Special Airways for Ventilation PDF

Special Airways for Ventilation Special Airways for Ventilation Announcement: The Airway Review Quiz in BB will open after class today. * It is 17 questions and worth 50 points. * You may use your notes and PowerPoints if you wish. * The questions will appear in random order, and only one question...

Special Airways for Ventilation Special Airways for Ventilation Announcement: The Airway Review Quiz in BB will open after class today. * It is 17 questions and worth 50 points. * You may use your notes and PowerPoints if you wish. * The questions will appear in random order, and only one question will appear at a time. * Once you answer a question you cannot go back to a previous question. * You will have 60 minutes per attempt, and you may attempt the quiz 2 times. * If you attempt the quiz a 2nd time, the two attempts will be averaged together for your final score.  Oropharyngeal Airway Indications Relieve upper airway obstruction if airway maneuvers fail to establish airway Use as a bite block in intubated patients Uses and precautions Use in sedated or unconscious patient Insert airway using scissors (crosses fingers) technique Remove airway if the patient gags or retches Body fluid precaution (saliva)  Oropharyngeal Airway Size selection Center of mouth to angle of jaw Corner of mouth to earlobe Central incisors to angle of jaw Too large an airway can push the epiglottis against the larynx, leading to airway obstruction Too small an airway may not clear the tongue, leading to airway obstruction by the tongue Oropharyngeal Airway Correct placement of an oropharyngeal airway  Also called nasal trumpet or nasal horn Indications Facilitate ventilation Removal of secretions by nasotracheal Nasopharyng suctioning eal Airway Uses and precautions Inspect nares for obstruction Use local anesthetic spray Use water-soluble lubricant on airway Insert airway parallel to the nasal floor Distal end should be 1 cm from epiglottis  Size selection Size 6 for adult female, Size 7 for adult male Too short – cannot separate soft palate from posterior Nasopharyng wall of pharynx Too long – may enter larynx, eal Airway causing laryngeal reflexes or enter the space between epiglottis and vallecula, leading to potential obstruction NPA Esophageal Obturator Airway (EOA) EOA is inserted into the esophagus EOA has an opening at top end (for manual ventilation), small holes in mid-section (divert air to lungs), a blind distal end (prevents air from going to stomach) A cuff on top of the distal end prevents aspiration of stomach contents Esophageal Obturator Airway (EOA) Esophageal Obturator Airway (EOA) EOA Esophageal Gastric Tube Airway (EGTA) Similar to EOA with exceptions EGTA has an opening at the distal end for removal of gastric distention due to air or contents EGTA has a nasogastric port No ventilation holes along the tube Ventilation is provided through the ventilation port via a mask and resuscitation bag Esophageal Gastric Tube Airway (EGTA) Laryngea l Mask Airway LMA resembles a LMA provides a seal (LMA) short ET tube with a small cushioned over the larynx with standard cuff pressure oblong-shaped mask of 60 cm H2O on the distal end LMA  LMA Indications Airway during CPR in profoundly unconscious patients without glossopharyngeal and laryngeal reflexes Unable to perform endotracheal intubation Sometimes an elective airway used in surgery  LMA Contraindications LMA does not protect airway from aspiration Should not be used in patients who Have not fasted or with hiatal hernia Are not profoundly unconscious Have severe oropharyngeal trauma Require emergency resuscitation drug instilled directly into airway (e.g., epinephrine)  LMA Selection of LMA: Large LMA with less air in cuff gives a better seal.  LMA Insertion of LMA Place profoundly unconscious patient in supine position Open mouth by depressing chin Deflate cuff completely or partially Mask opening should face away from operator Insert LMA blindly through the mouth and along the hard palate, then to the posterior pharynx May use fingers to guide the LMA for the curved turn around toward the trachea and larynx Removal of LMA Can be done safely when the patient is anesthetized or awake  LMA Limitation of LMA Unstable airway may cause misplacement of mask and gastric insufflation Cannot withstand high airway pressure (20 cm H2O, up to 30 cm H2O with LMA-ProSeal) Optimal duration of use is 60 cm H2O) may lead to malposition Does not protect lower airway from aspiration Requires steam autoclave for reusable LMA (seldomly used)  Esophageal-Tracheal Combitube (ETC) ETC is also called pharyngeal-tracheal lumen airway and esophageal- tracheal airway Blind intubation ETC may be inserted into the esophagus or trachea Ventilation is provided via Lumen 1 when ETC is in esophagus Lumen 2 when ETC is in trachea  Esophageal-Tracheal Combitube (ETC) When tube is in the esophagus, a small distal cuff (15 mL) seals off the esophagus (Figure A) When tube is in the trachea, a large proximal cuff (100 mL) seals off trachea (Figure B) Ventilation is provided via the openings (Figure A) or tube (Figure B)  Esophageal-Tracheal Combitube (ETC) Complications of ETC Hemodynamic stress Cuff leaks Other air leaks due to esophageal laceration subcutaneous emphysema pneumomediastinum pneumoperitoneum  Double-Lumen Endobronchial Tube (DLT) DLT is also called double-lumen tracheobronchial tube Indications Lung isolation (prevent lung-to-lung spillage of blood pus) Surgical procedure on nonventilated lung Bronchopleural or bronchocutaneous fistulas DLT has 2 lumens, 2 cuffs, and 2 pilot balloons Left- or right-sided DLT Left-sided DLT is more commonly used Right-sided DLT may cause RUL atelectasis if bronchial cuff passes the RUL bronchus (RUL bronchus is only about 2 cm distal from carina in adults) Bronchocutaneous Fistula  DLT Insertion of DLT Patient is anaesthetized and paralyzed Insert DLT under direct laryngoscopy When tracheal cuff passes the vocal cords, the tube is about 6 cm (5+ in) from final position Remove stylet (if used) Inflate bronchial cuff and ventilate both lungs via the bronchial tube Advance DLT to bronchus and note endpoint signs Resistance to advancement Unilateral ventilation Reduction in compliance (increase in PIP) Deflate bronchial cuff and advance DLT another 2.5 to 3 cm (bronchial cuff length + 1 cm) Reinflate bronchial cuff (requires only 1 to 2 mL of air) Inflate tracheal cuff Ventilate one or both lungs DLT  DLT Complications of DLT Airway injuries and rupture