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N610 Anesthesia Concepts > Airway > Flashcards

Airway Flashcards

0
Q

The end of the mac blade connects to what anatomical part?

A

Vallecula

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1
Q

Mac (macintosh) vs. Miller blade

A

Mac is curved, miller is straight

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2
Q

What is the epiglottis function and where is it located

A

Closes during swallowing to prevent aspiration, located at C3 (end of oropharynx, start of larynx)

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3
Q

What are the functions of the nasal passages?

A

Humidify, filter, and warm

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3
Q

Where is the larynx and what are its functions

A

Larynx from C3 (epiglottis) to C6 (cricoid)

Protects airway, respiration, phonation

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4
Q

Nasopharynx is innervated by which nerve?

A

Trigeminal (CN5), opthalmic and maxillary divisions

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5
Q

What are the 9 cartilages that make up the larynx?

A

2x arytenoid, 2x corniculate, 2x cuneiform, thyroid, cricoid, epiglottis

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6
Q

Which nerve supplies the posterior 1/3 of tongue and oropharynx to vellecula?

A

CN9- Glossopharyngeal

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7
Q

All intrinsic muscles of the larynx are supplied by which nerve (and which branch), except for which muscle?

A

RLN (recurrent laryngeal nerve) of Vagus Nerve (CN X)

Exception: cricothyroid muscle is SLN (superior) on external branch

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8
Q

What landmark is at C6?

A

Cricoid cartilage

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9
Q

Intrinsic laryngeal muscles that adduct and abduct glottis

A

lateral cricoarytenoid- adduct (close)
arytenoids- adduct (close)
posterior cricoarytenoid- abduct (open)

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10
Q

intrinsic laryngeal muscles that put tension on vocal ligaments

A

cricothyroid- elongates (high pitch) vocal cords (only SLN-external!)
vocalis- shortens (low pitch) vocal cords
thyroarytenoid- shortens (low pitch) and relaxes vocal cords

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11
Q

extrinsic laryngeal muscles that move hyoid bone and thyroid cartilage

A

Sternohyoid, thyrohyoid, omohyoid - move hyoid caudad (down)

Sternothyroid - move thyroid cartilage caudad

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12
Q

does right or left bronchus have the smaller angle? (which are you more likely to intubate?)

A

Right bronchus

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13
Q

Mallampati’s stages

A

Class 1: uvula exposed (best), we see glottic opening and vocal cords
Class 2: base of uvula visible, we see glottic opening and vocal cords
Class 3: soft palate visible, we see arytenoids
Class 4: only hard palate visible, we see epiglottis only (use miller blade)

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14
Q

Normal Thyromental distance and what distance is considered a contributing factor to a more difficult intubation?

A

Thyromental distance: from lower mandible to thyroid notch, with neck fully extended, normally 6cm/ 4 fingerbreadths
difficult intubation at 3 or less fingerbreadths

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15
Q

For someone who is determined to be a difficult intubation, what is the alternative to giving succinylcholine?

A

Awake intubation with airway blocks, airway block will abolish gag reflex and hemodynamic response to laryngoscopy and bronchoscopy

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16
Q

Complication of putting in an oral airway

A

Laryngospasm!

Bleeding, soft tissue damage

17
Q

2 types of oral airways

A

Geudel (suction through the middle is possible)

Berman

18
Q

contraindications to nasal airway

A

basal skull fx, epistaxis, anticoagulant use

19
Q

ETT size for men vs. women?

A

women: 6.5-7
men: 7.5-8

20
Q

How far does ETT get inserted? men vs. women and proximation to carina and vocal cords

A

men: 23 cm
women: 21 cm
4 cm above carina, 2 cm below vocal cords

21
Q

Steps of induction sequence

A
  1. preoxygenate, 2. sniffing position, 3. monitors on, 4. give induction agent, 5. lash reflex then test ventilation, 6. check neuromuscular blocking monitor (train of 4), 7. give paralytic, 8. tape eyes closed, 9. bag until loss of twitches, 10. larygoscopy and intubation, 11. confirm ETT placement, 12. keep bagging or turn on vent, 13. Start maintenance anesthetic, 14. tape ETT
22
Q

Sensory and motor innervation of SLN-int branch of vagus nerve?

A

sensory- above vocal cords: epiglottis, tongue, supraglottic mucosa, cricothyroid joint and thyroepiglottic joint
motor- none

23
Q

Sensory and motor innervation of SLN-ext branch of vagus nerve?

