Airway management 4 Flashcards
(54 cards)
When compared to the LMA classic, benefits of the ProSeal include
a better seal
max pressure for PPV <30 cmH2O (LMA classic is <20 cmH2O)
The iGel is a
supraglottic airway that’s an alternative to the LMA
With the iGel there is no
inflatable cuff which can contribute to a poor seal
Can the iGel be used in MRI?
Yes, it doesn’t contain metal parts
The iGel has a
gastric port
The iGel can serve as a conduit for
endotracheal intubation (the lumen has a larger diameter and there are no aperture bars)
Complications of the iGel include
tongue trauma
mucosal erosion of the cricoid cartilage
compression of the trachea
nerve injury
airway obstruction
regurgitation and aspiration
All of the following are contraindications to a laryngeal mask airway EXCEPT:
a. gastroparesis
b. asthma
c. tracheal tumor
d. hiatal hernia
b. asthma
What is the device in a can’t intubate, can’t ventilate scenario?
LMA
The LMA should not be used in the following situations:
risk of gastric regurgitation and aspiration (full stomach, hiatal hernia, small bowel obstruction)
airway obstruction at the level of the glottis or below the glottis
poor lung compliance
high airway resistance
In patients with _____________, the LMA is preferred over a standard ETT assuming there are no contraindications to the LMA
reactive airway disease
Compared to tracheal intubation, the LMA is less likely to
activate the SNS
The risk of aspiration can be minimized with an LMA by
selecting the appropriate use based on the surgical procedure and position as well as the patient’s history (e.g. no history of GERD)
maintaining a deep enough plane of anesthesia to prevent swallowing as this can produce gastric insufflation
removing the LMA at the first sign of rejection during emergence
avoid using too much or too little air in the cuff
using the correct size device (not under-sizing)
minimizing inflation pressure (no higher than 20 cm H2O with a classic LMA)
epigastric auscultation can be used to assess for gastric insufflation
If you observe gastric contents inside the airway tube of the LMA, then you should perform the following interventions:
Leave LMA in place
Place in Trendelenburg (30 degrees) & deepen anesthesia
Give 100% oxygen via a self-inflating resuscitation bag (if gastric contents are in the breathing circuit)
use a low FGF and low Vt
use a flexible suction catheter to suction around the LMA
use a FOB to evaluate the presence of gastric contents in the trachea- consider intubation and aspiration protocols
The tendency of airway device placement to activate the SNS (from most to least stimulating):
combitube
DVL
fiberoptic intubation
LMA
If you’re going to use an LMA for a laparoscopic procedure, then the following guidelines should be observed:
select an LMA that allows for gastric drainage
use in patients with normal BMI
observe traditional NPO fasting guidelines
avoid light anesthesia
be an experienced LMA user
Follow the “15” rule: use <15 degree tilt, <15 cmH2O intraabdominal pressure, and <15 minutes of insufflation
Identify the contraindications to the combitube: (select 3)
a. full stomach
b. Zenker’s diverticulum
c. obesity
d. intact gag reflex
e. Klippel-Feil
f. prolonged use
b. Zenker’s diverticulum
d. intact gag reflex
f. prolonged use
The combitube is a
supraglottic, double lumen device that is blindly placed in the hypopharynx
The patient’s __________ determines which size Combitube is used:
height
A size 37 combitube is suitable for
4-6 ft
A size 41 combitube is suitable for
> 6 ft.
A size __________ combitube is suitable for <4 ft
no size available
Benefits of a Combitube include
provides a secure airway (aspiration protection)
ability to decompress the stomach
useful for the obese population
minimal training required
Contraindications for a Combitube include
intact gag reflex
esophageal disease (zenker’s diverticulum)
ingestion of caustic substances
prolonged use (>2-3 hours) due to the risk of ischemia from the oropharyngeal balloon
