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JW: Principles of Anesthesia I > Exam 3- Airway Equipment II (7/6/23) > Flashcards

Exam 3- Airway Equipment II (7/6/23) Flashcards

1
Q

Name the components of the laryngoscope.

A
  • Handle
  • Blade
  • Light source (usually fiberoptic)

Manufactured as a single piece or detachable blade/handle

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2
Q

Which hand should handle the laryngoscope?

A
  • Left Hand
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3
Q

Source of power for the laryngoscope light.

A
  • Disposable batteries in the handle of the laryngoscope
  • Typically C-Size Batteries
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4
Q

Most laryngoscope blades form a ________ angle to blade when ready for use.

A
  • right
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5
Q

What does the blade of the laryngoscope do to the tongue and epiglottis?

A
  • Tongue: Manipulates and compresses soft tissue
  • Epiglottis: Tip of blade will directly or indirectly elevates epiglottis
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6
Q

What are the two types of laryngoscope blades?

A
  • Mac (Curved)
  • Miller (Straight)
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7
Q

What is the purpose of the blade spatula?

A
  • Compresses the tongue into the mandibular space
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8
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
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9
Q

Typical Mac sizes for adults

A
  • Mac #3 (most common)
  • Mac #4
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10
Q

Describe the tongue of a Mac blade compared to a Miller blade.

A
  • Mac blade tongue has a gentle curve
  • Miller blade has a straight tongue with a slight upward tip
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11
Q

Typical Miller sizes for adults

A
  • Miller #2 (most common)
  • Miller #3
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12
Q

Which laryngoscope blade has been shown to cause greater cervical spine movement?

A
  • Macintosh Blade
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13
Q

Which laryngoscope blade is great for smaller mouths and longer necks?

A
  • Miller Blade
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14
Q

Which laryngoscope blade will be used to minimize the movement of the cervical spine?

A
  • Miller Blade
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15
Q

Which laryngoscope blade makes intubation easier because the blade requires adequate mouth opening.

A
  • Macintosh Blade
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16
Q

When would you want to use a Miller #3 blade?

A
  • Tall person
  • Long neck
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17
Q

The laryngoscope blade requires less force, less head extension, and less cervical spine movement.

A
  • Miller Blade
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18
Q

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

A

Vallecula

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19
Q

When using a Mac Blade, the pressure applied at the right angle of the blade and the handle moves the ______ and ________forward.

A
  • Base of the tongue
  • Epiglottis
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20
Q

The Miller Blade will lift the ______.

A
  • Epiglottis
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21
Q

If the Miller Blade is inserted too far, what structures can it elevate?

A
  • Larynx
  • Esophagus
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22
Q

What can happen if the Miller Blade is withdrawn too far?

A
  • Epiglottis flips down and covers the glottis
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23
Q

How can the Miller Blade be used as a Macintosh?

A
  • Miller Blade can also be inserted into the vallecula
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24
Q

What is the optimal position for the patient undergoing direct laryngoscopy?

A
  • Sniffing position
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25
Q

The sniffing position will have a ______ degree neck flexion (lower cervical).

The sniffing position will have a ______ degree head extension at the atlanto-occiptal level.

A
  • 35 degree
  • 80-90 degree
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26
Q

In the sniffing position, there should be an imaginary horizontal line that connects the _______ and ________.

A
  • external auditory meatus
  • sternal notch
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27
Q

Steps to inserting laryngoscope blade.

A
  • Right hand opens mouth (“scissor”) to keep the lips free to accommodate blade insertion
  • Insert blade on right side of the mouth
  • Advance blade, keeping tongue to the left and elevated
  • Epiglottis comes into view
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28
Q

What are some interventions for difficult airways?

A
  • Maintain a neutral position and use an OPA
  • Flexible fiberoptic scope
  • Video laryngoscope
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29
Q

What is the maneuver to displace the larynx to get the glottis in view?

