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N928 Basic Principles of Anesthesia > Airway Anatomy > Flashcards

Airway Anatomy Flashcards

1
Q

List the nine cartilages of the airway

A 
Thyroid
Cricoid
Epiglottis 
Pairs:
Corniculate 
Arytenoid
Cuneiform
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2
Q

The vestibular folds are known as

A

False vocal cords

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3
Q

What is the narrowest portion of an adult airway?

A

Glottis opening (average of 6-9 mm)

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4
Q

What is the narrowest portion of the airway in children?

A

Just below the cords of the cricoid ring

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5
Q

What is the complete ring of cartilage?

A

Cricoid cartilage

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6
Q

The cricothyroid membrane is

A

Relatively AVASCULAR

Emergency airway site- “can’t ventilate, can’t intubate”

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7
Q

The nerve involved with laryngospasm is

A

Superior laryngeal nerve

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8
Q

What axis are we aligning to perform intubation?

A

OPL

Oral pharyngeal laryngeal axis

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9
Q

Describe the different mallampati classifications.

A

Class 0- epiglottis, pillars, uuvula, soft and hard palate
Class 1- pillars, uuvula, soft & hard palate
Class 2- portion of uvula, soft and hard palate
Class 3- soft palate, base of uvula
Class 4- hard palate only

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10
Q

What are the structures of the upper airway?

A

Nose- leads to nasopharynx; nasal breathing is 2x more resistant than mouth breathing
Mouth- leads to oropharynx
The nose and mouth are separated anteriorly and join posteriorly to form the pharynx

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11
Q

What are the three compartments of the pharynx?

A

Nasopharynx
oropharynx
hypopharynx

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12
Q

Where is the pharynx located?

A

extends from posterior aspect of nose to the level of the cricoid cartilage

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13
Q

What is a major source of obstruction in the upper airway?

A

the tongue

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14
Q

What is the Waldeyer’s Tonsillar ring?

A

lymphoid tissue ring in the pharynx that is at high risk for bleeding especially with nasal intubation
highly vascular area

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15
Q

The Waldeyer’s tonsillar ring is made up of

A

Pharyngeal tonsils (aka adenoids)-located in nasopharynx
Palatine tonsils-located in oropharynx
Lingual tonsils- located at base of tongue

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16
Q

The upper esophageal sphincter lies

A

at the lower edge of the hypopharynx and acts as a barrier to regurgitation in the conscious patient

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17
Q

Where is the hypopharynx?

A

lies posterior to the larynx and leads to the esophagus

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18
Q

The larynx is located at ____ and is responsible for_____

A

C3-C6 in adults; organ of phonation and a valve to protect the lower airways

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19
Q

What could distort our view of the cords?

A

smoke inhalation, mass, swelling

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20
Q

The epiglottis (location)

A

sits at base of tongue and separates hypopharynx from the larynx and hangs over the laryngeal opening

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21
Q

The epiglottis (role

A

protects against aspiration by covering the glottis during swallowing

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22
Q

Fast facts about the epiglottis:

A

broad/leaf shaped
VASCULAR AREA
can be traumatized and swell incredibly

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23
Q

The arytenoids

A 
are a paired cartilage 
pyramidal in shape
posterior 
cords are attach to them
most commonly seen on laryngoscopy
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24
Q

The vestibular folds are known as

A

the false vocal cords & they are narrow bands of fibrous tissue on each side of the larynx that are found first inside the laryngeal cavity opening

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25
Q

The glottic opening is

A

a triangular fissure between the vocal cords

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26
Q

The thyroid cartilage is located

A

in the anterior neck/thyroid notch
largest cartilage of the larynx
vocal cords are attached anteriorly

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27
Q

Where is the cricoid cartilage located?

