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AS - N928 Basic Principles of Anesthesia > Airway > Flashcards

Airway Flashcards

1
Q

Posterior Cricoarytenoid

A

Larynx INTRINSIC

Abducts (opens) the vocal cords and opens the glottis

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2
Q

Lateral Cricoarytenoid

A

Larynx INTRINSIC

Adducts (closes) the vocal cords

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3
Q

Arytenoids

A

Larynx INTRINSIC

Adducts (closes) the vocal cords

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4
Q

Cricothyroid

A

Larynx INTRINSIC
Produces cord tension, closure, & elongates the vocal cords
Laryngospasm results in total & profound glottic closure

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5
Q

Thyroarytenoid

A

Larynx INTRINSIC

Shortens & relaxes the vocal cords

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6
Q

Sternohyoid

A

Larynx EXTRINSIC

Draws hyoid bone inferiorly

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7
Q

Sternothyroid

A

Larynx EXTRINSIC

Draws thyroid cartilage caudal

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8
Q

Thyrohyoid

A

Larynx EXTRINSIC
Connects thyroid cartilage w/ hyoid bone
Draws hyoid bone inferiorly
Internal SLN penetrate the membrane at hyoid cornu

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9
Q

Omohyoid

A

Larynx EXTRINSIC

Draws hyoid bone caudal

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10
Q

Stylohyoid

A

Larynx EXTRINSIC

Elevates the larynx

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11
Q

Mylohyoid

A

Larynx EXTRINSIC

Elevates the larynx

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12
Q

Trigeminal

A

Cranial nerve V
Lingual nerve (mandibular division)
Sensory & motor
Anterior 2/3 tongue

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13
Q

Facial Nerve

A 
Cranial nerve VII
Sensory & motor
Taste to anterior 2/3 tongue
Facial muscles - expression
Motor control stylohyoid laryngeal muscle
Salivary glands (PSNS stimulation)
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14
Q

Glossopharyngeal

A

Cranial nerve IX
Sensory & motor
Posterior 1/3 tongue

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15
Q

Vagus

A

Cranial nerve X
Sensory & motor
Innervates airway below the epiglottis
SLN & RLN

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16
Q

Hypoglossal

A

Cranial nerve XII
Motor below/behind the tongue
Impaired nerve or injury → airway obstruction d/t tongue relaxation

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17
Q

Nasopharynx

A

Anterior to C1

Contains nasal septum, turbinates, & adenoids

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18
Q

Oropharynx

A

C2-C3 level
Opens into mouth anteriorly
1° obstruction = tongue d/t ↓genioglossus muscle tone

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19
Q

Hypopharynx

A

Posterior to larynx
Leads to the esophagus
Superior border - epiglottis
Inferior border - cricoid cartilage

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20
Q

Cricoid Cartilage

A

COMPLETE RING
C5-C6
Narrowest portion in pediatric airway
Sellick’s maneuver (cricoid pressure) site

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21
Q

Waldeyer’s Tonsillar Ring

A

Pharyngeal tonsils (adenoids) located in nasopharynx
Palatine tonsils located in oropharynx
Lingual tonsils located at tongue base
(Tubal tonsils)

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22
Q

Larynx

A

Adults C3-C6
Infants/children C2-C4 (descends to C4-C5 by age 5)
Phonation & valve to protect lower airways
Located at junction b/w airway & esophagus

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23
Q

NINE Cartilages

A 
Thyroid
Cricoid
Epiglottic
Arytenoid (posterior pair)
Corniculate (middle pair)
Cuneiform (lateral pair)
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24
Q

Epiglottis

A

Broad leaf-shape
Sits at tongue base & separates hypopharynx from larynx
Covers laryngeal opening during swallowing to protect against aspiration
Vascular area → trauma & swelling

25
Q

Vestibular Folds

A

False vocal cords

Narrow bands fibrous tissue on either side larynx

26
Q

Vocal Cords

A

True cords
Pale, white ligamentous structures
Attach to thyroid anteriorly & arytenoids posteriorly

27
Q

Glottic Opening

A

Narrowest portion in adult airway
Average width 6-9mm (able to stretch up to 12mm)

*Children narrowest airway portion lies just below the vocal cords at the cricoid ring

28
Q

Thyroid Cartilage

A

Anterior neck thyroid notch
Largest larynx cartilage
Vocal cords are attached anteriorly

29
Q

Cricothyroid Membrane

A

Relatively avascular
Attaches thyroid cartilage to the cricoid cartilage anteriorly
Emergency airway

30
Q

Trachea

A

Begins at C6 at inferior cricoid cartilage border & extends to carina
Approximately 10-15cm
Cricoid cartilage = only complete ring
16-20 cartilagenous rings anteriorly
Bifurcates to R/L maintain bronchus at T5 level
- R bronchus 25-30° angle
- L bronchus 45°

31
Q

Pediatric Airway

A
  • Larynx positioned higher
  • Tongue larger relative to mouth size
  • Epiglottis large, stiffer, angled more posteriorly (omega shape)
  • Head & occiput larger relative to body size
  • Short neck
  • Narrow nares
  • Cricoid ring = narrowest region
32
Q

