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Mar: Sem 3 - Principles I > Exam 2 Airway Equipment I [6/25/24] > Flashcards

Exam 2 Airway Equipment I [6/25/24] Flashcards

1
Q

This airway equipment allows gas administration to the patient from the breathing system without any apparatus in the patient’s mouth.

A
  • Face Mask

S3

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2
Q

The administration of oxygen before induction of anesthesia does what?

A
  • Preoxygenation
  • Denitrogenation

S3

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3
Q

Can a face mask be used for entire anesthetic?

A

yes, may be used for entire anesthetic
* for example: non invasive cases, or pedatric cases

S3

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4
Q

What is the goal of masking?

A

to provide positve pressure

S3- lecture

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5
Q

How do we know if we are masking appropriately?

A
  • chest rise
  • tidal volume
  • ETCO2
  • O2 saturations

S3-lecture

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6
Q

What are the three components of the 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

S4

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7
Q

Face Mask may have scent, pacifier or ports. What are these?

A
  • Scent: for pediatrics to spray good scents
  • Pacifier: attached to the mask which also allows for gas inhalation.
  • Ports: little hole where the endoscopist can perform the bronch.

S4-lecture

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8
Q

What is one-handed method placement for face mask?

A
  • C shaped
  • Dont smother the face or you’ll compress the facial nerve/artery.

S5- lecture

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9
Q

What is the two-handed method/technique for face mask?

A
  • Double C + chin lift
  • someone else bags for you
  • Use: Pt with big face, edentulous [no teeth]

S6- lecture

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10
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

S-7

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11
Q

Ways to Overcome Difficult Mask Ventilation

A
  • Oral airway OR nasopharyngeal airway [if no CI for nasopharngeal, insert it bc oral can be hard to place]
  • Two-handed technique
  • Cut the beard (let the pt know beforehand)
  • Tegaderm over mouth to create seal for face mask

S8

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12
Q

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

A
  • Do not give paralytics

S8- Andy

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13
Q

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

A
  • Emergency adjunct (difficult airway algorithm)
  • wont have test question on this alogrhytm

S8

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14
Q

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

A
  • Mask Straps

S9

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15
Q

When should you use mask straps?
When should you NOT use mask straps?

A
  • Use for:
    • large face, large beard
    • no teeth
    • need hands free for other task
    • sponatenous ventilation [pt can be sedated to be comfortable]
  • Dont use for:
    • controlled ventilation

S9-lecture

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16
Q

What is an OPA and how does it work?

A
  • An oropharyngeal airway is a device used to maintain or open the airway by lifting the tongue and epiglottis away from the posterior pharyngeal wall.
  • OPA decreases the work of breathing during spontaneous ventilation.

S11

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17
Q

When should you remove the OPA?

A
  • remove when pt is ready to remove it. This means they can support their own airway
  • OPA are poorly tolerated in awake pts

S11 lecture

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18
Q

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

A
  • Patient will fight you
  • Gag reflex still intact
  • High risk of laryngospasm

S11- Andy

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19
Q

Most OPA are made of ____

A
  • Plastic

S12

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20
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 when using this, if poor dentition dont use

S12

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21
Q

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

A
  • millimeters
  • not all OPA’s are color coded, the size will be on the side

S12

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22
Q

How should the size of the OPA be determined?

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

S13

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23
Q

What reflexes should be depressed when placing an OPA?

A
  • Pharyngeal Reflexes
  • Laryngeal Reflexes

S13

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24
Q

What are the two methods to OPA insertion?

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

S13

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25
Q

Why is a bite block used?

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

S14

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26
Q

Bite block placement

A
  • A bite block is placed between the upper and lower teeth and gums

S14

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27
Q

When pt is getting endoscopy, when do you place the bite block?

A

While the pt is awake, before the pt goes to sleep because they start clinching when going to sleep

S14- lecture

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28
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

S15- Andy

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29
Q

NPAs are tolerated in patients with intact ____.

A
  • Airway Reflexes

S15

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30
Q

When would NPA be contraindicated?

A
  • Basilar skull fracture
  • Nasal deformity
  • Hx of epistaxis [not an absolute CI]
  • Pregnancy (very vascular)
  • Coagulopathy
  • Chronic NSAID use

Nasal Contraindications Consist of Boring Patient Histories

S15

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31
Q

NPAs are preferably used with these patients

A
  • Loose Teeth
  • Oral Trauma
  • Gingivitis
  • Limited Mouth Opening
  • poor dentention

S15

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32
Q

Design of NPA

A
  • Resembles shortened tracheal tube
  • Flange at outer end to prevent complete passage
  • Less stimulating than OPA
  • Sized by outer diameter in French scale [10-36]

S16

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33
Q

Correct size is important for NPA, how should the size of the NPA be determined?

