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Principles of Anesthesia 1 (Summer 25') > **********EXAM 3**************** > Flashcards

**********EXAM 3**************** Flashcards

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1
Q

What type of airway equipment is discussed that has largely been replaced by video laryngoscopes?

A

Rigid laryngoscopes

Rigid laryngoscopes, such as the Bullard laryngoscope and Wu scope, are mentioned as older technology that is not commonly used in practice today.

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2
Q

What is the primary purpose of the Bullard laryngoscope?

A

To assist in intubation, particularly in difficult airway situations

The Bullard laryngoscope has a rigid angle designed to mimic the oral-pharyngeal angle and is used to facilitate intubation in challenging cases.

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3
Q

What is a significant disadvantage of the Bullard laryngoscope?

A

Requires experience and can feel awkward to use

Users may find it difficult to master the technique due to its bulkiness and the need for specific handling.

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4
Q

What feature does the Wu scope have that allows for nasal intubation?

A

A channel for the endotracheal tube to pass through

The Wu scope allows the endotracheal tube to be inserted nasally, providing a different approach to airway management.

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5
Q

True or False: The Wu scope requires a large mouth opening for intubation.

A

False

The Wu scope is designed to be used with minimal jaw opening, making it advantageous for patients with limited mouth opening.

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6
Q

What is the Shikani optical stylet primarily used for?

A

To facilitate intubation by providing rigidity and visualization

The Shikani optical stylet allows the endotracheal tube to be loaded backwards and provides a visual confirmation of tracheal intubation.

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7
Q

Fill in the blank: The Bullard laryngoscope is particularly effective in situations involving _______.

A

Difficult intubation

Its design helps manage anatomical challenges that can complicate intubation.

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8
Q

What is a common limitation of both the Bullard laryngoscope and the Wu scope?

A

They cannot accommodate double lumen tubes

Both rigid scopes have restrictions in terms of the types of tubes that can be used, limiting their versatility.

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9
Q

What are some advantages of using the Shikani optical stylet?

A
  • Provides direct visualization of the trachea
  • Available in pediatric sizes
  • Less bulk and trauma to the airway

The design of the Shikani optical stylet minimizes the risk of airway trauma compared to other rigid laryngoscopes.

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10
Q

What is a disadvantage associated with the use of the Shikani optical stylet?

A

Longer intubation time compared to standard laryngoscopy

Difficult airways often lead to longer intubation times, which can be exacerbated by the use of the Shikani optical stylet.

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11
Q

What is a significant feature of video laryngoscopes compared to rigid laryngoscopes?

A

They provide enhanced visualization and ease of use

Video laryngoscopes have largely replaced rigid laryngoscopes due to their ability to improve intubation success rates.

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12
Q

What is a key limitation of using nasal intubation with certain devices?

A

You can’t use nasal intubation at all with it

This refers to the non-malleable nature of some intubation devices.

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13
Q

What is the primary advantage of video laryngoscopes?

A

Magnified anatomy

Video laryngoscopes provide a clearer view of the airway, enhancing the intubation process.

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14
Q

What was the first video laryngoscope called?

A

GlideScope

GlideScope was the original video laryngoscope that set the standard for future designs.

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15
Q

What is a disadvantage of video laryngoscopes during intubation?

A

You may catch soft tissue or go into the molecular

This can occur if the placement of the tube is not managed correctly.

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16
Q

What is the purpose of the GlideScope’s curved blade?

A

To mimic the Mac blade

The design of the blade helps facilitate the visualization of the airway.

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17
Q

True or False: Video laryngoscopes allow multiple personnel to view the intubation process simultaneously.

A

True

This can enhance training and support during intubation.

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18
Q

What is the recommended technique if the intubation tube cannot be placed correctly?

A

Pull back the laryngoscope a little

This creates more space for the tube to enter the trachea.

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19
Q

What is a key feature of the McGrath video laryngoscope?

A

It is adjustable for different airway sizes

This flexibility allows it to accommodate various patient anatomies.

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20
Q

What is a notable feature of the AirTrack video laryngoscope?

A

It is disposable and has a battery life of about 90 minutes

This makes it convenient for single-use scenarios.

