difficult?

A

< 23 degrees

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40
Q

What are top conditions affecting Atlanto-occipital joint mobility?

A 
Degenerative joint disease
RA
Ankylosing spondylitis
Trauma 
Surgical fixation
Klippel-feil
Down syndrome
DM (joint glycosylation)
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41
Q

Cormack and lehane grading if you can only see the EPIGLOTTIS

A

3

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42
Q

Cormack and lehane grading: Grade I what can you see

A

Complete or nearly complete view of the glottic opening

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43
Q

Cormack and lehane grading: Grade II what can you see

A

Posterior region of the glottic opening seen

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44
Q

Cormack and lehane grading: Grade III what can you see

A

Epiglottis opening

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45
Q

Cormack and lehane grading: Grade IV

A

Soft palate only

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46
Q

Grade II BCormack and lehane grading:

A

corniculate cartilages and posterior vocal cords. ( if you see arytenoids pick that if corniculate is not an answero

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47
Q

Grade indicating easier intbuation Cormack and lehane grading?

A

I & IIA

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48
Q

Grade indicating harder intubation Cormack and lehane grading?

A

Grade IIB & III

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49
Q

Grade indicating alternative approach to intubation Cormack and lehane grading?

A

Grade IV

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50
Q

Best predictors of Difficult mask ventilation?

BONES

A 
Beard
Obese (BMI >26)
No teeth (edentulous) 
Elderly
Snoring
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51
Q

5 Questions to answer before providing airway management?

A
  1. Will you be able to mask ventilate
  2. Will you be able to intubate
  3. Will you be able to place a supraglottic airway
  4. Will you be able to place invasive airway
  5. HOw fast must you secure the airway
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52
Q

Mouth opening and incisors, overbite with intubation, what makes difficult

A

Small mouth opening,
Long incisors
Prominent overbite

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53
Q

Palate and mallampati, what makes intubation difficult?

A 
High arches palate
Mallampati class III or IV
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54
Q

Jaw and difficult intubation, what makes it difficult

A

Retrognathic jaw

Inability to sublux jaw

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55
Q

Neck and difficult intubation

A

Short, thick neck
Short thyromental distance
Reduce cervical mobility

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56
Q

Risk factors for difficult supraglottic device placement? Mouth opening and upper airway implications

A

Limited mouth opening
Upper airway obstruction (anything that prevent the passage of the airway to the pharynx)
Altered pharyngeal ANATOMY (preventing a seal)

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57
Q

Risk factors for difficult supraglottic device placement? lung and Upper and lower airway implications

A

Poor lung complinace (requiring excessive PIP)
Increase airway resistance( Requiring excessive PIP)
lower airway obstruction

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58
Q

Risk factors for difficult invasive airway placement?

neck anatomy

A

Abnormal neck anatomy (tumor, radiation, abscess)

Short neck

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59
Q

Risk factors for difficult invasive airway placement?

Weight

A

Obesity (cant see cricothyroid membrane)

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60
Q

Risk factors for difficult invasive airway placement?

Larynx

A

Laryngeal trauma

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61
Q

Fasting guidelines Clear liquid

A

2 hours

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62
Q

Fasting guidelines breastmilk

A

4 hours

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63
Q

Fasting guidelines nonhuman milk, infant formula solid food

A

6 hours

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64
Q

Fasting guidelines Fried and fatty food

A

8 hours

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65
Q

Clear liquid 2 hours before surgery does what?

A

Reduces gastric volume and increases gastric pH

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66
Q

Mendelson syndrome risk factors

A

Gastric ph<2.5

Gastric volume > 25 ml

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67
Q

RSI , different because

A

pt is not ventilated
Esophagus compressed by applied pressure to cricoid ring (applied before the patient loses consciousness and maintained until tracheal intubation is confirmed.

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68
Q

Pressure before LOC

A

2kg

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69
Q

Pressure after LOC

A

4kg

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70
Q

RSI avoid if patient is

A

actively vomiting

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71
Q

RSI and LES pressure

A

reduce

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72
Q

Complications of RSI

A

AID
Airway obstruction
Difficulty with laryngoscopy
Difficult intubation

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73
Q

Congenital associated with cervical spine abnormalities?

