Exam 3- Airway Equipment I (6/29/23) Flashcards
This airway equipment allows gas administration to the patient from the breathing system without any apparatus in the patient’s mouth.
- Face Mask
The administration of oxygen before induction of anesthesia.
- Preoxygenation
- Denitrogenation
What are the three components of the 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
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
Ways to Overcome Difficult Mask Ventilation
- Oral airway OR nasopharyngeal airway
- Two-handed technique
- Cut the beard (let the pt know beforehand)
- 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 the CRNA’s hand to be free?
- Mask Straps
What is an OPA and how does it work?
- 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.
Why should you not put an OPA in an awake patient?
- Patient will fight you
- Gag reflex still intact
- High risk of laryngospasm
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)
The OPAs are color-coded by size, which is measured in ______.
- millimeters
How should the size of the OPA be determined?
- OPA should be used to measure from the corner of the mouth to the angle of the mandible or the earlobe for appropriate sizing.
What reflexes should be depressed when placing an OPA?
- Pharyngeal Reflexes
- Laryngeal Reflexes
What are the two methods to OPA insertion?
- Approach with OPA backward and use 180-degree turn method
- Use a tongue depressor to insert OPA method
Why is a bite block used?
- Prevents patient from biting on the ETT, bronchoscope, or endoscope
Bite block placement
- A bite block is placed between the upper and lower teeth and gums
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?
- Basilar skull fracture
- Nasal deformity
- Hx of epistaxis
- Pregnancy (very vascular)
- Coagulopathy
- Chronic NSAID use
NPAs are preferably used with these patients
- Loose Teeth
- Oral Trauma
- Gingivitis
- Limited Mouth Opening
Design of NPA
- Resembles shortened tracheal tube
- Flange at 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 the external auditory meatus
How can you mitigate epistaxis during NPA insertion?
- Lubricate NPA thoroughly
The bevel of the NPA should rest above the _______.
- Epiglottis
10 mm above the epiglottis
What are some complications of airways discussed per lecture?
- 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
When should you remove an NPA or OPA?
- When the patient can remove the NPA or OPA themselves
- Follow commands
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
Who created the Supraglottic Airway?
What year was it created?
- Dr. Archie Brain
- 1982/1983
The LMA classic is shaped like a ________ proximally.
- Tracheal Tube
The LMA classic is shaped like a ________ mask distally.
- Elliptical
Where does the LMA classic sit when inserted properly?
- Sits in hypopharynx and surrounds the supraglottic structure
- An inflatable cuff provides seal
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
Some LMA Classics are “reusable.” How many times can they be reused, according to Dr. Ericksen?
- 40 times
LMA Sizing Chart to Memorize.
-_-
What happens if the LMA size is too small?
- Gas leaks during positive pressure
What happens if the LMA size is too large?
- Won’t seat over glottis
- Greater incidence of sore throat
- Possible pressure on lingual, hypoglossal, and recurrent laryngeal nerves
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 the 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 and LMA may “rise” slightly
What can you do to troubleshoot a difficult LMA placement?
- Jaw lift
- Pull the tongue forward
- Slightly inflate the balloon
- Change to a different technique
What is an LMA unique?
- 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
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
Why would CRNAs have reservations about placing LMAs in diabetic patients?
- 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…
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 per lecture?
- IGEL LMAs
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
Disadvantages of LMA
- Smaller seal pressures than ETTs
- 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)
Name First Generation LMAs
- LMA Classic
- LMA Unique
Name Second Generation LMAs
- LMA Proseal
- LMA IGEL
