Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia Equipment Exam 1 > General Anesthesia Induction/Intubation Equipment > Flashcards

General Anesthesia Induction/Intubation Equipment Flashcards

1
Q

Anesthesia, or anesthesia means

A
  • greek meaning an= without and asthesia: sensation
  • condition of having sensation (including feeling of pain) blocked or temporarily taken away
  • “reversible lack of awareness”
  • total lack of awareness of lack of awareness of a part of the body such as a spinal anesthetic (regional anesthetic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GA Induction

A
  • pharmacological induction of a sate of loss of consciousness
  • loss or alteration of reflexive responses which effects the respiratory, CV, and NM systems
  • types: inhalation induction (mask), IV (RSI or modified RSI) combination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Main sequences of most GA inductions typically includes

A
  1. Monitor application
  2. Pre-oxygenation
  3. Induction agents given
  4. Airway support through masking, LMA (supraglottic) or ETT placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pre-oxygenation

A
  1. FRC: lung volume at the end of normal exhalation (gas patient will drawn upon when we induce apnea)
  2. At FRC, elastic recoil forces of the lungs and chest wall are equal but opposite and there is no exertion by the diaphragm or other respiratory muscles
  3. ERV: lung volume after normal tidal breathing + RV: lung volume remaining after exhalation
  4. Pre-oxygenation increased apnea threshold by filling the FRC with oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mask Induction Indications

A
  1. Pediatric patient that are NPO where IV placement may be distressing
  2. Adult patients that are NPO that are difficult IV placement or unable to cooperate with IV placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Typical Mask Induction Sequence

A
  1. Monitors, sometimes just pulse ox
  2. Nitrous/Oxygen mixture then add servo
  3. Gentle mask ventilation until IV placed
    - patient can be susceptible to obstruction, laryngospasm and bradycardia in this time period. Delicate balance of anesthetic depth, too light can lead to laryngospasm and too deep can lead to bradycardia
  4. Intubation or airway placement after IV placed
  5. Some GAs may be able to just mask without IV- must have back up plan (IM or sublingual drugs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Laryngospasm

A
  • mediated by the superior laryngeal nerve in response to irritating glottic or supraglottic stimulation such as presence of food, blood, vomit or airway secretions. Occurs most frequently with light anesthesia, upon induction or emergence*
  • false cords and epiglottic body come together firmly and allow no air flow and no vocal sound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment of Laryngospasm

A
  • forward displacement of jaw and apply positive pressure with 100% oxygen
  • severe spasm may require small doses of such (0.1 to 1 mg/kg) and re-intubation. May be given IM or SL
  • laryngospasm will eventually cease as hypercapnia and hypoxia develop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Intravenous Induction

A
  • General Sequence of patient that has been NPO
  • Pre-oxygenation (filling FRC with O2)
  • IV induction agent
  • Mask airway
  • IV paralytic if ETT used
  • no paralytic if LMA placed
  • placement of airway device and confirmation of placement (bilateral breath sounds and ETCO2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RSI

A
  • Anesthesia induction sequence that aids in securing airway with an ETT as quickly as possible. There is no masking after induction agent is given
  • Reduces the time at risk for pulmonary aspiration and hypoxemia
  • Indications: full stomach, severe GERD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RSI Sequence

A
  1. Pre-oxygenate up to 5 minuets
  2. IV anesthetic agent
  3. Rapid-onset NMB (sux)
  4. Use of cricoid pressure
  5. Intubation with ETT
  6. Release of cricoid pressure after confirmation of ETT placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Modified RSI

A
  • Patient is masked with gentle pressure while cricoid pressure is maintained
  • may be done if you need extra oxygenation or feel the need to see if the patient has a good mask airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cricoid Pressure

A
  • aka Sellick Maneuver
  • Used to prevent pulmonary aspiration since its description by Sellick
  • hypothetical basis is that pressure on the front of the cricoid cartilage is transmitter to its posterior lamina, which occludes the esophagus by compression against vertebral bodies
    technique: find thyroid prominence, go slightly below to cricoid cartilage. Pressure is placed with thumb and index finger on lateral edges of cricoid cartilage (3N posterior)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cricoid pressure during laryngoscopy

A
  • maintain cricoid pressure during laryngoscopy
  • do NOT release cricoid pressure until after confirmation of successful intubation: visualization of ETT through vocal cords, fogging of OET, ETCO2, bilateral breath sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cricoid disadvantages

A
  • reduces tone of lower esophageal sphincter so the risk of regurgitation from stomach to esophagus is increased
  • impairs insertion of the laryngoscope
  • degrade view of larynx
  • impede passage of an introducer or ET
  • causes airway obstruction
  • application of CP by an assistant impedes external laryngeal manipulation by anesthesiologist
  • fracture of cricoid cartilage has be reported
  • rupture of esophagus from vomiting in the presence of cricoid pressure
  • low levels of cricoid pressure might be safe in the presence of vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Induction complications

A
  • induction involves rendering a patient breathless and unconscious
  • in any typical induction involves anticipating difficulties and having a back up plan
  • laryngospasm
  • bronchospasm
17
Q

Difficult airway in summary

A
  1. assess airway and try to anticipate difficult intubation
  2. if so, then consider doing awake fiberoptic or keep the patient breathing
  3. if at any time you are unable to intubate a patient and unable to mask a patient, the LMA is next line
  4. surgical airway is the end option if can’t intubate, cannot ventilate
18
Q

Miller vs. Mac Blade

A
  1. Miller is a straight blade. Lifts epiglottis.

