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Apex > Unit 1 Respiratory Unit 4: Airway Management > Flashcards

Unit 1 Respiratory Unit 4: Airway Management Flashcards

1
Q

What are the classes of the Mallampati exam?

A

Class I: (tonsills) Pillars, Uvula, soft palate, hard palate
Class II: Uvula, soft palate, hard palate
Class III: soft palate, hard palate
Class IV: hard palate

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2
Q

What does the inter-incisor gap affect? Normal measurements?

A

The ability to align oral, pharyngeal, and laryngeal axes.

2-3 finger breadths or 4 cm

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3
Q

What are the 3 borders of the submandibular space?

A

Superior border: mental
Inferior border: hyoid bone
Lateral border: either side of neck

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4
Q

What test helps estimate the size of the submandibular space?

A

Thyromental distance

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5
Q

What 2 thyromental distance measurements may indicate a more difficult laryngoscopy?

A

Less than 6 cm - 3 fingerbreadths

Greater than 9 cm

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6
Q

What test assesses the function of the temporomandibular joint?

A

Mandibular protrusion test (upper lip bite test)

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7
Q

What are the classes of the mandibular protrusion test?

A

Class I: can move lower incisors past upper and bite vermilion of lip
Class II: can move lower incisors in line with upper
Class III: cannot move lower incisors past uppers

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8
Q

What test assesses the ability to place patient into a sniff position?

A

Atlantic-occipital join mobility

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9
Q

What is normal AO flexion and extension?

A

90-165 degrees

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10
Q

What is normal AO extension? What degree suggests laryngoscopy will be difficult?

A

35 degrees

<23 degrees

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11
Q

What 8 conditions impair AO mobility?

A 
DJD
Rheumatic arthritis
Ankylosing spondylitis
Trauma
Surgical fixation
Klippel-Feil
Down syndrome
DM (joint glycosylation)
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12
Q

What test grading system is used for the view obtained during direct laryngoscopy?

A

Cormack and Lehane score

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13
Q

What are the grades of the Cormack and Lehane score?

A

Grade I: complete or nearly complete view of glottic opening
Grade II: posterior region of the glottic opening
Grade III: epiglottis only
Grade IV: soft palate only

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14
Q

What is a IIA and IIB score of Cormack and Lehane?

A

IIA: posterior region of the glottic opening
IIB: corniculate cartilages and posterior vocal cords, no part of the opening

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15
Q

Risk factors for difficult mask ventilation? Mnemonic

A 
“BONES”
Beard
Obese - BMI > 26
No teeth
Elderly - > 55y
Snoring
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16
Q

What are 10 risk factors for difficult laryngoscopy and endotracheal intubation?

A 
Small mouth opening
Long incisors
Prominent overbite
High, arched palate
Mallampati class III or IV
Retrognathic jaw
Inability to subluxation jaw
Short, thick neck
Short thyromental distance
Reduced cervical mobility
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17
Q

What are 6 risk factors for placement of a supraglottic airway/ will it work?

A

Limited mouth opening
Upper airway obstruction
Altered pharyngeal anatomy
Poor lung compliance - requires excessive PIP
Increased airway resistance - requires excessive PIP
Lower airway obstruction

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18
Q

What are 5 risk factors for difficult invasive airway placement?

A 
Abnormal neck anatomy
Obesity 
Short neck
Laryngeal trauma
Limited access to cricothyroid membrane
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19
Q

What are the current fasting guidelines?

A

2 hrs - clear liquid
4 hrs - breast milk
6 hrs - nonhuman milk, infant formula, solid food
8 hrs - fried or fatty food

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20
Q

What does ingestion of clear liquid 2 hours before surgery do to gastric volume and pH?

A

Reduces gastric volume and increases gastric pH, this reduces risk of Mendelson syndrome

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21
Q

What is Mendelson syndrome risk factors?

A

Gastric pH < 2.5

Gastric volume > 25 mL (0.4 mL/kg)

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22
Q

During an RSI how much pressure is applied to the cricoid ring before, and after LOC?

