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Principles of Anesthesia I EXAM 2 (Summer 2024: Monte) > Exam 2 Airway Equipment: Part 1 (6/25/24) COPY > Flashcards

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

1
Q

Face Mask uses:

A
  • 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
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2
Q

True or False: Face masks are only used for induction

A

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

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3
Q

Pressure required for adequate seal when using a face mask:

A

20-25 cm H2O

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4
Q

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

A

Male
Over 55
Beard
Edentulousness
OSA/snoring
BMI > 30

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5
Q

How can we overcome a difficult mask ventilation?

A
  • Oral airway OR nasopharyngeal airway
  • Two-handed technique
  • Cut the beard
  • Use a Tegaderm
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6
Q

Uses of an OPA?

A
  • Lifts tongue and epiglottis away
  • Decreases work of breathing during Spontaneous ventilation
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7
Q

When are OPA’s poorly tolerated by patients?

A

When they are awake

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8
Q

When is the apropriate time to remove the OPA?

A

When the patient can remove it themselves

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9
Q

Why might we decide not to use an OPA?

A

If the patient likes meth
(Poor dentition)

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10
Q

Sizes of OPA’s are designated in ___

A

Millimeters

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11
Q

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

A

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

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12
Q

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

A

False:
They only need to be DEPRESSED!

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13
Q

2 methods of OPA insertion per Dr. Ericksen

A

Tongue Depressor Method
4x4/Gauze Method

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14
Q

Procedures in which a Bite block are commonly used:

A

Endoscopy
Bronchoscopy

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15
Q

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

A

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

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16
Q

Nasopharyngeal Airways are preferred when the patient has:

A
  • Loose teeth
  • Oral Trauma
  • Gingivitis
  • Limited Mouth Opening
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17
Q

When are NPA’s contraindicated?

A
  • Basilar skull fracture
  • Nasal deformity
  • Hx of epistaxis (not 100% CI)
  • Anti-Coagulants
  • Pregnancy (very vascular)
  • Coagulopathy
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18
Q

What prevents complete passage of an NPA through the airway?

A

A flange at the outer end of the NPA

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19
Q

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

A

OPA’s are more stimulating

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20
Q

Sizing Scale used for NPA’s:

A

Outer diameter is sized in French scale

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21
Q

Best way to measure the correct size of an NPA?

A

Bony mandible or nostril to the external auditory meatus

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22
Q

Airway complications that can arise with the use of a NPA:

A
  • 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
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23
Q

Difference between 1st Gen and 2nd Gen LMAs:

A

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

24
Q

Where should the LMA classic sit?

A

In the hypopharynx and surrounds the supraglottic structure

25
Q

Is the LMA classic MRI Compatible?

A

NO!

26
Q

LMA sizing

What LMA would you use for the following patients?

Infants between 5-10kg
Adults 50-70kg

A

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

27
Q

LMA sizing

What LMA would you use for the following patients?

Adults over 100 kg:
Children 30-50 kg:

A

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

28
Q

LMA sizing

What patients would require these sized LMAs?

LMA Size 1:
LMA size 5:

A

LMA Size 1: Neonates/infants up to 5 kg

LMA size 5: Adults 70-100 kg

29
Q

LMA sizing

What patients would require these sized LMAs?

LMA Size 2:
LMA Size 2.5:

A

LMA Size 2: Infants/children between 10-20 kg

LMA Size 2.5: Children between 20-30 kg

30
Q

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

A

Gas leaks during positive pressure

31
Q

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

A
  • Won’t seat over glottis
  • Greater incidence of sore throat
  • Possible pressure on vital nerves
32
Q

Which nerves are at risk of experiencing excess pressure if an LMA is too large?

A
  1. Lingual Nerve
  2. Hypoglossal Nerve
  3. Recurrent Laryngeal Nerve
33
Q

Insertion Technique for an LMA

A
  • 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
34
Q

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

A

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

35
Q

Techniques for a “difficult” insertion of an LMA:

A
  • Jaw Lift
  • Pull the tongue forward
  • Slightly inflate the balloon
  • Switch to a different technique
36
Q

Describe the LMA Unique:

A
  • Single use, disposable
  • Made of PVC
  • Stiffer, cuff less compliant vs LMA Classic
  • Insertion same; resembles LMA Classic
37
Q

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

A

LMA Proseal

2nd Gen LMA

38
Q

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

A
  1. Pharyngeal
  2. Laryngeal
  3. Perilaryngeal
39
Q

What kind of LMA is this?

A

IGEL LMA
(No cuff)

40
Q

Advantages to using an LMA:

A
  • Ease and speed of placement
  • Improved hemodynamic stability
  • Reduced anesthetic requirements
  • No muscle relaxation needed
  • Avoidance of some of the risks of tracheal intubation
41
Q

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?

A

Inadequate ventilation

42
Q

True or False: LMAs have no protection from laryngospasm?

A

True

43
Q

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

A

IGEL
(2nd Gen’s in general are better due to the gastric outlet availabilty)

44
Q

What size Mac blades should be used for adults?

A

3 and #4

45
Q

What size Miller blades should be used for Adults?

A

2 and #3

46
Q

Cervical spine movement comparison between Mac and Miller Blades?

A

Mac: cause greater cervical spine movement

Miller: cervical spine movement is less

47
Q

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

A

Miller Blade:

Great for smaller mouths and longer necks

48
Q

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

A

Visualize the epiglottis and then advance the tip of the blade into the vallecula.

49
Q

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

A

Epiglottis

Larynx or Esophagus

50
Q

Optimal position for direct Laryngoscopy:
Describe this position:

A

“Sniffing Position”

35 degree lower cervical flexion; 80 to 90 degree head extension at the atlanto-occipital level

51
Q

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

A

The external auditory meatus and sternal notch

52
Q

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

A
  • Flexible fiberoptic scope or video largyngoscope
  • Maintain a neutral position
  • Use of an OPA
  • Can perform awake (not only asleep)
53
Q

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

A

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

54
Q

Using the BURP technique should align these 3 axis’:

A

Oral
Pharyngeal
Laryngeal

55
Q

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

A

Obese pts require elevation of the shoulders and upper back (Ramped Position)

Troop Elevation Pillow
Folded Blankets

56
Q

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

A

The external auditory meatus and sternal notch

(Same as Sniffing Position)

Principles of Anesthesia I EXAM 2 (Summer 2024: Monte) (6 decks)

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