Week 5 Handout Supplement Flashcards
What remains central to airway management?
Tracheal intubation (TI)
Methods include direct laryngoscopy, flexible intubating scope, intubating laryngeal mask airway, and videolaryngoscopy.
What factors influence the choice of intubation technique?
Patient’s history and physical airway assessment
* Previous anesthetic history
* Risk factors suggesting a challenging airway
What is the Sniffing Position?
Flexing the neck and extending at the atlantooccipital joint to align the oral, pharyngeal, and tracheal axes.
What is the goal of preoxygenation?
Extend time to desaturation during induction and apnea.
What is the technique for effective preoxygenation?
100% O₂ for 3–5 minutes at normal tidal volumes with a tight mask seal and ≥5 L/min fresh gas flow.
If time is limited, 8 vital capacity breaths w/i 60 sec, which is equivalent to 3 mins of normal tidal volume breaths
What should be monitored during preoxygenation?
Visible bag movement
* Well-defined end-tidal CO₂ waveform
* Fraction of expired oxygen (F_EO₂) ≥90%
What is the purpose of the BURP maneuver during laryngoscopy?
To improve visualization by applying backwards-upwards-rightwards pressure on the larynx.
What is the immediate focus during a difficult or failed intubation?
Ensure adequate oxygenation and ventilation.
What should be done if ventilation or intubation fails after induction?
Shift to a difficult-airway management strategy immediately.
Define a difficult airway.
Difficulty with facemask ventilation, supraglottic airway placement, endotracheal intubation, or invasive airway (cricothyrotomy).
What are signs of a difficult airway during facemask ventilation?
Significant leak
* Poor chest rise
* Absent breath sounds
* Gastric air entry
* Poor CO₂ waveform
What is the ASA Difficult Airway Algorithm?
A guideline that prepares for failed attempts and recommends awake intubation if difficulty is suspected.
What are the benefits of awake intubation?
Maintained ventilation
* Preserved muscle tone
* Preserved Lower esophageal sphincter tone
What techniques can be used for awake intubation?
Videolaryngoscopy
* Flexible intubating (fiberoptic) endoscope
What is the role of antisialagogues in awake intubation?
To reduce secretions and improve visualization.
What is the technique for a glossopharyngeal nerve block?
Topically anesthetize the tongue and inject 1–2 mL of 2% lidocaine at the palatoglossal arch.
What is the technique for a superior laryngeal nerve block?
Inject ~1 mL of 2% lidocaine above the thyrohyoid membrane after palpating the greater cornu of the hyoid bone.
What should be done during a transtracheal block?
Insert a needle at the cricothyroid membrane and inject 3–5 mL of 2% lidocaine after aspirating air.
What is a key takeaway regarding airway management?
Preparation and vigilance are critical for comprehensive airway assessment and strategy.
What should be maintained during awake intubation?
Spontaneous ventilation and protective reflexes.
Fill in the blank: The airway anesthesia is achieved via _______.
[topical application or infiltration nerve blocks]
What is the risk associated with benzocaine/cetacaine sprays?
Risk of methemoglobinemia.