INTRINSIC Larynx Muscles

A

Open, close, & control vocal cord tension

33
Q

EXTRINSIC Larynx Muscles

A

Connect larynx w/ hyoid bone & other structures

Serve to move larynx as whole (elevating & depressing) during phonation, swallowing, & breathing

34
Q

SLN

A
  • Internal sensation SIS to larynx epiglottis to vocal cords (ABOVE)
  • External motor SEM innervation to cricothyroid muscle → laryngospasm
35
Q

RLN

A

Sensory:
- Provides sensation to larynx BELOW vocal cords & upper esophagus
Motor:
- Innervates all larynx muscles EXCEPT cricothyroid
- R leaves Vagus at subclavian level & loops UP
- L leaves Vagus at aortic arch level & loops UP
- Runs in groove alongside the trachea

36
Q

Laryngeal Nerve Injury

A

SLN
Unilateral - minimal effects
Bilateral - hoarseness & vocal tiring

RLN
Unilateral - hoarseness
Bilateral
- Acute → stridor & respiratory distress d/t unopposed cricothyroid muscle tension 
- Chronic → aphonia
37
Q

Laryngeal Blood Supply

A

Superior laryngeal artery
- Blood supply to supraglottic laryngeal structures
- Carotid to superior thyroid artery to SLA
Inferior laryngeal artery
- Blood supply to infraglottic laryngeal structures
- Subclavian to inferior thyroid artery to ILA
Venous drainage
- Superior/inferior thyroid veins to SVC

38
Q

Atlanto-Occipital Joint

A

“Sniffing position”
Align oral, pharyngeal, & laryngeal axes → optimal cord visualization
PiLlow aligns pharyngeal & laryngeal axes then extend to head to align the oral axis
Creates the shortest distance to intubate - straight line from incisor teeth to the glottic opening
Normal extension = 35°
Limited neck mobility <12° extension

39
Q

Temporomandibular Mobility

A

Mouth opening or inter-incisor gap
Normal 30-40mm or 2-3 fingerbreadths
<2 fingerbreadths indicates difficult airway
3 fingerbreadths = ideal

40
Q

Mallampati Sensitivity

A

True positive

60-80%

41
Q

Mallampati Specificity

A

True negative

50-80%

42
Q

Mallampati I

A

CLASS I

Hard & soft palate, tonsillar pillars, & uvula visible

43
Q

Mallampati II

A

CLASS II

Hard & soft palate, tonsillar pillars, & partial uvula

44
Q

Mallampati III

A

CLASS III

Hard & soft palate w/ uvula base visible

45
Q

Mallampati IV

A

CLASS IV

Only hard palate visible

46
Q

Upper Lip Bite Test

A

Assesses mandible mobility (protrusion)

47
Q

Thyromental Distance

A 
Patil's test
Reflects amount space to displace the tongue
Sniffing position w/ mouth closed
Distance from thyroid cartilage notch to mentum tip
Normal >6cm
Retrognathia <6cm ↑risk difficult airway
6-7cm = questionable
7-8cm typically easy intubation

Considerations:

  • Chin implant (assess for scar)
  • Plastic surgery potential to distort anatomy
48
Q

Sternomental Distance

A

Sniffing position w/ mouth closed
Distance between sternal notch & mentum
Normal > 13.5cm

49
Q

Prayer Sign

A

Assesses joints & ability to align oropharyngeal & laryngeal axes

Negative - palms flat together
Positive - unable to place palms flat

50
Q

Neck Circumference

A

> 45cm indicates difficult intubation

Average male 38cm
Literature varies 42-50cm

51
Q

STOP BANG

A 
Snoring
Tired
Observed apnea
Pressure HTN
BMI >35kg/m^2
Age >50yo
Neck circumference >45cm
Gender M
52
Q

Cormack-Lehane I

A

GRADE I

Full view glottic opening & arytenoid cartilages

53
Q

Cormack-Lehane II

A

GRADE II
Posterior portion glottic opening & arytenoid cartilage visible
Unable to visualize full vocal cords

54
Q

Cormack-Lehane III

A

GRADE III
Only epiglottis visible
Unable to visualize glottic opening or cords

55
Q

Cormack-Lehane IV

A

GRADE IV
Only soft palate visible
No recognizable laryngeal structures

56
Q

Difficult Mask Ventilation

A 
Beard
Obesity BMI > 26kg/m^2
Neck circumference
Age > 55yo
Edentulous - no teeth especially upper unable to obtain/maintain proper mask seal
OSA or snores
57
Q

Predicting Difficult Intubation

A 
Look externally
Evaluate the mandibular space
Mallampati classification
Obstructions
Neck mobility ROM
58
Q

Sellick’s Maneuver

A

Cricoid Pressure
Protects against passive aspiration
Compress/occlude esophageal lumen b/w cricoid cartilage & cervical spine
RSI apply 3lbs initially when push induction drugs then ↑6.6-8.8lbs or 3-4kg

59
Q

Cricoid Pressure Contraindications

A 
Neck injury (C-collar)
Esophageal rupture/tear
Active emesis (opposing forces → esophageal rupture)

AS - N928 Basic Principles of Anesthesia (18 decks)

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