General Anesthesia Induction/Intubation

Question 1

GA Induction Sequence

Answer 1

1. pre-anesthesia check
2. monitor application
3. pre-oxygenate
4. admin induction agents
5. airway support

Question 2

Indications of mask induction

Answer 2

1. peds that are NPO without IV

2. adults that are NPO that are difficult IV placement/do not cooperate with IV placement

Question 3

Mask Induction Sequence

Answer 3

1. monitor application- just pulse-ox?
2. N2O/O2 mix, then Sevo
3. mask ventilation until IV placed- **pt susceptible to obstruction, laryngospasm, and bradycardia
4. intubation or airway placement
5. GA without IV- must have IM or SL backup plan

Question 4

What nerve mediates laryngospasm?

Answer 4

superior laryngeal nerve, primarily occurs during induction/emergence

Question 5

What stimuli produces laryngospasm?

Answer 5

• irritating glottic/supraglottic stimuli
• food
• blood
• vomit
• airway secretions

Question 6

How do you treat laryngospasm?

Answer 6

1. forward displacement of jaw with positive pressure with 100% O2
2. small doses of SUX (0.1-1 mg/kg) and reintubation
3. will cease as hypercarbia/hypoxia develop

Question 7

IV Induction Sequence

Answer 7

1. pt is NPO
2. pre-oxygenate
3. administer IV induction agent
4. mask airway
5. IV paralytic for ETT placement, if using
6. no paralytic if LMA placed
7. placement of airway device/comfirmation

Question 8

RSI Indication

Answer 8

• full stomach
• severe GERD
• anticipated possible difficult mask/intubation

Question 9

RSI Sequence

Answer 9

1. pre-oxygenate up to 5 min
2. administer IV induction agent
3. administer rapid-onset NMBA- SUX
4. apply cricoid pressure
5. intubation/confirmation
6. release cricoid pressure after confirmation

Question 10

Modified RSI

Answer 10

• patient masked with gentle pressure while cricoid pressure maintained
• extra oxygenation/adequate mask airway

Question 11

Why do you use cricoid pressure?

Answer 11

• prevent pulmonary aspiration

- pressure transmitted to posterior lamina that occludes esophagus against vertebral bodies

Question 12

What is the cricoid pressure technique?

Answer 12

• pressure placed with thumb and index finger on lateral edges of cricoid cartilage
• 30N of pressure is directed posterior

Question 13

What are the disadvantages of cricoid pressure?

Answer 13

1. reduces lower esophageal sphincter tone
2. impair laryngoscope insertion
3. degrade view of larynx
4. impede passage
5. cause airway obstruction
6. impedes external laryngeal manipulation
7. fracture
8. esophageal rupture

Question 14

What are the complications of induction?

Answer 14

• patient breathless/unconscious
• laryngospasm
• bronchospasm
• know Difficult Airway Algorithm
• know ACLS/PALS

Question 15

Macintosh blades

Answer 15

size 1-4

most adults size 3

Question 16

Miller blades

Answer 16

size 0-4

most adults size 3

Question 17

Difficult Airway Algorithm

Answer 17

• assess airway & anticipate difficult intubation
• consider awake fiberoptic intubation
• unable to intubate/mask -> use LMA
• can’t intubate/can’t ventilate -> surgical airway