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Intro to Anesthesia: Part A > Airway Anatomy & Management > Flashcards

Airway Anatomy & Management Flashcards

1
Q

Pharynx Divisions and Borders (3 items)

A
  1. Nasopharynx (nose => soft palate)
  2. Ororpharynx (mouth => epiglottis)
  3. Laryngopharynx (epiglottis => trachea)
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2
Q

Nasopharynx Structures and Innervation

A
  1. Septum, Turbinates, Adenoids; humidify, warm, filter

2. Trigeminal (CN V)

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3
Q

Oropharynx Structures and Innervation

A
  1. Teeth, tongue, hard palate, soft palate; predominate cause of airway resistance
    2 a. Trigeminal CN V (hard/soft palate, ant 2/3 tongue)
    b. Glossopharyngeal CN IX (soft palate, posterior 1/3
    tongue)
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4
Q

Larynx Location

A

C4-C6

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5
Q

9 Larynx Cartilages (6 items)

A 
3 Paired Cartilages
    a. Arytenoid
    b. Corniculate
    c. Cuneiform
3 Unpaired    
    a. Thyroid  
    b. Cricoid  
    c. Epiglottis
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6
Q

3 Unpaired Larynx Cartilages

A
  1. Thyroid: anterior attachment for vocal chords; most
    prominent cartilage
  2. Epiglottis: covers opening to larynx
  3. Cricoid: narrowest part of pediatric airway; ONLY
    complete cartilaginous ring
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7
Q

3 Paired Larynx Cartilages

A
  1. Arytenoid: posterior attachment for vocal chords
  2. Corniculate: posterior portion of aryepiglottic fold
  3. Cuneiform: lateral to corniculates on aryepiglottic fold
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8
Q

Describe

  1. Vocal Chords
  2. Glottic Opening
A
  1. Pearly white color; formed by thyroarytenoid ligamints; attached anteriorly to thyroid, posteriorly to arytenoid
  2. Triangular fissure between vocal chords; narrowest portion of adult airway
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9
Q

Lateral Cricoarytenoid Muscle

A

Controls glottic opening, adducts the vocal cords (Let’s Close the Airway); contracts in laryngospasm

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10
Q

Arytenoid Muscles

A

Control glottic opening; has oblique and transverse components; adducts the vocal cords

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11
Q

Posterior Cricoarytenoid Muscle

A

Control glottic opening; only vocal cord abductors (Please Come Apart)

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12
Q

Cricothyroid Muscle

A

Controls vocal cord length; only muscle that tenses/elongates cords; contracts in laryngospasm

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13
Q

Thyroarytenoid Muscle

A

Controls vocal cord length; relaxes/shortens vocal cords; contracts in laryngospasm

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14
Q

Vocalis Muscle

A

Controls vocal cord length; relaxes/shortens vocal cords

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15
Q

Innervation of Laryngeal Muscles

A
  1. Cricothyroid: External branch of Superior Laryngeal Nerve (branch of Vagus CN X)
  2. All Others: Recurrent Laryngeal Nerve (Vagus CN X)
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16
Q

Lower Airway: Anatomical Deadspace (5 items)

A
  1. Trachea
  2. Carina
  3. Bronchi
  4. Bronchioles
  5. Terminal Bronchioles
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17
Q

Lower Airway: Anatomical Respiratory (2 items)

A
  1. Respiratory Bronchioles

2. Alveoli

18
Q

Trachea Anatomy:

  1. Length
  2. Diameter
  3. Cartilage #
  4. Carina Location
  5. Right Bronchi (Length/Angle)
  6. Left Bronchi (Length/Angle)
A
  1. 10-20cm
  2. 22mm
  3. 16-20 U shaped rings (no cartilage posterior)
  4. T4
  5. 2.5cm long, 25 degrees (short/fat)
  6. 5cm long, 45 degrees (long/lean)
19
Q

Mallampati Classification:

  1. Indication
  2. Technique
  3. 4 Classes (PUSH)
A
  1. Correlates oropharyngeal space and size of tongue with ease of direct laryngoscopy
  2. Pt sits upright, head neutral, mouth open/tongue protruded maximally (no Ahhhhh)
  3. Classifications:
    Class 1: Pillars at back of soft pallet (Faucial pillars), entire
    Uvula, Soft and Hard palate
    Class 2: Uvula tip masked by tongue, Soft and Hard palate
    Class 3: Soft and Hard palates (uvula base only)
    Class 4: Hard palate
20
Q

Cormack and Lehane Score (4 Grades)

A

Grade 1: most of glottis visible
Grade 2: Only posterior portion of glottis visible
(corniculate/cuneiform visible)
Grade 3: Only epiglottis visible
Grade 4: No airway structures visible(Grades 3/4 must use
video assisted intubation)

*usually correlates to Mallampati CLASS

21
Q

Thyromental Distance:

  1. Technique
  2. Indications
A
  1. Fully extend next; measure from lower border of mandible till the thyroid notch; normal is 6-6.5cm or 4 fingerbreadths
  2. <3 fingerbreadths indicates receding mandible or “anterior airway”; difficult intubation
22
Q

Mandibular Protrusion Test (3 Classes)

A

Class A: lower incisors can be protruded anterior to upper incisors
Class B: lower incisors brought edge to edge with upper
Class C: lower incisors cannot be brought edge to edge with upper incisors

*Test indicates how easy it is to jaw thrust

23
Q

MSMAID of Induction

A 
Monitors on and machine check
Suction at head of bed
Means of PPV
Airway setup
IV
Drugs (emergency and case specific)
24
Q

