Airway

Question 0

Trachea

Answer 0

R and L bifucation; angle of R can cause R mainstem

• loss of breath sounds (listen to the L first)
• airway pressures
• look for bilateral chest rise
• end tidal CO2

Question 1

General Considerations

Answer 1

Every pt who receives any type of anesthesia must receive an airway assessment to predict easy or difficulty of airway management

consider type of surgery, type of anesthetic, safety factors

Question 2

anterior attachment to vocal cords

Answer 2

thyroid

Question 3

posterior attachment

Answer 3

arytenoids

Question 4

indications for intubation

Answer 4

• airway protection
• maintenance of patent airway
• application of positive pressure ventilation
• maintenance of adequate oxygenation
• deliver predictable fi02
• provide positive end-expiratory pressure

Question 5

Indications for Mask Case

Answer 5

• No instrumentation of airway required
• will avoid trauma and CV stimulation
• difficult ariway not present
• surgeon does not need access to head/neck except in BMT cases
• No airway bleeding/secretions
• case of short duration
• no table position changes- head available to anesthesia provider
• ventilation by mask requires the ability to achieve a seal between the mask and face to overcome upper airway obstruction. obstruction should be easily relieved with airway/chin lift.

Question 6

Airway Assessment: The History

Answer 6

Previous anesthesia hx with airway management?

difficulty with prior anesthetics/intubations?

• past awake or fiberoptic intubation?
• severe sore throat or dental damage/ or recent dental work?

Co-existing disease?

surgical hx that may affect airway management

Question 7

Medical Hx

What co-morbidities does this patient have that may effect airway management?

Answer 7

lesions of larynx- can cause larynx to not be midline 
thryoid dz- goiter 
cancer- radiation therapy
gerd
diabetes
sleep apnea- uvuloplasty
obesity- reduced frc and short apnea time so sats drop 
genetic disorders
rheumatoid arthritis
musculoskeletal 
scleroderma

Question 8

Surgical History

What surigcal hx may effect the airway management?

Answer 8

Tracheostomy or scar
neck dissection
UVPP
cervical neck insturmentation (fusion)
radiation (causes scar tissue)
sign of a difficult airway: cant put chin to chest

Question 9

Airway Assessment: Physical Exam Standards

Answer 9

essential for preoperative asssessment for patients who are undergoing surgery

agrees with standards I and III of the AANA
standard I - a practitioner shall perform a through and complete pre-anesthesia assessment, allowing the practitioner to (standard III) formulate a patient-specific plan for anesthesia care

Question 10

Airway Assessment: The physical exam

general appearance

Answer 10

head
neck size circumference + length
*greater than 60 cm neck than will have 35% chance of difficult airway
*bad to have short neck
presence of heavy facial hair (hard to get a seal)
mouth-lips, gums and tissues

Question 11

Airway Assessment: The physical exam

teeth

Answer 11

length of incisors
condition of teeth-missing, protrusions, overbite
relationship of upper incisors (maxillary) to lower incisors (mandible)
dentures/bridges out?

Question 12

Airway Assessment: The physical exam

mouth opening

Answer 12

normal > 4cm or >2 fingerbreadths
size and mobility tongue
size and shape mandible; maxillary overgrowth
TMJ

Question 13

physical exam: Thyromental Distance

Answer 13

distance from mandible to prominence of thyroid cartilage (thyro-mental) to normal 6.5 cm (50mm); 3 fingerbreadths

Question 14

physical exam: Hyoidmental distance

Answer 14

distance hyoid to mandible (hyoid-mental) to normal 2FB

Question 15

The physical exam

Answer 15

cervical ROM- atlanto-occipital joint

listen to BBS/upper airway sounds for snoring, stridor

Question 16

mandibular protrusion test:

Class A

Answer 16

lower incisors can be protruded anterior to the upper incisors

Question 17

mandibular protrusion test:

Class B

Answer 17

The lower incisors can be brought edge to edge with upper incisors

Question 18

Mallamptati Exam

Answer 18

Relates the size of base of tongue to the oral cavity

visulization pharyngeal structures- soft palate, fauces, uvula, and pillars

during this assessment the patient is seated upright with the head in neutral position. the patient is asked to open the mouth as wide as possible and to stick out the tongue

patients encouraged NOT to phonate or say “ahh” as phonation can inappropriately elevate the soft palate

Question 19

Mallampati Class 1

Answer 19

entire uvula
pillars
fauces
soft/hard palate

Question 20

Mallampati Class 2

Answer 20

uvula
fauces
soft-hard palate

Question 21

Mallampati Class 3

Answer 21

base of uvula

soft/hard palate

Question 22

Mallampati Class 4

Answer 22

hard palate only

Question 23

airway assessment strong predictors:

Answer 23

obesity
decreased head and neck movement
decreased jaw movement
receding mandible
buck teeth

Question 24

airway set up

Answer 24

laryngoscope (2 blades)
oral nasal airways several sizes
tongue depressor
Et tubes 2 sizes with stylets and syringe on cuff
suction
ambu bag
lma

Question 25

documentation

Answer 25

preop
-dental, cervical range of motion, mallampati class, TM distance, mouth opening

post-intubation
-visulization, trauma, equipment used, hemodynamic or respiratory changes

post-extubation
-loose teeth intact, airway patency, adjuncts airway maneuvers used