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*Anesthesia Concepts 1 > Airway > Flashcards

Airway Flashcards

0
Q

What is the narrowest part of adult airway? Pediatric airway?

A

Glottic opening - triangular opening to VC

Cricoid cartilage

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1
Q

What is the level of the larynx?

A

C3-C6

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2
Q

3 paired cartilages. Where do they attach?

A

arytenoids - posterior attachment to VC
corniculate - n/a
cuneiform - n/a

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3
Q

3 unpaired cartilages. Describe them

A

thyroid - ant attachment to VC
cricoid - complete cartilaginous signet-shaped ring
epiglottis - covers larynx during swallowing

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4
Q

Name the intrinsic muscles and innervations of airway.

A
  1. lateral cricoarytenoids - adduct/close VC
  2. arytenoids - adduct/close VC
  3. posterior cricoarytenoids - abduct/open VC
  4. cricothyroid - elongates VC
  5. vocalis - shortens VC
  6. thyroarytenoid - shortens VC
    - ALL innerv by RLN except cricothyroid = External SLN
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5
Q

Name the extrinsic muscles of airway and their functions.

A

sternohyroid, thyrohyoid, omohyoid - move hyoid caudad (down)
sternothyroid - move thyroid caudad

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6
Q

Describe sensory and motor innervation of the airway.

A

Glossopharyngeal - sensory - posterior 1/3 of tongue, oropharynx to vallecula
Internal SLN - sensory - VC, epiglottis and supraglottic mucosa
RLN - sensory - subglottic mucosa
External SLN - sensory - anterior subglottic mucosa

RLN - motor - all intrinsic except cricothyroid motor = External SLN

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7
Q

Describe the trachea.

A 
10-20 cm long
22 mm diameter
posterior lacks cartilage
T4=carina
R bronchus = 25 degree angle, 2.5 cm long
L bronchus = 45 degree angle, 5 cm long
*Check L lung sounds first*
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8
Q

What is the Mallampati hypothesis? How do you assess it?

A
  • When base of tongue is disproportionally large and overshadows larynx = difficult exposure of VC during laryngoscopy
  • Pt sit upright, head neutral, mouth wide open, stick out tongue, NO “AHH”
  • Class I - clear view of soft palate and uvula
  • Class II - uvular partially covered by tongue
  • Class III - soft palate, base of uvula only
  • Class IV - hard palate only
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9
Q

How do you measure thyromental distance?

A
  • lower mandible border to thyroid notch with neck extended
  • normal is 6-6.5 cm (4 fingers)
  • difficult intubation < 3 fingers, receding mandible
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10
Q

What is test ventilation?

A

Tests if patient can be ventilated/bagged after sedative and prior to muscle relaxant. If failed, avg pt can go w/o 10 min O2 if preoxygenated.

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11
Q

What is sniffing position? Why is it important? When is it used?

A
  • Aligns 3 axes: oral, pharyngeal, laryngeal for optimal visualization and mask ventilation
  • Allows best visualization of VC and best mask fitting position
  • Done before preoxygenation (RSI)
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12
Q

What is preoxygenation? How do you perform it?

A
  • Goal is to increase O2 concentration of FRC and decrease Nitrogen concentration > replace N with O2
  • 5 minutes of tight mask fit normal tidal breathing of 100% O2 > 5LPM (allows up to 10 min of apnea)
  • 4 vital capacity breaths in 30 seconds (allows up to 5 min of apnea)
  • occurs prior to RSI
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13
Q

What are complications/precautions for an oral airway?

A

laryngospasm, bleeding, soft tissue damage

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14
Q

What are complications/precautions for nasal airway? How is it placed?

A
  • epistaxis, nasal or basal skull fractures, adenoid hypertrophy, recent anticoagulant therapy
  • LUBRICATE!
  • used in series, smaller to larger to dilate prior to nasal intubation
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15
Q

Describe the difference between Mac and Miller blades and their sizes.

A
  • Mac - blade inserts into vallecula (#0-4) avg = #2-4

- Miller - blade pics up epligottis (#1-4), avg = #3

16
Q

How deep do you want the ETT placed?

A

4 cm above carina

2 cm below VC

17
Q

What is the avg size and distance ETT for males/females?

A
  • Male - 7.5-8, 23 cm

- Female - 6.5-7, 21 cm

18
Q

Describe noxious stimuli effects of DVL and ETT placement.

What can be done to avoid this stimuli if pt is high risk?

A
  • CV: HTN, ST, MI, can precipitate MI
  • RS: laryngospasm, bronchospasm

-Deep plane of anesthesia prior to airway manipulation: inhalant with N2O, narcs, prophylactic bronchodilator, effective topical anesthesia/airway blocks

19
Q

Complications of airway intubation:

A
  1. trauma to airway structures
  2. esophageal intubation
  3. endobronchial intubation
  4. endotracheal tube ignition
  5. sore throat
  6. laryngospasm
  7. croup
20
Q

What are the 3 airway blocks and why are they used?

A
  1. transtracheal
  2. SLN block
  3. Glossopharyngeal N block
    - awake intubation to abolish gag reflex or hemodynamic response to DVL
21
Q

What is transtracheal block? Where and how do you inject?

A
  • anesthesia of RLN/trachea below VC
  • inject thru cricothyroid membrane caudad; visualize air bubbles = trachea; pt take deep breath and inject prior to inspiration = stimulates cough reflex to spread anesthetic
22
Q

What does superior laryngeal block do? Where and how do you inject?

A
  • blocks internal branch of SLN = VC, epiglottis, supraglottic region
  • palpate hyoid bone and displace toward side to be injected, palpate inferior border of cornu, insert perpendicular to skin and caudad/medial; inject 1-2 ml above and below membrane (ASPIRATING)
  • perform on BOTH sides
23
Q

What is glossophayngeal n block? When is it used? Where and how do you inject?

A
  • blocks lingual branch of glossopharyngeal n to posterior tongue
  • used when topical anesthetic is not effective
  • inject into base of palatoglossal arch, air = too deep, blood = withdraw and redirect
24
Q

Perform RSI

A

see guide

25
Q

What are complications of airway blocks?

A
  1. hematoma

2. systemic toxicity (injecting LA into blood vessel)

*Anesthesia Concepts 1 (4 decks)

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