Airways Listen to Audio oral airways nasal airways facemask laryngeal mask esophageal-tracheal combitube endotracheal tubes
nasal airways -helps prevent the tongue and epiglottis to fall back onto the posterior pharyngeal wall -nasal airway creates an artificial airway for the passage of air through the nose leading into the larynx -estimated length of nasal airways: distance from the nares to the meatus of the ear -should not be placed in anticoagulated patients, children with prominent adenoids and basilar skull fractures oral airways -helps prevent the tongue and epiglottis to fall back onto the posterior pharyngeal wall -oral airway creates an artificial airway for the passage of air through the mouth leading into the pharynx and later larynx -adult airways generally come in 3 sizes: small 80mm, medium 90 mm and large 100mm FACE MASK -creating an airtight seal around the patients face the face mask can facilitate delivery of air/oxygen and anesthetic agents -recognition of vomiting and exhalation of expired air can be noticed using a transparent face mask -retaining hooks on the face mask allow for an attachment of headstrap leaving hands free management of the airway -improper positioning of the face mask can lead to a substantial air leak -airleak from improper positioning can be evidenced by a continual deflation of the resevoir bag while the PRV is open -obstructed airway may be observed with high pressure during attempts of ventilation with little or no chest movement -facemask and face strap positions should be changed frequently to prevent ischemic injury -corneal abrasions must be avoided by not creating pressure on the eyes while mask ventilating the patient LARYNGEAL MASK AIRWAY -commonly used in replace of a face mask or endotracheal tube -allows for delivery of oxygen/air and anesthetic gases to be delivered from the breathing to circuit to the patient's airway -facilitates in ventilation especially in a difficult venitlation patient and also helps in the placement of an ETT -partially protects the larynx from pharyngeal secretions but not gastric contents if regurgitation were to occur -should generally be in place and not removed until the patient has intact airway reflexes contraindications for LMA use: -pharyngeal pathology ex. pharyngeal abcess -patients considered full stomachs (ex. trauma, pregnancy, SBO, diabetic gastroparesis) -patients with low pulmonary compliance who require increased peak inspiratory pressures (ex. obese patients) -controversy still remains wether it is to be avoided or beneficial in bronchospastic prone patients ESOPHAGEAL-TRACHEAL COMBITUBE -consists of two fused tubes of differing lengths -longer blue tube has an occluded distal tip with various side ports for air entry into the larynx -shorter clear tube has a patent distal end and no side ports therefore air entry into the larynx occurs at the tip of the tube -generally inserted blindly and then both cuffs are inflated -95% of the time the distal lumen usually lies in the esophagus -distal lumen intubating the esophagus requires ventilation through side ports of the longer blue tube into the larynx -if the combitube enters into the trachea then ventilation can be performed through the shorter clear tube through distal opening -combitube may be more advantageous over an LMA because it allows for better protection from aspiration of gastric contents ENDOTRACHEAL TUBES -allows for most control of oxygenation and ventilation -allows for delivery of oxygen/air anesthetic gases into the trachea from the breathing circuits -usually made from polyvinyl chloride -I.T = 'implant-tested' to make sure there is no toxicity -inserting a stylet allows for rigidity and maintained shape of the ETT -beveled tip at the distal end of the ETT allows for better visualization while passing through the tip past the vocal cords -murphy eye decreases the risk of occlusion in case the distal end of the ETT abuts the walls of the carina -size of ETT are generally measure by internal diameter (I.D) -deciding on ETT size is a balance between decreased airflow resistance of larger size and decreased airway trauma with smaller -ETT cuffs allow for postive pressure ventilation and helps to prevent aspiration in case of gastric regurgitation occurs -two major types of cuffs: high pressure (low volume) cuffs and low pressure (high volume) cuffs -ischemic damage to the tracheal mucosa is more associated with a high pressure (low volume) cuff -sore throat, aspiration, spontaneous extubation and more difficult insertion are associated with low pressure (high volume) cuffs -generally low pressure (high volume) cuffs are more commonly used flexible, spiral-wound, wire reinforced ETT: resist kinking microlaryngeal ETT RAE preformed ETT double lumen ETT armored tubes -generally useful in head and neck surgery and procedures involving the prone position -if the armored tube becomes kinked (ex.biting the tube), the occlusion will remain and the ETT replacement will be indicated