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Intro to Anesthesia Main > Airway > Flashcards

Airway Flashcards

1
Q

Cormack and Lehane Score

A

Laryngoscopic view of the glottis

Grade I: most of the glottis visible

Grade II: Only the posterior portion of glottis visible

Grade III: Only epiglottis visible

Grade IV: No airway structures visualized

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2
Q

carina

A

where trachea bifurcates.

Left and right sides come off at different angles.

right bronchi is 2.5 cm long with 25 degree angle

left bronchi is 5cm long with a 45 degree angle

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3
Q

Thyroarytenoid/ Vocalis

A

shortens and relaxes the vocal cords

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4
Q

Pharynx

A

Connects nasal and oral cavities or larynx and esophagus

  • nasopharynx
    • border is soft palate
  • oropharynx
    • border is the epiglottis
    • includes tonsils, uvula
  • Hypopharynx/Laryngopharynx

Innervation:

Glossopharyngeal (CN IX)

Vagus (CN X)

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5
Q

Oral airways

A

measure from the corner of the mouth to the earlobe

  • use tongue depressor to insert
  • Complications:
    • laryngospasm
    • bleeding
    • soft tissue damage
  • 2 types: Berman (BOA) and Guedel (hollow)
    • small- BOA 80mm / Guedel 3
    • medium- BOA 90mm / Guedel 4
    • large - BOA 100mm / Guedel 5
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6
Q

MAC case

A

Monitored Anesthesia Care

  • Spontaneously breathing patient
  • Always have COMPLETE airway setup ready to go
  • Nasal Cannula (everybody gets O2)
    • 2L NC = 28% FiO2
    • 6L NC = 45% FiO2
  • Nasal airway if snoring
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7
Q

Nasal airways

A

measure from distance of nare to meatus of ear

  • Tolerated better than oral airway with light sedation
  • lubricate
  • complications:
  • epistaxis (nose bleed), nasal or basal scull fractures, adenoid hypertrophy
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8
Q

lower airway

A

trachea

carina

bronchi

bronchioles

terminal bronchioles

respiratory bronchioles

alveoli

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9
Q

Glossopharyngeal Nerve (CN IX)

A
  • Posterior 1/3 of tongue
  • soft palate
  • oropharynx
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10
Q

Airway set up

A
  1. appropriately sized face mask
  2. ambu bag, circuit (for pos pres)
  3. suction
  4. tongue depressor
  5. oral and nasal airways
  6. laryngoscope handle
  7. 2 different blades
  8. ETT, 2 sizes
  9. stylet
  10. syringe
  11. LMA
  12. tape
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11
Q

Larynx

A

Located at C4-C6 in an adult

Functions: airway protection, respiration, phonation

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12
Q
A

Macintosh blade

  • Inserted in vallecula above epiglottis
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13
Q

Optimal intubating position

A

“sniffing”

Oral, pharyngeal, and laryngeal axis

Most optimal for visualization of vocal cords and most effective mask ventilation

Obease pt: Tragus to Sternum

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14
Q

Mallampati score

A

Pt sitting upright, head neutral mouth open as wide as possible and tongue maximally protruded. No AAAH!

  • Correlates the oropharyngeal space with the ease of direct laryngoscopy and tracheal intubation.
    • When the base of the tongue is disproportionately large, the tonge overshadows the larynx resulting in difficult exposure of the vocal cords during laryngoscopy.

No AAAH!

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15
Q

Pre- Oxygenation

A
  • Goal to increas O2 concentration in functional residual capacity (FRC) by “washing out” nitrogen in the FRC with O2
    • 3-5 minutes of tight mask with normal breathing and 100% FiO2
      • = 10 minutes of safe apnea time
    • 4 vital capacity breaths within 30 seconds with 100% FiO2
      • =5 minutes safe apnea time.
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16
Q

glottic opening

A

triangular fissure between the cords

*Narrowest portion of the adult airway

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17
Q
A

Miller blade

  • Inserted below epiglottis
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18
Q

ETT

A

*always have two sizes available

  • Female: 6.5-7.0 mm (depth ≈ 21 cm)
  • Male: 7.5-8.0 mm (depth ≈23 cm)
  • Ideal position: 4 cm above carina and 2 cm below vocal cords
  • All ETT have 15mm outer diameter universal connector
  • CHEST RISE, BILATERAL BREATH SOUNDS, ETCO2
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19
Q

