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Plan/Prep II exam 1 > Difficult airway > Flashcards

Difficult airway Flashcards

1
Q

Criteria for difficult intubation

A
  • MP score III or IV
  • Cormack-Lehane grade view III or IV
  • TMD < 3 finger breadths
  • small mouth opening
  • minimal head/neck ROM
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2
Q

Overall incidence of difficult intubation

A

5.8%

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3
Q

Incidence of difficult intubation for normal patients

A

6.2%

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4
Q

Incidence of difficult intubation for obstetric patients

A

3.1%

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5
Q

Incidence of difficult intubation for obese patients

A

15.8%

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6
Q

Difficult airway is generally defined as

A

3 or more basic DL attempts from an experienced practitioner

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7
Q

How does video laryngoscopy work

A

the laryngoscope handle has a video camera attached to the tip in which you look at a remote screen to indirectly visualized the laryngeal aperture

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8
Q

Video laryngoscopy pros

A
  • tend to get a great view
  • short learning curve, user friendly
  • up to 40% less traumatic than DL
    (potential become std of care)
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9
Q

Video laryngoscopy cons

A
  • limited mouth opening may make introduction of blade impossible
  • passing tube can be difficult
  • usually requires specific equipment (rigid stilettos, variable attachments, etc)
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10
Q

Safest method for difficult intubation

A

awake fiberoptic

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11
Q

Methods of anesthetizing the airway for an awake fiberoptic

A
  • transtracheal block
  • SLN block (superior laryngeal nerve)
  • topic anesthesia in mouth/tonsils
  • nebulizer with LA
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12
Q

What should you use during awake fiberoptic intubation

A
  • antisialagogue (like glycopyrolate to recuse salivation)

- possibly need sedation (conscious sedation) with versed, fentanyl, little propofol or ketamine, precedex

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13
Q

Dexmedetomidine (precedex) allows for

A

spontaneous ventilation and some airway protection (safety and efficacy similar to versed)

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14
Q

Loading dose dexmedetomidine (precedex)

A

1 mcg/kg over 10 minutes

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15
Q

Maintenance infusion for dexmedetomidine (precedex)

A

0.2-1 mcg/kg/hr

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16
Q

How is dexmedetomidine (precedex) prepared

A

100 mcg/cc diluted to 4 mcg/cc

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17
Q

Side effects dexmedetomidine (precedex)

A
  • hypotension
  • bradycardia/sinus arrest
  • respiratory depression with high doses
  • nausea
18
Q

dexmedetomidine (precedex) contraindications

A
  • cautious in patients with heart block or ventricular dysfunction
19
Q

dexmedetomidine (precedex) MOA

A

A2 agonist

20
Q

dexmedetomidine (precedex) onset and elimination

A

10-15 minutes (slow loading dose)

2 hours

21
Q

dexmedetomidine (precedex) metabolism and excretion

A

hepatic (2A4 and 2A6) metabolism

Urine/feces excretion

22
Q

Awake fiberoptic intubation pros

A

SAFEST (pt remains in complete control of airway assuming sedation is kept to minimum)

  • good views early to obtain with experience
  • atraumatic
23
Q

Awake fiberoptic intubation cons

A
  • most time consuming
  • sharp learning curve (due to prep, not physic use of scope)
  • least tolerated by patients )explanation, pt participation, localization necessary)
24
Q

Intubating LMA pros

A
  • Easy to place (potential for airway control)

- If placed correctly, may easily/blindy pass ETT (even if fail, LMA used for airway control)

25
Q

Intubating LMA cons

A
  • time consuming

- not guaranteed to be placed correctly nor ventilate the patient

26
Q

Light wand pros

A

Minimal set up
Quick
Short learning curve

27
Q

Light wand cons

A
  • no direct or indirect visualization of vocal cords is utilized
  • can be traumatic to the airway
  • may require significant OR darkness
28
Q

Only difficult intubation technique used for tube exchange

A

Bougie

29
Q

Bougie pros

A
  • no set up
  • more accessible (esp with unanticipated difficult airways)
  • only device that feasibly allows tube exchange
  • user friendly
  • flexibility make it atraumatic
30
Q

Bougie cons

A
  • blind approach often (not considered a blind approach)
  • no view of laryngeal aperture if poor grade DL
  • Lack of rigidity
31
Q

Combitude pros

A
  • User friendly
  • potential more secure than LMA but less than ETT (pushes air and hopes it goes through)
  • quicker to prepare than some other difficult airway equipment
32
Q

Combitude cons

A
  • less secure than ETT
  • potential for leaks around the cuffs (difficult ventilation or aspiration risk)
  • traumatic
33
Q

Last resort effort when you are on the verge of respiratory collapse

A

criciothyroidotomy

34
Q

criciothyroidotomy pros

A
  • most direct access to trachea
  • may be only route of access (facial trauma)
  • quick with experience
  • can be converted for long term vent
35
Q

criciothyroidotomy cons

A
  • rare to use (few people have significant experience, MD only)
  • invasive (not for normal surgery, emergency only)
36
Q

Post Difficult airway considerations

A
  • check teeth/lips for trauma (suction blood)
  • ensure ETT cuff still intact
  • decadron to decrease swelling
  • OG suction air from stomach (likely after aggressive BMV)
  • strict emergence criteria to protect airway
37
Q

Decadron dose to decrease swelling post difficult intubation

A

8-10 mg

38
Q

What drug should you use post difficult intubation to decrease swelling

A

decadron

39
Q

Strict emergence criteria post difficult airway intubation

A

Des vs sevo
Tight narcotic control (don’t collapse their airway more)
Adequate NMBD reversal

40
Q

Post difficult intubation identification of vocal cord damage

A
  • hoarseness
  • loss of vocal ability
  • difficulties breathing
  • granulomas long term

Plan/Prep II exam 1 (1 decks)

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