Airway Assessment And Anatomy Flashcards
List types of preanesthetic airway assessment
Mouth opening- incisor distance >3cm
Mallampati- PUSH
Thyromental distance- 332
Neck circumference <17cm
Upper lip bite test
What is the earliest indication of bronchial intubation?
High peak inspiratory pressures
Know IT
What is the larynx?
Part of respiratory tract between pharynx and trachea
Voice box
Cervical vertebrae location of larynx
C4-c6
3 single and 3 paired cartilages
Epiglottis
Thyroid
Cricoid
Arytenoid
Corniculate
Cuneiform
Types of cartilage in the airway
All major cartilages are hyaline cartilage
Exception: epiglottis is elastic cartilage
Describe surface anatomy of arytenoid cartilages
Apex
Anterolateral surface
Medial surface
Muscular process
Vocal process
Purpose of corniculate/ cuneiform cartilages
Support ary-epiglottic folds (swelling under mucosa are called tubercles)
Attachment points for epiglottis
Hyo-epiglottic ligament
Thyro-epiglottic ligament
Extrinsic ligaments
Thyrohyoid ligament (elevation of larynx during swallowing)
Cricothyroid ligament
Other name for laryngeal inlet
Aditus
How many vocal folds in the laryngeal cavity?
Vestibular folds
Vocal folds…
Term for the space between the vocal folds
Rima glottidis
2 parts of the fibro elastic membrane of the larynx
Quardangular membrane- supports vestibule between vestibular and vocal folds
Conus elasticus- superior, internal continuation of the cricothyroid ligament
Movement of arytenoids
Rotating
Gliding
Adduction- together
Abduction- apart
What are the four basic action of the “muscles of phonation”
Adduct
Abduct
Tense/relax
Close laryngeal inlet
Muscles that ABduct vocal cords and innervation
Posterior Crico-arytenoid muscles
Recurrent Laryngeal Nerve
Muscles that ADduct the vocal cords
Lateral crico-arytenoid muscles and transverse arytenoid muscles
Recurrent Laryngeal Nerve
Close rima glottidis
Muscles that tense the vocal cords and motor innervation
Cricothyroid muscles
External branch of the superior laryngeal nerve
Pull down and tilting forward of thyroid c
Fine, regional adjustments of tension on vocal cords
Vocalis muscles
Muscles that close the laryngeal inlet
Transverse arytenoid, ary-epiglottic, and thyro-epiglottic muscles
Recurrent LN
Blood supply to the larynx
Superior and inferior laryngeal arteries
All the nerves of the larynx
Vagus!! CN X
Superior laryngeal nerve (internal and external)
Recurrent laryngeal nerve
Explain motor innervation of larynx
RLN supplies all muscles EXCEPT
cricothyroid-external branch of superior laryngeal nerve
Sensory innervation inferior to the vocal cords
Recurrent laryngeal nerve
Sensory innervation superior to vocal cords
Internal branch of superior laryngeal nerve
INCLUDES vocal cords
Lymph drainage pathways above and below vocal folds
Above: superior group of deep cervical nodes
Below: paratracheal and inferior group of deep cervical nodes
5 steps of airway assessment
H&P
Assess intubation difficulty preop
Formulate multiple plans
Aspiration risk
Approximate risk of airway failure
H&P of airway?
Previous issues
Congenital or anatomical issues
Visual inspection
Active pathologies
Weight changes
OSA
Pierre robin
Micrognathia- small jaw
(Mandibular hypoplasia)
(Choanal atresia-narrowing of nasal passages)
Large tongue
Treacher Collins
Cleft palate
Micrognathia
Recessed mandible
Down syndrome-trisomy 21
Extreme variation
Redundant skin (neck)
Large tongue- acute angle
Klippel-feil
Vertebral fusion
Can’t place spirals
Cretinism
Caused by iodine deficiency during pregnancy
Goiters common
Beckwith syndrome
VERY large tongue
Cherubism
Cyst filled sacs in facial structures
Neurofibromatosis type 1
Fairly common
Accompanies scoliosis commonly
Croup
Barking cough
Inflammation/narrowing of upper airways
Ludwig angina
Submandibular space infection (fluid sacs)
Push tongue up
Acromegaly considerations
Instability in c1/c2
Longer tube
Rheumatoid arthritis
Always elevate head, you can decapitate them
Ankylosing spondylitis
Very painful inflammation of vertebrae resulting in fusion
Aspiration risk chart
Five airway measurements
Thyromental distance
Mouth opening
Mallampati score
Head and neck mobility
Ability to prognath
Thyromental distance
3 fingers (6 cm)
Cormack lehane
Grade 1: full view of glottic opening
Grade 2a- posterior portion of glottic opening
Grade 2b- epiglottis and arytenoids
Grade 3- epiglottis
Grade 4- nothing/palates
Mallampati
1- uvula, pillars, hard and soft
2- pillars, hard and soft
3- hard and soft
4- hard only
Which joint are we assessing in neck mobility
Atlantoaxial?
ULBT
1- full bite
2- doesn’t cross vermillion border
3- can’t bite upper lip
Best airway screening test?
ULBT
Mask ventilation difficulty mneumonic
BONES
Beard
Obese BMI>26
No teeth
Elderly >55
Snoring
Rapid airway assessment LEMON
LEMON
Look- malformations
Evaluate 332
Mallampati
Obstruction?
Neck mobility
Saturation
Notes on preoxygenation
Tight fitting mask 5 minutes
10-12L flows
Gives you 8 min of apnea in healthy adult
ASA minimum monitoring standards
Four indications for awake intubation
Difficult mask ventilation
Significant risk of aspiration
Increased risk of rapid desaturation
Suspected difficult emergent airway
Pharynx cranial nerves
Nasopharynx-trigeminal
Oropharynx- glossopharyngeal
Larynx- vagus nerve
-superior laryngeal nerve
External branch
Internal branch
Recurrent laryngeal nerve
Also called the cricovocal ligament
Conus elasticus
Superior, internal continuation of cricothyroid ligament
Differentiate between conus elasticus and quadrangular membranes in relation to vocal cords
Conus- inferior
Quad- superior
Risk factors for airway assessment to get percentages
Mallampati >1 or =4
Mouth opening <4cm
Do they have teeth or history of difficult intubation
Least to most sensitive muscle mnemonic
Very -vocal cords
Daring -diaphram
Octopuses -orbicularis oculi
Also - abdominal rectus
Admire- adductor pollicis
Mighty- masseter
Pearls - pharyngeal
Everyday- extraocular