A
  • BURP (Backwards Upward Rightward Pressure)
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30
Q

___________ patients will require elevation of the shoulder and upper back.

A
  • Obese

Use ramping technique for these patients so they can have a horiztonal ear to sternal notch line.

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31
Q

What can be used to ramp a patient?

A
  • Troop Elevation Pillow
  • Folded Blankets
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32
Q

Describe a Shikani Optical Stylet.

A
  • Stainless steel lighted stylet with a malleable distal tip
  • Design utilizes an eyepiece for DL
  • Oxygen port for oxygen insufflation
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33
Q

What kind of position will the patient have for a Shikani Optical Stylet?

A
  • Neutral Position

Stylet Inserted Midline.

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34
Q

Shikani Optical Stylet will advance into the trachea with light pressure, and the tip should remain _________ at all times to avoid injury.

A
  • Anterior (pointed up)
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35
Q

Shikani Optical Stylet can be used as a ________, check ETT placement, or placement of double-lumen ETT

A
  • Light wand
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36
Q

Advantages of the Shikani Optical Stylet

A
  • Easy to use for routine and difficult intubations
  • Trachea is visualized. Esophageal intubation should not occur
  • Decreased incidence of sore throat
  • Results in less C-spine movement over conventional laryngoscopy
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37
Q

Disadvantages of the Shikani Optical Stylet

A
  • Longer intubation time
  • Cannot be used with nasal intubation. (not flexible)
  • Cannot be adjusted into a precise direction compared to a traditional malleable stylet
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38
Q

Name the four most common Video Laryngoscopes.

A
  • Glidescope
  • Co-Pilot
  • King
  • McGrath
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39
Q

What are the advantages of using a video laryngoscope?

A
  • Magnified anatomy
  • Some scopes have curved/straight blades to mimic laryngoscopes
  • Operator and assistant can see
  • May result in decreased c-spine movement
  • Further distance from infectious patients
  • Demonstrates correct technique in legal cases
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40
Q

What are the limitations of using a video laryngoscope?

A
  • Requires video system
  • Portability varies (Glidescope needs to be plugged in)
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41
Q

What is the strongest predictor of failure when using a video laryngoscope?

A
  • Altered neck anatomy with the presence of a surgical scar, radiation changes, or mass
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42
Q

Complications of Laryngoscopy

A
  • Dental Injuries
  • Cervical Spinal Cord Injury
  • Swallowing of foreign body (lightbulbs, teeth)
  • Abrasions/Hematoma
  • Lingual/ Hypoglossal nerve injury
  • Arytenoid Subluxation
  • Anterior TMJ dislocation
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43
Q

What is the most frequent anesthesia-related claim?

A
  • Dental Injury
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44
Q

What is most likely damaged during laryngoscopy?

A
  • Upper incisors
  • Restored or weakened teeth
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45
Q

What can help mitigate laryngoscopy-related dental injury?

A
  • Tooth protectors (placed on upper teeth during DL)
  • Protects from blade causing direct surface damage
  • Does not guarantee safety from dental trauma
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46
Q

How do you prevent cervical spinal cord injury during a laryngoscopy?

A
  • Do not aggressively position the head
  • Manual in-line stabilization (remove C-collar before intubation, have neurosurgeon remove C-collar)
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47
Q

What will happen to the tongue if there is a hypoglossal nerve injury?

A
  • Tongue will deviate to the side when it is stuck out
  • Tongue will look wrinkled on the side that it is deviated to
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48
Q

How many teeth does a healthy adult patient have?

A
  • 32 teeth
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49
Q

What ETT properties will contribute to the change in resistance in the breathing system?

A
  • Internal Diameter of the tube
  • Tube Length
  • Configuration changes (if tube knots up)
  • Connectors
50
Q

Manufacturing Requirments of ETT

A
  • Low cost
  • Lack of tissue toxicity
  • Easy sterilization
  • Non-flammability
  • Smooth, non-porous surface
  • Sufficient body to maintain its shape
  • Sufficient wall strength
  • Conforms to patient anatomy
  • Lack of reaction with anesthetic agents and lubricants
  • Latex-free
51
Q

What is the function of having a smooth, non-porous surface of the ETT?

