Principles of Anesthesiology Nursing I Advanced Airway Management

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Principles of Anesthesiology Nursing IAdvanced
Airway Management Jeffrey Groom, PhD,
CRNADirector and Clinical Associate
ProfessorNurse Anesthetist ProgramFlorida
International University
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Describe the technique for performing oral and
nasal intubation
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Discuss the procedures for a difficult airway,
failure to intubate, failure to ventilate scenario
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ASA Difficult Airway Algorithm
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Difficult Airway Cart
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• Available Airway options
• Nasal and Oral Airways
• Intubating Stylets
• Specialized Stylets
• Airway Exchange Catheters
• Esophageal Airways
• Laryngeal Mask Airways
• Rigid Fiberoptic Laryngoscopes
• Flexible Fiberoptic Bronchoscopes
• Retrograde Intubation
• Cricothyrotomy Devices
• Transtracheal Jet Ventilation

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Describe the criteria and steps for extubation
following a difficult intubationDescribe the
follow-up and documentation following a difficult
intubation
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Describe the indications and steps for Rapid
Sequence Intubation (RSI)
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Rapid Sequence Induction (RSI)

• Aspiration prophylaxis
• Airway Equipment - Suction
• Optimize intubating conditions
• Denitrogenate Oxygenate
• STP SUX IV Push
• Cricoid Pressure
• No Bag Ventilation
• Intubate
• On emergence Awake Extubation

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Describe the indications and steps of Awake
Intubation
What nerve blocks may be used in awake intubation?
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Peripheral Nerve Blocks

• Awake Fiberoptic Intubation- Tracheal Blocks
• Glossopharyngeal
• Superior Laryngeal
• Transtracheal
• Oral Topicalization Prep
• 2 - 3 ml LIDO

CAUTION Following topical block pt is without
airway reflexes!
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glycopyrrolate
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What are the options for a surgical airway?When
is a surgical airway indicated?
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Cant VENTILATE Cant INTUBATE SURGICAL AIRWAY
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Describe the criteria for extubation.Discuss
the potential complications following extubation
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Emergence and Extubation

• Spontaeous ventilation
• Negative inspiratory force gt 20 cmH2O
• Vital capacity gt 15 ml/kg
• Regular respiratory pattern
• Paralytics reversed
• Equal grip strength, head lift gt 5 sec
• Awake, responsive, stable VS

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Post-extubation Complications

• Laryngospasm
• 100 FiO2 - Jaw thrust Positive Pressure
• SUX 10 20 mg IV
• SUX 100 mg IV and Reintubate prn
• Hypoxemia
• 100 FiO2
• Hypoventilation
• Inadequate reversal, opioids, pain, neurologic
• Laryngeal edema
• Racemic epi, steroids
• Negative pressure pulmonary edema
• Shivering
• Blood loss

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