A

Before - 20 Newtons or ~ 2 kg

After - 40 Newtons or ~ 4 kg

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23
Q

What are 6 complications of cricoid pressure?

A

Airway obstruction
Difficult with laryngoscopy
Impaired glottic visualization
Difficult intubation
Reduced lower esophageal sphincter pressure
Esophageal rupture if patient is actively vomiting

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24
Q

List 3 causes of angioedema

A

Anaphylaxis
Angiotensin-converting enzyme inhibitors
Hereditary angioedema (C1 esterase deficiency)

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25
Q

What it the cause and treatment for anaphylaxis?

A

Cause - exposure to triggering agent

TX - epinephrine, antihistamines, steroids

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26
Q

What is the cause and treatment for angioedema caused by ACE inhibitors?

A

Cause - ACE inhibitor prevents bradykinin breakdown
TX - discontinue ACE
Icatibant (bradykinin receptor antagonist)
Ecallantide (plasma kallidrein inhibitor - stops conversion of kininogen to bradykinin)
FFP (contains enzymes that metabolize bradykinin)
C1 esterase concentrate

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27
Q

What is the cause and treatment of hereditary angioedema?

A

Cause: genetics (C1 esterase deficiency)
TX: C1 esterase concentrate, FFP, ecallantide, icatibant

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28
Q

What patients should receive prophylactic treatment for angioedema?

A

Those with C1 esterase deficiency for procedures requiring tracheal intubation

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29
Q

What is Ludwig’s Angina?

A

A bacterial infection characterized by rapidly progressing cellulitis in the floor of the mouth

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30
Q

What are the airway implications of Ludwig’s Angina?

A

Inflammation and edema compresses the submandibular, submaxillary, and sublingual spaces, most significant concern is posterior displacement of the tongue resulting in complete, supraglottic airway obstruction

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31
Q

What is the best way to secure an airway in a patient with Ludwig’s Angina?

A

Awake nasal intubation

Awake tracheostomy

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32
Q

Why is retrograde intubation contraindicated in a patient with Ludwig’s Angina?

A

Retrograde intubation is contraindicated in anyone with infection about the level of the trachea

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33
Q

What congenital conditions have large tongue?

A

“Big Tongue”
Beckwith syndrome
Trisomy 21

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34
Q

What congenital conditions have small/underdeveloped mandible? (Micrognathia)

A 
“Please Get That Chin”
Pierre Robin
Goldenhar
Treacher Collins
Cri du Chat
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35
Q

What congenital conditions have cervical spine anomaly?

A

“Kids Try Gold”
Klippel-Feil
Trisomy 21
Goldenhar

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36
Q

What 3 symptoms are seen with Pierre Robin?

A

Small/underdeveloped mandible - micrognathia or mandibular hypoplasia
Tongue that falls back and downwards - glossoptosis
Cleft palate

Neonates often require intubation

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37
Q

What 4 symptoms are seen with Treacher Collins?

A

Small mouth
Small/underdeveloped mandible
Nasal airway is blocked by tissue - choanal atresia
Ocular and auricular anomalies

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38
Q

What 4 symptoms are seen with Trisomy 21?

A

Small mouth
Large tongue
Atlantoaxial instability
Small sub glottic diameter - subglottic stenosis

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39
Q

What symptoms is seen with Klippel-Feil?

A

Congenital fusion of cervical vertebrae

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40
Q

What 2 symptoms are seen with Goldenhar

A

Small/underdeveloped mandible

Cervical spine anomaly

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41
Q

What symptom is seen with Beckwith syndrome?

A

Large tongue

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42
Q

What 3 symptoms are seen with Cri du Chat?

A

Small/underdeveloped mandible
Laryngomalacia - congenital softening of tissues of the larynx
Stridor

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43
Q

The sniffing position involves what movement of the cervical vertebra and Atlanta-occipital joint?

A

Cervical flexion

Atlanta-occipital extension

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44
Q

What 3 axes does the sniff position align?