A
  • Prevent/mitigate trauma
  • Prevent/mitigate secretion buildup
  • Allow passage of suction catheter or bronchoscope
52
Q

How does the ETT design decrease kinking?

A
  • Circular internal and external walls
53
Q

What part of the ETT provides an alternate pathway for gas flow?

A
  • Murphy eye
54
Q

What does RAE Tube stand for?

A
  • Ring-Adair-Elwin (RAE) Tube
55
Q

What are the advantages of RAE Tubes?

A
  • Facilitate surgery around the head and neck
  • Temporarily straightened during insertion
  • Increased tube diameter… increased distance from tip to curve
  • Easy to secure
  • Nasal fiberoptic intubation.
56
Q

What are the disadvantages of RAE Tubes?

A
  • Difficult to pass suction/scope
  • Increases airway resistance
57
Q

What are other names for Armored Tubes?

A
  • Reinforced Tube
  • Anode Tube
  • Spiral Embedded Tubes
58
Q

What are the advantages of Armored Tubes?

A
  • Useful when tube is likely to be bent or compressed
  • Resistance to kinking and compression
  • Useful in head, neck, tracheal surgeries
59
Q

What are the disadvantages of Armored Tubes?

A
  • Need a stylet or forceps
  • Difficult to use during nasal intubation
  • Cannot be shortened
  • Tube can be damaged if bitten
60
Q

What makes up the laser-resistant tubes?

A
  • Metallic or silicone/ metal mixture
61
Q

What kind of laser’s do laser-resistant tubes reflect?

A
  • CO2 Laser
  • KTP (Potassium-titanyl-phosphate) Laser
62
Q

What is Laser-Resistant Tube’s cuff filled with?

A
  • The cuff is filled with methylene blue crystals and saline so that, if the laser bursts the cuff, this will be detected quickly by the surgeon.
63
Q

Which cuff is filled first in the Laser-Resistant Tube?

A
  • Distal Cuff first
  • Proximal Cuff second
64
Q

Location of ETT markings

A
  • Bevel side above the cuff
65
Q

How do you read the ETT markings?

A
  • From patient side (balloon) to machine side
66
Q

What are the safety standards of the ETT markings?

A
  • The word oral or nasal or oral/nasal
  • Tube size in ID in mm (7.0, 7.5, etc)
  • Name of manufacturer
  • Graduated markings in centimeters from patient’s end
  • Cautionary note… single use only if disposable
  • Radiopaque marker at patient’s end (CXR for positioning)
67
Q

Inflatable balloon near patient’s end of the tube

A
  • Cuffs
68
Q

Characteristics of an ETT Cuff.

A
  • Strong
  • Tear-resistant
  • Thin
  • Soft
  • Pliable
69
Q

The cuff must not herniate over what part of the ETT?

A
  • Muphy eye
  • Bevel
70
Q

What is the recommended cuff pressure?

How much air is that?

A
  • 18-25 mmHg
  • 8-10 mL of air
71
Q

Monitor cuff pressure frequently with a manometer if using ________, as this causes cuff inflation/expansion.

A
  • Nitrous
72
Q

What are the two different types of cuffs?

Which one is more common?

A
  • High-volume, Low-pressure Cuff (more common)
  • Low-volume, High-pressure Cuff
73
Q

Describe the High-Volume, Low-Pressure Cuffs.