A
  • Nostril to the external auditory meatus

S17

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34
Q

How can you mitigate epistaxis during NPA insertion?

A
  • Lubricate NPA thoroughly

S17

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35
Q

The bevel of the NPA should rest above the ____.

A
  • Epiglottis
  • 10 mm above the epiglottis

S17- andy

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36
Q

What should you do if unable to insert NPA in one nostirl?

A
  • do not force
  • remove and insert in the other nostril
  • make sure adequate lubrication

S17-lecture

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37
Q

What are some complications of airways ?

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

DULLAR

S18

38
Q

when is airway obstruction usually complication of airway placement?

A
  • usually seen with OPA bc it’ll sit in the hardpalate. Pt will be desatting or unable to to get adequate Vt.
  • Can protude out.

S18-lecture

39
Q

How do you prevent the complication of retention/swallowing of an airway?

A

size appropriately

S18-lecture

40
Q

Why would a laryngospasm occur as a complication of airways?

A

pt is inadequetly anestheized

S18- lecture

41
Q

When should you remove an NPA or OPA?

A
  • When the patient can remove the NPA or OPA themselves
  • Follow commands

might be a duplicate

42
Q

When would you not want to place in OPA?

A
  • when pts are prone b/c of the added pressure can cause ulceration of nose/tongue
  • also wont be able to assess for problems

S18-lecture

43
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

S20

44
Q

Who created the Supraglottic Airway?

What year was it created?

A
  • Dr. Archie Brain
  • 1982/1983

S20

45
Q

What is the benefit of SGA/LMA?

A

less invasive

S20

46
Q

The LMA classic is shaped like a ____ proximally.

A
  • Tracheal Tube

S21

47
Q

The LMA classic is shaped like a ____ mask distally.

A
  • Elliptical

S21

48
Q

Where does the LMA classic sit when inserted properly?
What provides the seal?

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

S21

49
Q

The LMA classic is ____ free and can be ____, or ____

A

latex free
reusable
disposable

S21

50
Q

When can SGA or LMA be used?

A
  • Can be used in both spontaneous ventilation and PPV

S20

51
Q

The following LMA sizes are used on what patient sizes?
* 1
* 1.5
* 2
* 2.5
* 3
* 4
* 5
* 6

A

S22-Erickson we need to know this chart!

52
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

andy

53
Q

Some LMA Classics are “reusable.” How many times can they be reused, according to Dr. Ericksen?

A
  • 40 times

S21???

54
Q

Whats the difference between 1st and 2nd generation of SGA/LMA?

A
  • 1st: doesnt have gastric lumen so cant have a gastric tube
  • 2nd: has gastric lume.

S20

55
Q

What happens if the LMA size is too small?

A
  • Gas leaks during positive pressure

S23

56
Q

What happens if the 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

S23

57
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

S23- lecture???

58
Q

Insertion of LMA

A
  • Needs to be well lubricated; cuff down
  • Deflate the cuff as much as possible
  • held like a pencil
  • 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

S24

59
Q

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

A
  • Neck bulges and LMA may “rise” slightly

S25

60
Q

What can you do to troubleshoot a difficult LMA placement?

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

Just Perform Slight Changes if you have a difficult time placing an LMA

S25

61
Q

What is an LMA unique?

A
  • Single-use and disposable LMA device
  • Made of PVC
  • Stiffer: cuff is less compliant than LMA classic
  • Same insertion technique of LMA classic
  • Easier to place than the Classic LMA

MESS

S26

62
Q

What is an LMA Proseal?

A
  • Wire reinforced LMA
  • Shorter than Classic LMA
  • Gastric access - OGT can be passed through to decompress the stomach to decrease the risk of aspiration

S27

Must have right size and be seated correctly in order to get gastric access

63
Q

Why would CRNAs have reservations about placing LMAs in diabetic patients?

A
  • Gastroparesis in DM pt leading to ↑ aspirations
  • D/t autonomic neuropathy affecting the vagus nerve.
  • Chronic hyperglycemia can damage the vagus nerve.
  • Gastroparesis has been reported in 30-50% of Type I and II diabetics.
  • Food can still be in the stomach > 48 hours. Your mileage may vary…

????

64
Q

What is an IGEL LMA?

A
  • LMA with no cuff
  • Medical-grade thermoplastic elastomer
  • Noninflatable, anatomical seal of the pharyngeal, laryngeal, and peri-laryngeal structure (seat well w/ good airway protection)
  • Gastric access - OGT
  • Conduit for intubation
    Con Gel Might Not Last

S28

65
Q

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

A
  • IGEL LMAs

S28- lecture

66
Q

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

S30

67
Q

Disadvantages of LMA

A
  • Smaller seal pressures than ETTs (seal pressure to seal glottis is lower than ETT which increases risk of inadequate ventilation d/t not being passed through vocal cords)
  • Ineffective ventilation when higher pressures are needed.
  • No protection from laryngospasm
  • Little protection from gastric regurgitation and aspiration (First-generation LMA: LMA Classic and LMA Unique)

S31 and lecture

68
Q

List the LMA types from best to worst for prevention of gastric regurgitation and aspiration

A

IGEL
LMA proseal
Unique and Classic

S31 and lecture

69
Q

Name First Generation LMAs

A
  • LMA Classic
  • LMA Unique

S31 and lecture

70
Q

Name Second Generation LMAs

A
  • LMA Proseal
  • LMA IGEL
71
Q

What are the parts of a direct rigid laryngoscope?