A

Goldenhar
Klippel-Feil
Trisomy 21 (down syndrome)

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74
Q

What is angioedema?

A

Results in vascular permeability leading to swelling of the face, tongue, and airway. Acute obstruction is a concern>

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75
Q

2 main causes of Angioedema

A

ACEI

Hereditary

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76
Q

ACEI angioedema treatment

A

Epinephrine
Antihistamine
Steroids

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77
Q

Hereditary angioedema caused by

A

C1 esterase deficiency

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78
Q

Hereditary angioedema treatment

A

C1 esterase concentrate or FFP

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79
Q

For hereditary angioedema , does ACEI angioedema treatment work?

A

No

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80
Q

What is ludwig’s angina?

A

bacterial infection, rapidly progressive cellulitis in the floor of the mouth.

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81
Q

Ludwig’s angian affect

A

Submandibular
Submaxillary
Sublingual spaces

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82
Q

Most significant concern with Lugwig’s angina

A

Displacement of the tongue resulting in complete, supraglottic airway obstruction.

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83
Q

With Ludwig’s angina, The best way to secure the airway is with the patient

A

Awake (Awake nasal intubation, awake tracheostomy )

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84
Q

Contraindicated in patients with an infection above the level of the trachea

A

Retrograde intubation

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85
Q

Congenital abnormality: Large tongue (BIG TONGUE (BT)

A 
Beckwith syndrome
Trisomy 21 ( Down syndrome)
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86
Q

Congenital abnormality: Small under developed mandible (PGTC)

A 
Please GET THAT CHIN
Pierre Robin
Goldenhar
Treacher collins
Cri du chat
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87
Q

Congenital abnormality: Cervical Spine anomaly (KTG)

A

Kids TRY GOLD ‘
Klippel - Feil
Trisomy 21
Goldenhar

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88
Q

Congenital abnormality subglottic stenosis

A

Trisomy 21 (down syndrome)

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89
Q

What is choanal atresia?

A

Nasal airway is blocked by tissue

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90
Q

Pierre ROBIN tongue

A

Falls back and downwards (GLOSSOPTOSIS)

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91
Q

Terms that indicate small underdeveloped mandible

A

Micrognathia

Mandibular hypoplasia

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92
Q

What is the optimal position for tracheal intubation?

A

Cervical Flexion and atlanto-occipital joint extension

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93
Q

Sniffing position maximizes the probability of successful tracheal intubation by aligning the

A

oral
Pharyngeal
laryngeal axes

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94
Q

2 key elements of sniffing position

A

Cervical flexion

Atlanto-occipital joint extension: Extends the head on the neck

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95
Q

Best position for direct vision laryngoscopy

A

sniffing position

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96
Q

Best position for obese patient is HELP

A

HELP means HEAD ELEVATED laryngoscopy position

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97
Q

Optimal position is achieve for sniffing when

A

Sternum and EXTERNAL AUDITORY MEATUS are in the same horizontal plane,

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98
Q

Why is putting the bed in reverse trendelenburg positio help?

A

prolongs the time between apnea and desaturation?

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99
Q

How does the head position affect the ETT after intubation

A

The tube goes where the NOSE goes

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100
Q

Nose to chest pushes tip of ETT

A

Towards the carina 2cm

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101
Q

Nose away from chest pushes tip of ETT

A

away from carina 2cm

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102
Q

Lateral rotation of the head moves the tip of ETT

A

Away from carina 0.7cm

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103
Q

Steep Tredelenburg position causes

A

Abdominal content to shift towards the chest. This reduces thoracic volume and increases the risk of ENDOBRONCHIAL INTUBATION

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104
Q

Position increases the risk of endobronchial intubation>

A

Steep Tredelenburg

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105
Q

Contraindications of nasopharyngeal airway

A

Coagulopathy

Le Fort II or III fractures

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106
Q

What can LeFort fracture can cause that affect airway?

A

Can disrupt the cribiform place, direct line of communication with nasal and cranial cavities. Placing a nasal airway , nasal ETT and NGT could be catastrophic.

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107
Q

Signs of cribiform plate injury include

A

Raccoon eyes,
Periorbital edema
CSF leak in the nose or ears

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108
Q

Most common used oral airway

A

Berman

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109
Q

How do you size oral pharungeal airway (OPA)

A

Measured from the corner of the mouth to the EARLOBE or Angle of the mandible

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110
Q

If OPA too short what can happen?

