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24 ANE 8509 Principles of Anesthesia I > Exam 3- Airway Equipment I (6/29/23) > Flashcards

Exam 3- Airway Equipment I (6/29/23) Flashcards

1
Q

This airway equipment allows gas administration to the patient from the breathing system without any apparatus in the patient’s mouth.

A
  • Face Mask
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2
Q

The administration of oxygen before induction of anesthesia.

A
  • Preoxygenation
  • Denitrogenation
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3
Q

What are the three components of the Face Mask?

A
  • Body- Transparent, Provides shape
  • Seal - Inflatable cushion, 20 to 25 cm H2O with minimal leak
  • Connector- 22 mm internal diameter, circular ring with prongs for straps
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4
Q

Criteria associated with difficult mask ventilation

A
  • Obese, BMI > 30 kg/m2
  • Beard (big bushy ones)
  • Edentulousness
  • Snore/OSA
  • Elderly >55, Male
  • Mallampata 3 or 4

OBESE M

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5
Q

Ways to Overcome Difficult Mask Ventilation

A
  • Oral airway OR nasopharyngeal airway
  • Two-handed technique
  • Cut the beard (let the pt know beforehand)
  • Tegaderm over mouth to create seal for face mask
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6
Q

What should you NOT give if your patient can not mask ventilate?

A
  • Do not give paralytics
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7
Q

What should you do if you can not mask ventilate the patient?

A
  • Emergency adjunct (difficult airway algorithm)
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8
Q

What might be used to hold the face mask in place and allows the CRNA’s hand to be free?

A
  • Mask Straps
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9
Q

What is an OPA and how does it work?

A
  • An oropharyngeal airway is a device used to maintain or open the airway by lifting the tongue and epiglottis away from the posterior pharyngeal wall.
  • OPA decreases the work of breathing during spontaneous ventilation.
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10
Q

Why should you not put an OPA in an awake patient?

A
  • Patient will fight you
  • Gag reflex still intact
  • High risk of laryngospasm
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11
Q

Most OPA are made of _______

A
  • Plastic
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12
Q

The bite portion of an OPA must be firm enough that the patient cannot close the lumen by ________.

A
  • biting (duh)
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13
Q

The OPAs are color-coded by size, which is measured in ______.

A
  • millimeters
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14
Q

How should the size of the OPA be determined?

A
  • OPA should be used to measure from the corner of the mouth to the angle of the mandible or the earlobe for appropriate sizing.
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15
Q

What reflexes should be depressed when placing an OPA?

A
  • Pharyngeal Reflexes
  • Laryngeal Reflexes
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16
Q

What are the two methods to OPA insertion?

A
  • Approach with OPA backward and use 180-degree turn method
  • Use a tongue depressor to insert OPA method
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17
Q

Why is a bite block used?

A
  • Prevents patient from biting on the ETT, bronchoscope, or endoscope
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18
Q

Bite block placement

A
  • A bite block is placed between the upper and lower teeth and gums
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19
Q

A type of airway adjunct designed to be inserted through the nasal passage down into the posterior pharynx to secure an open airway.

A
  • Nasopharyngeal airway (NPA)
  • Nasal trumpet
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20
Q

NPAs are tolerated in patients with intact _________.

A
  • Airway Reflexes
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21
Q

When would NPA be contraindicated?

A
  • Basilar skull fracture
  • Nasal deformity
  • Hx of epistaxis
  • Pregnancy (very vascular)
  • Coagulopathy
  • Chronic NSAID use
22
Q

NPAs are preferably used with these patients

A
  • Loose Teeth
  • Oral Trauma
  • Gingivitis
  • Limited Mouth Opening
23
Q

Design of NPA

A
  • Resembles shortened tracheal tube
  • Flange at outer end to prevent complete passage
  • Less stimulating than OPA
  • Sized by outer diameter in French scale
24
Q

How should the size of the NPA be determined?

A
  • Nostril to the external auditory meatus
25
Q

How can you mitigate epistaxis during NPA insertion?

A
  • Lubricate NPA thoroughly
26
Q

The bevel of the NPA should rest above the _______.

A
  • Epiglottis

10 mm above the epiglottis

27
Q

What are some complications of airways discussed per lecture?

A
  • Airway obstruction (incorrect placement)
  • Ulceration of the nose or tongue
  • Dental/oral damage
  • Laryngospasm
  • Latex allergy (some older NPAs usually green in color)
  • Retention/swallowing
28
Q

When should you remove an NPA or OPA?