A
  • Manufactured as a single piece or detachable blade/handle
  • light source is light bulb or fiberoptic
  • Handle
  • Blade

S33

72
Q

Describe the Handle of a direct Rigid laryngoscope

A
  • Part held in hand [usually non-dominant hand]
  • Provides power for light…. most use disposable batteries
  • Most form right angle to blade when ready for use

S33

73
Q

Describe the blade of the Direct Rigid Laryngoscope

A
  • Inserted into mouth
  • Different sizes; increasing number = increased size
  • Tongue: manipulates and compresses soft tissue
  • Tip: directly or indirectly elevates epiglottis

S33

74
Q

Most blade alterations change the ____ from the ____ to ____ and there are differences as noted in how they are used.

A

angle
tongue to handle

S34

75
Q

what are the 2 types of rigid direct Laryngoscopes

A

Macintosh and Miller

S35

76
Q

Describe a Macintosh Blade

A
  • Tongue has gentle curve
  • # 3 and #4 useful for adults
  • Has been shown to cause greater cervical spine movement than with Miller
  • Makes intubation easier because blade requires adequate mouth opening due to blade size

S35

77
Q

Describe Miller Blades

A
  • Tongue is straight with slight upward tip
  • # 2 and #3 for adults
  • Force, head extension, and cervical spine movement is less
  • Great for smaller mouths and longer necks

S35

78
Q

How do you view the epiglottis with macintosh?

A
  • After epiglottis is visualized, tip advanced into vallecula
  • Pressure at right angle of the blade and the handle to move base of tongue and epiglottis forward to lift the vallecula (epiglottis lifts up like a garage door and you can drive the tube in per erickson)
  • Can be used like Miller to elevate tip of epiglottis

S36

79
Q
  • How do you view the epiglottis with a miller blade?
  • What happens if the blade is inserted too far?
  • What happens if the blade is withdrawn too far?
A
  • Blade lifts epiglottis
  • If blade inserted too far, it elevates larynx or esophagus
  • If withdrawn too far, epiglottis flips down and covers glottis
  • Can use like a Macintosh to insert into the vallecula

S37

80
Q

Describe the optimal positioning for laryngoscopy

A
  • “Sniffing” position is ideal
    • 35 degree lower cervical flexion; 80 to 90 degree head extension at the atlanto-occipital level
    • Create an imaginary horizontal line connects the external auditory meatus and sternal notch

S38

81
Q

When you advance the blade for laryngoscopy, what are the landmarks you look for with a miller blade?
Mac blade?

A
  • Miller target:
    • vocal cord
    • bypassing the epiglottis
  • MAC target:
    • look for epiglottis
    • slide in velecula
    • see the vocal cords

S41

82
Q

What are the steps for advancing the blade?

A
  • Right hand opens mouth (“scissor”) to keep the lips free to accommodate blade insertion
  • Blade inserted on right side of mouth
  • Advance blade, keeping tongue to left and elevated
  • Epiglottis comes into view

S38

83
Q

What techniques can we use for difficult airways and direct laryngoscopy?

A
  • Flexible fiberoptic scope or video largyngoscope
  • Maintain a neutral position and use of an OPA
  • Can be awake or “asleep”

S39

84
Q

What technique can be used with direct laryngeal laryngoscopy to displace the larynx?

A

BURP
Backward, upward, rightward, pressure

S40

basically, we are moving the larynx to get a better view of the glottis

85
Q

What is SO important in the OR?

A

Positioning!

S41

86
Q

Obese patients require elevation of the ____ and ____.
We place them in a ____ position to create a horizontal line that connects the ____ and ____.

A
  • shoulders and upper back
  • ramped position
  • external auditory meatus and sternal notch

S41

87
Q

What devices can be used to place patients int he ramped position?

A

troop elevation pillow
folded blankets

S41

88
Q

What is the purpose of the blade spatula?

A
  • Compresses the tongue into the mandibular space

andy

89
Q

What is the purpose of the flange?

A
  • The flange (if present) is used to move the tongue laterally and create a visual lumen

andy

90
Q

When using a Mac Blade, after epiglottis is visualized, the tip advanced into the _________.

A

Vallecula

andy

Mar: Sem 3 - Principles I (29 decks)

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