E2- Airway Equipment I Flashcards
This airway equipment allows gas administration to patient from breathing system without any apparatus in patient’s mouth.
May be used for entire anesthetic
- Face Mask
The administration of oxygen before induction of anesthesia.
- Preoxygenation
- Denitrogenation
What are 3 components of Face Mask?
- 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
What is the pressure of the pneumatic cushion?
20-25 cmH2O with minimal leak
Criteria associated with difficult mask ventilation
- Obese, BMI > 30 kg/m2
- Beard (big bushy ones)
- Edentulousness
- Snore/OSA
- Elderly >55,
- Male
- Mallampata 3 or 4
OBESE M
Importance of proper hand placement with mask ventilation?
Don’t compress facial artery or nerve
Ways to Overcome Difficult Mask Ventilation
- OPA or NPA
- Two-handed technique
- Cut beard
- Tegaderm over mouth to create seal for face mask
^^
What should you NOT give if your patient can not mask ventilate?
- Do not give paralytics
What should you do if you can not mask ventilate the patient?
- Emergency adjunct (difficult airway algorithm)
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?
- Mask Straps
- Pt should be spontaneously breathing + adequately sedated/comfortable
What is an OPA and how does it work?
- 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.
Why should you not put an OPA in an awake patient?
- Patient will fight you
- Gag reflex still intact - aspiration rx
- High risk of laryngospasm
Criteria for OPA removal?
- pt is awake enough to remove it
- follows commands
Most OPA are made of _______
- Plastic
The bite portion of an OPA must be firm enough that the patient cannot close the lumen by ________.
- biting (duh)
- make sure pt has good teeth to use
The OPAs are color-coded by size, which is measured in ______.
- millimeters
How should size of OPA be determined?
- OPA should be used to measure from the corner of mouth to the angle of the mandible or the earlobe for appropriate sizing.
What 2 reflexes should be depressed when placing OPA?
- Pharyngeal Reflexes
- Laryngeal Reflexes
NPA = reflexes are intact
What are 2 methods to OPA insertion?
- 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
Why is a bite block used?
- Prevents patient from biting on the ETT, bronchoscope, or endoscope
Bite block placement? Pt condition with insertion?
- 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
A type of airway adjunct designed to be inserted through the nasal passage down into the posterior pharynx to secure an open airway.
- Nasopharyngeal airway (NPA)
- Nasal trumpet
NPAs are tolerated in patients with intact _________.
- Airway Reflexes
When would NPA be contraindicated? 5
- Basilar skull fracture
- Nasal deformity
- Hx of epistaxis
- Pregnancy (very vascular)
- Coagulopathy
NPAs are preferably used with these patients
- Loose Teeth
- Oral Trauma
- Gingivitis
- Limited Mouth Opening
Design of NPA
- Resembles shortened tracheal tube
- Flange - outer end … to prevent complete passage
- Less stimulating than OPA
- Sized by outer diameter in French scale
How should the size of the NPA be determined?
- Nostril to external auditory meatus
How can you mitigate epistaxis during NPA insertion?
- Lubricate NPA thoroughly
The bevel of the NPA should rest ______ above the _______.
- 10 mm above the Epiglottis
What are 6 complications of airways (opa/npa) ?
- 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
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.
- Supraglottic Airway
Can be used in both spontaneous ventilation and PPV
What is a supraglottic ariway?
Who created?
- *Bridge bw facemask + tracheal ETT
- Dr. Archie Brain
The LMA classic is shaped like a ________ proximally.
- Tracheal Tube
The LMA classic is shaped like a ________ mask distally.
- Elliptical (face mask)
Where does the LMA classic sit when inserted properly?
- Sits in hypopharynx and surrounds supraglottic structure
- An inflatable cuff provides seal
What is the LMA Classic not compatible with?
MRI - d/t metal spring (needs to be plastic)
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How big of a syringe is needed to inflate an LMA classic?
How much pressure of water is needed to inflate the LMA classic?
- 20 cc syringe
- 60 cmH2O
LMA Sizing Chart to Memorize.
neonates = 1
infants = 1.5-2.5 *only 2 half sizes
children = 2-3
adults = 4-6
What happens if LMA size is too small?
- Gas leaks during positive pressure
What happens if LMA size is too large?
- Won’t seat over glottis
- Greater incidence of sore throat
- Possible pressure on lingual, hypoglossal, and recurrent laryngeal nerves
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How many LMAs should you take out during pre-op?
- Two LMA’s
- The size that you think and one size above or below
Insertion of LMA
- 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
When the LMA balloon is inflated, what happens to the patient’s neck?
- Neck bulges + LMA may “rise” slightly
What can you do to troubleshoot a difficult LMA placement?
- Jaw lift
- Pull tongue forward
- Slightly inflate the balloon
- Change to a different technique
What is an LMA unique? How is it different + similar from Classic?
- Made of PVC
- STIFFER cuff is less compliant than LMA classic
- Same insertion technique of LMA classic
What is an LMA Proseal?
- Wired reinforced LMA
- Shorter than Classic LMA
- Gastric access - OGT can be passed through to deflate the stomach to decrease the risk of aspiration
What is an IGEL LMA?
- 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
Which LMA creates the most adequate seal of the supraglottic structure?
- IGEL LMAs
- lowest aspiration risk
5 Advantages of LMA
- 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
3 Disadvantages of LMA
- Smaller seal pressures than ETTs
- No protection from laryngospasm
- Little protection from gastric regurgitation and aspiration (First-generation LMA: LMA Classic and LMA Unique)
Name First Generation LMAs
- LMA Classic
- LMA Unique
Name Second Generation LMAs.
Why are they different?
- LMA Proseal
- LMA IGEL
- have a gastric outlet
