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Anesthesia Concepts > Airway Intro > Flashcards

Airway Intro Flashcards

1
Q

Nasal passages include 3

A

Septum, turbinates, adenoids

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2
Q

Nasal passages function: 4

A

2/3 of upper airway resistance, humidify, filter, warm

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3
Q

Nasal passage innervation

A

Branches of CN V trigeminal

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4
Q

Oral cavity include 4

A

Teeth, tongue, hard palate, soft palate

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5
Q

What is predominate cause of airway resistance in oral cavity

A

Tongue

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6
Q

Oral cavity innervation

A

Trigeminal nerve: hard palate, soft palate, ant 2/3 of tongue
Glossopharyneal: posterior 1/3 tongue, soft palate, oropharynx

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7
Q

What connects nasal and oral cavities to larynx and esophagus

A

Pharynx

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8
Q

Pharynx divided into: ____, border of soft palate. ___ border is epiglottis, includes tonsils and uvula. Also ___/___

A

Nasopharynx
Oropharynx
Hypopharynx/laryngopharynx

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9
Q

Innervation of pharynx

A

CN 9 and 10

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10
Q

Larynx
Located where in adult
Functions 3

A

C4-C6

Airway protection, respiration, phonation

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11
Q

Larynx composed of ___ ___ and ___ __ which is fissure between

A

Vocal cords and glottic opening

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12
Q

Vocal cords: formed by ___ ligament, attached anteriorly to ___ cartilage and posteriorly to ___ cartilages

A

Thyroartyenoid
Thyroid
Artyenoid

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13
Q

What is the triangular fissure between vocal cords

A

Glottic opening

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14
Q

What is narrowest part of adult airway

A

Glottic opening

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15
Q

Paired cartilages larynx

A

Arytenoid, corniculate, cuneiform

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16
Q

Unpaired cartilage in larynx

A

Thyroid, cricoid, epiglottis

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17
Q

Arytenoid: ___ attachment for vocal cords. Falsely identified in an __ __

A

Posterior, anterior airway

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18
Q

Corniculate: ___ portion of the ___ fold

A

Posterior, aryepiglottic

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19
Q

Cuneiform: in the ___ fold but not always ___. Lateral to ___

A

Aryepiglottic, present

Corniculates

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20
Q

Which cartilage is large, most prominent, and anterior attachment for vocal cords

A

Thyroid

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21
Q

Epiglottis: covers opening to ___ during swallowing

A

Larynx

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22
Q

Only complete signet shaped ring, narrowest part of peds airway

A

Cricoid cartilage

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23
Q

Which muscles control length and tension of vocal cords, and size of glottic opening

A

Intrinsic laryngeal muscles

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24
Q

Cricothyroid muscle innervated by the ___ branch of the __ __ nerve and a branch of the __ nerve

A

External
Superior laryngeal
Vagus

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25
Q

All intrinsic laryngeal muscles except for ___ innervated by __ __ nerve, branch of __ nerve

A

Cricothyroid
Recurrent laryngeal
Vagus

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26
Q

Which muscles adduct vocal cords

A

Lateral cricoarytenoid, oblique and transverse arytenoids

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27
Q

Which is only vocal cord abductor

A

Posterior cricoarytenoid

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28
Q

Cricothyroid action

A

Tenses and elongates vocal cords

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29
Q

Thyroarytenoid action

A

Relaxes and shortens vocal cords

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30
Q

Vocalis action

A

Relaxes and shortens vocal cords

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31
Q

Action of extrinsic laryngeal muscles

A

As a whole move larynx cephalad or caudad

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32
Q

Suprahyoid group
4
Action

A

Stylohyoid, mylohyoid, geniohyoid, digastric

Raises larynx cephalad

33
Q

Infrahyoid group
4
Action

A

Sternothyroid, sternohyoid, thyrohyoid, omohyoid

Moves larynx caudad

34
Q

Functions of branches of trigemincal nerve
Ophthalmic
Maxillary
Mandibular

A

Sensory to nares and anterior nasal septum
Sensory to turbinates and posterior nasal septum
Sensory to ant 2/3 tongue, motor to mastication muscles

35
Q

Glossopharyngeal nerve

Sensory and motor to what

A

Sensory to soft palate, oropharynx, post 1/3 tongue, tonsils, vallecula, topside of epiglottis

Motor to stylopharyngeus

36
Q

Vagus nerve
Superior laryngeal nerve
External branch innervates what
Internal branch innervates what

A

Motor to cricothyroid, sensory to ant subglottic mucosa

Sensory of posterior epiglottis to VC, thyroepiglottic joint, and cricothyroid joint

37
Q

Vagus nerve
Recurrent laryngeal nerve
Innervates what

A

Motor to all intrinsic laryngeal muscles except cricothyroid

Sensory below VC, trachea

38
Q

Injury to external branch of superior laryngeal nerve:
Action
through what
leads to what

A

Tensing vocal cords through cricothyroid
Thyroidectomy
Hoarseness

39
Q

Injury to recurrent laryngeal nerve
Controls what
About chronic unilateral injury

A

All other intrinsic muscles like posterior cricoarytenoids

Generally well tolerated

40
Q

Injury to recurrent laryngeal nerve

Acute bilateral injury leads to what

A

Bilateral paralysis of VC abductors (post cricoarytenoids), unopposed tensing of cricothyroid, strider and respiratory distress

