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AIRWAYS EXAM 1 > AIRWAYS IN SPECIAL CONDITIONS > Flashcards

AIRWAYS IN SPECIAL CONDITIONS Flashcards

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1
Q

what is the prevalence of obesity in the US?

A

36% of adults

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2
Q

what is the best method for bringing an obese pt into the correct sniff position?

A

elevate trunk and head with sheets or ramp

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3
Q

what is the primary concern of airway management when attempting to intubate an obese patient?

A

obese patients desaturate quickly due to decreased FRC (oxygen reserve)

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4
Q

what is the component of the obese airway that presents the biggest problem in visualization of the vocal cords?

A

paraglottic soft tissue

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5
Q

what is the overall obstetric mortality rate?

A

1:20,000

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6
Q

what is the anesthesia-related obstetric mortality rate?

A

1:500,000

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7
Q

what is the leading cause of anesthetic mortality?

A

airway management

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8
Q

what are the risk factors of pregnancy and airway management?

A

failure to intubate

aspiration

hypoxemia

urgency for two patients

failure to prepare completely

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9
Q

what are the aspiration risks for pregnant women?

A

solid and or liquid ingestion soon before delivery

decreased gastric emptying

increased gastric acidity

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10
Q

what factors decrease gastric emptying in gravid women?

A

progesterone

stress of labor

narcotics

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11
Q

what factors predispose gravid women to decreased gastro-esophageal sphincter tone and aspiration?

A

reflux

anticholinergics

narcotics

insertion/removal of NG tube

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12
Q

what percent of obstetric anesthia-related aspiration is due to hiatial hernia?

A

27%

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13
Q

how much is gastric pressure increased in mothers pregnant with a single child?

A

7 → 17cmH2O

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14
Q

how much is gastric pressure increased in mothers pregnant with twins?

A

7 → 40cmH2O

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15
Q

how much does lithotomy postioning increase gastric pressure increased in gravid mothers?

A

17 → 40cmH2O

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16
Q

what are the contributing factors that increase the likelihood of a failed intubation in gravid pts?

A

upper airway edema

adiposity of head, neck, trunk

breast enlargement

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17
Q

by what margin does pregnancy increase the incidence of failed intubations?

A

increased 10 fold

nongravid – 1:2500

gravid – 1:250

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18
Q

what are the contributing factors that increases the risk of hypoxemia in gravid pts?

A

20% decrease in FRC

VO2 increase

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19
Q

how does VO2 vary in gravid term vs. active labor pts?

Study These Flashcards
A

20% increase VO2 – term

60% increase VO2 – active labor

20
Q

what four steps must you take to manage increased airway risks of gravid pts?

Study These Flashcards
A

identify risks

prevent acid reflux

identify number of fetuses

vigilance during active labor

21
Q

what position should the gravid pt be in while evaluating the airway?

22
Q

what physical characteristics of the gravid pt should be assessed during evaluation of the potentially difficult airway?

Study These Flashcards
A

head, neck, trunk, breasts

23
Q

what is the established patient preparation protocol for labor?

Study These Flashcards
A
  1. NPO – provide good hydration
  2. cimetidine (tagamet) 300mg IV – 60min prior (histamine receptor antagonist; inhibits stomach acid production)
  3. metoclopramide (reglan) 10mg IV – 30min prior (anti-nauseau and gut-motility inhibitor)
  4. sodium citrate 30ml PO – immediately prior (used as an antacid)
24
Q

outline plan A for orotracheal intubation of the gravid pt

Study These Flashcards
A

goal: prepare for 1st attempt success

optimize pt position

provide complete preoxygenation

down size ETT

utilize sellick maneuver throughout

use ETT introducer if needed

25
what is the goal of Plan B when attempting to intubate the gravid pt?
oxygenate/support both pts
26
what should be applied continuously from Plan A to Plan B airway management of the gravid pt?
sellick maneuver
27
what is the goal of Plan C airway management of the gravid pt?
establish viable airway with oxygenation
28
what two methods of airway management are viable for Plan C airway management of the gravid pt?
HPOV or RGW
29
what three structures should be evaluated for arthritis in the geriatic airway?
the cervical spine, the cricoarytenoid joint, and the temporomandibular joint
30
what changes in the chest wall and lungs of the geriatric pt may present difficulty for airway management?
muscle loss, stiffer chest wall decreased lung elastic recoil decreased vital capacity
31
despite the comorbidities of the geriatric chest wall and lungs, what component of total lung capacity remains unaffected?
FRC
32
how might arthritis in the cervical spine impact DL/intubation?
limited ROM – little to no atlanto-occipital extension
33
how might arthritis of the TMJ impact DL/intubation?
limited mouth opening – have alternate plan for intubation
34
how might arthritis of the cricoarytenoid joint impact the geriatric airway?
hoarseness (needs to be documented) – may limit the ability of the vocal cords to relax
35
how might changes in the chest wall and lungs impact airway management of the geriatric pt?
decreased ability to cough and protect airway – be cautious during emergence; pt must be able to cough and protect airway
36
how might dentition of the geriatric pt (endentulous, facial skin looseness) affect airway management?
increased difficulty in mask fit/ PPV – use adjuncts (OAW, face mask strap)
37
what risk does the pt with osteoporosis present?
increased fracture risk
38
how might the reliability and cooperation of a senile pt affect airway evaluation and management?
poor historian – use alternate source for history increased safety risk – minimum to no sedation
39
when drainage in the neck is compromised, how is airway patency affected?
edema in the glottic tissues decrease vocal cord visualization leading to increased risk of intubation failure
40
definition: supine, head lower than heart, legs and pelvis elevated
trendelenburg position
41
the trendelenburg postition was first described by whom?
Dr. Willy Meyer (1885) credited to his teacher, Friedrich Trendelenburg, used for urologic surgery in 1870
42
when was the trendelenburg position first used in the US?
1890
43
what advantages does tburg give for surgical procedures?
physical access to specific regions moves abdominal contents cephalad alters regional circulation
44
how does tburg negatively affect anesthetic procedures?
increases diameter of jugular veins (increases cephalad edema) moves regurgitated material into pharynx
45
what parts of the patients anatomy should remain in neutral longitudinal alignment during lithotomy positioning?
head, neck, thorax should remain in neutral longitudinal alignment
46
what should be avoided when using the kidney rest for lateral decubitus positioning?
do not compress abdominal contents with the kidney rest
47

AIRWAYS EXAM 1 (6 decks)

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