Airway Assessment Flashcards
Why must patients receive an airway assessment?
To predict ease or difficulty of airway management.
What is the anterior and posterior attachments of the vocal cords?
Anterior-thyroid cartilage
Posterior- arytenoids
What are the indications for intubation?
- Airway protection/maintenance of patent airway
- Application of positive pressure ventilation/provide PEEP
- Maintenance of adequate oxygenation/deliver predictable FiO2
What are indications for a mask case?
- No instrumentation of airway required
- Difficult airway not present
- Surgeon does not need access to head/neck (ear tubes ok)
- No airway bleeding/secretions
- Case of short duration
- No table position changes-head available
- Ventilation by mask requires the ability to achieve a seal between the mask and face to overcome upper airway obstruction. Obstruction should be easily relieved with airway/chin lift
What questions should be asked in an airway assessment history?
- Previous anesthesia history with airway management?
- Difficulty with prior anesthetics/intubations?
- Co-existing disease?
- Surgical history that may affect airway management?
What co-morbidities may effect airway management?
- Lesions of larynx
- Thyroid disease
- Cancer
- GERD
- Diabetes
- Sleep apnea
- Obesity
- Genetic disorders
- Rheumatoid arthritis
- Musculoskeletal
- Scleroderma
What surgical history may effect the airway management?
- Tracheostomy or scar
- Neck dissection
- Uvuloalatoplasty
- Cervical neck instrumentation (fusion)
What AANA standards are met with the physical exam?
1- a practitioner shall perform a thorough and complete pre-anesthesia assessment
3-The practitioner shall formulate a patient-specific plan for anesthesia care
What aspects of general appearance do you look at in the physical exam?
- Head
- Neck-size circumference and length
- Presence of heavy facial hair
- Size and shape of mandible, maxillary overgrowth
What aspects of the mouth do you look at in the physical exam?
- Lips
- Gums
- Tissues
- Mouth opening (normal is more than 4 cm or 2 fingerbreadths)
- Size and mobility of tongue
- TMJ
What aspects of the teeth do you look at during the physical exam?
- Length of incisors
- Condition of teeth-missing, protrusions, overbite
- Relationship of upper incisors (maxillary) to lower incisors (mandible)
- Dentures/bridges out?
Describe the thyromental distance
-Distance from mandible to prominence of thyroid cartilage. Normal is 6.5cm or 3 fingerbreadths
Describe the hyoidmental distance.
Distance from hyoid to mandible. Norma is 2 ginerbreadths
What do you look for in the dental assessment?
- Poor dentition
- Loose teeth
- Chipped teeth
- Capped teeth
- Removable bridges
- Dentures
Describe the Mallampati exam.
- Relates the size of the base of the tongue to the oral cavity
- Visualization of pharyngeal structures-soft palate, fauces, uvula and pillars
- Patient is seated upright with the head in neutral position. The patient is asked to open the mouth as wide as possible and to stick out the tongue