41
Q

Recurrent laryngeal nerve

Unilateral injury leads to what

A

Paralysis of ipsilateral vocal cord abductors, no airway emergency

42
Q

Parts of lower airway

A

Trachea, carina, bronchi, bronchioles, terminal bronchioles, respiratory bronchioles, alveoli

43
Q

Trachea
__-__ __ length
___ __ diameter in adult

A

10-20

22

44
Q

Trachea
How many u shaped cartilages
Posterior side lacks what
Bifurcated where

A

16-20
Cartilage
T4

45
Q

Right bronchi is __ __ long with angle of __

Left bronchi is __ __ long with angle of __

A

2.5 cm, 25 degrees

5 cm, 45 degrees

46
Q

What creates a difficult airway

A

Not 1 factor, combination of factors

47
Q

Questions to consider when evaluating airway 9

A 
Radiation or burn to head or neck 
C spine pain of LROM 
TMJ pain 
Rheumatoid arthritis 
Ankylosing spondylitis 
Abscess or tumor 
Prior intubation or trach 
Snoring or sleep apnea 
Dysphagia or stridor
48
Q

Mallampati score
Correlates __ space with ease of direct laryngoscopes and intubation
How to test

A

Oropharyngeal

Have pt sit up with neutral head and open mouth, stick tongue out, no aah

49
Q

Mallampati
Class I
Class II

A

Faucial pillars, entire uvula, soft and hard palates

Uvula tip masked by tongue, soft and hard palates

50
Q

Mallampati
III
IV

A

Soft and hard palates, uvula base only

Hard palate only

51
Q

Score of laryngoscopic view of the glottis

A

Cormack and Lehane

52
Q

Cormack and lehane score
Grade I
Grade II

A

I- most of glottis visible

II- only posterior portion of glottis visible

53
Q

Cormack and lehane score
Grade III
Grade IV

A

III- only epiglottis visible

IV- no airway structures visualized

54
Q

Thyromental distance
Distance from what to what with neck fully extended
Normal:
Difficult intubation if what

A

Lower border of mandible to thyroid notch
6-6.5 cm, 4 fingerbreadths
<3 fingers, receding mandible, anterior airway

55
Q

What you need to prepare for induction

A 
Monitors on, appropriate settings
Suction on and at HOB 
Machine checked, means of PPV 
Airway
IV 
Drugs- emergency and case specific
56
Q

Airway set up

What you need on top of msmaids

A

Appropriate sized face mask, tongue depressor, oral and nasal airways, laryngoscope handle, 2 different blades, 2 size ETTs, stylet, syringe, LMA, tape

57
Q

3 things that can make a mask hard to fit

A

Beard, edentulous (no teeth), short mandible

58
Q

Goal of pre oxygenation

A

To increase O2 in functional residual capacity by washing out nitrogen (79% in RA) with oxygen

59
Q

FRC is what

A

Volume of air left in lung at end of passive expiration

60
Q

Doing what will lead to 10 minutes of safe apnea time

A

3-5 min of tight mask fit during normal tidal breathing with 100% fio2 at >6LPM flow

61
Q

What leads to 5 minutes of safe apnea time

A

4 vital capacity breaths within 30 seconds w 100% fio2 at > 6LPM

62
Q

Common problem in induction is airway obstruction by tongue and epiglottis due to relaxation of what

A

Genioglossus muscle

63
Q

Two types of oral airways

A

Berman BOA

Guedel

64
Q

Adult sizes of BOA and Guedel. Small, medium, large

A

S- 80 mm BOA, guedel 3
Med- 90 mm BOA, guedel 4
L- 100 mm BOA, guedel 5

65
Q

Measure oral airway how

A

Center of mouth to angle of the jaw

Or from corner of the mouth to the earlobe

66
Q

Complications of oral airways 3

A

Laryngospasm (if not asleep before placement)
Bleeding
Soft tissue damage

67
Q

Nasal airway
Provides passage of nose to what
3 __ sizes:
Length estimates distance from nares to what

A

Pharynx
French 24, 26… 36
Meatus of eat

68
Q

Nasal airway
Important for what
How to use, how its tolerated compared to oral

A

Used in series small to large, dilate prior if elective
Lubricate
Better

69
Q

Nasal airway complications

If on anticoagulants

A

Epistaxis
Nasal or basal skull fractures
Adenoid hypertrophy
Dont use

70
Q

Mac (__-__)

Miller (__-__)

A

1-4

0-4

71
Q

ETT
Size for female
Size for male
Want what available

A

6.5-7 mm id
7.5-8 mm id
2 sizes

72
Q

Ideal position ett
Males approx ___ cm, females __
How to calculate depth

A

23, 21

ID x 3

73
Q

Optimal intubating position

Aligns what

A

Sniffing

Oral, pharyngeal, laryngeal axis

74
Q

Sniffing position allows for what 2

A

Optimal visualization of vocal cords and most effective mask ventilation

75
Q

How to get sniffing position normal adult

A

Pillow and tilt head back

76
Q

How to get sniffing position if obese

A

Ramp up, bring chest cavity up by using pillows or blankets

77
Q

LMA
___ airway device
Used for __ and __ ___ management
Can be used as conduit for what

A

Supra glottic
Routine and difficult airway
Ett placement

78
Q

Appropriate sized lma based on what

A

Weight

79
Q 
Adult size lma
30-50 kg
50-70 kg 
70-100 kg 
>100 kg
A

3
4
5
6

Anesthesia Concepts (12 decks)

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