Airway Management Flashcards
Three airway axis
1.) oral axis
2.) pharyngeal axis
3.) Laryngeal axis
Two problems with laying flat on our backs
1.) airway axis do not align so no clear path for ventilation
2.) tongue falls against the back of our throat
Two ways to align the axis of the airway
1.) “sniff” postion (pillow under head)
2.) head tilt/chin lift
Three benefits of the sniff position
1.) creates better passage for air
2.) easier for an anesthetist to ventilate a patient (by mask or LMA/ETT)
3.) creates a better view of the vocal cords
Four types of airway obstruction
1.) Soft tissue (tongue) obstruction
2.) Laryngospasm
3.) Bronchospasm
4.) Airway swelling
Causes of soft tissue obstruction
1.) MAC anesthesia (sedated patients)
2.) Right after induction of general anesthesia (before LMA/ETT is inserted)
3.) After extubation (if patient is not awake yet)
Treatments for soft tissue obstruction
1.) chin lift (aligns the three axis)
2.) jaw thrust (pulls tissue up and stimulates respirations)
3.) oral and nasal airways
Oral airways
More likely to cause gagging, so use in unconscious patients. Sizing: one end at lips the other at the angle of the mandible
Nasal airway
Less likely to cause gagging. Can cause nosebleeds. Contraindicated in patients taking blood thinners and ones with facial fractures. Sizing: nares to the meatus of the ear
Etiology (cause) of laryngospasm
Stimulation of the superior laryngeal nerve (brand of the vagus nerve). Stimulation of vocal cords. ETT tube during extubation and airway sections (suction pharynx prior to extubation)
When do laryngospasms occur?
During stage II. Never extubatne until they can response to commands
How to diagnose laryngospasms
1.) absence of ventilation and difficulty providing positive pressure ventilation immediately after extubation
2.) during surgery without ETT we could see a sudden loss of ETco2 and an inability to ventilate
Laryngospasm treatment
1.) High jaw lift at “laryngospasm notch” combined with positive pressure
2.) Positive pressure with CPAP while you hold the mask with jaw lift
3.) Propofol to relax the vocal cords
4.) Succinylcholine administered IM does of 4-6mg/kg
Bronchospasm causes
1.) ETT tube
2.) Light anesthesia during surgery (ETT tube irritates lungs)
3.) During emergence from anesthesia
4.) Desflurane the most pungent (irritating) volatile agent
5.) Anaphylaxis - rare but possible during surgery
Diagnosis of bronchospasm
Sudden difficulty to ventilate due to increased resistance to lung expansion
