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Principles of Anesthesia > Airway anatomy > Flashcards

Airway anatomy Flashcards

1
Q

What structures make up the airway

A
  1. oral cavity
  2. nasal cavity
  3. pharynx
  4. larynx
  5. trachea
  6. principal bronchi
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2
Q

5 components of upper airway

A
  1. nose
  2. nasopharynx
  3. oropharynx
  4. laryngopharynx
  5. larynx
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3
Q

What is a patient response to too long of an oral airway?

A

laryngospam

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4
Q

Where does the airway begin?

A

nares

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5
Q

What is the nose’s function?

A
  1. air movement
  2. humidification
  3. olfaction
  4. filtration
  5. phonation
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6
Q

What is the length from nostrils to nasopharynx in an adult?

A

10-14cm

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7
Q

What is the primary pathway for normal breathing?

A

Nose- unless obstruction is present

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8
Q

Sensory innervation of the nasal mucosa arises from what?

A

2 divisions of the trigeminal nerve

anterior ethmoidal nerve- supplies anterior septum and lateral wall

nasopalatine nerves from sphenopalatine ganglion- where posterior areas are innervated

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9
Q

Blood supply to the nose consists of

A

opthalmic artery- upper part of nasal cavity

maxillary artery- lower part of nasal cavity

Kiesselbach’s plexus- anastomoses of 4 small arteries (very vascular, origination of most nose bleeds)

large submucous venous plexus

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10
Q

Nerve supply to the nose consists of

A
  1. olfactory
  2. 1st division of V (opthalmic nerve)
  3. 2nd division of V (maxillary nerve)
  4. sphenopalatine ganglion (behind turbinates)
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11
Q

Nasal intubation

A
  1. use topical vasoconstrictor and local anesthetic
  2. stay below inferior turbinate-parallel to hard palate (follow floor of nasal cavity)
  3. lubricate tube with warm water and use nasal trumpet to dilates nares
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12
Q

The pharyngeal anatomy consists of

A
  1. nasopharynx- behind nasal cavity, above soft palate
  2. oropharynx- soft palate to tip of epiglottis
  3. laryngopharynx- tip of epiglottis to lower border of cricoid cartilage at level of C-6
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13
Q

Describe the pharyngeal airway

A
  1. extends from posterior aspect of the nose down to cricoid cartilage
  2. extends from spenoid bone to C-6
  3. retropharyngeal space permits free glutition and retropharyngeal abcesses can infiltrate this space and enter superior mediastinum
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14
Q

Name the muscles of the pharynx

A
  1. genioglossus- protrudes tongue
  2. geniohyoid- displaces hyoid arch anterior
  3. sternohyoid- displaces hyoid arch anterior
  4. pharyngeal constrictors- form lateral pharyngeal walls

external muscles- constrictors superior, middle, and inferior (advance food down esophagus)

internal- stylopharyngeus, salpinopharyngeus, palatopharyngeous

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15
Q

Pharyngeal innervation

A

glossopharyngeal, vagus, recurrent, and external laryngeal

glossopharyngeal provides nerve sensation to back 1/3 of tongue, valleculae, superior surface of epiglottis, and most of posterior pharynx

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16
Q

SUccessful airway management amounts to preventing airway obstruction at what level?

A

Pharynx b/c its decreased by sedation, lost by neuromusular blockade and general anesthesia

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17
Q

Order of importance for upper airway obstruction

A
  1. soft palate
  2. epiglottis
  3. tongue
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18
Q

What muscle is important when considering patients with obstructive sleep apnea (OSA)

A

genioglossus- may need to insert oral airway

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19
Q

Tongue motor innervation

A

hypoglossal, except for palatoglossus muscle (vagus CN10)

20
Q

Tongue sensory innervation

A
  1. lingual
  2. chorda tympani
  3. glosspharyngeal (CN9)
  4. superior laryngeal
21
Q

Tongue blood supply

A

lingual artery- branch of external carotid

22
Q

Describe numbering system for dentation

A

number 1 is upper right to 16 upper left, 17 lower left to 32 lower right

23
Q

Structures within the larynx include

A
  1. hyoid bone
  2. thyroid cartilage
  3. cricoid and arytenoid cartilages
  4. tracheal cartilages
  5. cricoid cartilages
24
Q

Name the 9 cartilages in the larynx

A

unpaired- thyroid, cricoid, epiglottis

paired- arytenoids, cuneiforms, corniculates

25
Q

Where is the cricothyroid membrane

A

Between thyroid and cricoid cartilages- this is the place for puncture during emergent intubation

26
Q

What do extrinsic and intrinsic muscles within the larynx move?