A

Oral
Pharyngeal
Laryngeal

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45
Q

What is the HELP position?

A

A modification of the sniff position for obese patients.
Head Elevated Laryngoscopy Position.
AKA ramping

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46
Q

How far can head position change the depth of the ETT?

A

Neck flexion and extension moves the tube ~ 2cm

Lateral rotation of the neck moves the tip of the tube away from the carina ~ 0.7 cm

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47
Q

What are the 4 types of oral airways?

A

Guedel
Berman
Williams
Ovassapian

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48
Q

What are the 2 specific uses of a Williams oral airway?

A

Blind orotracheal intubation

Fiberoptic intubation

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49
Q

What is the specific use for a Ovassapian oral airway?

A

Fiberoptic intubation

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50
Q

Why is a nasal airway better tolerated than oropharyngeal in a lightly anesthetized patient?

A

It can precipitate laryngospasm

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51
Q

What are 5 complications of placing a oral/nasal airway?

A 
Laryngospasm
Vomiting if gag reflex is intact
Dental injury 
Oropharyngeal trauma
Ischemia from compressing blood flow to affected areas
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52
Q

List 5 contraindications to a nasopharyngeal airway

A 
Cribiform plate injury 
Coagulopathy 
Previous transsphenoidal hypophyesctomy
Previous Caldwell-Luc procedure
Nasal fracture
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53
Q

What 5 things should alert to a cribiform plate injury?

A 
LeFort II or III fracture
Basilar skull fracture
CSF rhinorrhea
Raccoon eyes
Periorbital edema
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54
Q

What should cuff pressure be in an ETT?

A

< 25 cm H2O

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55
Q

What are the 2 types of cuffs? Which is the more common today?

A

Low-volume, high pressure cuff

High-volume, low pressure cuff: nearly all tubes today in modern practice

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56
Q

Which type of cuff has better protection against aspiration?

A

Low-volume, high pressure cuff

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57
Q

Which cuff’s pressure can be measured with a monometer?

A

High-volume, low pressure cuff

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58
Q

Which cuff has a lower incidence of sore throat?

A

Low-volume, high pressure cuff

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59
Q

What type of cuff is a “microthin cuff”? What are it’s benefits?

A

High-volume, low pressure cuff.
Lower pressure on tracheal mucosa
Better protection against liquid aspiration

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60
Q

What are 4 ways to minimize cuff pressure?

A

Use a manometer periodically during case
Fill cuff with same O2/N2O mixture
Full cuff with water or saline - provides more stable pressure but takes longer to deflate
Use ETT with Lanz pressure-regulating valve

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61
Q

What is the Murphy eye?

A

The small hole on the opposite site of an ETT from the bevel

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62
Q

What is the purpose of the Murphy eye?

A

Provides an alternative passage for air moment in case the tip becomes occluded

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63
Q

How do you calculate the size and depth of a pediatric ETT?

A

ETT size without cuff: (age / 4) + 4
ETT size with cuff: (age / 4) + 3.5
Depth: ID x 3 (size of tube x 3)

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64
Q

What is max PPV pressure that can be used with an LMA?

A

20 cm H2O

65
Q

What is the max cuff pressure for an LMA?

A

60 cm H2O

Target: 40 - 60

66
Q

What is the most common cause of nerve injury with an LMA? What nerves are at risk?

A

Over inflation of the cuff.

Lingual, hypoglossal, RLN

67
Q

What are 4 risk factors for nerve injury with an LMA?

A

Over inflation of the cuff
LMA that is too small
Lidocaine lubrication
Traumatic insertion

68
Q

What increases the risk of sore throat and pharyngeal necrosis with an LMA?

