airway assessment

Question 1

Airway assessment general

Answer 1

EVERYONE receives one

must consider type of anesthesia, surg

Question 2

indications for intubation 6

Answer 2

airway protection 
maintain airway protection 
delivery predictable FiO2
maintain adequate O2
apply positive pressure vent
provide positive end-expiratory pressure

Question 3

indication for mask case

Answer 3

• no difficult airway present
• surgeon doesn’t need access to head/neck (expect BMT)
• no table position changes…always have access to head
• Short case
• no airway instrument needed-therefore avoid trauma, CV stimulation
• no airway bleeding/secretions
• must be able to ventilate by achieving a tight mask seal
• and can overcome upper airway obstruction with chin lift.

Question 4

airway hx

Answer 4

previous anesthesia hx
difficulty with prior anesthetics/intubation
--past fiberoptic intubation 
--severe sore throat or dental damage
coexisting disease 
surg hx that may effect airway mgmt

Question 5

co-morbidities that may effect airway 11

Answer 5

lesions of larynx 
CA
DM (problem with gastric emptying) 
obesity 
Rh arthritis-overflexion-spinal cord injury 
thyroid disease
GERD
musculoskeletal problems
neck lesions---larynx can not be midline
Sleep apnea 
Scleroderma--deposits on larynx

Question 6

surg hx that might effect airway

Answer 6

trach
neck dissection
UVPP-cut out uvula
cervical neck fusion—can flex chin to chest?

Question 7

physical exam airway 11

Answer 7

• general appearance: head, neck (circum), facial hair
• mouth: lips, gums, tissue
• teeth: condition, missing, overbite, length of incisors, dentures, relationship of maxillary incisors to mandible incisors
• Mouth opening
• tongue size and mobility
• mandible: size, shape, overgrowth
• TMJ
• Thyromental distance
• Hyoidmental distance
• Cervical ROM (atlanto-occipital joint)
• listen to breath sounds

Question 8

Mouth opening normal

Answer 8

> 4cm or >2 finger breaths

-laryngealblade are approx 2cm

Question 9

Hyoidmental distance

Answer 9

distance hypiod to mandible—normal 2fb

Question 10

Mandibular protrusion test class ABC

Answer 10

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

Question 11

dental assessment

Answer 11

GROSS
poor dentition
loose, chipped capped teeth
removable bridges
dentures 
COUNT Right upper 1- 16 bottom L 17-32

Question 12

sniffing position

Answer 12

aligning oral, pharyngeal, and laryngeal axis

Question 13

difficult airway predictors

Answer 13

-no ideal methods exit that is both high sensitive and specific to predict difficult airway
-obesity
decreased head and neck mvmt
decreased jaw mvmt
receding mandible
“buck teeth” huge overbite

Question 14

airway set up

Answer 14

laryngoscope/blades 2 types
oral/nasal airway several sizes
tongue depressor
ETT 2 sizes with styles and syringe on cuff
suction
ambu-bag
LMA #4--ETT 6.5 intubating LMA--8ETT

Question 15

difficult airway cart

Answer 15

• airway set up AND…
• different laryngoscope blades
• ETT guides: bougi, semi-ridg stylets with or without hollow core, light wands, forceps-for distal portion of ETT
• various supraglottic airway devices
• fiberoptic
• retrograde intubation equipment
• jet ventilation
• surgical airway stuff

Question 16

Documentation

Answer 16

• preop: dental, cervical ROM, mallampati class, TM distance, mouth opening
• Post-intubation: visualization, trauma, equipment used, hemodynamic or resp changes
• Post-Extubation: loose teeth still intact, airway protection, adjuncts/airway maneuvers used