Airway Anatomy and Management (plus Complications) Flashcards
CricoThyroid
“Cords Tense” (elongates)
ThyroaRytenoid
“They Relax” (shortens)
Posterior CricoArytenoid
“Please Come Apart”
-solely responsible for opening vocal cords
Lateral CricoArytenoid
“Lets Close the Airway”
The RLN innervates all of the intrinsic muscles EXCEPT the ___________.
cricothyroid muscle
(innervated by the external branch of the superior laryngeal nerve)
Laryngeal muscle chart
3 branches of the Trigeminal Nerve (C5)
V1 (ophthalmic)- nares and anterior 1/3 of nasal septum,
V2 (maxillary)- turbinates and nasal septum,
V3 (mandibular)- anterior 2/3 of tongue (somatic
The _______ nerve gives rise to the _______ and the _______.
Vagus
SLN and RLN
The ______ branch of the __________ innervates the _________ muscle.
External
SLN
cricothyroid
Adult larynx lies anterior to ________.
C3-C6
Picture of the airway
Complicatons of laryngospasm
Complications: airway obstruction, negative pressure pulmonary edema, pulmonary aspiration of gastric contents, cardiac dysrhythmias, cardiac arrest, and death.
Signs and Symptoms of Laryngospasm
S&S: inspiratory stridor, suprasternal & supraclavicular retraction during inspiration, “rocking horse” appearance of the chest wall, increased diaphragmatic excursion, lower rib flailing, absent or altered EtCO2 waveform
Causes of Laryngospasm
Causes: airway manipulation, airway secretions, surgery in the airway, active or recent respiratory tract infection (less than 2 weeks), age < 1 y.o
Treatment of Laryngospasm
Tx: 100% fio2, remove stimuli, deepen anesthesia, Larson’s maneuver, CPAP 15-20cmH2O, Succs ( adult and child IV .1-1mg/kg, IM 4mg/kg, Neonate and infant IV 2mg/kg, IM 5mg/kg) ***give .02mg/kg of atropine with succs in children less than 5 y.o
Valsalva’s maneuver
exhalation against a closed glottis or obstruction
Muller’s maneuver
inhalation against a closed glottis or obstruction (risk of negative pressure pulmonary edema)
Laryngeal Assessment ( Cormack and Lehane score)
Difficult airway conditions
Sniffing position
MAC blade
lifts epiglottis by applying tension to the hyoepiglottic ligament
Miller blade
lifts epiglottis directly
Pediatric ETT size without cuff
(Age / 4) + 4
Ex. (8/ 4) + 4 = size 6”
Pediatric ETT size with cuff
(Age / 4) + 3.5)
Ex. (8/4) + 3.5 = 5.5”
Most common cause of nerve injury from LMA is?
Cuff overinflation
LMA size guide chart
What is the “go to” device in the “can’t intubate and can’t ventilate” situation?
LMA!!!!
Preferred airway for patient with reactive airway disease?
LMA
Pros and Cons of Awake vs Deep extubation
All anesthesia-related deaths from airway obstruction or hypoventilation occurred during ___________.
emergence and recovery (not induction) of general anesthesia.
Postoperative Cognitive Dysfunction (POCD) onset?
- Onset is weeks/ months
- Subtle presentation of deterioration of memory, concentration, and information processing
Postoperative Delirium onset is______.
Onset is acute (hours/days)
Anesthesia related Drugs known to cause prolong QT interval
o Halothane
o Isoflurane
o Sevoflurane
o Atropine
o Glycopyrrolate
o Ondansetron
o Methadone
Intraoperative awareness risk factors
o Female
o Young adults
o Obesity
o Previous awareness
o Anesthesia providers experience
o Procedures performed after normal working hours
o Traumas
o OB
o Open heart surgery
o Use of NDMR
Large Tongue
” Big Tongue”
-Beckwiths Syndrome
-Trisomy 21 (down syndrome)
Small/Underdeveloped mandible
“Pease Get That Chin”
-Pierre Robinson
-Goldenhar
-Treacher Collins
-Cri du Chat
Cervical Spine Anomaly
“Kids Try Gold”
-Klippel-Fiel
-Trisomy 21
-Goldenhar