A

Cuff over inflation

69
Q

LMA size : Patient size : Cuff inflation : Largest ETT that fits : Largest scope

A

1 : < 5kg : 4 mL : 3.5 : 2.7

  1. 5: 5-10 : 7 mL : 4.0 : 3.0
    2: 10-20: 10 mL : 4.5 : 3.5
  2. 5: 20-30 : 14 mL : 5.0 : 4.0
    3: 30-50 : 20 mL: 6.0 : 5.0
    4: 50-70 : 30 mL : 6.0 : 5.0
    5: 70-100 : 40 mL : 7.0 : 5.5
70
Q

What are the features of a ProSeal LMA?

A

Double lumen LMA designed for:
Gastric drainage
Larger mask
Bite block

71
Q

How do you use a ProSeal LMA to drain the stomach?

A

You must pass an OGT through the tube, do not place suction directly to the drain tube

72
Q

What are 2 benefits of the ProSeal vs classic LMA?

A

Better seal

Max pressure for PPV < 30 cm H2O

73
Q

What is an LMA Supreme?

A

A disposable version of the LMA ProSeal

74
Q

What is an LMA Fastrach?

A

LMA designed for intubating

-comes with a specifically designed ETT

75
Q

Why is the LMA fastrach not suitable for MRI?

A

It has a metal handle

76
Q

What is the LMA C-Trach?

A

An intubating LMA that includes a camera

77
Q

What is an LMA Flexible?

A

A wire-reinforced, longer, narrower LMA that is useful for head and neck surgery

78
Q

List 4 contraindications of an LMA

A
  1. Risk of gastric regurgitation and aspiration: full stomach, hiatal hernia, small bowel obstruction, symptomatic GERD, delayed gastric emptying
  2. Airway obstruction at the level of the glottis or below it
  3. Poor lung compliance
  4. High airway resistance
79
Q

Should an LMA be used in a “cannot intubate and cannot ventilate” situation in a person with risk for aspiration?

A

Yes. Hypoxemia in this situation is the greatest risk to the patient

80
Q

List 6 steps if gastric content is seen inside the LMA

A
  1. Leave it in place
  2. T burg and deepen anesthetic if necessary
  3. 100% FiO2 via ambu bag
  4. Use low FGF and low Vt
  5. Use flexible suction catheter to suction through LMA
  6. Use FOB to evaluate the presence of gastric content in the trachea, if present consider intubation and aspiration protocols
81
Q

Describe the benefit of using an LMA with asthma

A

During emergence pulmonary reflexes “wake-up”, since the LMA is over the glottis there is nothing inside the trachea causing stimulation

82
Q

List in order from most stimulating to least: LMA, DVL, Combitube, FOB

A

Combitube
DVL
FOB
LMA

83
Q

What are the 6 guidelines given for using an LMA with Laparoscopy

A
  1. “15 rule”: < 15 degrees tilt, < 15 cm H2O intraabdominal pressure, < 15 minutes of insufflation
  2. Use LMA that allows gastric drainage
  3. Normal BMI
  4. Observe traditional NPO guidelines
  5. Avoid light anesthesia
  6. Be an experienced LMA user
84
Q

What is a Combitube?

A

A supraglottic, double lumen device designed for blind placement in the hypopharynx

85
Q

Combitube sizes are 37 and 41, what size patient should these be used in?

A

37: height 4-6 ft
41: height > 6 ft
No options for < 4 ft

86
Q

Where are the 2 balloons on a Combitube?

A 
Oropharyngeal balloon (proximal cuff) - occludes the hypopharynx
Distal balloon - occludes the esophagus (usually)
87
Q

Which balloon is inflated first on a Combitube?

A

The oropharyngeal balloon (proximal cuff)

88
Q

How much air is placed in each cuff of a Combitube?

A

Size 37: Oropharyngeal (proximal) cuff 40-85 mL, distal cuff 5-12 mL
Size: 41: Oropharyngeal (proximal) cuff 40-100 mL, distal cuff 5-12 mL

89
Q

Where should ventilation be attempted with use of a Combitube?

A

Since the tip usually enters the esophagus, attempt ventilation through the blue (proximal or esophageal) lumen

90
Q

Where should a Combitube be ventilated if the tip enters the trachea?

