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Anesthesia Concepts > Airway > Flashcards

Airway Flashcards

1
Q

Nasal Passages - cricoid cartilate

A

septum, turbinates UPPER AIRWAY
trigeminal nerve CN X
nasal passage very responsive to transmucosal anesthesia (lidocaine, afran)

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2
Q

Oral cavity

A

teeth, tongue, hard palate, soft palate
posterior 1/3 tongue back,
glossalpharyngeal nerve
hard to eliminate gag reflex, not as responsive to transmucosal

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3
Q

pharynx

A

nose to cricoid cartilage
nasopharynx - seperates soft palate
oropharynx - tonsils, uvula, epiglottis c2-c3

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4
Q

cricoid cartilage

A

c6

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5
Q

larynx

A

c3-c6
airway protection
respiration
phonation

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6
Q

tube size

A

6.5-7 female
7-7.5 male
8-8.5 long term intubation
pressure of tube against cords can cause swelling therefore try for smallest possible

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7
Q

3 paired cartilages

A

arytenoid
corniculate
cuneiform

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8
Q

3 unpaired cartilages

A

thyroid
cricoid - external superior laryngeal
epiglottis

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9
Q

cricoid

A

complete signet shaped ring of cartilage
external external superior laryngeal
narrowest point of pediatric airway (in adults, glottal opening)

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10
Q

intrinsic laryngeal muscles

open and close glottis

A 
all innervated by recurrent laryngeal 
 (AB and AD)
lateral cricoarytenoid (ADD)
arytenoids (ADD)
posterior cricoarytenoid (only ABD)
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11
Q

intrinsic laryngeal muscles
tension on vocal ligament
elongate and shorten

A

cricothyroid - elongates (external superior laryngeal)
vocalis - shortens
thyroarytenoid - shorten and relax

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12
Q

Extrinsic laryngeal muscles

A

sternohyoid
thyrohyoid
omohyoid
sternothyroid

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13
Q

carina

A

5th thoracic vertebrae

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14
Q

lower airway

A

main function - conduction of air and gas exchange
trachea, carina, bronchi, bronchioles, terminal bronchioles, resp bronchioles, alveoli

innervated by superior laryngeal

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15
Q

trachea

A 
sits opposite 6th cervical vertebrae
flattened in back
16-20 horse shoe cartilages
10-20 cm length and 22 mm diameter
R 2.5cm long 25 degree angle
L 5cm long 45 degree angle
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16
Q

class I airway

A

faucil pillars
soft palate
uvula
full vocal cords

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17
Q

class II airway

A

uvula masked by tongue

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18
Q

class III airway

A

soft palate
uvula base
maybe just arytenoid (post attachement vocal cords)

19
Q

class IV airway

A

only hard palate

epiglottis

20
Q

thyromental distance

A

lower border mandible to thyroid notch with neck fully extended
normal 6-6.5cm or 4 finger breadths
less than 3 is difficult airway

21
Q

optimal intubating position

A

“sniffing” position
oral
pharyngeal
laryngeal

22
Q

preoxygenation

A

increased O2 conc in FRC. decreased nitrogen in FRC (79% in RA)
3-5 min tight mask tidal breathing of 100% O2 over 5L/min flow (healthy person tolerates up to 10 min apnea)
4 vital capacity breaths in 30 sec (healthy person tolerates up to 5 min apnea)

23
Q

airway setup

A 
laryngoscope/ 2 blade types
oral/nasal airway
tongue depressor
ETT tubes 2 sizes
suction
ambu bag
stylet
LMA (difficult airway)
24
Q

nasal airways/trumpets

A

provide passageway (nose to pharynx) beneath obstructing tongue
length estimate dist from nare to meatus of ear
complications - epistaxs, nasal/basal skull fx, adenoid hypertrophy, anticoagulants???? bleeding

25
Q

laryngoscopes and blades

A

macintosh (curved, behind velicula) 1-4

miller (straight, pick up epiglottis) 0-4

26
Q

Adult ETT sizes

A
  1. 5, 7 females

7. 5, 8 males

27
Q

how far does ETT go?

A

4cm above carina
2cm below vocal cords

males approx 23 cm
females approx 21 cm

28
Q

order of events

A 
preoxygenate
induction drug
lash reflex
test vent
muscle rela
laryngoscopy
29
Q

sensory innervation of airway

A 
glossal pharyngeal
internal branch superior laryngeal (above cords)
recurrent laryngeal (below cords)
30
Q

motor innervation of airway

A

external branch superior branch laryngeal

recurrent laryngeal

31
Q

glossal pharyngeal CN IX

A

sensory o posterior 1/3 tongue and oropharynx to vallecula

32
Q

interior superior laryngeal (sensory)

A

branch of vagus, sensory to vocal cords and above

epiglottis
base of tongue
supraglottic mucosa
thyroepiglottic joint
cricothyroid joint
33
Q

recurrent laryngeal (sensory)

A

branch of vagus, mucosa below vocal cords

muscle spindles

34
Q

external branch superior laryngeal (motor)

A

motor to cricothyroid (adductor

tension on vocal cords)

35
Q

recurrent laryngeal (motor)

A

ALL intrinsic muscles of larynx (except for cricothyroid muscle)

thyroarytenoid
lateral cricoarytenoid
interarytedoid (add)
post arytenoid (ABD)

36
Q

external branch superior laryngeal (sensory)

A

anterior subglottic mucosa

37
Q

responses to tracheal intubation

A

cv - HTN, tachy, MI,
resp - laryngospasm, bronchospasm
trauma, esophageal intubation, et ignition, sore throat, croup

38
Q

induction sequence

A

1) preoxygenation
2) position in sniffing
3) monitors on/working
4) induction agent
5) lash reflex
6) test vent
7) check NM blocking monitor working
8) paralytic
9) tape eyes closed
10) continue bag/mask vent until paralytic drug takes effect (loss of twitches)
11) laryngoscopy and intubation
12) confirm ETT placement - bilat breath sound, chest rise, etco2
13) cont vent bag or ventilator
14) begin maintenance anesthetic
15) tape ETT

39
Q

indications for airway blocks

A

abolish or blunt reflexes

provide comfort and airway anesthesia during performance of these procedures

40
Q

complication of airway blocks

A 
systemic toxicity (metal taste, seizure)
hematoma formation
41
Q

transtracheal block

A

block recurrent laryngeal nerve - cricothyroid membrane (sensory but not motor) for awake laryngoscopy, riberpotic and/or retrograde intubation

abolition of gag reflex, hemodynamic response
results in anesthesia of trachea below vocal cords, cough stimulus spreads to upper

continuously aspirate, caudad direction, visualize air bubbles, instruct to take deep breath, inject lidocaine on inspiration
cough sill spread (SLN above VC)

42
Q

superior laryngealblock

A

internal (sensory) branch SLN

blocks supraglottic region, abolition gag and hemodynamic respons

palpate hyoid, displace toward side to be injected, inferior border cornu 23 g 1/75cm needle perpendicular into skin, 1/4 caudal, 1/4in medial

1-2cc LA 1-2cc above and helow thyrohyoid membrane, aspiration, if air, you are deep in pharynx

repeat on other side… dont want air or blood

43
Q

glossopharyngeal nerve block

A

lingual branch GPH nerve sensory to back of tongue

abolition gag and hemodynamic
when topical application ineffective
move tongue with blade, form gutter, 25g spinal needle at base of palatoglossal arch .5 cm deep and .5 cm lateral to tongue base
aspirate before inn 1-2cc lidocaine

air - too deep
blood - withdraw and redirect needle medially

Anesthesia Concepts (6 decks)

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