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
What are some predictors of a difficult airway?
- Obesity
- Decreased head and neck movement
- Decreased jaw movement
- Receding mandible
- “buck teeth”
What are the components of the airway set up?
- Laryngoscope/blades- 2 types
- Oral/nasal airways- several sizes
- Tongue depressor
- ETT- 2 sizes with stylets and syringe on cuff
- Suction
- Ambu-bag
- LMA
What should be documented Preop?
- dental
- cervical range of motion
- mallampati class
- thyromental distance
- mouth opening
What should be documented post-intubation?
- Visualization
- Trauma
- Equipment used
- Hemodynamic or respiratory changes
What should be documented post-extubation?
- Loose teeth intact
- Airway patency
- Adjuncts airway maneuvers used