A

The clear (distal or tracheal) lumen

91
Q

What is the max cuff pressure for a Combitube?

A

60 cm H2O

92
Q

List 7 benefits of a Combitube?

A
  1. Secure airway (aspiration protection)
  2. Ability to decompress the stomach
  3. Useful for obese population
  4. Minimal training required for blind technique
  5. Does not require neck extension
  6. Allows high ventilatory pressure up to 50 cm H2O
  7. Does not need to be taped
93
Q

List 6 contraindications to a Combitube

A
  1. Intact gag reflex
  2. Prolonged use >2-3 hrs due to risk of ischemia from oropharyngeal balloon
  3. Esophageal disease (Zender’s diverticulum)
  4. Ingestion of caustic substances
  5. Do not use size 37 F in someone < 4ft
  6. Do not use size 41 F in someone < 6 ft
94
Q

What hand is used to move the lever of a FOB? Which holds the cord?

A

Non-dominant moves the lever

Dominant holds the cord

95
Q

Moving the lever on a FOB in what direction moves the tip in what direction?

A

Push the lever down to point the tip up

Push the lever up to point the tip down

96
Q

How do you achieve horizontal movement with a FOB?

A

Rotate the scope in either direction

97
Q

What is the gold standard for managing a difficult airway?

A

Flexible fiberoptic bronchoscopy in the awake, spontaneously ventilating patient

98
Q

What are the contraindications of FOB?

A 
No absolute contraindications.
Relative ones:
Hypoxia (lack of time)
Secretions not relieved by suction or an antisialagogue 
Hemorrhage that impairs visualization 
Uncooperative patient for awake attempt
Local anesthetic allergy
99
Q

What oral airways can help with FOB?

A

Williams or Ovassapian help keep FOB midline

100
Q

During FOB what do you do if the bevel of the ETT hands up on the right arytenoid?

A

PUll back a little
Rotate the ETT 90 degrees counterclockwise
Advance ETT

101
Q

During FOB what do you do if the FOB gets stuck in the Murphy eye?

A

Remove the FOB and ETT start over

102
Q

Nerve blocks for FOB?

A

Glossopharyngeal block
SLN block
Transtracheal block

103
Q

What are the 3 branches of the Trigeminal nerve and what does it innervated in the airway?

A

V1: ophthalmic : nares and anterior 1/3 of nasal septum
V2: maxillary : turbinates and septum
V3: mandibular : anterior 2/3 of tongue

104
Q

What does the glossopharyngeal nerve innervate in the airway?

A 
Soft palate
Oropharynx
Tonsils
Posterior 1/3 of tongue
Valllecula 
Anterior side of epiglottis
105
Q

What nerve is the afferent limb of the gag reflex?

A

Glossopharyngeal nerve CN IX

106
Q

What does the SLN innervate in the airway?

A

External branch: cricothyroid muscle

Internal branch: posterior side of epiglottis to level of vocal cords

107
Q

What does the RLN innervate in the airway?

A

Sensory below level of vocal cords to trachea

Motor all intrinsic muscles except cricothyroid

108
Q

What is a Bullard Laryngoscope?

A

A rigid, fiberoptic device used for indirect laryngoscopy

109
Q

List 5 situations to use the Bullard laryngoscope

A
  1. Small mouth opening - minimum of 7 mm
  2. Impaired cervical spine mobility
  3. Short, thick neck
  4. Treacher Collins syndrome
  5. Pierre-Robin syndrome
110
Q

What are the contraindications to a Bullard Laryngoscope?

A

No absolute contraindications.

The learning curve is high

111
Q

What angle is the Bullard pulled for glottic exposure?

A

Straight up (90 degrees to the spine), not up and caudal like DVL

112
Q

List 2 other rigid fiberoptic laryngoscopes similar to the Bullard

A

WuScope

UpsherScope

113
Q

List 3 names for the Eschmann introducer

A

Eschmann introducer
Intubating stylet
Gum elastic bougie

114
Q

What is another name for angled tip of the bougie?