A

at the level of C6

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28
Q

Fast facts about the cricothyroid membrane:

A

relatively AVASCULAR
translaryngeal injection
emergency airway site
thyroid cartilage is attached to the cricoid cartilage anteriorly by the cricothyroid membrane

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29
Q

The thyrohyoid (role)

A

connects the thyroid cartilage with the hyoid bone

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30
Q

How long is the trachea?

A

approximately 10-15 cm in length

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31
Q

Where are the tracheal rings located?

A

composed of 16-20 cartilagenous rings located anteriorly

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32
Q

Where does the trachea bifurcate?

A

at the level of T5
Right bronchus bifurcates at 25-30 degree angle
Left bronchus bifurcates at 45 degree angle

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33
Q

What is the transition between upper and lower airway

A

the vocal cords and glottic opening

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34
Q

Where does the trachea begin?

A

begins at C6 at the inferior border of the cricoid cartilage and extends to the carina

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35
Q

The pediatric airway differs from the adult airway in the following ways:

A

larynx positioned higher in the neck
tongue larger relative to mouth size
epiglottis larger, stiffer, angled more posteriorly
head & occiput larger relative to body size
short neck
narrow nares
cricoid ring is narrowest region

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36
Q

The intrinsic muscles of the airway

A

open, close, and control tension of the vocal cords

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37
Q

The extrinsic muscles of the airway

A

connect the larynx with the hyoid bone and other structures & serve to move the larynx as a whole (elevating and depressing) during phonation, swallowing, and breathing

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38
Q

What is the action of the posterior cricoarytenoid muscle?

A

abducts (opens) the vocal cords and opens the glottis)

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39
Q

What is the action of the lateral cricoarytenoid muscle?

A

adducts (closes) the vocal cords

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40
Q

What is the action of the arytenoid muscle?

A

adducts the vocal cords

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41
Q

What is the action of the cricothyroid muscle?

A

produces cord tension, closure, and elongates the vocal cords; can result in total and profound glottic closure called laryngospasm

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42
Q

What is the action of the thyroarytenoid muscle?

A

shortens and relaxes the vocal cords

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43
Q

The extrinsic muscles of the larynx include:

A

Sternohyoid, sternothyroid, thyrohyoid, omohyoid, stylohyoid, mylohyoid

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44
Q

The intrinsic muscles of the larynx include:

A

posterior cricoarytenoid, lateral cricoarytenoid, arytenoids, cricothyroid, thyroarytenoid

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45
Q

What is the action of the sternohyoid muscle?

A

draws hyoid bone inferiorly

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46
Q

What is the action of the sternothryoid muscle?

A

draws thyroid cartilage caudad

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47
Q

What is the action of the thyrohyoid muscle?

A

draws hyoid bone inferiorly

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48
Q

What is the action of the omohyoid muscle?

A

draws hyoid bone caudad

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49
Q

What is the action of the stylohyoid muscle?

A

elevates the larynx

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50
Q

What is the action of the mylohyoid

A

elevates the larynx

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51
Q

A concern with the nasal area is that

A

PSNS stimulation (seen with anesthesia) results in engorgement of blood vessels & increases likelihood of bleeding with airway manipulation

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52
Q

What cranial nerves innervate the tongue?

A

anterior 2/3rds: lingual nerve of trigeminal nerve

Posterior 1/3rd: glossopharyngeal nerve

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53
Q

What cranial nerve innervates the tonsils, roof of pharynx, and underside of soft palate?

A

glossopharyngeal nerve

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54
Q

The facial nerve is responsible for

A

supplying muscles of facial expression
taste to anterior 2/3rds of tongue
motor control of stylohyoid laryngeal muscle
salivary gland production
small amount of afferent conduction to oropharynx

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55
Q

The hypoglossal nerve is responsible for

A

providing motor innervation to most muscles of the tongue

damage to the hypoglossal nerve can relax the tongue causing it to fall back and cause airway obstruction

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56
Q

The vagus nerve innervates airway

A

below the epiglottis

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57
Q

The vagus nerve has two pertinent branches:

A

superior laryngeal nerve & recurrent laryngeal nerve

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58
Q

The recurrent laryngeal nerve provides

A

sensation to larynx below vocal cords and to upper esophagus

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59
Q

The superior laryngeal nerve provides

A

internal branch-sensation to larynx from epiglottis to vocal cords (sensation ABOVE vocal cords)
(SIS- superior internal sensory)
external branch is a motor nerve
(SEM- superior external motor)

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60
Q

Which nerve is responsible for laryngospasm?