A
  • When the patient can remove the NPA or OPA themselves
  • Follow commands
29
Q

Airway device that can be inserted into the pharynx to allow ventilation, oxygenation, and administration of anesthetic gases without the need for endotracheal intubation.

This was the intermediate bridge between a face mask and ETT.

A
  • Supraglottic Airway

Can be used in both spontaneous ventilation and PPV

30
Q

Who created the Supraglottic Airway?

What year was it created?

A
  • Dr. Archie Brain
  • 1982/1983
31
Q

The LMA classic is shaped like a ________ proximally.

A
  • Tracheal Tube
32
Q

The LMA classic is shaped like a ________ mask distally.

A
  • Elliptical
33
Q

Where does the LMA classic sit when inserted properly?

A
  • Sits in hypopharynx and surrounds the supraglottic structure
  • An inflatable cuff provides seal
34
Q

How big of a syringe is needed to inflate an LMA classic?

How much pressure of water is needed to inflate the LMA classic?

A
  • 20 cc syringe
  • 60 cmH2O
35
Q

Some LMA Classics are “reusable.” How many times can they be reused, according to Dr. Ericksen?

A
  • 40 times
36
Q

LMA Sizing Chart to Memorize.

A

-_-

37
Q

What happens if the LMA size is too small?

A
  • Gas leaks during positive pressure
38
Q

What happens if the LMA size is too large?

A
  • Won’t seat over glottis
  • Greater incidence of sore throat
  • Possible pressure on lingual, hypoglossal, and recurrent laryngeal nerves
39
Q

How many LMAs should you take out during pre-op?

A
  • Two LMA’s
  • The size that you think and one size above or below
40
Q

Insertion of LMA

A
  • Needs to be well lubricated; cuff down
  • Deflate the cuff as much as possible
  • Place LMA upward towards the hard palate
  • Follow the posterior pharyngeal wall
  • Smooth motion
  • Should feel it curve downward in the airway, then come to a stop
  • Inflate balloon
41
Q

When the LMA balloon is inflated, what happens to the patient’s neck?

A
  • Neck bulges and LMA may “rise” slightly
42
Q

What can you do to troubleshoot a difficult LMA placement?

A
  • Jaw lift
  • Pull the tongue forward
  • Slightly inflate the balloon
  • Change to a different technique
43
Q

What is an LMA unique?

A
  • Single-use and disposable LMA device
  • Made of PVC
  • Stiffer cuff is less compliant than LMA classic
  • Same insertion technique of LMA classic
  • Easier to place than the Classic LMA
44
Q

What is an LMA Proseal?

A
  • Wired reinforced LMA
  • Shorter than Classic LMA
  • Gastric access - OGT can be passed through to deflate the stomach to decrease the risk of aspiration
45
Q

Why would CRNAs have reservations about placing LMAs in diabetic patients?

A
  • Gastroparesis in DM pt leading to ↑ aspirations
  • D/t autonomic neuropathy affecting the vagus nerve.
  • Chronic hyperglycemia can damage the vagus nerve.
  • Gastroparesis has been reported in 30-50% of Type I and II diabetics.
  • Food can still be in the stomach > 48 hours. Your mileage may vary…
46
Q

What is an IGEL LMA?

A
  • LMA with no cuff
  • Medical-grade thermoplastic elastomer
  • The LMA conforms to create an anatomical seal of the pharyngeal, laryngeal, and peri-laryngeal structure
  • Gastric access - OGT
  • Conduit for intubation
47
Q

Which LMA creates the most adequate seal of the supraglottic structure per lecture?

A
  • IGEL LMAs
48
Q

Advantages of LMA

A
  • Ease and speed of placement (as fast as 5 secs)
  • Improved hemodynamic stability
  • Reduced anesthetic requirements
  • No muscle relaxation needed
  • Avoidance of some of the risks of tracheal intubation
49
Q

Disadvantages of LMA

A
  • Smaller seal pressures than ETTs
  • Ineffective ventilation when higher pressures are needed.
  • No protection from laryngospasm
  • Little protection from gastric regurgitation and aspiration (First-generation LMA: LMA Classic and LMA Unique)
50
Q

Name First Generation LMAs

A
  • LMA Classic
  • LMA Unique
51
Q

Name Second Generation LMAs

A
  • LMA Proseal
  • LMA IGEL

24 ANE 8509 Principles of Anesthesia I (27 decks)

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