Exam 2 Airway Equipment: Part 1 (6/25/24)

Question 1

Face Mask uses:

Answer 1

• Allows gas administration to the patient from the breathing system without any apparatus in patients mouth
• Preoxygenation/denitrogenation
• Used in order to provide positive pressure through unprotected airway

Question 2

True or False: Face masks are only used for induction

Answer 2

False:
May be used for entire anesthetic case (Ear procedures)

Question 3

Pressure required for adequate seal when using a face mask:

Answer 3

20-25 cm H2O

Question 4

Why might one be labeled as a “difficult mask ventilation”?

Answer 4

Male
Over 55
Beard
Edentulousness
OSA/snoring
BMI > 30

Question 5

How can we overcome a difficult mask ventilation?

Answer 5

• Oral airway OR nasopharyngeal airway
• Two-handed technique
• Cut the beard
• Use a Tegaderm

Question 6

Uses of an OPA?

Answer 6

• Lifts tongue and epiglottis away
• Decreases work of breathing during Spontaneous ventilation

Question 7

When are OPA’s poorly tolerated by patients?

Answer 7

When they are awake

Question 8

When is the apropriate time to remove the OPA?

Answer 8

When the patient can remove it themselves

Question 9

Why might we decide not to use an OPA?

Answer 9

If the patient likes meth

Question 10

Sizes of OPA’s are designated in ___

Answer 10

Millimeters

Question 11

What is the best way to measure for correct OPA sizing?

Answer 11

Corner of mouth to the angle of the jaw or the earlobe

Question 12

True or False:
Pharyngeal and Laryngeal reflexes must be paralyzed in order to insert an OPA?

Answer 12

False:
They only need to be DEPRESSED!

Question 13

2 methods of OPA insertion per Dr. Ericksen

Answer 13

Tongue Depressor Method
4x4/Gauze Method

Question 14

Procedures in which a Bite block are commonly used:

Answer 14

Endoscopy
Bronchoscopy

Procedures where mouth is the surgical access.

Question 15

When is the best time to put a bite block in?

Answer 15

Either when they are awake and can understand the need for it or during the “propofol yawn”.

Question 16

Nasopharyngeal Airways are preferred when the patient has: (4)

Answer 16

• Loose teeth
• Oral Trauma
• Gingivitis
• Limited Mouth Opening

Tolerated in patients with intact airway reflexes.

Question 17

When are NPA’s contraindicated? (5)

Answer 17

• Basilar skull fracture
• Nasal deformity
• Hx of epistaxis (not 100% Contraindicated)
• Anti-Coagulants / Coagulopathy
• Pregnancy (very vascular)

Question 18

What prevents complete passage of an NPA through the airway?

Answer 18

A flange at the outer end of the NPA

Question 19

NPA vs OPA:
Which of the two is MORE stimulating than the other?

Answer 19

OPA’s are more stimulating

Question 20

Sizing Scale used for NPA’s:

Answer 20

Outer diameter is sized in French scale

Question 21

Best way to measure the correct size of an NPA?

Answer 21

Bony mandible or nostril to the external auditory meatus

Nose-to-Ear

Question 22

Airway complications that can arise with the use of an Airway (OPA or NPA): (6)

Answer 22

• Airway obstruction (incorrect placement)
• Ulceration of nose or tongue (prone, lateral position = don’t use)
• Dental/oral damage
• Laryngospasm
• Latex allergy (some older NPAs usually green in color)
• Retention/swallowing

Question 23

Difference between 1st Gen and 2nd Gen LMAs:

Answer 23

1st Gen LMAs do not have a gastric tube lumen whereas 2nd Gens do

Question 24

Where should the LMA classic sit?

Answer 24

In the hypopharynx and surrounds the supraglottic structure

Question 25

Is the LMA classic MRI Compatible?

Answer 25

NO!

Question 26

# LMA sizing What LMA would you use for the following patients? Infants between 5-10kg Adults 50-70kg

Answer 26

Infants between 5-10kg: **1.5** Adults 50-70kg: **4**

Question 27

# LMA sizing What LMA would you use for the following patients? Adults over 100 kg: Children 30-50 kg:

Answer 27

Adults over 100 kg: **6** Children 30-50 kg: **3**

Question 28

# LMA sizing What patients would require these sized LMAs? LMA Size 1: LMA size 5:

Answer 28

LMA Size 1: **Neonates/infants up to 5 kg** LMA size 5: **Adults 70-100 kg**

Question 29

# LMA sizing What patients would require these sized LMAs? LMA Size 2: LMA Size 2.5:

Answer 29

LMA Size 2: **Infants/children between 10-20 kg** LMA Size 2.5: **Children between 20-30 kg**

Question 30

If an LMA size is too small, what may occur?

Answer 30

Gas leaks during positive pressure Too small = won’t cover the supraglottic area…

Question 31

If an LMA size is too large, what may occur?

Answer 31

* Won’t seat over glottis (likely going to pop out of the mouth during inflation) * Greater incidence of **sore throat** * Possible **pressure** on *lingual, hypoglossal, and recurrent laryngeal nerves*

Question 32

Insertion Technique for an LMA

Answer 32

1. Well-Lubricated & Cuff Down. 2. Held Like a Pencil 3. Upward against the **hard palate** 4. Follows the **posterior pharyngeal wall** *Smooth motion* 5. Should feel it curve around downward in the airway then come to a stop

Question 33

How would we know that the balloon in the LMA is functioning properly after inflating it?