A

Coude

115
Q

What is the best time to use the bougie?

A

Grade III Cormack-Lehane view

next best Grade IIb

116
Q

When is the worse time to use a bougie?

A

Grade IV Cormack-Lehane view - the chance of successful intubation is unacceptably low

117
Q

Explain how to use the bougie

A
  1. Hook the angled tip under the epiglottis
  2. Advance the tip to 23-25 cm, feel for clicks on the tracheal rings “railroading”
  3. If you don’t feel click and think you’re tracheal, feel for “hold up sign” - resistance at carina at 35-10 cm
  4. If neither of these are felt, you’re in the esophagus
118
Q

What 2 or other intubation methods can a bougie be used?

A

Nasotracheal intubation

Orotracheal intubation through a supraglottic airway

119
Q

How can you tell with a lighted stylet if you are in the trachea vs the esophagus?

A

In the trachea the light has to travel through less tissue, so there is a well-defined circumscribed glow below the thyroid prominence.

In the esophagus the light has to travel though more tissue, so there is a more diffuse trans illumination of the neck without the circumscribed glow.

120
Q

When should a lighted stylet NOT be used?

A

In an emergency or cannot intubate cannot ventilate situation
In the presence of a tumor, foreign body, airway injury, or epiglottitis
Traumatic laryngeal injury
It is also difficult to use in the patient with a short, thick neck

121
Q

What angle should the Trachlight be bent when using in an adult? Child?

A

Adult: 90 degree
Child: 60-80 degree to better accommodate a more cephalad glottic opening

122
Q

Unlike a double lumen tube, what 3 things can the bronchial blocker NOT do?

A

Suction secretions from the isolated lung
Prevent contamination from contralateral lung infection
Ventilate the isolated lung

123
Q

The lumen on a bronchial blocker can be used for what 2 things?

A
  1. Insufflate oxygen into the non-ventilated lung

2. Suction air from the non-ventilated lung

124
Q

What age can a double lumen tube NOT be used?

A

Children under 8 years old

The smallest DLT is 26 F for kids 8-10 y

125
Q

Where is the puncture created for the wire for retrograde intubation? What size needle is used for this?

A

The cricothyroid membrane

14-18 g

126
Q

What is the most common use for retrograde intubation?

A

Unstable cervical spine

127
Q

Should retrograde intubation be used in a cannot intubate cannot ventilate situation?

A

No. Retrograde intubation takes time (5-7 min) and best used when intubation has failed but ventilation is still possible

128
Q

Name 2 situation that are indications for retrograde intubation

A

Unstable cervical spine

Upper airway bleeding

129
Q

Name 7 contraindications for retrograde intubation

A

Neck flexion deformity
Unable to identify landmarks
Pretracheal mass (thyroid goiter)
Tracheal stenosis under the puncture site
Tumor that obstructs the path of the wire
Coagulopathy
Infection

130
Q

What 6 complications are associated with retrograde intubation?

A 
Bleeding
Pneumomedistinum
Pneumothorax
Trigeminal nerve trauma
Breath holding
Wire travels in wrong direction
131
Q

Name 3 ways to create a surgical airway (invasive airways)

A

Transtracheal jet ventilation
Cricothyroidotomy
Tracheostomy

132
Q

What is Transtracheal jet ventilation?

A

A percutaneous technique that requires a high-pressure oxygen source

133
Q

Where is the needle inserted for Transtracheal jet ventilation?

A

Through the cricothyroid membrane

134
Q

What pressure of oxygen is required for Transtracheal jet ventilation?

A

~50 psi or wall pressure

135
Q

Why is the patient at risk for hypercapnia with Transtracheal jet ventilation?

A

Ventilation cannot be controlled

136
Q

What are 2 contraindications to Transtracheal jet ventilation?

A

Upper airway obstruction - air passively still exits the mouth/nose
Laryngeal injury

137
Q

What is a cricothyroidotomy?

