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N928 Basic Principles of Anesthesia > Airway highlights- In class need to know > Flashcards

Airway highlights- In class need to know Flashcards

1
Q

Nasal airways (describe how placed)

A

leave phalange on outside
could be awake or light
use water-soluble lubricant- don’t occlude the opening
aim straight to the floor

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2
Q

Nasal airways should be avoided in patients with

A

facial trauma, pregnant because increased blood volumes and nose is highly vascular, history of recurrent nosebleeds, anti-coagulants, hemophiliac, liver disease, integrity issue with hard palate

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3
Q

In this stage of anesthesia, we should avoid placing anything…

A

stage 2

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4
Q

Concerns when masking include

A

excessive pressure which could cause tissue and nerve damage (facial), temporal, buccal, cervical, mandibular

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5
Q

How to place a face mask

A

start at bridge of nose and roll down while pulling cuff out
could injure the eyes so use smallest size mask & avoid excessive pressure on nose
“C” and “E” with fingers- 2 fingers on bony prominence- do not put pressure on soft tissue, nose, or eyes

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6
Q

Steps to perform when you cannot mask-ventilate

A

reposition patient, insert oral airway, insert nasal airway, two handed masks

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7
Q

What occurs with ETT placement?

A

increased heart rate, increased blood pressure, increased ICP, increased IOP (all of these are avoided with LMA & mask general)

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8
Q

Reasons for using mask ventilation over ETT?

A

don’t have to paralyze, cheaper, less risk for trauma, not as deep of anesthesia

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9
Q

What is the size connector for the LMA?

A

15 mm

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10
Q

Where does the LMA sit?

A

supraglottic above the cords

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11
Q

The fast track LMA

A

has a preformed curvature and could be exchanged for ETT if you have the right equipment

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12
Q

Can the LMA be used for mechanical ventilation?

A

Yes, as long as you maintain peak pressure <20 cmH2O

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13
Q

What is a laryngospasm?

A

adduction of vocal cords

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14
Q

How do we treat a laryngospasm?

A 
give positive pressure- turn APL valve all the way down
need a good mask seal
align axis
Larson's maneuver- dig behind the jaw
deepen anesthetic- give Propofol
Succinylcholine
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15
Q

What muscle is involved with laryngospasm?

A

lateral cricoartynoid, thryoartenoids, cricothyroid

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16
Q

Difficult mask airway:

A

BONES & MOANS
beard, obese, no teeth, elderly >55, snores
provider experience, NG tube, retrognathia, tall/big nose, appropriately fitted mask

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17
Q

LEMON stands for

A

Look externally, evaluate the 3-3-2 rule, Mallampati >3, obstruction, limited neck mobility

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18
Q

Basic airway set up includes:

A

suction, 2 blades & 2 handles, 2 oral airways, 2 ET tubes, stylets, tape, syringe, ambu bag

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19
Q

Sizing of the oral airway

A

phalange-corner of the mouth to the tip of the mandible

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20
Q

The airway is composed of the

A

pharynx, larynx, and trachea

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21
Q

What is BURP?

A

back, upward right pressure because 60% of people have esophagus to the left

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22
Q

List the cranial nerves:

A
  1. olfactory
  2. optic
  3. oculomotor
  4. trochlear
  5. trigeminal
  6. abducens
  7. facial
  8. acoustic
  9. glossopharyngeal
  10. vagus
  11. spinal accessory
  12. hypoglossal
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23
Q

Which cranial nerves are important to the airway?

A

trigeminal, facial, glossopharyngeal, and vagus

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24
Q

What might a hypoglossal injury cause?

A

tongue could fall backward and obstruct the airway

could use an oral airway

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25
Q

Explain 9 to 5

A

the 9th cranial nerve innervates the 1/3rd posterior portion of the tongue and the 5th cranial nerve innervates the 2/3rd anterior portion of the tongue

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26
Q

Waldeyer’s tonsillar ring is

A

a highly vascular area that is at high risk for bleeding

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27
Q

The vagus nerve is composed of the

A

superior laryngeal nerve (both sensory & motor)

and the recurrent laryngeal nerve (inferior & loops around subclavian artery and aortic arch)

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28
Q

Indicators for difficult intubation include

A

large neck circumference, short thyromental distance, mallampati grade 3 & 4, limited mouth opening/positive prayer sign, mass or trach scars, pronathy- teeth are protruding, retrognathia- mandible is recessed

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29
Q

Sensitivity is

A

a true positive

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30
Q

Specificity is

A

a true negative

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31
Q

The sternomental distance cutoff is

A

13.5 cm

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32
Q

What do we look to see is aligned when aligning our OPL?

A

the sternal notch to the external meatus

33
Q

What causes our pharyngeal and laryngeal axis to align?

A

elevation of the head aligns laryngeal and pharyngeal

34
Q

What aligns the oral axis with the rest of our axes?

A

extension of the head

35
Q

The blood is supplied to the airway via the

A

superior laryngeal artery (above cords) and recurrent laryngeal artery (below cords)

36
Q

Causes of airway obstruction include

A

laryngospasm-adduction of cords, anaphylaxis, secretions, tumor/mass, mucous plug, tongue, sleep apnea

37
Q

What actions do we take with an airway obstruction?