A

Obstruct the airway by causing tongue to kink against roof of the mouth

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111
Q

OPA too long can

A

Obstruct the patien’ts ariway by displacing the epiglotiss towards the glottis.

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112
Q

How do you size the Nasopharyngeal airway (NPA)

A

From the nare to the earlobe or the angle of the mandible.

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113
Q

Do not do this with NPA

A

Do not push towards the brain, it can traumatize the turbinates.

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114
Q

NPA too short will

A

fail to relieve the obstruction

115
Q

NPA too longs will

A

obstruct the airway but displacing the epiglottis towards the glottis. may also cause trauma

116
Q

Complications of OPA and NPA and anesthesia

A

Placing an airway into a lighly anesthesized patient can precipitate laryngospasm. Nasal ariway is better tolerated in this situation

117
Q

NPA contraindication

A 
le Fort II and III fracture
Basilar skull fracture
CSF rhinorrhea
Racoon eyes
Periorbital edema
Coagulopathy
118
Q

NPA contraindication if they’ve had this surgery

A

Transphenoidal hypophysectomy
Caldwell-luc procedure
Nasal fracture.

119
Q

Which intervention demonstrates the MOST accurate understanding of inflating the cuff on the ETT ?

A

Attaching a manometer to the PILOT BALLOON is the best way to determine the pressure inside the cuff.

120
Q

When can tracheal ischemia occur?

A

If the cuff pressure exceed tracheal mucosal perfussion pressure

121
Q

What should the ETT cuff pressure be

A

Less than 25 cm H2O

122
Q

What is the purpose of inflating the ETT cuff

A

occlude trachea because it Create a seal that permits PPV and protects the lung from aspiration of gastric contents.

123
Q

2 types of cuffs

A

Low volume and high pressure

High volume, low pressure.

124
Q

Types of cuff with low volume and high pressure

A

Red rubber tube

Silicone tube for LMA fastrach

125
Q

Can you measure inside the cuff pressure with red rubber tube or LMA fasttrach

A

no

126
Q

Way to minimize cuff pressure

A

Use manometer after intubation
Fill cuff with the same gas mixture you will use during the case
Fill cuff with saline or water.

127
Q

What is the murphy eye?

A

small hole on the opposite side of the bevel

Provide and alternate passage for air movement in case the tip of the ETT becomes occluded

128
Q

What is the murphy’s law?

A

A fiberoptic scope, forceps or tube exchanges can get stuck in the murphy eye

129
Q

How do you calculate size for ETT for kids: ETT without cuff?

A

(Age/4)+ 4

130
Q

How do you calculate size for ETT for kids: ETT with cuff?

A

(Age/4) +3.5

131
Q

Depth of placement for pediatric ETT

A

ID x 3

132
Q

For LMA, where does the distal end ends?

A

Upper esophageal sphincter (cricopharyngeus muscles)

133
Q

For LMA, where does the sides of the LMA lie?

A

Pyriform sinuses

134
Q

For LMA, where does the proximal end of the LMA lie?

A

Base of the tongue

135
Q

Most commonly used supraglottic airway

A

LMA

136
Q

LMA and tracheal intubation

A

May be used as a conduit for tracheal intubation

137
Q

Inflating the LMA cuff creates

A

Seal over the larynx which allows for PPV

138
Q

Max PPV pressure with LMA

A

20 cm H2O

139
Q

Max cuff pressure

A

60 cm H2O

140
Q

Most common cause of nerve injury for LMA

A

Cuff overinflation

141
Q

Nerve injuries associated with LMA

A

Lingual
Hypoglossal
RLN

142
Q

LMA size 1 weight _____Cuff inflation ___ largest ETT to fit

A

<5kg; 4 ml ; 3.5

143
Q

LMA size 1.5 weight _____Cuff inflation___

A

5-10 kg; 7ml ; 4.0

144
Q

LMA size 2 weight _____Cuff inflation___

A

10-20kg; 10ml ; 4.5

145
Q

LMA size 2.5 weight _____Cuff inflation___

A

20-30; 14 ml; 5.0

146
Q

LMA size 3 weight _____Cuff inflation___

A

30-50; 20ml; 6.0

147
Q

LMA size 4 weight _____Cuff inflation___

A

50-70; 30ml; 6.0

148
Q

LMA size 5 weight _____Cuff inflation___

A

70-100 kg; 40 ml ; 6.0

149
Q

Which LMA is designed for Intubation

A

LMA fastrach

150
Q

LMA designed for gastric drain

A

LMA proseal

151
Q

LMA designed for Wire-reinforced airway tube

A

LMA flexible.

