Exam 2 Airway Equipment: Part 1 (6/25/24) Flashcards
Face Mask uses:
- 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
True or False: Face masks are only used for induction
False:
May be used for entire anesthetic case (Ear procedures)
Pressure required for adequate seal when using a face mask:
20-25 cm H2O
Why might one be labeled as a “difficult mask ventilation”?
Male
Over 55
Beard
Edentulousness
OSA/snoring
BMI > 30
How can we overcome a difficult mask ventilation?
- Oral airway OR nasopharyngeal airway
- Two-handed technique
- Cut the beard
- Use a Tegaderm
Uses of an OPA?
- Lifts tongue and epiglottis away
- Decreases work of breathing during Spontaneous ventilation
When are OPA’s poorly tolerated by patients?
When they are awake
When is the apropriate time to remove the OPA?
When the patient can remove it themselves
Why might we decide not to use an OPA?
If the patient likes meth
Sizes of OPA’s are designated in ___
Millimeters
What is the best way to measure for correct OPA sizing?
Corner of mouth to the angle of the jaw or the earlobe
True or False:
Pharyngeal and Laryngeal reflexes must be paralyzed in order to insert an OPA?
False:
They only need to be DEPRESSED!
2 methods of OPA insertion per Dr. Ericksen
Tongue Depressor Method
4x4/Gauze Method
Procedures in which a Bite block are commonly used:
Endoscopy
Bronchoscopy
When is the best time to put a bite block in?
Either when they are awake and can understand the need for it or during the “propofol yawn”.
Nasopharyngeal Airways are preferred when the patient has:
- Loose teeth
- Oral Trauma
- Gingivitis
- Limited Mouth Opening
When are NPA’s contraindicated? (6)
- Basilar skull fracture
- Nasal deformity
- Hx of epistaxis (not 100% CI)
- Anti-Coagulants
- Pregnancy (very vascular)
- Coagulopathy
What prevents complete passage of an NPA through the airway?
A flange at the outer end of the NPA
NPA vs OPA:
Which of the two is MORE stimulating than the other?
OPA’s are more stimulating
Sizing Scale used for NPA’s:
Outer diameter is sized in French scale
Best way to measure the correct size of an NPA?
Bony mandible or nostril to the external auditory meatus
Airway complications that can arise with the use of an NPA: (6)
- 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
Difference between 1st Gen and 2nd Gen LMAs:
1st Gen LMAs do not have a gastric tube lumen whereas 2nd Gens do
Where should the LMA classic sit?
In the hypopharynx and surrounds the supraglottic structure
Is the LMA classic MRI Compatible?
NO!
LMA sizing
What LMA would you use for the following patients?
Infants between 5-10kg
Adults 50-70kg
Infants between 5-10kg: 1.5
Adults 50-70kg: 4
LMA sizing
What LMA would you use for the following patients?
Adults over 100 kg:
Children 30-50 kg:
Adults over 100 kg: 6
Children 30-50 kg: 3
LMA sizing
What patients would require these sized LMAs?
LMA Size 1:
LMA size 5:
LMA Size 1: Neonates/infants up to 5 kg
LMA size 5: Adults 70-100 kg
LMA sizing
What patients would require these sized LMAs?
LMA Size 2:
LMA Size 2.5:
LMA Size 2: Infants/children between 10-20 kg
LMA Size 2.5: Children between 20-30 kg
If an LMA size is too small, what may occur?
Gas leaks during positive pressure
If an LMA size is too large, what may occur?
- Won’t seat over glottis
- Greater incidence of sore throat
- Possible pressure on lingual, hypoglossal, and recurrent laryngeal nerves
Insertion Technique for an LMA
- Upward against the hard palate
- Follows the posterior pharyngeal wall
- Smooth motion
- Should feel it curve around downward in the airway then come to a stop
How would we know that the balloon in the LMA is functioning properly after inflating it?
The patient’s neck bulges and LMA may “rise” up slightly
Techniques for a “difficult” insertion of an LMA:
- Jaw Lift
- Pull the tongue forward
- Slightly inflate the balloon
- Switch to a different technique
Describe the LMA Unique:
- Single use, disposable
- Made of PVC
- Stiffer, cuff less compliant vs LMA Classic
- Insertion same; resembles LMA Classic
This type of LMA is wire reinforced, is shorter than a Classic LMA and has the ability to place an OG tube.
LMA Proseal
2nd Gen LMA
The IGEL LMA provides a noniflatable, anatomical seal of these 3 structures:
- Pharyngeal
- Laryngeal
- Perilaryngeal
What kind of LMA is this?
IGEL LMA
(No cuff)
Advantages to using an LMA:
- Ease and speed of placement
- Improved hemodynamic stability
- Reduced anesthetic requirements
- No muscle relaxation needed
- Avoidance of some of the risks of tracheal intubation
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?
Inadequate ventilation
True or False: LMAs have no protection from laryngospasm?
True
Which LMA provides the best protection from gastric regurgitation and aspiration?
IGEL
(2nd Gen’s in general are better due to the gastric outlet availabilty)
What size Mac blades should be used for adults?
3 and #4
What size Miller blades should be used for Adults?
2 and #3
Cervical spine movement comparison between Mac and Miller Blades?
Mac: cause greater cervical spine movement
Miller: cervical spine movement is less
Which blade would you want to use on this person and why?
Miller Blade:
Great for smaller mouths and longer necks
Describe what you should be visualizing and what point you are targeting for a Mac blade:
Visualize the epiglottis and then advance the tip of the blade into the vallecula.
With a Miller blade, you will left the ____.
If it is inserted too far it could elevate the ___ or ___.
Epiglottis
Larynx or Esophagus
Optimal position for direct Laryngoscopy:
Describe this position:
“Sniffing Position”
35 degree lower cervical flexion; 80 to 90 degree head extension at the atlanto-occipital level
In the Sniffing position, we want to create an imaginary horizontal line connecting these 2 landmarks.
The external auditory meatus and sternal notch
If we encounter a difficult airway while performing direct laryngoscopy, what techniques can we use to ensure proper placement?
- Flexible fiberoptic scope or video largyngoscope
- Maintain a neutral position and use of an OPA
- Can perform awake (not only asleep)
BURP technique: What does it stand for and what it is used for?
Used to displace the larynx
* Backward
* Upward
* Rightward
* Pressure
Using the BURP technique should align these 3 axis’:
Oral
Pharyngeal
Laryngeal
Describe positioning needs for an obese patient during direct laryngoscopy:
What assistive devices may be required?
Obese pts require elevation of the shoulders and upper back (Ramped Position)
Troop Elevation Pillow
Folded Blankets
For an obese patient undergoing direct laryngoscopy, we want to create an imaginary horizontal line connecting these 2 landmarks:
The external auditory meatus and sternal notch
(Same as Sniffing Position)