A

positioning change- head tilt, chin lift, paralyze, suction, oral or nasopharyngeal airway

38
Q

If we don’t take action during an airway obstruction, the patient will become

A

hypoxemic and anoxic

39
Q

Signs of airway obstruction:

A

any physiological signs that there is impaired gas exchange: no chest rise and fall, diaphragmatic tugging, cyanosis, increased peak airway pressure, no ETCO2, the bag will not move if in bag mode, ETT will not have fog

40
Q

The MAC blade

A

tip of blade sits at velecula, above epiglottis; enter on right, scoop tongue to the left

41
Q

The miller blade

A

direct manipulation of epiglottis- lifts below the epiglottis

42
Q

DVL

A

direct visual laryngoscopy

43
Q

ETT is made up of

A

PVC- polyvinyl chloride-flammable

44
Q

The tube size measures the

A

internal diameter of the tube in mm

45
Q

The blue line on the ETT

A

allows for the tube to appear on XR

46
Q

The murphy’s eye on the tube

A

allows for escape of gases in the cause of an obstructed bevel
do not advance stylet beyond Murphy’s eye

47
Q

Nitrous oxide can

A

cross air filled membranes so periodically check cuff pressure

48
Q

Where are the tracheal rings?

A

located anteriorly

49
Q

What is the complete ring of cartilage?

A

cricoid cartilage

50
Q

What are the appropriately sized ETT for men, women, and children?

A

men: 7.5-8
females: 7-7.5
children: age+4/4 & depth 12+ age/2

51
Q

What causes more resistance in the ETT?

A

smaller radius and longer length

52
Q

The cuff pressure of the ETT should

A

not exceed 25 mmHg because tracheal perfusion pressure is 25-30

53
Q

ET tube placement can be verified by:

A

listening for absent sounds over the stomach, listening to bilateral lung sounds, continuous end tidal CO2, bilateral chest rise and fall, condensation in the tube

54
Q

List the nine cartilages found in the larynx:

A

Thyroid, cricoid, epiglottic

arytenoid, corniculate, and cuneiform (pairs)

55
Q

The narrowest portion of the adult & child’s airways are

A

adult: glottic opening
children: cricoid ring

56
Q

The only complete ring of laryngeal cartilages is

A

the cricoid cartilage

57
Q

The arytenoid muscle

A

adducts the vocal cords

58
Q

The posterior cricoarytenoid

A

abducts (opens) the vocal cords and opens the glottis

59
Q

The lateral cricoarytenoid

A

adducts (closes) the vocal cords

60
Q

The cricothyroid muscle

A

produces cord tension, closure, and elongates the vocal cords; can result in total and profound glottic closure called laryngospasm

61
Q

The thyroarytenoid muscle

A

shortens and relaxes the vocal cords

62
Q

Which muscles elevate the larynx?

A

the stylohyoid & mylohyoid

63
Q

Which muscles draw the hyoid bone inferiorly?

A

the sternohyoid & thyrohyoid

64
Q

Which muscle draws the thyroid cartilage caudad?

A

sternothyroid

65
Q

The omohyoid muscle

A

draws the hyoid bone caudad

66
Q

The vagus nerve innervates the airway

A

below the epiglottis and has the superior and recurrent laryngeal nerve branches

67
Q

The superior laryngeal nerve

A

has internal branch which provides sensation to larynx from epiglottis to vocal cords (sensation ABOVE) vocal cords
the external branch is a motor nerve

68
Q

The recurrent laryngeal nerve

A

provides sensation to larynx BELOW the vocal cords

69
Q

The external branch of the superior laryngeal nerve is responsible for

A

motor movement of the cricothyroid muscles

70
Q

The internal branch of the superior laryngeal nerve is responsible for

A

sensory to the lower pharynx, underside of epiglottis, larynx above the cords

71
Q

The normal extension of the atlanto-occipital joint mobility is

A

35 degrees

11 degrees is associated with a grade III or IV laryngoscopic view

72
Q

With an upper airway obstruction, soft tissue obstruction is treated by

A

head-tilt, chin-lift maneuver or by jaw thrust which moves the hyoid bone anteriorly and lifts the epiglottis to clear the obstruction

73
Q

MOANS stands for

A

difficult mask ventilation:

mask seal, obesity, aged, no teeth& snores

74
Q

LMA size 3

A

pt weight: 30-50 kg
test volumes: 30 cc
max cuff volume: 20 cc
Largest ETT: 6.0

75
Q

LMA size 4

A

pt weight: 50-70 kg
test volumes: 45 cc
max cuff volumes: 30 cc
Largest ETT: 6.0

76
Q

LMA size 5

A

pt weight: 70-99 kg
test volume: 60 cc
Max cuff volumes: 40 cc
Largest ETT: 7.0

77
Q

ETT & positioning- how much does the tube move with flexion/extension, and rotation

A

flexion: advance 1.9 cm
extension: withdraw 1.9 cm
Rotation: 0.7 cm

78
Q

How much more depth is needed with nasal intubation?

A

3-4 cm

79
Q

What are the physiologic responses to laryngoscopy and intubation?

A

HTN, tachy or reflex bradycardia, arrhythmias, MI, increased IOP, increased ICP, bronchospasm

N928 Basic Principles of Anesthesia (16 decks)

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