A

Superior laryngeal nerve

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61
Q

The recurrent laryngeal nerve provides motor to

A

muscles of the larynx except for the cricothyroid muscle

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62
Q

The external branch of the superior laryngeal nerve provides motor innervation to

A

the cricothyroid muscle

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63
Q

Superior laryngeal nerve damage

A

unilateral: minimal effects
bilateral: hoarseness, vocal tiring

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64
Q

Recurrent laryngeal nerve damage

A

unilateral: hoarseness
Bilateral: acute- stridor, respiratory distress from unopposed tension of the cricothyroid muscle
chronic: aphonia

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65
Q

Vagus nerve injury can cause

A

flaccid, midpositioned cords resulting in aphonia

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66
Q

The laryngeal blood supply is made up of the

A

superior laryngeal artery & inferior laryngeal artery

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67
Q

The superior laryngeal artery supplies blood to

A

supraglottic laryngeal structures

carotid to the superior thyroid artery to SLA

68
Q

The inferior laryngeal artery supplies blood to

A

infraglottic laryngeal structures

subclavian to inferior thyroid artery to ILA

69
Q

If considering nasal intubation,

A

should assess for nostril size and patency

70
Q

Risk factors for difficult airways include

A

large beards, morbid obesity, OSA, cervical collars, traction devices, external trauma, hoarseness, stridor, shortness of breath, trach scar

71
Q

What is normal neck extension & what degree makes for difficult intubation?

A

normal is 35 degrees

>2/3rds decrease (~11 degrees) is associated with a grade III to IV laryngoscopic view

72
Q

The distance between incisors in adults with mouth fully open should be

A

30-40 mm (2 large fingerbreaths)

73
Q

Mandibular movement (upper lip bite test) is important to indicate

A

the available space for the tongue to be displaced anteriorly during laryngoscopy

74
Q

The sternomental distance measures

A

the distance between sternal notch and mentum

distance less than 13.5 cm is suggestive of intubation difficulty

75
Q

The laryngoscopic view grade 1:

A

full view of glottic opening

76
Q

The laryngoscopic grade 2 view:

A

posterior portion of glottic opening and arytenoid cartilage is visible

77
Q

The laryngoscopic grade 3 view:

A

only tip of epiglottis is vissible

78
Q

The laryngoscopic grade 4 view:

A

soft palate visible; no recognizable laryngeal structures

79
Q

What are the components that protect the lower airway from aspiration of foreign bodies and secretions?

A

pharynx, epiglottis, vocal cords

epiglottis covers laryngeal inlet during swallowing

80
Q

A laryngospasm is a

A

prolonged, intense glottic closure and an exaggeration of glottic closure reflex

81
Q

Laryngospasm results from

A

direct glottic or supraglottic stimulation, secretions, foreign bodies, inhalational agents, and other noxious stimuli

82
Q

Treatment for laryngospasm

A

depends on severity of laryngospasm: remove the stimulus, CPAP for mild, incomplete glottic closure, deepen anesthetic, muscle relaxants and intubation necessary for more severe cases

83
Q

An additional important protective mechanism of the airway is

A

coughing because it expels secretions and foreign bodies from upper or lower respiratory tract

84
Q

What does lemon stand for

A

look externally, evaluate the mandibular space, mallampati classification, neck mobility

85
Q

Predictors for difficult mask ventilation include

A

MOANS: mask seal, obesity (>26 kg/m2), aged >55, no teeth, and snores
facial edema, prominent nares, receding jaw, drainage tubes, tumors/infections