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21
Q

Why might video laryngoscopes be considered a crutch in intubation training?

A

They can lead to dependency on technology rather than mastering basic laryngoscopy skills

It’s important for practitioners to be proficient in traditional methods.

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22
Q

What is the complication rate associated with video laryngoscopes in a study involving residents?

A

1%

This indicates a high success rate even in challenging airway situations.

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23
Q

Fill in the blank: Video laryngoscopes are particularly useful for _______.

A

[difficult airways]

They provide better visibility and success rates in complex cases.

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24
Q

What is a common mistake when using video laryngoscopes?

A

Getting too close to the patient

This can obstruct the view and complicate tube placement.

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25
What anatomical features can be observed with a video laryngoscope?
* Vocal cords * Glottis * Trachea ## Footnote These structures are critical for successful intubation.
26
What does the term 'non-malleable' refer to in the context of intubation devices?
A design that cannot easily be bent or shaped ## Footnote This feature is intended to maintain the integrity and effectiveness of the device.
27
What is required for the proper use of a laryngoscope?
Skill in inserting a blade into the mouth and identifying necessary anatomy for intubation ## Footnote Use both Miller and Mac blades eventually
28
What common complication is associated with both video and regular laryngoscopes?
Dental injury ## Footnote A common saying in the SIM lab is 'get off the teeth'
29
What should be documented during the pre-op assessment regarding a patient's teeth?
Condition of teeth (loose, chipped, scraped) ## Footnote Important to avoid liability for dental restoration costs
30
What does malpractice insurance generally cover for students?
Broken tooth or scratched cornea ## Footnote Must report incidents to the faculty
31
True or False: Anesthesia groups often cover dental injuries.
False ## Footnote Some anesthesia groups will not cover common complications
32
What are the risks of aggressive head and neck movement during intubation?
Cervical spine injury and damage to other structures ## Footnote This applies to both video and regular laryngoscopes
33
What is a common mistake made when using a video laryngoscope?
Focusing on the TV screen instead of the patient's mouth ## Footnote Can lead to palate perforations
34
What is the Universal Numbering System in dentistry?
A system for identifying teeth numerically from 1 to 32 ## Footnote Helps dentists know exactly which tooth is affected
35
What are some requirements for designing endotracheal tubes?
Low cost, non-toxic, sterilizable, smooth surface, latex-free ## Footnote Must maintain shape and conform to anatomy
36
What can happen if an endotracheal tube is kinked?
It can obstruct airflow ## Footnote Circular design helps decrease kinking
37
Fill in the blank: The cuff of the endotracheal tube is critical for _______.
[sealing the airway during ventilation]
38
What should be considered when selecting an endotracheal tube size?
Internal diameter and post-operative needs ## Footnote Size affects compatibility with bronchoscopy
39
What is a common issue when using a regular intubation technique?
Inserting the tube incorrectly due to improper angling ## Footnote Can lead to trauma and complications
40
What is one way to keep the endotracheal tube out of the surgical field?
Use of connectors to extend the tube length ## Footnote Helps avoid obstruction during surgical procedures
41
What is the purpose of cutting the endotracheal tube?
To ensure it is the correct length and to facilitate patient safety during intubation ## Footnote Cutting the tube properly prevents complications such as cuff damage.
42
What does a maxillofacial surgeon prefer regarding intubation?
Oral intubation with specific measurements and adjustments ## Footnote The surgeon prefers intubation to be tailored to the patient's anatomy.
43
What is a nasal ray?
A specialized airway device that allows endotracheal tubes to be positioned out of the surgical field ## Footnote It curves immediately upon exiting the nostril to avoid obstruction.
44
What is the difference between an oral ray and a nasal ray?
Oral ray comes out of the mouth and bends down; nasal ray comes out of the nose and curves up ## Footnote Both are used to facilitate surgeries in the head and neck region.
45
True or False: The Murphy eye on an endotracheal tube helps with ventilation if the tip is occluded.