Answer 33

The patient's neck bulges and LMA may “rise” up slightly

Question 34

Techniques for a "difficult" insertion of an LMA: (4)

Answer 34

* Jaw Lift * Pull the tongue forward * Slightly inflate the balloon - (Sometimes the tip can flip up or down if it is completely deflated) * Switch to a different technique

Question 35

Describe the LMA Unique:

Answer 35

* Single use, disposable * Made of PVC * **Stiffer, cuff less compliant** vs LMA Classic * Insertion same; resembles LMA Classic Unique = PVC/ Stiffer than the Classic.

Question 36

This type of LMA is wire reinforced, is shorter than a Classic LMA and has the ability to place an OG tube.

Answer 36

LMA Proseal | 2nd Gen LMA The PRO is 2nd Gen + OGT (It’s a Pro!)

Question 37

The IGEL LMA provides a noniflatable, anatomical seal of these 3 structures:

Answer 37

1. Pharyngeal 2. Laryngeal 3. Perilaryngeal

Question 38

What kind of LMA is this?

Answer 38

IGEL LMA (No cuff)

Question 39

Advantages to using an LMA (5):

Answer 39

* Ease and speed of placement * Improved hemodynamic stability - (Less VA) * Reduced anesthetic requirements * No muscle relaxation needed - (No paralytic) * Avoidance of some of the risks of tracheal intubation (Coughing reduced if sized appropriately).

Question 40

One disadvantage of using an LMA is that there is a smaller seal pressure compared to ETT. What can this cause an increased risk of?

Answer 40

Inadequate ventilation (May req. higher pressures d/t position (surrounding the supraglottic area as opposed to being passed the vocal cords.)

Question 41

True or False: LMAs have no protection from laryngospasm?

Answer 41

True

Question 42

Which LMA provides the best protection from gastric regurgitation and aspiration?

Answer 42

1. IGEL 2. 2nd Gen > 1st Gen (OGT)

Question 43

What size Mac blades should be used for adults?

Answer 43

3 and #4

Question 44

What size Miller blades should be used for Adults?

Answer 44

2 and #3

Question 45

Cervical spine movement comparison between Mac and Miller Blades?

Answer 45

Mac: cause greater cervical spine movement Miller: cervical spine movement is less

Question 46

Which blade would you want to use on this person and why?

Answer 46

Miller Blade: Great for smaller mouths and longer necks

Question 47

Describe what you should be visualizing and what point you are targeting for a Mac blade: (3)

Answer 47

1. Visualize the epiglottis 2. Advance the tip of the blade into the vallecula. 3. Lift/Provide pressure at a Right Angle to the Blade.

Question 48

With a Miller blade, you will lift the ____. If it is inserted too far it could elevate the ___ or ___.

Answer 48

Epiglottis Larynx or Esophagus

Question 49

Optimal position for direct Laryngoscopy: Describe this position (2):

Answer 49

"Sniffing Position" 1. 35 degree lower cervical flexion; 2. 80 to 90 degree head extension at the atlanto-occipital level

Question 50

In the Sniffing position, we want to create an imaginary horizontal line connecting these 2 landmarks.

Answer 50

The external auditory meatus and sternal notch

Question 51

If we encounter a difficult airway while performing direct laryngoscopy, what techniques can we use to ensure proper placement?

Answer 51

* Flexible **fiberoptic** scope or **video largyngoscope** * Maintain a *neutral position* and use of an **OPA** * Can perform **awake** (not only asleep)

Question 52

BURP technique: What does it stand for and what it is used for?

Answer 52

Used to displace the larynx * Backward * Upward * Rightward * Pressure

Question 53

Using the BURP technique should align these 3 axis':

Answer 53

Oral Pharyngeal Laryngeal

Question 54

Describe positioning needs for an obese patient during direct laryngoscopy: What assistive devices may be required?

Answer 54

Obese pts require elevation of the shoulders and upper back (Ramped Position) Troop Elevation Pillow Folded Blankets

Question 55

For an obese patient undergoing direct laryngoscopy, we want to create an imaginary horizontal line connecting these 2 landmarks:

Answer 55

The external auditory meatus and sternal notch | (Same as Sniffing Position)

Question 56

OPAs are sized by ___ (units); NPAs are sized by ____ (units)

Answer 56

OPA = mm NPA = French

Question 57

Is an OPA or NPA less stimulating?

Answer 57

NPA

Question 58

What position do we not use an OPA or NPA? (2)

Answer 58

Lateral or Prone Too much pressure can lead to ulceration

Question 59

What hand do we hold the laryngoscope in ?

Answer 59

Non-dominant (Left-hand)

Question 60

Insertion of Laryngoscope? What does the Tongue of the blade do? What does the tip of the blade do?

Answer 60

Right corner of the mouth and sweep toward the middle. Tongue: Manipulates and compresses soft tissue Tip: Directly or indirectly elevates epiglottis (MAC vs Miller)

Question 61

Macintosh blades can be considered easier bc…

Answer 61

The blade is bigger requiring adequate mouth opening and improved view of the epiglottis/glottis. This is why Millers are preferential for small mouths and long necks.

Question 62

Which blade has improved force, head extension, and cervical spine movement (less)?

Answer 62

Miller Blade

Question 63

Which (Mac or Miller) directly lifts the Epiglottis?

Answer 63

Miller