86
Q

Treatment for upper airway obstruction includes

A

placement of oropharyngeal or nasopharyngeal airway, treatment depends on cause of obstruction (soft tissue, foreign body, tumor, laryngospasm); soft tissue obstruction treated by head-tilt, chin-lift maneuver or by jaw thrust

87
Q

A partial upper airway obstruction is characterized by

A

diminished tidal exchange, retractions of upper chest, snoring sound heard with pharyngeal obstruction, inspiratory stridor heard with laryngeal obstruction

88
Q

A complete upper airway obstruction is characterized by

A

lack of any air movement or breath sounds; may observe diaphragmatic tugging or paradoxical movements of abdomen and rib cage

89
Q

Basic airway equipment includes:

A

suction, oral & nasal airways, face mask, laryngoscope handles and blades, multiple sizes of ET tubes with stylets, pilot balloon checked; O2 supply & ambu bag

90
Q

Oral airway placement

A

follows curvature of the tongue and lifts tongue and epiglottis away from posterior pharyngeal wall, preventing obstruction
wrong size can worsen obstruction

91
Q

The phalange of the oral airway

A

sits outside of the lips

92
Q

Common sizes of oral airways include

A

80 mm-100 mm

93
Q

Oral airway considerations:

A

not well tolerated in lightly anesthetized patient as it may provoke gag reflex, cough, vomiting, laryngospasm, or bronchospasm
It is NOT associated with increased incidence of sore throat or bacteremia

94
Q

Nasal airways are beneficial in patients

A

who are awake or lightly anesthetized as it provokes less airway stimulation than hard oral airways

95
Q

Clinical uses of nasal airways include:

A

relieve upper airway obstruction, facilitation of pharyngeal suctioning, nasal dilation for nasal intubation, fiberoptic guide

96
Q

Nasal airways are

A

artificial airways that pass through the nose, go behind the tongue and rest just above the epiglottis

97
Q

Relative contraindications to nasal airways include

A

coagulopathy or hemorrhagic disorders, anticoagulant therapy, pregnancy, basilar skull fractures, nasal infections, deformities of nose, history of nosebleeds requiring treatment

98
Q

Complications of oral and nasal airways include:

A

airway obstruction, tongue/soft tissue damage, CNS trauma, uvula edema, dental damage, laryngospasm, coughing, ulceration/necrosis, latex allergy

99
Q

Face masks components include

A

body, seal, and connector (fitting with a 22 mm internal diameter)

100
Q

When sizing face masks,

A

the smallest mask that works is the correct size because it has the least dead space, is easier to hold, and has less risk for eye injury

101
Q

When utilizing a mask-ventilation hand positioning should

A

avoid fingers on soft tissue
C & E shape
downward displacement of the mask with the thumb and first finger
Upward displacement of the mandible with the other three fingers, with little finger at angle of mandible

102
Q

What are reasons why mask ventilation may be ineffective?

A

obstruction, laryngospasm, foreign body, and poor technique

103
Q

Advantages to face mask include

A

low incidence of sore throat, less anesthetic depth needed, no muscle relaxants necessary, cost efficient for short cases

104
Q

Disadvantages to face mask include

A

hands are “tied up”, user fatigue, higher FGF, more difficulty in maintaining airway versus LMA, unprotected airway

105
Q

Complications of face mask include

A

skin problems, nerve injury, aspiration, eye injury (blindness from occlusion of retinal artery), movement of cervical spine, latex allergy, environmental pollution, lack of correlation between PaCO2 and ETCO2 due to dilution from high FGF

106
Q

A laryngeal mask airway

A

is a supraglottic airway device designed to secure the airway by providing a circumferential seal around the laryngeal inlet with an inflatable cuff
allows for spontaneous or assisted ventilation