Airway Setup Components (LOSTSEAL)

A 
LMA
Oral/Nasal Airways
Suction
Tape/tongue depressor
Stylet/Syringe
ETT (2 sizes)
Amub bag w/ face mask
Larygoscope w/ two blades
25
Q

Face Masks:

  1. Sizes
  2. Holding technique
A
  1. Size 1 (neonate) => Size 6 (large adult)

2. C/E grip with left hand; put 4/5th finger at angle of mandible for chin lift/ jaw thrust

26
Q

Pre-oxygenation Goal/Techniques

A

Goal: complete washing out of nitrogen
Technique:
1. 3-5 minutes @ 100% >6L/min flow (10 mins safe apnea)
2. 4 VC breaths within 30 sec @ 100% >6L/min flow (5 mins safe apnea)

27
Q

Oral Airways:

  1. Types
  2. Sizes
  3. Measurement
  4. Complications
A
  1. Berman (channels down the side) or Guedel (one
    opening in center)
  2. a. Small: BOA 80mm = Guedel #3
    b. Medium: 90mm = #4
    c. Large: 100 = #5
  3. Measure from corner of mouth to earlobe
  4. Unconscious patients only; soft tissue damage,
    laryngospasm
28
Q

Nasal Airway:

  1. Sizes
  2. Measurement
  3. Complications
A
  1. Measured in French; 24-36; diameter depends on ease
    of insertion
  2. Measure from nares to meatus of ear
  3. Don’t push if too much resistance, try different size or extra lube; lubricate; can cause epistaxis/fractures; can be used on conscious patients
29
Q

Laryngoscope Blades:

  1. Types
  2. Sizes
  3. Usage
  4. Complications
A
  1. Mac and Miller
  2. Mac 1-4 (M 3,4/ F2,3) Miller 0-4 (M 3,4/ F 2,3)
  3. Mac: scoop R => L, wrist straight, tip @ vallecula
    (depression behind root of tongue)
    Miller: straight back, better for anterior airway/ peds; tip
    on epiglottis
  4. Always check battery in handle and lights on blade
30
Q

Enodtrachial Tubes:

  1. Types (6)
  2. Typical sizes
  3. Ideal Position
A
  1. Cuffed, uncuffed, Oral RAE, Nasal RAE, Double Lumen, Reinforced
  2. F: 6.5-7mm, M: 7.5-8mm
  3. 4cm above carina; 2cm below vocal cords; M=23mm, F=21 cm; IDx3 for appx peds; 3 ETCO2 is gold standard for placement confirmation
31
Q

Sniffing Position:

  1. Landmarks
  2. 3 Axis
A
  1. Tragus even with sternum

2. Aligns oral, pharyngeal, laryngeal axis

32
Q

Laryngeal Mask Airway:

  1. Sizes
  2. Insertion
  3. Advantages
  4. Disadvantages
A
  1. a. LMA 3 (30-50kg) b. LMA 4 (50-70kg) c. LMA 5 (70-100kg) d. LMA 6 (>100kg)
  2. Have 20-50cc syringe; lubricate posterior side only; hold w/ black line facing away and insert midline till resistance; inflate, ventilate, auscultate, tape
  3. Speed/ease, improved hemodynamic stability, reduced anesthetic requirements, lower coughing; avoids foreign body stimulis in trachea (sits supraglottic)
  4. No positive pressure, increase risk of gastric insuflation/aspiration, can’t use mechanical ventilation (must be spontaneously breathing)
33
Q

Mask Case Indications (6 items)

A
  1. No difficult airway
  2. No access to head needed
  3. No excess secretions
  4. Short duration
  5. No position changes
  6. No NMB (spontaneous ventilation)
34
Q

LMA Case Indications (6 items)

A
  1. No difficult airway
  2. No access to head needed
  3. No excess secretions
  4. Short duration
  5. Need hands free during case
  6. No NMB (spontaneous ventilation)
35
Q

ETT Case Indications (8 items)

A
  1. Airway compromise/inaccessible/ difficult to maintain
  2. Long cases
  3. Access to head needed
  4. Controlled ventilation needed
  5. Alternate positions during surgery
  6. Aspiration risk
  7. NMB use
  8. Airway/lung disease
36
Q

Concerns Managing Airway and Intubation (8 items)

A
  1. Hypertension/Tachycardia/MI
  2. Laryngospasm
  3. Brnchospasm
  4. Broken Teeth
  5. Airway Trauma
  6. Aspiration
  7. Hyopxia/Hypercapnia
  8. Gastric Insuflation
37
Q

3 Functions of Larynx

A
  1. Phonation
  2. Respiration
  3. Airway Protection
38
Q

Components of Airway Assessment (8 items)

A
  1. Surgery/Diagnosis/ PMH (including planned surgery;
    previous intubation history)
  2. Body Shape
  3. ROM of neck
  4. Thyromental Distance (3-4 fingerbreadths
  5. Mouth Opening (2-3 fingers or 30-40mm)
  6. Dentition and condition of mouth, lips, gums
  7. Mallampati
  8. Mandibular Protrusion
39
Q

Upper airway resistance

A

2/3 from nasal cavity; 1/3 tongue

40
Q

Common Diseases that affect intubation (8 items)

A
  1. Radiation/bunrs
  2. C-spine injuries
  3. TMJ
  4. Arthritis
  5. Tumors
  6. Tracheotomy/prior intubation issues
  7. Sleep apnea
  8. Dysphagia/stridor

Intro to Anesthesia: Part A (6 decks)

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