A

The creating of a small, horizontal incision through the cricothyroid membrane and then inserting a cuffed entotracheal tube

138
Q

What are the 3 contraindications for cricothyroidotomy?

A

Children
Laryngeal fracture
Laryngeal neoplasm

139
Q

Why are cricothyroidotomies contraindicated in children?

A

They have a more pliable and mobile laryngeal and cricoid cartilage, making this procedure incredibly challenging.
The thyroid isthmus commonly covers the cricothyroid membrane as well.

140
Q

What is the emergency surgical airway of choice for children less than or equal to 6 y (some books say less than 10)?

A

Percutaneous Transtracheal jet ventilation

141
Q

Name 5 complications of cricothyroidotomy

A 
Tracheal stenosis
Tracheal or esophageal injury 
Hemorrhage 
Disordered swallowing 
SQ or mediastinal emphysema
142
Q

What surgical airway procedure has no absolute contraindications?

A

Tracheostomy

143
Q

What are 4 acute and 4 long term complications from tracheostomy?

A

Acute: airway obstruction, hypoventilation, pneumothorax, bleeding
Long term: tracheal stenosis, tracheomalacia, tracheoesophageal fistula, tracheal necrosis

144
Q

When should and shouldn’t a patient be extubated?

A

Extubate awake or deep

Not inbetween

145
Q

During a deep anesthetic plane (Guedel stage ___), airway reflexes are _____

A

III

Attenuated

146
Q

During a light anesthetic place (Guedel stage ___), airway reflexes are _____

A

II

Hyperreactive

147
Q

Awake, airway reflexes are _____

A

Intact

148
Q

A light plane of anesthesia is characterized by what 3 things?

A

Disconjugate gaze
Breath holding
Unable to follow commands

149
Q

List 3 pros and 5 cons of awake extubation

A

Pros:
Airway reflexes intact
Ability to maintain airway patency
Decreased risk of aspiration

Cons:
Increased CV and SNS stimulation 
Increased coughing
Increased intracranial pressure 
Increased intraocular pressure 
Increased intraabdominal pressure
150
Q

List 2 pros and 3 cons of deep extubation

A

Pros:
Decreased CV and SNS stimulation
Decreased coughing

Cons:
Airway reflexes are ineffective
Increased risk of airway obstruction
Increased risk of aspiration

151
Q

What can be done to prevent the complications of awake extubation?

A

CV & SNS stimulation:
BB
CCB
Vasodilators

Coughing and increased pressures:
Lidocaine IV or in ETT cuff
Opioids

152
Q

The risk of difficult extubation is increased if you can answer yes to any of these 3 questions:

A
  1. Was the airway abnormal or difficult during induction
  2. Did anything change during surgery that would make the airway difficult (edema, bleeding, restricted access)
  3. Any risk factors for increased extubation risk (known difficult airway, aspiration risk, OSA, obesity, cardiopulmonary disease, neuromuscular disease, or metabolic abnormality such as acidosis, electrolyte imbalance, hypothermia)
153
Q

List 10 risk factors for increased extubation risk

A 
known difficult airway
aspiration risk
OSA
obesity
cardiopulmonary disease
neuromuscular disease
metabolic abnormality such as acidosis, electrolyte imbalance, hypothermia
154
Q

What is the best technique to manage the patient at high risk for failed extubation?

A

Airway exchange catheter

155
Q

where are the lip should the airway exchange catheter sit?

A

~25-26 at the lip

156
Q

How long can the airway exchange catheter be left in place?

A

Up to 72 hours

157
Q

What is the Seldinger technique?

A

ETT is passed over the airway exchange catheter like a stylet

158
Q

What can be done through the airway exchange catheter?

A 
EtCO2
Jet ventilation (via luer-lock adapter)
Oxygenation insufflation (via 15 mm adapter)
159
Q

What complications can occur with airway exchange catheter?

A

Barotrauma - via jet ventilation with upper airway obstruction
Pneumothorax
Inability to replace ETT

Apex (46 decks)

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