Lecture 13: Airway Management Flashcards
What is the purpose of endotracheal tube
1.provide positive pressure ventilation
2. Deliver inhalant
3. Deliver O2
4. Protect airway-avoid aspiration pneumonia
What species are obligate nose breathers
Rabbits, horses
What is insufflation
System in which gases are delivered directly to patients airway in the absence of valves, reservoir bag, or carbon dioxide absorption
Insufflation is only used to supplement ___
Oxygen
What is the equipment needed for insufflation
Nasal cannula, face mask, O2 line connected to large bore IV catheter going through trachea
What is a mask used for
Pre-oxygenation and respiratory distress
What is better: flow by or face mask for oxygenation
Face mask
What are some pros for oxygen cages
Patient behavior, free mobility, control humidity and temp, short term
What are some cons of oxygen cages
FiO2 up to 30-60%, expensive, long filling time, difficult to control humidity and temp with large breeds, FiO2 decreases when cage opened, not practice for large animals
What are guarded ET tubes used for
Prevent airway obstruction/kink
How do you find correct ET tube size
Measure from manubrium to tip of nose
If the ET tube is too long what will happen
Incensed dead space
If ET tube is too short what will happen
Leak and increased airway resistance
what’s wrong with this invitation
One lung intubation
Why do we use cuffed ET tubes
- Prevent aspiration pneumonia
- Seals airway for ventilation
What happens with under inflation and over inflation of cuff
Under: aspiration pneumonia
Over: necrosis of tracheal mucosa
___cuff for extubation
Deflate
What is a challenge when intubating cats and what is solution
Laryngeal hyper-responsiveness to mechanical stimulation
Desensitize larynx with lidocaine spray
What 5 things make for a challenging intubation in brachycephalics
- Narrow rima glottis
- Everted laryngeal saccules
- Elongated soft palate
- Enlarged tonsils
- Hypoplastic trachea
Why do you use lidocaine spray vs benzocaine for cat intubation
Benzocaine causes methemoglobinemia
What are some important things for brachycephalic extubation
- Keep ET tube in as long as possible
- Have laryngoscope available
- Have anesthesia induction agent available
- ET tube available
- Do not hesitate to re-intubate
If reintubation necessary what 4 things are important
- Mannitol
- Dexamethasone
- Time
- Sedatives
How do you confirm ET intubation
- Capnography- best practice
- Direct auscultation of the ET tube during expiration
- Condensation inside ET tube
- Fogging of glass in front of ET tube
What this and what is normal value
ETCO2
Normal:35-45