152
Q

Double lumen LMA is the _____-

A

Proseal

153
Q

Feature of the double lumen LMA proseal?

A

Gastric drain tube (for easy gastric decompression)
Larger mask
Bite block

154
Q

What not to do with LMA proseal ?

A

Do not place suction directly to the drain tube. Instead you must pass an OGT through the tube to decompress the stomach

155
Q

comparing classic LMA to proSeal.?

A

Better seal

Max pressure for PPV< 30cm H2O

156
Q

Special features of the fastrach LMA

A

Metal handle
Tube pusher
Epiglottic elevating bar

157
Q

The LMA flexible has an airway tube that is

A

Flexible

longer than classic LMA

158
Q

When do you use the LMA flexible?

A

Useful for head and neck surgery, where the airway tube of the LMA classic would limit access to the surgical site.

159
Q

Is the LMA suitable for asthma?

A

Yes because it produces less airway irritation and making it a suitable choice in asthmatic patient.
However, the PROVIDE A SECURE AIRWAY

160
Q

LMA contraindicated in

A

Airway obstruction at or below the level of the glottis (tracheal tumor)

161
Q

4 main situation where you should use an LMA (RAPH)

A

Risk of gastric regurgitation and aspiration; (full stomach, hiatal hernia, SBO, symptomatic GERD, delayed gastric emptying
Airway obstruction at the level of the glottis of below the glottis
Poor lung compliance
High airway resistance

162
Q

In the event of CVCI , should you use an LMA with full stomach?

A

LMA can be lifesaving and should be use, even if the patient is at risk of aspiration. In that situation, hypoxemia is the greatest risk to the patient.

163
Q

What if mid-case you notice gastric contents inside the tube of the LMA?

A

Leave the LMA in place
Place the patient in Trendelenburg position
Deepen the anesthetic
Give 100% via abu
Use Low FGF and low VT
use flexible suction catheter through the LMA

164
Q

Even though an LMA does not provide a truly secure airway, it does

A

Shield the glottic openin g

165
Q

Direct vision laryngoscopy and SNS

A

intensely stimulating procedure that can lead to increase catecholamines, tachycardia, HTN, dysrhythmias, bronchospasm

166
Q

What is the least stimulating airway disease?

A

LMA

167
Q

The tendency of airway device placement to activate the SNS (MOST to LEAST stimulating)

A

Combitude
DVL (direct visual laryngoscopy)
Fiberoptic
LMA

168
Q

If you’re using an LMA for laparoscopy follow this rule: 15 rule

A

use < 15 degree tilt
< 15 cm H2O intraabdominal pressure
< 15 minutes of insufflation

avoid light anesthesia

169
Q

VA action and pulmonary reflexes

A

decrease the sensitivity of pulmonary reflexes.

170
Q

Contraindications for the combitube : gag reflex

A

Intact gag reflex is a contraindications

171
Q

This disease is a contraindication to the combitube use

A

Zencker’s Diverticulum

172
Q

What is the combitube?

A

Supraglottic double lumen device BLINDLY placed in the hypopharynx

173
Q

How long can you use a combitube for?

A

2-3 hours max

174
Q

Combitube useful alternative for patient with

A

Full stomach

175
Q

Does the placement of combitube need hyperextension? what is the significance of that?

A

No; May be use for patient with joint disease such as Klipper feil syndrome

176
Q

Combitube sizing is based on

A

Height

177
Q

Combitube size for < 4 ft

A

None

178
Q

Combitube size for patients height 4-6ft

A

Size 37

179
Q

Combitube size for patients height > 6ft

A

Size 41

180
Q

Combitube: what are the 2 balloons and what do they occlude?