A

sensory: anterior supraglottic mucosa
motor: cricothyroid

24
Q

sensory and motor of RLN branch of vagus nerve?

A

sensory- below vocal cords: subglottic mucosa muscle spindles
motor- intrinsic muscles of larynx (except cricothyroid is SLN-ext)

25
Q

Which muscle ABDucts, closes the glottis?

A

Posterior cricoarytenoid

26
Q

complications of airway blocks

A 
systemic toxicity (if drug is given to vessel, aspirate to prevent this)
hematoma
27
Q

Transtracheal blocks which nerve, so what is blocked? (indications)

A

Blocks RLN branch of vagus which blocks sensory below the vocal cords, this will block the gag reflex and hemodynamic response to laryngoscopy

28
Q

Steps of Transtracheal block

A
  1. skinwheel of local, 2. local to cricothyroid membrane, 3. advance 23g butterfly needle caudad through cricothyroid membrane while aspirating, 4. aspirate air to know you’re in the correct spot, 5. instruct patient to take a deep breath, 6. inject lidocaine on inspiration, 7. pt will cough, this spreads lidocaine
29
Q

What nerve is blocked by superior laryngeal nerve block? What sensory areas are blocked? (indications)

A

SLN internal branch of vagus nerve, blocks above the vocal cords (supraglottic region), blocks gag reflex and hemodynamic response to laryngoscopy

30
Q

Steps and landmarks of superior laryngeal nerve block

A
  1. palpate hyoid bone and displace toward injection site, 2. insert 23g needle perpendicular, hit hyoid bone, 3. angle needle 1/4 inch caudad and 1/4 inch medial, 4. aspirate, 5. repeat on other side
    Landmarks: cornu of hyoid bone
31
Q

Glossopharyngeal nerve block will block what nerves, and what sensory functions?

A

Lingual branch of glossopharyngeal nerve (CN 9), sensory to posterior 1/3 of tongue, this will also block gag reflex

32
Q

Glossopharyngeal block steps

A
  1. use tongue blade to move tongue away, 2. insert 25g needle at base of palatoglossal arch, 0.5 cm deep and lateral, 3. aspirate, get nothing, 4. inject lidocaine, 5. repeat on other side
33
Q

Cricothyrotomy: indications and contraindications

A

indication: emergency airway
contraindication: children under 12 and patients with laryngeal fractures

34
Q

Cricothyrotomy steps

A
  1. stabilize larynx between thumb and middle finger, 2. palpate thyroid and cricoid cartilage, 3. insert 14g IV through cricothyroid membrane (1.3cm or less), angle towards carina, 4. aspirate air, 5. hook up to jet ventilator
35
Q

Cricothyrotomy complications (3)

A

esophageal perforation (to avoid this, do not let needle advance more than 1.3cm), subcutaneous emphysema, excessive bleeding (vessel rupture)

36
Q

Innervation of anterior 2/3 of tongue? Innervation of posterior 1/3 of tongue?

A

anterior 2/3: (taste is facial carried by chorda tympani) tactile is lingual nerve from mandibular division of trigeminal nerve (CN5).. Motor is hypoglossal
posterior 1/3: glossopharyngeal (CN9) taste and sensory (hypoglossal motor)

37
Q

What physical assessments might you do to determine if the patient will be a difficult intubation? What history questions might you ask?

A

Physical: Mallampati, thyro-mental distance, look at surrounding tissue (burns, old trachs, mass)
History: Radiation/burn to head/neck? C-spine pain? TMJ pain? Rheumatoid arthritis? Ankylosing Spondylitis? Abcess/tumor? Prior intubations or tracheotomy? Snoring or sleep apnea? Dysphagia or stridor?

38
Q

What is aligned in the “sniffing” position?

A

oral, pharyngeal, and laryngeal axis

39
Q

What does preoxygenation consist of?

A

3-5 minutes of mask breathing of 100% O2 at over 5L/min

OR 4 vital capacity breaths in 30 sec (for emergencies)

40
Q

What does the airway setup consist of?

A

Laryngoscope (2 types of blades), oral/nasal airways (several sizes), tongue depressor, ETT tube (2 sizes), suction, ambu-bag, stylet, LMA

41
Q

What do the vocal cords attach to posteriorly and anteriorly?

A

posterior: arytenoids
anterior: thyroid cartilage

42
Q

List complications of tracheal intubation

A 
Trauma to airway
Esophageal intubation
Endobronchial intubation
Endotracheal tube ignition
Sore throat
Laryngospasm
Croup

N610 Anesthesia Concepts (4 decks)

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