2. Mac is a curved blade. Curves into vaceula.

19
Q

Airway assessment

A
  1. Grade 1 View= Class I Mallampati score. Can visualize uvula, hard palate and soft palate. Can visualize vocal cords
  2. Grade 2 View= Class II Mallampati score. Can somewhat see vocal cords
  3. Grade 3 View= Class III Mallampati score. Can only see epiglottis
  4. Grave 4 View= Class IV Mallampati score. All you can see is palate.
20
Q

Intubation Equipment: Direct Visualization

A

Direct Visualization or Direct Laryngoscopy (DL)

  • Laryngoscope with light source and blade
  • NO CAMERA
21
Q

Intubation Equipment: Fiberoptic Camera Assisted

A
  • video assisted
  • rigid fiberoptic
  • a version of DL blade with a camera
  • Flexible fiberoptics
22
Q

For optimal visualization what position should your patient be in?

A

-sniffing position

23
Q

List a few types of laryngoscope handles and blades

A
  1. Large, medium, penlite, stubby, mini and mico mini handles
    - Prior to induction, light source must be checked
  2. Straight Miller blade or Curved MAC blade
24
Q

Sizes of Macintosh and Miller blades?

A
  1. Infant size O neonate
  2. Child size 2
  3. Most adults size 3
  4. Large adult size 4
25
Q

DL Technique with a MAC Blade

A
  1. Hold laryngoscope blade in left hand and scissor mouth open with right thumb and 3rd finger
  2. Insert blade at the right side of the mouth, sweep tongue out of the way as you insert tip of blade into vallecular space
  3. Make sure lip is not caught under blade on top or bottom
  4. Remove fingers once blade is inserted and epiglottis is visualized
26
Q

MAC DL technique angle of blade

A
  1. Initial angle should be downward as you insert blade
  2. Once epiglottis is visualized upward force brings posterior pharynx and vocal cords into view
  3. Teeth are NOT used as fulcrum*
27
Q

Tips with Mac Blade

A
  1. If you do not initially see epiglottis pull your blade back a little, sometimes you are in too deep and the blade is actually under the epiglottis and in the esophagus. Epiglottis will fall into view as you pull back (happens with Mac 4)
  2. If the patient has large epiglottis, the ETT can be used to gently lift the epilogs and you may get a better view
28
Q

DL Technique with Miller Blade

A
  1. Control of the tongue is critical with straight blade
  2. Small flange height prevents any ability to sweep the tongue. Proper position is achieved with straight blades by deliberately directing the bade to the right paraglossal space
  3. No tongue should be present to the right of the blade
  4. Full insertion of blade should occur through the right lateral mouth over the molar dentition, while the distal blade may then be directed medially, the proximal blade should never be brought back towards midline. (It can hit central incisors)
  5. After the epilogs edge is identified, the handle must be titled forward
  6. The blade is then inserted slightly farther (1-2 cm) and the tip passed under the epiglottis. Once the epiglottis is trapped under the blade, the blade is rocked slightly backward and upright and then the lifting force increased
29
Q

Direct Visualization or Direct Laryngoscopy

A
  • fast and simple

- requires some movement of the head and neck and takes some training to become sufficient

30
Q

What if we can’t or shouldn’t move the patients neck?

A
  • Rigid fiberoptic laryngoscopes use fiberoptic to transmit image from tip of device to eye piece
  • elevates the jaw without the need for neck extension and useful with small mouth opening
  • ETT slides along device or through device
31
Q

Video laryngoscope

A
  • Glidescope
  • Storz C-Mac
  • insert blade down middle of tongue
  • some issues with I can see where I want the tube to go but I can’t get it through cords= use metal stylet and follow ETT along the course of the blade
32
Q

When using a bougie how do you know you’re in the right place?

A

-clicking or bumping felt as bougie tip runs along tracheal rings

33
Q

Video Laryngoscopes: Airtraq (2006)

A
  • provides a magnified wide angle (panoramic view) without the need for eye piece like Bullard)
  • does allow for a clip on monitor
34
Q

Flexible Fiberoptic Laryngoscopes (Bronchoscopes)

A
  • AFOI gold standard for anticipate difficult airway
  • advantage: scope can follow any anatomic space, working around obstructions
  • used to view the airways and check any abnormalities
  • not without limitations*
  • gold standard for awake fiberoptics too
35
Q

What LMA can you intubate through?

A

LMA fastrach

36
Q

Maximum pressure when ventilating a patient with an supraglottic airway?

A

20 cmH2O

Anesthesia Equipment Exam 1 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions