Session 3: Airway Management - LCC

Question 1

how many axis’ does the airway have

Answer 1

3

Question 2

types of airway axis

Answer 2

oral (OA)
pharyngeal (PA)
laryngeal (LA)

Question 3

axis’ alignments laying flat on back

Answer 3

unaligned

Question 4

problems with laying pt flat on back

Answer 4

do not have a clear path for ventilation

potentially harder to breath

tongue falls against back of throat - obstruct airway

Question 5

snoring obstruction type

Answer 5

partial obstruction

Question 6

sleep apnea obstruction type

Answer 6

total obstruction

Question 7

which pts typically struggle breathing on backs?

Answer 7

obese pts due to unaligned axis and more soft tissue mass in airway

Question 8

methods to align airway axis’

Answer 8

1. sniff position
2. head tilt/chin lift

Question 9

how to maximally align airways

Answer 9

sniff position and neck extension

Question 10

sniff position benefits

Answer 10

better passage for air
less likely to obstruct
easier to ventilate
better view of vocal cords

Question 11

anesthesia drugs will do either of these 2 things

Answer 11

make pt stop breathing

cause airway to obstruct

Question 12

how can we breathe for pts?

Answer 12

breathing bag
ventilator

Question 13

4 types of airway obstruction

Answer 13

1. soft tissue (tongue) obstruction
2. laryngospasm
3. bronchospasm
4. airway swelling

Question 14

soft tissue (tongue) obstruction

Answer 14

• most common type of airway obstruction
• tongue falls against back of pharynx
• obese pts more prone to severe obstruction

Question 15

laryngospasm

Answer 15

can occur with every extubation

Question 16

bronchospasm
causes

Answer 16

• most common cause is too lightly anesthetized
• can also occur w/anaphylaxis

Question 17

airway swelling

Answer 17

seen following trauma, burn injury, pregnancy , etc

Question 18

soft tissue obstruction situations

Answer 18

1. MAC anesthesia
2. right after GA induction before LMA/ETT inserted
3. after extubation if pt is not quite awake

Question 19

treatments for soft tissue obstruction

Answer 19

chin lift
jaw thrust
oral airway
nasal airway

Question 20

chin lift

Answer 20

can relieve airway obstruction by aligning the 3 axis’ of the airway

indicated for minor airway obstruction

Question 21

jaw thrust

Answer 21

opens airway
stimulates respirations (Painful)
try after chin lift
push HARD

Question 22

oral airways

Answer 22

• more likely to cause gagging in awake pts
• dental injuries

Question 23

nasal airways

Answer 23

• better tolerated in conscious pts
• can cause nosebleeds
• contraindicated in pts w/facial fractures and blood thinners

Question 24

how do oral/nasal airways work?

Answer 24

relieve airway obstruction by lifting tongue off posterior pharynx

Question 25

laryngospasm

Answer 25

sudden muscle spasm and closure of vocal cords life threatening medical emergency - pt cannot ventilate

Question 26

what triggers laryngospasm

Answer 26

stimulation of the superior laryngeal nerve stimulation of vocal cords during stage II (light) anesthesia

Question 27

causes of laryngospasm stimulation

Answer 27

- ETT during extubation - airway secretions

Question 28

stage 2 anesthesia

Answer 28

pt half awake/half asleep

Question 29

never extubate during stage

Answer 29

2

Question 30

can you laryngospasm in stage 1

Answer 30

unlikely because pt has airway protection from cough/talk reflexes

Question 31

can pt laryngospasm in stage III

Answer 31

unlikely because laryngeal muscles are deeply anesthetized

Question 32

diagnosis of laryngospasm after extubation

Answer 32

- absence of ventilation - difficult providing positive pressure ventilation after extubation

Question 33

diagnosis of laryngospasm during procedure w/o intubation

Answer 33

- pt too lightly anesthetized - sudden loss of end tidal CO2 and inability to ventilate

Question 34

laryngospasm treatment

Answer 34

1. high jaw thrust behind ear w/positive pressure breathing 2. propofol - relaxes vocal cords - takes pt to stage III 3. succinylcholine - muscle relaxant - IM dose 4-6 mg/kg

Question 35

bronchospasm

Answer 35

narrowing of the bronchioles that is caused by inflammation/constriction can occur if lungs get irritated

Question 36

what type of pts are more prone to bonchospasm

Answer 36

smokers asthmatics

Question 37

causes of bronchospasm

Answer 37

1. endotracheal tubes 2. light anesthesia 3. emergence 4. Desflurane 5. Anaphylaxis

Question 38

how do ETTs cause bronchospasm

Answer 38

lungs/trachea/airway are always irritated by tube

Question 39

how does light anesthesia cause bronchospasm

Answer 39

ETT will irritate airway making pt cough if not anesthetized enough

Question 40

how does emergence cause bronchospasm

Answer 40

as pt emerges, they notice the ETT and will typically cough

Question 41

how does desflurane cause bronchospasm

Answer 41

- most pungent/irritating volatile agent

Question 42

does anaphylaxis cause bronchospasm

Answer 42

- rare but possible

Question 43

diagnosis of bronchospasm

Answer 43

sudden difficult to ventilate due to increase resistance to lung expansion difficult to squeeze bag high pressure in lungs most likely observed during light anesthesia

Question 44

treatment for bronchospasm cause by light anesthesia

Answer 44

give propofol and/or higher concentrations of volatile agent to anesthetize more deeply

Question 45

treatment for bronchospasm caused during emergence

Answer 45

give albuterol inhaler via ETT albuterol is a beta 2 agonist/bronchodilator

Question 46

treatment for bronchospasm caused by anaphylaxis

Answer 46

give bronchodilators: 1) epinephrine - (300 mcg IM) 2) beta 2 agonists - albuterol inhaler - subcutaneous terbutaline injection (0.25mg) 3) volatile agent - isoflurane or sevoflurane

Question 47

prevention of coughing on ETT

Answer 47

1. anesthetize trachea w/lidocaine jelly or LTA kit 2. keep patient paralyzed or deeply anesthetized

Question 48

LTA Kit

Answer 48

device that allows you to spray 4% lidocine into the trachea during laryngoscopy and prior to intubation anesthetizes trachea can reduce coughing during procedure and during emergence

Question 49

treatment of coughing on endotracheal tube

Answer 49

1. turn off ventilator 2. dose muscle relaxant or deepen anesthetic w/narcotics or volatile gases

Question 50

edema

Answer 50

swelling

Question 51

vasodilation induced edema

Answer 51

when blood vessels vasodilate, they become leaky and allow more blood to leak into interstitial space increased fluid in interstitial space causes edema

Question 52

common causes of vasodilation induced edema

Answer 52

injury anaphylaxis

Question 53

causes of airway swelling

Answer 53

1. burns 2. traumatic intubation / multiple laryngoscopies 3. pregnancy 4. allergic rxn / anaphylaxis

Question 54

traumatic intubation swelling

Answer 54

consider leaving pt intubated until swelling decreases extubation in presence of significant airway swelling could be catastrophic

Question 55

regurge

Answer 55

passive reflux

Question 56

cause of regurge

Answer 56

reduction in tone of the lower esophageal sphincter (LES)

Question 57

prevention of regurge

Answer 57

cricoid pressure (sellicks maneauver)

Question 58

benefits of cricoid pressure

Answer 58

1. occludes the esophagus 2. improves intubation view

Question 59

vomiting

Answer 59

active reflux

Question 60

vomiting treatment

Answer 60

suction pt place in trendelenburg with head tilted to side

Question 61

aspiration

Answer 61

gastric contents entering trachea/lungs

Question 62

aspiration treatment

Answer 62

intubation send to ICU potentially prophylactic antibiotics and/or steroids