Trachea

A

Fibromuscular

10-20 cm length, 22 mm diameter

16-20 U shaped cartilage

no cartilage on posterior side

bifurcates at T-4 (carina)

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20
Q

Lateral Cricoarytenoid

A

Closes the glottis

Adducts vocal chords

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21
Q
A

just remember where all that shit is

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22
Q

3 paired cartilages of Larynx

A

Arytenoid- Posterior attachment of vocal chords

Corniculate-Posterior portion of aryepiglottic fold

Cuneiform- aryepiglottic fold, lateral to corniculates

23
Q

Arytenoid Muscles

A

Oblique and transverse

Adducts vocal cords

24
Q

Intrinsic Laryngeal muscles

A
  • Control the movements of the laryngeal cartilages
    • length and tension of cords and size of glottic opening
  • Cricothyroid muscle innervated by the external branch of the superior laryngeal nerve, a branch of the Vagas nerve (CN X)
  • All others innervated by the recurrent laryngeal nerve, a branch of the Vagus nerve (CN X)
  1. posterior cricoarytenoid
  2. lateral cricoarytenoid
  3. arytenoids
  4. cricothyroid
  5. thyroarytenoid
25
Q

3 unpaired cartilages of the Larynx

A

Thyroid-large and prominent, anterior attachment of vocal chords

Cricoid- complete cartilaginous, signet shaped, ring

Epiglottis-covers opening to larynx for swallow

26
Q

Thyromental Distance

A
  • Distance from lower border of mandible to thyroid notch with neck fully extended
    • Normal 4 fingerbreadths (6-6.5 cm)
  • Difficult intubation <3 fingers
27
Q

Nasal passage innervation

A

Branches of the trigeminal nerve (CN V)

28
Q

Laryngospasm

A

Sever, sudden, sustained contraction of the glottic opening in response to stiumlus. Causes complete airway obstruction!!

Treatments:

Jaw life and mask

O2 with positive pressure

removal of stimulus

small dose of muscle relaxant Succinylcholine

29
Q

Pre-op airway assessment

A
  1. general appearance
  2. Malampati classification
  3. range of motion of neck
  4. thyromental distance
  5. dentition
  6. mouth (lips, gums, tissues)
  7. mouth oppening (2-3 fingers)
  8. teeth (missing, protrusions, overbite, bridges out)
  9. size and mobility of tongue
  10. body habitus
  11. Hx of difficult intubation

*aspiration risk (hiatal hernia, GERD, recently ate, OSA)

30
Q

Vocal cords

A
  • formed by the thyroarytenoid ligaments
  • appear pearly white
  • attached anteriourly to the thyroid cartilage and posteriourly to the arytenoid cartilages
31
Q

Nasal passage includes:

A
  • septum
  • turbinates
  • adenoids
  • paranasal sinuses
32
Q

Cricoid cartilage

A

Complete cartilaginous ring

Narrowest point of the pediatric airway

inferior to thyroid cartilage and cricothyroid membrane

33
Q

Trigeminal Nerve (CN V)

sensory and motor

A
  • Hard and soft palate
  • anterior 2/3 of tongue
34
Q

Mallampati classes

A
  1. faucial pillars, entire uvula, soft and hard palates.
  2. Uvula tip masked by tongue, soft and hard palates
  3. Soft and hard palates, uvula base only
  4. Hard palate only

PUSH

pillars, uvula, soft palate, hard palate

35
Q

Ensuring airway patency

A
  1. Airway maneuvers (heat tilt/chin lift, jaw thrust)
  2. Adjuncts (Nasal or oral airway)
  3. Two handed mask with bagging assistance.

**obstruction usually caused by tongue and epiglottis due to the relaxation of the genioglossus muscle

36
Q

Function of nasal passage

A
  • humidification
  • filter
  • warm
  • *accounts for 2/3 of total upper airway resistance
37
Q

posterior cricoarytenoid

A

Only vocal cord ABductors

“Please Come Apart!”