True ## Footnote The Murphy eye allows for some airflow even if the tip of the tube is blocked.
46
What is an armored tube?
A reinforced endotracheal tube designed to prevent kinking ## Footnote It contains wires that prevent the tube from collapsing.
47
Fill in the blank: The __________ tube is used for surgeries where lasers are involved.
laser resistant ## Footnote These tubes are specifically designed to reflect lasers and prevent airway fires.
48
What is one disadvantage of using an armored tube?
It is floppier and harder to intubate without a stylet ## Footnote This can complicate the intubation process, especially in nasal surgeries.
49
What material is commonly used to fill the cuffs of laser resistant tubes?
Methylene blue or saline ## Footnote Methylene blue helps indicate if the cuff has been punctured.
50
What is the function of marking on an endotracheal tube?
To indicate the depth of insertion and ensure proper placement ## Footnote Markings must be visible from the patient side to the machine side.
51
What should be done if there is a risk of cutting the cuff during surgery?
Deflate the cuff and main stem the tube ## Footnote This minimizes the risk of damage to the cuff during surgical procedures.
52
What is the primary benefit of using ray tubes during surgery?
They facilitate surgery by keeping the endotracheal tube out of the way ## Footnote This is especially important in head and neck surgeries.
53
What is the purpose of ventilating just the right lung instead of the left?
To avoid threatening the integrity of the tube
54
Where must the markings on an endotracheal tube be located?
On the bevel side above the cuff
55
How should the markings on the endotracheal tube be read?
From the patient side to the machine, left to right
56
What must be indicated on the endotracheal tube regarding its use?
Oral or nasal, or both
57
What unit of measurement is used for the internal diameter of the tube?
Millimeters
58
What information must be included on the endotracheal tube?
* Internal diameter in millimeters * Manufacturer's name * Single use indication if disposable * Radiopaque markings
59
What is the purpose of the inflatable cuff on an endotracheal tube?
To ensure a proper seal and prevent aspiration
60
What is the typical volume range for fully inflating a cuff?
8 to 10 milliliters
61
What can nitrous oxide do to cuff pressure?
It can absorb into the cuff, increasing its size
62
What type of cuff is more likely to cause a sore throat?
High volume, low pressure cuff
63
What is a disadvantage of using a low volume, high pressure cuff?
It can cause ischemia to the tracheal mucosa due to higher pressure
64
What is the primary reason for using cuffed endotracheal tubes in adults?
To decrease aspiration risk
65
How does cuffed endotracheal tubes affect accurate gas measurement?
It prevents leakage into the atmosphere
66
When is it acceptable to use uncuffed tubes in pediatrics?
In specific cases for very young children, but cuffed tubes are increasingly used
67
What is a common controversy regarding airway equipment?
The use of a stylet for intubation
68
What should be monitored if an endotracheal tube is used for an extended period?
Cuff pressure
69
What is the risk of losing an intubated tube when a patient is in a prone position?
It can lead to critical complications like anoxic brain injury
70
What is one method to secure an endotracheal tube?
Using tape effectively
71
Is it advisable to place an oral airway after intubation?
There are arguments for and against it
72
What is a critical consideration when intubating?
Recognizing if the tube is in the esophagus
73
What should be done before nasally intubating a patient?
Use Afrin in both nares
74
Fill in the blank: The cuff must be located near the _______ end of the endotracheal tube.
patient
75
True or False: Cuffed tubes are routinely used for pediatric patients.
False, they were traditionally uncuffed but are now increasingly cuffed
76
What should be done if cuff pressure appears to be too high?
Monitor and adjust to prevent mucosal injury
77
What should you do to the stylet when feeding it into a forward object?
Bend the stylet at the machine to prevent it from going in too far.
78
What is recommended to use for nasally intubating a patient?
Afrin in both nares multiple times.
79
When should Afrin be administered for nasally intubation?
Before pre-op, when picking up the patient, and again in the OR.
80
What can be done to dilate the nasal passage before intubation?
Use a smaller nasal airway and progressively increase the size.
81
What common error occurs during intubation that can lead to bronchial intubation?
Feeding the tube in too far after passing through the glottis.
82
What complication can arise from inadvertent bronchial intubation?