A

Proximal Oropharyngeal balloon, occludes the hypopharynx

Distal Esophageal balloon occlude the esophagus

181
Q

With the combitube with balloon is inflated first

A

Oropharyngeal balloon

182
Q

Inflation volume for oropharyngeal balloon for both sizes

A

Size 37 = 40-85

Size 41 = 40 -100ml + option for additional 50ml

183
Q

The distal cuff of both sizes for the combitube both get inflated with

A

5-12ml of air

184
Q

Combitude, you should attempt ventilation in which lumen? why

A

BLUE Proximal (esophageal lumen) : the tip usually enters the esophagus

185
Q

Describe parts of the combitube

A 
Double lumen: Tracheal and esophageal 
Oropharyngeal balloon
Distal cuff
Tracheal lumen: open
Esophageal lumen: Closed 
Perforation in the esophageal lumen
186
Q

If the tip of the combitube enters the trachea, where do you ventilate?

A

Through the CLEAR, distal tracheal lumen

187
Q

For combitube, cuff pressure should not exceed

A

60cm H2O

188
Q

Combitube benefits for stomach

A

Ability to decompress the stomach

189
Q

Combitube allow ventilation pressure up to

A

50 cm H2O

Uses a blind insertion techniques (min training needed)

190
Q

What is Zencker’s diverticulum?

A

diverticulum (pouches) for in the pharyngeal mucosa

191
Q

What is the GOLD STANDARD for managing the difficult airway?

A

Flexible Fiberoptic Bronchoscopy in the awake, spontaneously ventilating patient

192
Q

FOB under GA downsides

A

Loss of pharyngeal tone

Upper airway obstruction

193
Q

You’re doing a Flexible FOB, if the patient require PPV what can you do?

A

A special adapter can be placed between the mask and the y-piece. This allows PPV while FOB is in the patient’s airway

194
Q

FOB, describe hand position

A

The dominant hand holds the cord

The non-dominant hand holds the scope near the proximal end where the thumb controls the lever.

195
Q

FOB, pushing the lever down

A

Points the tip up

196
Q

FOB pushing the lever up,

A

points the tip down

197
Q

FOB rotating the scope left and right allows you to

A

control the score in the horizontal plane.

198
Q

The working channel port of the FOB allows

A

Insufflation
Suction
or injection

199
Q

Other indications for FOB

A

C-spine limitation, severe cervical stenosis, CHIARI MALFORMATION, Lmited mouth opening, TMJ disease, facial burn, mandibular-maxillary fixation.

200
Q

Relative contraindication for FOB

A 
Hypoxia
Secretions not relieved by antisialagogue
Hemorrhage impairing vision
Uncooperative patient
LA allergy (For awake attempt)
201
Q

What should be applied to the tip of the FOB

A

Anti-fog solution

202
Q

What should be given with FOB to minimize secretions

A

Antisialogogue (Glyco 0.2 mg IV)

203
Q

FOB for nasal approach use

A

Vasoconstrictors to minimize epistaxis

204
Q

FOB extra airway equipment

A

Williams or Ovassapian airway, help FOB stay midline but may stimulate gag reflex in the away patient.

205
Q

FOB second provider may do this

A

Grab tongue anteriorly with a 4x4 gauze

206
Q

What can be use in conjunction with the FOB

A

LMA

207
Q

During the FOB use, if the bevel of the ETT hangs up on the right arytenoid what should the provider do?

A

Pull back
rotate the ETT 90degrees counterclockwise
and advance ETT again

208
Q

If the FOB get stuck in the Murphy eye,

A

Remove the FOB and the ETT and repeat the procedure

209
Q

What is the BULLARD laryngoscope?

A

rigid, fiberoptic device used for indirect laryngoscopy

210
Q

BULLARD laryngoscope, useful for

A

Small mandible
Limited mouth opening (requires 7mm opening)
Limited cervical mobility .

211
Q

Compared to DVL, the BULLARD causes

A

Less cervical spinal displacement

212
Q

Compared to FOB intubation with BULLARD is

A

Faster

213
Q

The Eschmann introducers provides the most signifcant benefit when you obtain a

A

Grade III view during laryngoscopy

Grade IIb view

214
Q

3 names for the Eschman introducer

A

Eschman introducer
Intubating stylet
Gum elastic bougie

215
Q

The eschman introducer tip

A

Coude angled tip to facilitate a very anterior glottis

216
Q

WORST time to use the Eschman introducer

A

GRADE IV view, change of intubation is low

217
Q

How to use the Eschmann introducer? What confirms placement?