38
Q

LMA

A
  • Supraglottic airway device
  • used for routine AND difficult airway management
  • can be used as conduit for ETT placement
  • sizing based on weight
    • 30-50kg–> LMA 3
    • 50-70kg –> LMA 4
    • 70-100kg –> LMA 5
    • >100 kg –> LMA 6
  • Can be used for positive pressure but is not meant for it
    • only positive pressures below 15.
39
Q

General anesthesia Mask case

A
  • Can be used when:
    • no difficult airway
    • surgeon does not need access to head/neck
    • no airway bleeding/secretions
    • short case
    • no position changes and easy access to head
    • obstruction easily relieved with oral or nasal airway
    • no neuromuscular blocker used–spontaneous breathing
40
Q

Tracheal intubation indications

A
  1. airway compromise
  2. airway inaccessible
  3. long surgical time
  4. surgery of head, neck, cheek, or abdomen
  5. need for controlled venticalion and/or PEEP
  6. Inability to maintain airway with mask/LMA
  7. aspiration risk
  8. airway/lung disease
41
Q

LMA insertion

A
  1. position head: neck flexed and head extended
  2. hold LMA with right hand like a pen, black line facing you
  3. Insert lubricated LMA into mouth, follow palate centrally, push into oropharynx until resistance is felt, then stop
  4. release right hand, grasp upper aspect of LMA, and attempt further advancement
  5. inflate the cuff (LMA will move)
  6. ventilate: observe, listen
  7. secure with tape
42
Q

LMA advantages over ETT

A
  1. placement
  2. hemodynamic stability
  3. anesthetic
  4. cough
  5. sore throats
  6. “foreigh body” in trachea
  7. emerged before removal. (good for asthma patients)
43
Q

LMA disadvantages

A
  1. lower seal pressure
  2. high frequency of gastric insufflation
  3. esophageal reflux more likely
  4. inability to use mechanical ventilation
44
Q

Potential hazards in airway management

A
  1. dental damage
  2. soft tissue/mechanical injury
  3. laryngospasm
  4. bronchospasm
  5. vomiting/aspiration
  6. hypoxemia/hypercarbia
  7. SNS stimulation
  8. esophageal/endobronchial intubation
  9. sore throat
45
Q

General anesthesia LMA case

A
  1. difficult airway not present ??
  2. surgeon does not need access to head/neck
  3. no airway bleeding/secretions
  4. case of short duration
  5. more reliable patent airway than mask
  6. want hands free
46
Q

General Anesthesia ETT case use when:

A
  1. airway compromise
  2. airway inaccessible
  3. long surgical time
  4. alternate surgical positions
  5. surgery of head, neck, cheek, or abdomen
  6. need for controlled ventilation and PEEP
  7. inability to maintain airway with mask/LMA
  8. aspiration risk
  9. airway/lung disease
47
Q

Upper Airway

A
  • Nasal Passage
  • Oral Cavity
  • Pharynx
  • Larynx
48
Q

Oral Cavity

A
  • Teeth
  • Tongue
    • Cause of airway resistance
  • Hard/Soft Palate
49
Q

Oral Cavity Innervation

A
  • Trigeminal Nerve CN V
    • Hard and Soft palate
    • Anterior 2/3 tongue
  • Glossopharyngeal CN IX
    • Posterior 1/3 tongue
    • Soft palate
    • Oropharynx
50
Q

Cricothyroid

A

Tenses/Elongates vocal cords

51
Q

What are questions to consider for Airway assessment?

A

Radiation or burn to head/neck?

C-spine pain?

TMJ pain?

Rheumatoid arthritis

Ankylosing spondylitis?

Abscess or tumor?

Prior intubation or trach?

Snoring or Sleep apnea?

Dyspagia or stridor?

52
Q

Mandibular Protrusion Test

A

Class A: Lower incisors can be protruded anterior to upper incisors

Class B: Lower incisors can be brought to edge with uppper incisors

Class C: Lower incisors cannot be bought to edge of upper incisors

53
Q

Prepare for Induction

A

“MSMAIDP”

M- Monitors and alarm settings

S- Suction on and accessible

M- Mask appropriate, Machine check, Means of PPV

A- Airway LMA ETT

I- IV

D-Drugs

54
Q

Face Mask

A

Difficult mask: Beards, edentulous, short mandible

Head strap= potential nerve injuries

Technique: thumb top mask, index and middle on bottom, 4th and 5th finger on mandible

Intro to Anesthesia Main (7 decks)

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