A

extrinsic- move entire larynx
intrinsic- move individual cartilages (abductors and adductors)

*abduction during inspiration, partial adduction during expiration, and full abduction during phonation

27
Q

Intrinsic muscles within the larynx include

A
  1. interarytenoid
  2. lateral cricoarytenoid
  3. posterior cricoarytenoid
  4. cricothyroid
  5. thyroarytenoid (true vocal cord) muscle
28
Q

All intrinsic muscles work to adduct the vocal cords except

A

posterior cricoarytenoid- abducts vocal cords

29
Q

Name the 8 extrinsic laryngeal muscles

A
  1. stylohyoid
  2. mylohyoid
  3. geniohyoid
  4. digastric muscles
  5. sternothyroid
  6. sternohyoid
  7. thryrohyoid
  8. omohyoid muscles
30
Q

Which extrinsic muscles raise the larynx?

A

suprahyoid extrinic laryngeal muscles

  • stylohyoid
  • mylohyoid
  • geniohyoid
  • digastric muscles
31
Q

Which extrinsic muscles lower the hyoid bone and larynx?

A

infrahyoid extrinsic laryngeal muscles

  • sternothyroid
  • sternohyoid
  • thyrohyoid
  • omohyoid muscles
32
Q

Name the blood supply to the larynx

A
  1. external carotids (superior laryngeal artery)

2. subclavians (inferior laryngeal artery)

33
Q

Innervation of the larynx

A

Innervation- branches of the vagus nerve

  • superior laryngeal nerve
  • recurrent laryngeal nerve
34
Q

Sensory innervation of the larynx

A

internal branch of superior laryngeal nerve is sensory to and including surface of larynx facing pharynx, on tracheal side- receuurent laryngeal

35
Q

Motor innervation of larynx

A

all intrinsic muscles of larynx innervated by recurrent laryngeal nerve except cricothyroid, which is innervated by external branch of superior laryngeal nerve

36
Q

What is a laryngospams?

A

reflex closure of true cords (and sometimes false cords) because of stimulation of intrinsic laryngeal muscles

37
Q

Which muscles are involved in laryngospams?

A

cricothyroids (adduct and tense true cords)

38
Q

Laryngospam sensory and motor innervation

A

sensory- internal branch of superior laryngeal

motor- external branch of superior laryngeal

39
Q

What happens during laryngospams?

A
  1. responsible for significant portion of post-operative critical events
  2. immediate hypoxemia
  3. delayed-negative pressure pulmonary edema (forceful inspiratory effort against closed glottis)
40
Q

What are laryngeal palsies?

A

when one or both of the cords are not working properly

41
Q

Unilateral superior laryngeal nerve palsy causes what sound?

A

inability to create high-pitched C

42
Q

Unilateral recurrent nerve palsy cause what sound?

A

hoarseness

43
Q

What is the most critical time to observe for airway obstruction?

A

during emergence of anesthesia

44
Q

In the absence of a foreign body airway obstruction, airway may be restored by

A
  1. pulling mandible foreward
  2. slightly extended patient’s neck
  3. sniffing position
45
Q

How can oropharyngeal obstruction by overcome?

A

positive-pressure from manual inflations from ambu-bag

46
Q

What is the trachea? How long is it? Where does it end?

A
  • tubular structure that begins opposite 6th cervical vertebra at level of thyroid cartilage
  • 10-15cm
  • ends at carina (5th thoracic vertebra)
47
Q

Describe the steps of the couge mechanism.

A
  1. deep inspiration to attain high lung volume
  2. tight closure of glottis occurs with contraction of expiratory muscles
  3. intrapleural pressure rises to above 100cm H20 such that a sudden expulsion of air occurs as glottis opens

Principles of Anesthesia (1 decks)

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