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Principles I* > E2- Airway Equipment I > Flashcards

E2- Airway Equipment I Flashcards

1
Q

This airway equipment allows gas administration to patient from breathing system without any apparatus in patient’s mouth.
May be used for entire anesthetic

A
  • Face Mask
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2
Q

The administration of oxygen before induction of anesthesia.

A
  • Preoxygenation
  • Denitrogenation
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3
Q

What are 3 components of Face Mask?

A
    • Body- Transparent … Provides shape
    • Seal - Inflatable cushion … 20 to 25 cm H2O with minimal leak
    • Connector- 22 mm internal diameter … circular ring with prongs for straps

may have :: pacifier, ports, scent

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4
Q

What is the pressure of the pneumatic cushion?

A

20-25 cmH2O with minimal leak

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5
Q

Criteria associated with difficult mask ventilation

A
  • Obese, BMI > 30 kg/m2
  • Beard (big bushy ones)
  • Edentulousness
  • Snore/OSA
  • Elderly >55,
  • Male
  • Mallampata 3 or 4

OBESE M

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6
Q

Importance of proper hand placement with mask ventilation?

A

Don’t compress facial artery or nerve

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7
Q

Ways to Overcome Difficult Mask Ventilation

A
  • OPA or NPA
  • Two-handed technique
  • Cut beard
  • Tegaderm over mouth to create seal for face mask
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8
Q

^^

What should you NOT give if your patient can not mask ventilate?

A
  • Do not give paralytics
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9
Q

What should you do if you can not mask ventilate the patient?

A
  • Emergency adjunct (difficult airway algorithm)
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10
Q

What might be used to hold the face mask in place and allows CRNA’s hand to be free?

What should the pt be doing?

A
  • Mask Straps
  • Pt should be spontaneously breathing + adequately sedated/comfortable
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11
Q

What is an OPA and how does it work?

A
  • oropharyngeal airway is a device used to maintain or open the airway
  • lifts **tongue + epiglottis away from posterior pharyngeal wall. **
  • decreases WOB during spontaneous ventilation.
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12
Q

Why should you not put an OPA in an awake patient?

A
  • Patient will fight you
  • Gag reflex still intact - aspiration rx
  • High risk of laryngospasm
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13
Q

Criteria for OPA removal?

A
  • pt is awake enough to remove it
  • follows commands
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14
Q

Most OPA are made of _______

A
  • Plastic
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15
Q

The bite portion of an OPA must be firm enough that the patient cannot close the lumen by ________.

A
  • biting (duh)
  • make sure pt has good teeth to use
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16
Q

The OPAs are color-coded by size, which is measured in ______.

A
  • millimeters
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17
Q

How should size of OPA be determined?

A
  • OPA should be used to measure from the corner of mouth to the angle of the mandible or the earlobe for appropriate sizing.
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18
Q

What 2 reflexes should be depressed when placing OPA?

A
  • Pharyngeal Reflexes
  • Laryngeal Reflexes

NPA = reflexes are intact

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19
Q

What are 2 methods to OPA insertion?

A
  • Approach with OPA backward and use 180-degree turn method
  • Use a tongue depressor to insert OPA method

Ericksen = just a jaw lift + put in

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20
Q

Why is a bite block used?

A
  • Prevents patient from biting on the ETT, bronchoscope, or endoscope
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21
Q

Bite block placement? Pt condition with insertion?

A
  • A bite block is placed between the upper and lower teeth or gums
  • Put in before going to sleep - hard to get jaw open through stages of anesthesia
22
Q

A type of airway adjunct designed to be inserted through the nasal passage down into the posterior pharynx to secure an open airway.

A
  • Nasopharyngeal airway (NPA)
  • Nasal trumpet
23
Q

NPAs are tolerated in patients with intact _________.

A
  • Airway Reflexes
24
Q

When would NPA be contraindicated? 5

A
    • Basilar skull fracture
    • Nasal deformity
    • Hx of epistaxis
    • Pregnancy (very vascular)
    • Coagulopathy
25
Q

NPAs are preferably used with these patients

A
  • Loose Teeth
  • Oral Trauma
  • Gingivitis
  • Limited Mouth Opening
26
Q

Design of NPA

A
  • Resembles shortened tracheal tube
  • Flange - outer end … to prevent complete passage
  • Less stimulating than OPA
  • Sized by outer diameter in French scale
27
Q

How should the size of the NPA be determined?

A
  • Nostril to external auditory meatus
28
Q

How can you mitigate epistaxis during NPA insertion?