A
  • Thin compliant wall
  • Occludes trachea without stretching tracheal wall
  • Area of contact larger but cuff adapts shape to tracheal wall shape
74
Q

Advantages of High-Volume, Low-Pressure Cuffs

A
  • Easy to regulate pressure
  • Pressure applied to trachea less than mucosal perfusion pressure. (maintains circulation)
  • Low Risk to Tracheal Mucosa
75
Q

Disadvantages of High-Volume, Low-Pressure Cuffs

A
  • More difficult to insert
  • May obscure the view of the tube tip and larynx
  • Cuff is more likely to be torn during intubation
  • More likely to have a sore throat
  • May not prevent fluid leakage
  • Easy to pass NGT, esophageal stethoscopes around cuff
76
Q

Describe the Low-Volume, High-Pressure Cuffs.

A
  • Has small area of contact with trachea
  • Requires large amount of pressure to achieve a seal
  • Distends and deforms the trachea to a circular shape
77
Q

Advantages of Low-Volume, High-Pressure Cuffs.

A
  • Better protection against aspiration
  • Better visibility during intubation
  • Lower incidence of sore throat
78
Q

Disdvantages of Low-Volume, High-Pressure Cuffs.

A
  • Pressure exerted on trachea probably above mucosal perfusion pressure
  • Can cause mucosal damage
  • Should be replaced with a low-pressure cuff if postoperative intubation is required
79
Q

Factors that can cause changes in cuff pressure.

A
  • Use of nitrous (↑ pressure)
  • Hypothermic cardiopulmonary bypass (↓ pressure)
  • Increases in altitude (↑ pressure)
  • Coughing, straining, and changes in muscle tone (↑ pressure)
80
Q

What are common controversies involving airway equipment?

A
  • Use of a stylets
  • Securing ETT
  • Use of Bite blocks/airways while intubated
  • Is it bad to intubate the esophagus?
81
Q

List endotracheal tube complications

A
  • Trauma
  • Inadvertent bronchial intubation
  • Fluid accumulation above the cuff
  • Upper airway edema
  • Vocal cord granuloma
82
Q

Use _________ for nasal intubation to mitigate bleeding and pre-dilate nasal passage.

A
  • vasoconstrictors (Afrin/Cocaine)
83
Q

Inadvertent bronchial intubations are most common in:

A
  • Emergencies (Code Blue)
  • Pediatrics (shorter distance to carina)
  • Females (shorter right mainstem)
84
Q

Inadvertent bronchial intubation can lead to _________ if left in place for too long.

A
  • atelectasis
85
Q

The distance to the carina _________(decreases/increases) with Trendelenburg and laparoscopy.

A
  • Decreases
86
Q

What marking would you secure an ETT on a male patient?

Female patient?

A
  • Male: 23 cm at the teeth
  • Female: 21 cm at the teeth
87
Q

What can accumulate above the cuff of the ETT?

A
  • Fluids
88
Q

Why is upper airway edema dangerous in young children?

Peak incidence age?

A
  • Cricoid cartilage completely surrounds the subglottic area
  • 1-4 years old
89
Q

Complications of airway edema can occur as early as _____ hours post to 48 hours postop.

A
  • 1-2 hours
90
Q

Who is more prone to vocal cord granuloma?

A
  • Adults
  • Females

Vocal cord granulomas are masses that result from irritation.

91
Q

What are the causes of Vocal Cord Granuloma?

A
  • Trauma
  • ETT too large
  • Infection
  • Excessive cuff pressure
92
Q

Signs and Symptoms of Vocal Cord Granuloma?

A
  • Persistent hoarseness
  • Fullness
  • Chronic cough
  • Intermittent loss of voice
93
Q

Treatment of Vocal Cord Granuloma

A
  • Laryngeal evaluation (ENT appt)
  • Voice rest
94
Q

This airway adjunct is typically used to aid tracheal intubation in poor laryngoscopic views or diffcult ETT passage.

A
  • Bougie

The bougie has a polyester base with resin coating.

95
Q

The distal end of the bougie is angled _______- degrees.

A
  • 30-45 degrees

Introduce Bougie with anterior positioning of the tip.
Be Gentle.
You should feel the clicks of the tracheal rings.

96
Q

What are these called?
What are they used for?
Considerations?