107
Q

The aperture bars of the LMA

A

prevent epiglottis from obstructing the mask

108
Q

LMA size 3 stats

A

patient weight: 30-50 kg, cuff volume test: 30 cc, maximum cuff volume: 20 c, largest ETT 6.0

109
Q

LMA size 4 stats

A

patient weight: 50-70 kg, cuff volume test: 45 cc, maximum cuff volume: 30 cc, largest ETT 6.0

110
Q

LMA size 5 stats

A

patient weight: 70-99 kg, cuff volume test: 60 cc, maximum cuff volume: 40 cc, largest ETT 7.0

111
Q

The LMA connector diameter is

A

15 mm

112
Q

When placing a LMA

A

lubricate posterior surface of cuff

airway reflexes must be obtunded before inserted is attempted

113
Q

When ventilating using a LMA, airway pressures should

A

not exceed 20 cmH20

114
Q

Problems with LMA insertion include

A

mask tipping over on itself, airway obstruction if it pushes epiglottis to a down-folded position,

115
Q

Contraindications for use of LMA:

A

aspiration risk, patients with delayed gastric emptying, hiatal hernia, morbidly obese, >14 weeks pregnant, glottic or subglottic obstruction, limited mouth opening, trauma, acute abdomen, thoracic injury, patients with fixed decreased pulmonary compliance, peak airway pressures > 20 cmH20, patients who cannot adequately answer questions regarding medical history

116
Q

Adverse effects of LMA include

A

aspiration of gastric contents, sore throat, hypoglossal nerve injury, tongue cyanosis, vocal cord paralysis

117
Q

Indications for endotracheal intubation include

A

risk of aspiration, head/neck procedures, intracranial or intrathoracic procedures, intraabdominal procedures, procedures requiring mechanical ventilation, airway anomalies, positioning where airway is unavailable to anesthesia

118
Q

ET tubes are made up of ____ and come in ____ sizes

A

polyvinyl chloride (PVC) & are numbered according to internal diameter 2.5 mm to 9.0 mm (half sizes)

119
Q

Size selection & depth of insertion for ET tubes for men

A

men: 8.0 or 9.0; 24-26 ATL

120
Q

Size selection & depth of insertion for ETT for women

A

7.0-8.0; 20-22 cm ATL

121
Q

Size selection & depth of insertion for ETT for children:

A

size: 4 + age/4
depth: 12 + age/2

122
Q

What factors increase resistance in the ETT?

A

increased length and decreased radius

123
Q

What is the cuff pressure in the ETT?

A

cuff pressure 20-25 mmHg recommended because tracheal mucosal perfusion pressure= 25-30 mmHg

124
Q

Describe a MacIntosh blade

A

C shaped, tip is advanced to valleculae for an indirect lift of the epiglottis

125
Q

Describe a Miller blade

A

straight or L shaped, lifts epiglottis, less force & head extension needed… requires more skill

126
Q

Equipment needed for oral tracheal intubation:

A

laryngoscope handle x 2, blade x 2, oral airways, oral ETT x 2 w/ stylet, tape to secure, suction, stethoscope, backup airway plan

127
Q

When preparing for laryngoscopy, it is necessary to

A

optimize patient positioning, raise OR table, adequately preoxygenate, obtund airway reflexes, assess for ability to mask ventilate when appropriate

128
Q

Steps for performing laryngoscopy

A

open mouth with right hand (scissors technique), hold laryngoscope with left hand, insert blade into right side of patient’s mouth & sweep tongue to the left, sweep patient’s lips, lift upward and forward, remove stylet after ETT passes through cords, inflate cuff & verify placement

129
Q

Where should the cuff sit in the airway?

A

midpoint between vocal cords and carina

130
Q

How much depth needs to be added with nasal intubations?

A

3-4 cm.