A
  • Lubricate NPA thoroughly
29
Q

The bevel of the NPA should rest ______ above the _______.

A
  • 10 mm above the Epiglottis
30
Q

What are 6 complications of airways (opa/npa) ?

A
  • Airway obstruction (incorrect placement)
  • Ulceration of the nose or tongue - *prone or lateral *position
  • Dental/oral damage
  • Laryngospasm
  • Latex allergy (some older NPAs usually green in color)
  • Retention/swallowing
31
Q

Airway device that can be inserted into the pharynx to allow ventilation, oxygenation, and administration of anesthetic gases without the need for endotracheal intubation.

This was the intermediate bridge between a face mask and ETT.

A
  • Supraglottic Airway

Can be used in both spontaneous ventilation and PPV

32
Q

What is a supraglottic ariway?
Who created?

A
  • *Bridge bw facemask + tracheal ETT
  • Dr. Archie Brain
33
Q

The LMA classic is shaped like a ________ proximally.

A
  • Tracheal Tube
34
Q

The LMA classic is shaped like a ________ mask distally.

A
  • Elliptical (face mask)
35
Q

Where does the LMA classic sit when inserted properly?

A
  • Sits in hypopharynx and surrounds supraglottic structure
  • An inflatable cuff provides seal
36
Q

What is the LMA Classic not compatible with?

A

MRI - d/t metal spring (needs to be plastic)

37
Q

%%%%%%%%%%

How big of a syringe is needed to inflate an LMA classic?

How much pressure of water is needed to inflate the LMA classic?

A
  • 20 cc syringe
  • 60 cmH2O
38
Q

LMA Sizing Chart to Memorize.

A

neonates = 1
infants = 1.5-2.5 *only 2 half sizes
children = 2-3
adults = 4-6

39
Q

What happens if LMA size is too small?

A
  • Gas leaks during positive pressure
40
Q

What happens if LMA size is too large?

A
  • Won’t seat over glottis
  • Greater incidence of sore throat
  • Possible pressure on lingual, hypoglossal, and recurrent laryngeal nerves
41
Q

%%%%%%%%%%%%%%%%

How many LMAs should you take out during pre-op?

A
  • Two LMA’s
  • The size that you think and one size above or below
42
Q

Insertion of LMA

A
  • Needs to be well lubricated; cuff down
  • Deflate cuff as much as possible
  • Place LMA upward towards the **hard palate **
  • Follow the** posterior pharyngeal wall **
  • Smooth motion
  • Should feel it curve downward in the airway, then come to a stop
  • Inflate balloon
43
Q

When the LMA balloon is inflated, what happens to the patient’s neck?

A
  • Neck bulges + LMA may “rise” slightly
44
Q

What can you do to troubleshoot a difficult LMA placement?

A
  • Jaw lift
  • Pull tongue forward
  • Slightly inflate the balloon
  • Change to a different technique
45
Q

What is an LMA unique? How is it different + similar from Classic?

A
  • Made of PVC
  • STIFFER cuff is less compliant than LMA classic
  • Same insertion technique of LMA classic
46
Q

What is an LMA Proseal?

A
  • Wired reinforced LMA
  • Shorter than Classic LMA
  • Gastric access - OGT can be passed through to deflate the stomach to decrease the risk of aspiration
47
Q

What is an IGEL LMA?

A
  • LMA with NO CUFF
  • Medical-grade **thermoplastic elastomer **
  • The LMA conforms to create an anatomical seal of the** pharyngeal, laryngeal, and peri**-laryngeal structure
  • Gastric access - OGT
  • Conduit for intubation
48
Q

Which LMA creates the most adequate seal of the supraglottic structure?

A
  • IGEL LMAs
  • lowest aspiration risk
49
Q

5 Advantages of LMA

A
  • Ease and speed of placement (as fast as 5 secs)
  • Improved hemodynamic stability
  • Reduced anesthetic requirements
  • No muscle relaxation needed
  • Avoidance of some of the risks of tracheal intubation
50
Q

3 Disadvantages of LMA

A
  • Smaller seal pressures than ETTs
  • No protection from laryngospasm
  • Little protection from gastric regurgitation and aspiration (First-generation LMA: LMA Classic and LMA Unique)
51
Q

Name First Generation LMAs

A
  • LMA Classic
  • LMA Unique
52
Q

Name Second Generation LMAs.
Why are they different?

A
  • LMA Proseal
  • LMA IGEL
  • have a gastric outlet

Principles I* (20 decks)

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