A
  • Magill forceps
  • Used primarily with nasal intubations to directs tube into the larynx
  • Considerations: Possible damage to tube cuffs and lodged in Murphy eye
97
Q

The rationale for lung isolation in thoracic procedure

A
  • Deflating the lung to increase safety profile and surgical exposure
98
Q

The rationale for lung isolation to control contamination or hemorrhage

A
  • Can prevent material in one lung from contaminating other
  • Allows one lung to be ventilated while other hemorrhages
99
Q

The rationale for lung isolation in unilateral pathology

A
  • Isolate fistulas, ruptured cysts, or other issues with the diseased lung while allowing unilateral ventilation
100
Q

Anatomy of the Right Mainstem

A
  • Shorter, straighter, larger diameter
  • 25 degree takeoff from trachea
  • RUL tracheal takeoff very close to origin
  • Avg length 2.5 cm from carina to take-off
101
Q

Anatomy of the Left Mainstem

A
  • 45 degree takeoff from trachea
  • LUL tracheal takeoff more distal
  • Avg length 5.5 cm from carina to take-off
102
Q

What are the adult sizes for the double-lumen tube?

A
  • 35 Fr
  • 37 Fr
  • 39 Fr
  • 41 Fr
103
Q

What are the pediatric sizes for the double-lumen tube?

A
  • 26 Fr
  • 28 Fr
  • 32 Fr
104
Q

Which Double-Lumen Tube (DLT) is commonly used?

A
  • Left Double-Lumen Tube
105
Q

Procedures that will require a Right Double-Lumen Tube.

A
  • Left pneumonectomy
  • Left lung transplantation
  • Left mainstem bronchus stent in place
  • Left tracheo-bronchus disruption
106
Q

Insertion of DLT is placed similarly as a standard ETT, but more difficult due to what?

A
  • Stiffness
  • Size
107
Q

The DLT is advance through the larynx with angled tip anterior into the ________.

A
  • Trachea
108
Q

When inserting the DLT, when the bronchial cuff passes the cords, the tube is turned ____ degrees

A
  • 90 degrees

Bronchial portion points toward the appropriate bronchus

109
Q

DLT verification of the location of the bronchial port with a ________.

A
  • fiberoptic scope
110
Q

The blue bronchial cuff of the DLT is just below the _______ in the appropriate bronchus.

A
  • carina
111
Q

Inflate DLT’s bronchial balloon under ___________to verify proper placement

A
  • direct visualization
112
Q

Ensure DLT’s bronchial cuff does not herniate over the ______.

A
  • carina
113
Q

How can you isolate a lung with the DLT?

A
  • Clamping either the tracheal or bronchial connector
114
Q

What are some DLT complications?

A
  • Tube malpositions
  • Hypoxemia
115
Q

What can cause DLT malposition and unsatisfactory lung collapse?

A
  • Bronchial lumen in the wrong mainstem (needs reinsertion)
  • Tube too proximal in airway (correct with fiberoptic)
116
Q

What can cause hypoxemia with a DLT?

A
  • Malpositioning of DLT (needs reinsertion)
  • Patient comorbidities (may need PEEP or intermittent 2-lung ventilation)
117
Q

What are the indications for Bronchial-Blockers?

A
  • When DLT is not advisable
  • Nasal intubation
  • Difficult intubation
  • Patients with tracheostomy
  • Subglottic stenosis
  • Need for continued postoperative intubation
  • If a single-lumen tube is already in place (critically ill pts)
118
Q

The function of the Bronchial Blocker.

A
  • Can block a segment of the lung without isolating the entire lung
119
Q

Difficulties with Bronchial-blockers

A
  • Right upper lobe bronchus takeoff is high
  • Tracheal bronchus
  • Fixation by staples during surgery
  • Perforation by suture needle or instrumentation
120
Q

What two teeth have the highest incidence of dental injuries?

A

Left Central Incisor (47%)
Left Lateral Incisor (20%)

JW: Principles of Anesthesia I (61 decks)

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