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Apex Review > Airway anatomy 2 > Flashcards

Airway anatomy 2 Flashcards

1
Q

Which landmark is identified for a superior laryngeal nerve block?
a. greater cornu of hyoid bone
b. superior horn of thyroid cartilage
c. cricothyroid membrane
d. palatoglossal arch

A

a. greater cornu of hyoid bone

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2
Q

What must be anesthetized for awake intubation?

A

base of the tongue
oropharynx
hypopharynx
larynx

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3
Q

__________ is commonly selected to topicalize the airway

A

Benzocaine spray

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4
Q

A key risk of benzocaine spray is __________. The treatment is __________

A

methemoglobinemia. The treatment is methylene blue

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5
Q

____________ may be used to provide topical anesthesia to the airway, but you should avoid it in the patient with _________, _______________, or if _____________ is a problem.

A

Cocaine; PChE deficiency, on MAOI drugs, or if increased SNS tone is a problem (i.e. history of coronary artery disease)

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6
Q

What 3 nerves must be blocked to anesthetize the airway?

A
  1. glossopharyngeal (bilateral)
  2. superior laryngeal (bilateral)
  3. recurrent laryngeal (transtracheal)
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7
Q

To perform a glossopharyngeal block, insert the needle at

A

the base of the palatoglossal arch (anterior tonsillar pillar) to a depth of 0.25-0.5 cm, and inject 1-2 mL of LA

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8
Q

A risk of the glossopharyngeal block is

A

seizures 5%(due to intracarotid injection)

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9
Q

To perform a superior laryngeal nerve block, inject LA at

A

the inferior border of the greater cornu of the hyoid bone

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10
Q

To perform a transtracheal block, insert the needle through the

A

cricothyroid membrane (in a caudal direction). Ask the patient to take a deep breath, and then inject 3-5 mL of local anesthetic into the tracheal lumen

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11
Q

Is anesthetizing the mouth necessary for an awake intubation?

A

No

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12
Q

6 topical techniques to anesthetize the upper airway include

A
  1. cotton soaked pledgets in the nares-4% lidocaine+vasoconstrictor
  2. instill topical LA into each nare
  3. Swish and swallow (4% viscous lidocaine)
  4. LA spray- 20% benzocaine
  5. nebulization
  6. atomization- typically works better than nebulization
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13
Q

3 topical techniques to anesthetize the vocal cords includes

A
  1. inject LA through a nasal airway or ETT positioned just above the vocal cords
  2. spray as you go with a flexible fiberoptic scope
  3. inject LA through a multi-orifice epidural catheter that’s inserted into the suction port of a flexible fiberoptic catheter
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14
Q

The adult larynx lies anterior to

A

C3-C6

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15
Q

The essential components of the larynx include:

A

bone: hyoid
ligaments: thyrohyoid, cricothyroid
unpaired cartilages: epiglottis, thyroid, cricoid
paired cartilages: corniculate, arytenoid, cuneiform

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16
Q

What 2 instances may you need to place a needle through the cricothyroid membrane

A

cricothyroidotomy (to emergently secure the airway)
transtracheal block (to anesthetize the RLN)

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17
Q

During laryngoscopy, the bumps you see on the aryepiglottic folds are the

A

corniculates and cuneiforms (not the arytenoids)

18
Q

The narrowest region in the adult airway is the

A

glottic opening

19
Q

The narrowest region in the pediatric airway is

A

Narrowest “fixed” region= cricoid ring
Narrowest “dynamic” region= vocal cords

20
Q

The only complete cartilaginous ring in the airway is the

A

cricoid

21
Q

The movement of the arytenoids can be significantly restricted by

A

rheumatoid arthritis and systemic lupus erythematosus

22
Q

Situations that increase the risk of cricoid edema include

A

an endotracheal tube that is too large, multiple intubation attempts, prolonged intubation, frequent head positioning while intubated

23
Q

What maneuver is efficacious for the treatment of laryngospasm?
A. larson
b. valsalva
c. muller
d. bainbridge

A

A. Larson

24
Q

Laryngospasm is the

A

sustained and involuntary contraction of the laryngeal musculature

25
Q

Complications of laryngospasm include

A

airway obstruction, negative pressure pulmonary edema, pulmonary aspiration of gastric contents, cardiac dysrhythmias, cardiac arrest, and death

26
Q

Signs of laryngospasm include

A

inspiratory stridor
suprasternal and supraclavicular retraction during inspiration
“Rocking horse” appearance of the chest wall (paradoxical movement)
increased diaphragmatic excursion
lower rib flailing
absent or altered EtCO2 waveform

27
Q

Common causes of laryngospasm include

A

age <1 year
airway manipulation (particularly during light anesthesia)
airway secretions
surgery in the airway
active or recent respiratory tract infection (<2 weeks)

28
Q

Treatment of laryngospasm includes

A

FiO2 100%
remove noxious stimulation
deepen anesthesia
Larson’s maneuver, chin lift, CPAP 15-20 cmH2O
Consider succinylcholine

29
Q

What is the IV dose of succinylcholine for adult and children?

A

0.1-1 mg/kg

30
Q

What is the IM dose of succinylcholine for adult and children?

A

4 mg/kg

31
Q

What is the neonate and infant dose of succinylcholine (IV)?

A

2 mg/kg

32
Q

What is the neonate and infant dose of succinylcholine (IM)?

A

5 mg/kg

33
Q

__________________ should be given to children <5 years of age when succinylcholine is given.

A

Atropine 0.02 mg/kg

34
Q

Valsalva’s maneuver is

A

exhalation against a closed glottis or obstruction

35
Q

Examples of Valsalva’s maneuver include

A

coughing, bucking, or bearing down

36
Q

Risk of Valsalva’s maneuver include

A

increased pressure in the thorax, abdomen, and brain

37
Q

Muller’s maneuver is

A

inhalation against a closed glottis (or obstruction)

38
Q

Examples of Muller’s maneuver is

A

patient bites down on ETT and takes a deep breath

39
Q

Risk of Muller’s maneuver include

A

subatmospheric pressure in thorax–> negative pressure pulmonary edema

40
Q

Pre-anesthetic risk factors for laryngospasm include

A

active or recent upper respiratory tract infection (<2 weeks)
exposure to second-hand smoke
reactive airway disease
GERD
age <1 year

41
Q

Risk factors in the OR for laryngospasm include

A

light anesthesia
saliva or blood in the upper airway
hyperventilation/hypocapnia
surgical procedures in the airway include: tonsillectomy, adenoidectomy, nasal/sinus, laryngoscopy, bronchoscopy, palatal

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