131
Q

Position changes that can result in depth of tube change

A

Advance or withdraw 1.9 cm with head flexion and extension respectively
can move 0.7 cm with rotation of head

132
Q

Confirming ETT placement includes

A

absence of stomach gurgling sound made by air entering the stomach, equal bilateral breath sounds over the lungs, fogging of the ETT, refilling of the vent bag, presence of ETCO2 on three consecutive breaths, direct visualization of the ETT cuff passing the vocal cords

133
Q

Diagnosis of esophageal intubation includes:

A

gastric contents in ETT, ETCO2 waveform, reservoir bag collapses due to no return of airway gases, auscultation, gastric distension, absence of chest wall motion

134
Q

Physiologic responses to laryngoscopy and intubation include

A

htn, tachy or reflex bradycardia, arrhythmias, MI, increased IOP, increased ICP, bronchospasm

135
Q

complications of laryngoscopy & intubation include

A

upper airway edema, vocal cord dysfunction, vocal cord granuloma, arytenoid dislocation, glottic & subglottic granulation tissue leading to tracheal stenosis, aspiration, laryngospasm, bronchospasm, coughing, eye injury, CV changes, hypoxemia and hypercarbia, bleeding, submucosal dissection, esophageal intubation, damage to ETT cuff, C-spine injury, dental injury, damage to soft tissue and nerves

136
Q

Failures of direct laryngoscopy include

A

poor patient positioning, poor technique (inexperience, ego), inadequate preop assessment, poor preparation, backup techniques not available and ready, adjunct measures not utilized

137
Q

Extubation deep versus awake

A

awake: pt is able to maintain & protect airway, purposeful movement, eye opening, reaction to suctioning
deep: muscle relaxants fully reversed, pt spontaneously breathing with adequate minute ventilate, no response to suctioning

138
Q

When extubating, provide

A

100% O2, suction oropharynx and hypopharynx, close APL to 70, deflate cuff, remove ETT while applying positive pressure on bag, apply positive pressure and 100% FM immediately following extubation

139
Q

Subjective criteria for “awake” extubation includes

A

follows commands, clear oropharynx, intact, gag reflex, sustained head lift for 5 seconds, sustained hand grasp, adequate pain control, minimal end expiratory concentration of inhaled anesthetics ,

140
Q

Objective criteria for “awake” extubation includes

A

vital capacity >15 mL/kg, peak voluntary negative inspiratory pressure >25 cm H20, tidal volume >6 mL/kg, sustained tetanic contraction, SpO2 >90%, RR <35, PaCO2 <45

141
Q

Causes of ventilatory compromise during tracheal extubation

A

residual anesthetic, poor central respiratory effort, decrease respiratory drive in response to CO2 or O2, reduced tone of upper airway musculature, reduced gag and swallow reflex, surgical airway edema/compromise, vocal cord paralysis, subglottic edema, laryngospasm, bronchospasm

142
Q

Acute complications after extubation

A

laryngospasm, vomiting, aspiration, sore throat, hoarseness, laryngeal edema, subglottic edema

143
Q

Chronic complications after extubation

A

mucosal ulceration, tracheitis, tracheal stenosis, vocal cord paralysis, arytenoid cartilage dislocation (leads to flaccid cords & airway edema)

144
Q

Challenges of immediate reintubation

A

known difficult airway, surgical distortion, limited access, edema, uncooperative, combative patient, emergent nature, blood and secretions, poor oxygenation and ventilation, occurrence during transport, unavailability of equipment

145
Q

Indications for nasal intubation

A

maxillofacial or mandibular surgery

oral/dental surgery

146
Q

Contraindications for nasal intubation

A

coagulopathy, basilar skull fracture, severe intranasal disorder, CSF leak, extensive facial fractures

147
Q

Equipment needed for nasal tracheal intubation

A

laryngoscope handle x2, laryngoscope blades x2, magill forceps, oral airways, nasal airways, neosynephrine spray, nasal tubes x2, tape, suction, stethoscope, backup airway plan