A

Hook the angled tip under the epiglottis (grade III view)
Advance the tip into the trachea, lubricate EI to facilitate passing ETT over it
Feeling the click of the tracheal rings confirm placement.

218
Q

IF you don’t feel the click

A

Look for the hold up sign, (EI meet resistance at the carina 35-40 cm)

219
Q

To summarize the EI tube insertion

A

If you feel click, you’re in the trachea

If you dont feel the click, youre in the esophagus

220
Q

Lighted stylet useful for 2 conditions

A

Microsotomia
Mandibular Hypoplasia
Severe oropharyngeal bleeding

221
Q

With lighted stylet Esophageal placement

A

Diffuse transillumination of the neck

222
Q

With lighted stylet Tracheal placement

A

Well defined circumscribed glow

223
Q

Lighted stylet benefits

A

Anterior airway
Cervical spinal abnormality
Pierre Robin syndrome
Severe burn contractures.

224
Q

Can you use a lighted stylet with a traumatic laryngeal injury? CVCI situation?

A

NO; NO

225
Q

Trachlight in the adult should be bent

A

90 degrees

226
Q

Trachlight in the pediatric Angle should be

A

60-80 degrees to accommodate cephalad glottis opening

227
Q

What is the bronchial blocker?

A

Alternative to the double lumen tube.

228
Q

The bronchial blocker cannot

A

Prevent contamination from contralateral lung infection
Provide ventilation to the isolated lung
Be used to suction secretion from the isolated lung,.

229
Q

Unlike the bronchial blocker the DLT cannot

A

Provide lung separation in children < 8- 10 years old

Provide lung separation for the patient requiring nasotracheal intubation

230
Q

Similarity DLT and bronchial blocker allow you to

A

insufflate oxygen into the isolated lung.

231
Q

HOw can you provide single lung ventilation

A

with a bronchial blocker and a single lumen ET tube.

232
Q

Bronchial Blocker placmenet

A

Insert lumen ETT
Insert the bronchial blocker into the single lumen ETT.
After in the correct position, inflate the ballon to isolate the lungs

233
Q

With the bronchial blocker which lung is ventilated?

A

opposite side of the bronchial blocker

same side of the bronchial blocker not ventilated

234
Q

Bronchial blockers are indicated for

A

children less than 8
Requires nasotracheal intubation
Have a tracheostomy
Have a single lumen ETT in place

235
Q

A bronchial block is not the best choice for what situation?

A

When lung is isolated for concerns of contamination

236
Q

Retrograde intubation requires you to penetrate the

A

Cricothyroid membrane

237
Q

Needle size for a retrograde intubation

A

14-18 Ga needle

238
Q

Retrograde intubation steps

A

Insert needle
Aspirate for air to confirm proper placement inside the tracheal lumen
Pass wire thorugh the needle and advance in a cephalad direction.

239
Q

MOST COMMON Indications for retrograde intubation

A

UNSTABLE SPINE

240
Q

3 percutaneous airway management

A

Transtracheal Jet ventilation
Cricothyroidotomy
Tracheostomy

241
Q

Absolute contraindication for transtraceal jet ventilation

A

Upper airway obstruction / laryngeal injruy

242
Q

Absolute contraindication for cricothyroidotomy

A

Patient age less than 6 years

243
Q

Absolute contraindication for tracheostomy

A

No absolute contraindications.

244
Q

Describe Transtracheal Jet ventilation

A

Large bore needle inserted in the cricothyroid membrane
A jet ventilatior is used to ventilated the patient
Inspiration requires high pressure oxygen (50psi)

245
Q

Why is the Transtracheal jet ventilation needs high pressure

A

Because airway diameter is narrow

246
Q

Using transtracheal jet ventilation put the patient’s at risk for what?

A

Hypercapnia

247
Q

What is a cricothyroidotomy

A

Crease a small, horizontal incision through the cricothyroid membrane, and then inserted a cuffed ETT through the hole.

248
Q

Why is cricothyroidotomy not performed in children why?