Atelectasis and hypoxia.
83
How should the endotracheal tube be secured after intubation?
At the teeth to monitor for displacement.
84
Why should suction be performed before extubation?
To avoid fluid from the cuff entering the lungs.
85
What is a common cause of airway edema post-intubation?
Repeated attempts at intubation leading to trauma and inflammation.
86
What is a risk factor for airway closure in young children?
Complete encirclement of the airway by cricoid cartilage.
87
What is a common cause of vocal cord granulomas in adults?
Trauma from improperly sized endotracheal tubes.
88
What is the recommended treatment for vocal cord granulomas?
Voice rest.
89
What is the purpose of a gum elastic bougie?
To assist in intubation when visualization is poor.
90
How should a gum elastic bougie be used during intubation?
Insert it midline to help guide the endotracheal tube into the trachea.
91
What are McGill forceps used for?
To assist in nasal intubation by guiding the tube into the trachea.
92
What is a risk when using McGill forceps during intubation?
Tearing the cuff of the endotracheal tube.
93
What are double lumen tubes used for?
To isolate a lung during thoracic procedures.
94
What anatomical feature increases the likelihood of right main stem intubation?
The shorter and straighter angle of the right main stem bronchus.
95
What is the typical adult size range for double lumen tubes?
35 to 41 French.
96
What is a common size for double lumen tubes in females?
35 or 37 French.
97
Why are left double lumen tubes preferred?
They allow for more space and better placement without risking occlusion of the right upper lobe.
98
What should be checked after placing a double lumen tube?
Breath sounds in both lungs to confirm correct placement.
99
What complication can occur if a double lumen tube is placed incorrectly?
The lung intended to collapse may not do so.
100
What is a key complication of using a double lumen tube?
Placement in the wrong location can prevent the desired lung from collapsing ## Footnote If the lung is diseased, it may not collapse even with correct tube placement.
101
What can cause a lung to not collapse despite correct double lumen tube placement?
Severe infection, tumor, or adhesion to the chest wall ## Footnote These conditions may make the lung unable to collapse even if the tube is properly positioned.
102
What is the consequence of occluding one lung with a double lumen tube?
Hypoxemia may occur due to inadequate ventilation of the occluded lung ## Footnote Patients may experience hypoxia, but often adapt due to chronic lung issues.
103
When might a patient's oxygen saturation (SATs) not change after collapsing one lung?
If the patient has adapted to chronic lung disease ## Footnote Their body may be accustomed to lower oxygen levels due to long-term lung problems.
104
What can be done if hypoxemia occurs after lung collapse?
Increase FiO2, add CPAP or PEEP, or intermittently reinflate the lung ## Footnote This allows the surgeon to work while managing the patient's oxygenation.
105
What is the purpose of a bronchial blocker?
To isolate a lung or lobe when a double lumen tube cannot be placed ## Footnote Bronchial blockers are used as a backup for lung isolation.
106
What is the primary method for collapsing a lung during surgery?
Using a double lumen tube ## Footnote This provides better protection against contamination between lungs.
107
What is a potential issue with using a bronchial blocker?
It can be easily overlooked and cut or stapled during surgery ## Footnote Its small size may lead to accidental injury during surgical procedures.
108
What is a retrograde intubation?
A technique that involves threading a wire through the cricothyroid membrane to guide an endotracheal tube ## Footnote This method is often used in difficult intubation scenarios.
109
What is the difference between a cricothyrotomy and a tracheostomy?
Cricothyrotomy is less invasive and has fewer complications than tracheostomy ## Footnote Tracheostomy requires a larger incision and carries more risks.
110
What is jet ventilation primarily used for?
To manage airway surgery or severe tracheal stenosis ## Footnote It allows for ventilation while minimizing airway trauma.
111
What is a significant risk when using a jet ventilator?
Barotrauma from excessive pressure during ventilation ## Footnote Jet ventilation must be done in short bursts to avoid lung injury.
112
What is the recommended approach when using a jet ventilator?
Push the handle in quick bursts, avoiding prolonged pressure ## Footnote Continuous pressure can lead to complications such as CO2 buildup.

Principles of Anesthesia 1 (Summer 25') (16 decks)

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