148
Q

Complications of nasal intubation include

A

epistaxis, tracheal or esophageal trauma, displaced adenoids or polyps, resulting in bleeding and airway obstruction, bacteremia, sinusitis (seen with long-term NT intubation)

149
Q

Management of the difficult airway:

A

cannot ventilate- cannot cause a life-sustaining amount of gas exchange to occur with a jaw thrust and/or OPAW/NPAW
cannot intubate- cannot place ETT through the vocal cords within a life-sustaining period of time

150
Q

Causes of inability to ventilate:

A

laryngospasm- nerve injury; light anesthesia
Supraglottic tissue relaxation- tongue, epiglottis, soft palate & pharyngeal walls
Chest wall rigidity- breath holding, narcotic induced
Pathologic glottic and subglottic- foreign body, edema, infection, vocal cord palsy, stenosis, compression
Equipment failure

151
Q

A Fastrach LMA

A

is an intubating LMA

comes in sizes 3, 4 & 5 and can accommodate up to an 8.0 ETT

152
Q

A glidescope is

A

a video laryngoscope with integrated high resolution camera

clinical uses: known difficulty airway, “rescue”, anterior larynx, limited neck mobility

153
Q

Indications for a fiberoptic intubation include

A

assessment of double lumen ETT placement, airway evaluation, placement of ETT for difficult airway or patient with C-spine precautions

154
Q

Disadvantages of fiberoptic intubation

A

fragile and expensive, difficult to use, requires more time and experience, blood or secretions impede view

155
Q

Reasons for failed fiberoptic intubation

A

inadequate anesthesia, intraoperative laryngospasm or bronchospasm due to inadequate anesthesia, visualization obscured by blood, secretions, or edema, inexperienced provider (most common)

156
Q

A bullard scope is a

A

rigid laryngoscope anatomically shaped scope with fiberoptic bundle and eyepiece extending at a 45 degree angle from handle
useful in difficult airways
expensive; slow learning curve

157
Q

A Wu scope is a

A

rigid anatomically shaped blade with separate flexible fiberoptic scope, allows for O2 and suctioning during intubation, slow learning curve; parts must be assembled to use

158
Q

A upsher scope is a

A

rigid blade shaped in form of oropharynx with attached eyepiece
considerations similar to that for Bullard and Wu scope

159
Q

A lightwand

A

allows for trans-illumination of the neck to guide ETT

larynx not directly visualized

160
Q

A bougie is

A

a 60 cm long, angled at 40 degrees tip

useful when laryngoscopic view is poor (grade 3 and IV)

161
Q

A combitube is a

A

supraglottic airway device
used in the emergency airway
two lumens so can function whether it is placed in the esophagus or trachea

162
Q

A transtracheal jet ventilation requires

A

high pressure O2 source (~50 psi)
tidal volume dependent on: inspiratory time, chest wall, and lung compliance
catheter size 14g catheter~1600 mL/s
16g catheter ~500mL/s

163
Q

Complications with transtracheal jet ventilation include

A

tracheal mucosal damage and thickened secretions blocking the airway, resulting from inadequate humidification of inspired gases ** most common
tracheal & esophageal rupture, hematoma, failure to adequately ventilate, inadequate delivery of anesthetic gases, pneumothorax, pneumomediastinum, subcutaneous emphysema, barotrauma

164
Q

Retrograde intubation is

A

when a puncture is created with an 18g needle in the cricothyroid membrane and is directed cephalad at 45 degree angle; thread J-wire thru needle and out through mouth
follow ETT over wire guide into trachea

165
Q

Cricothyrotomy complications

A

pneumothorax, subcutaneous emphysema, bleeding, esophageal puncture, aspiration, respiratory acidosis

166
Q

Cricothyrotomy pearls

A

12-14g needle, 3 ml syringe- no plunger, 15 mm ETT adaptor from 7.0 tube, breathing circuit, TTJV

N928 Basic Principles of Anesthesia (16 decks)

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