A

Because the thyroid isthmus commonly covers the cricothyroid membrane

249
Q

What is the emergency surgical airway of choice for children 6 or younger? (some books say less than 10)

A

Percutaneous transtracheal ventilation , needle cric

250
Q

Where is the incision made for the tracheostomy?

A

2nd and 3rd tracheal rings

251
Q

Complications of tracheostomy acute

A

Airway obstruciton
Hypoventilation
Pneumothorax, and bleeding

252
Q

Complications of tracheostomy long term

A

Tracheal stenosis and necrosis
Tracheomalacia
TEF

253
Q

Pros of deep extubation inclde

A

Decrease CV and SNS stimulation (desirable with CAD)

Decreased coughing and airway irritation (desirable with asthma)

254
Q

Cons of deep extubation

A

Ineffective airway reflexes
Increase risk of airway obstruction
Increased risk of aspiration

255
Q

Extubation should be performed when

A

DEEP or awake

256
Q

What are the stages of anesthesia?

A

Awake
Light anesthesia
Deep anesthesia

257
Q

Guedel stage II is _____anesthesia

A

Light

258
Q

Guedel Stage III is _________ anesthesia

A

Deep

259
Q

Airway reflexes and anesthesia: Stage II

A

Airway reflexes are hyperreactive -> Increase risk of laryngospasm

260
Q

Airway reflexes and anesthesia: Stage III

A

Airway reflexes attenuated

261
Q

Pros of extubating awake: as far as airway reflexs

A

Airway reflexes intact
ability to maintain airway patency
Decrease risk of aspiration

262
Q

CONS of extubating awake

A

Increase CV and SNS stimulation
Increase coughing
Increase intracranial pressure, intraoccular pressure and intraabdominal pressure

263
Q

Preventing complications of AWAKE extubation do 2 things?

A

CV and SNS stimulation: BBlockers, CCBs and vasodilators

Coughing; lidocaine (IV or inside th ETT cuff and opioids)

264
Q

3 questions to determine possible difficult intubation?

A

Was the airway abnormal of difficult during induction
Did anything change during surgery that would make the airway difficult to manage
Does the patient have risk factors for increase extubation risk.

265
Q

What is the best technique to manage the patient at high risk for failed extubation

A

Airway Exchange catheter

Another best choice is a nasal airway

266
Q

How long can you use the Airway Exchange catheter?

A

up to 72 hours.

267
Q

Does the AEC provide the patent airway?

A

No its just a placehold, in case patient requires re-intubation the AEC is used as a stylet for re-intubation via the seldinger techniques.

268
Q

Nonhuman milk how long do you wait?

A

6 hours

269
Q

Which upper airway can precipitate laryngospasm?

A

Oropharyngeal in light anesthesia patient.

270
Q

the 2 most reliable signs of ETT tube placement

A

Visualizing ETT between cords
Fiberoptic visualization
ETCO2 for 3 breaths

271
Q

For LMA If you put 60cm H2O, and no seal what does that indicated?

A

LMA is improperly placed

272
Q

Adequacy of LMA is based on MOSTLY

A

Sizing and correct placement

273
Q

WHy is nitrous bad with LMA

A

Cuff pressure is increase and must be monitored

274
Q

Best intubation for UNSTABLE cervical spine

A

Blind nasal intubation

Fiberoptic bronchoscopy

275
Q

Airway Fire how to treat?

A

Remove ETT
Stop flow of all airway gases
Remove all material from airway
Pour saline on the airway

276
Q

How do you do the post tetanic count?

A

Use 5 second tetanic stimulation followed by TOF 3 seconds

277
Q

Intense blockade and response to tetanic count?

A

No response

278
Q

When intense block start going way, and before 1st TOF appears

A

First response to post tetanic twitch stimulation

279
Q

At a minimum you must have PTC TOF of less than

A

2

280
Q

You can’t repeat PTC TOF for a minimum of

A

6 minutes

281
Q

PTC TOF 1-2 How much sugammadex do you administer?

A

4mg/kg

282
Q

PTC of 1 means TOF

A

Of 1 within 30 minutes

283
Q

3 questions to ask and answering yes to any would indicate difficult intubation?

A

Was airway abnormal or difficult during induction

Did anything chane druign

SRNA4TopicsAnesthesia (47 decks)

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