Airway management Flashcards
Name the components of the upper respiratory tract.
◉ It refers to the structures that are located above the larynx, outside of the thorax, and it consists of:
* Nose, nasal cavity and paranasal sinuses (seio paranasal).
* Mouth
* Pharynx
➜ Pharynx consists of:
* Nasopharynx
* Oropharynx
* Laryngopharynx
Name the components of the lower respiratory tract.
- Larynx
- Tracheobronchial tree
Name the components of the larynx.
- Eppiglottis
- Supraglottis
- Vocal cords
- Glottis
- Subglottis
Describe the composition and division of the tracheobronchial tree.
Lower resp. tract
► The tracheobronchial tree is composed of 23 divisions / generations, that become progressively narrower (with each division) from the trachea to the alveoli (and ⬆︎ its cross-sectional area as it progresses).
➔ The tracheobronchial tree can further be subdivided into:
* Conducting zone
* Respiratory zone
Name the structures that compose the conducting zone of the tracheobronchial tree.
Lower respiractory tract
◉ Airways generations 0-16
➜ 0: Trachea
➜ 1: Main bronchi
➜ 2: Lobar bronchi
➜ 3-4: Segmental bronchi
➜ 5-11: Subsegmental bronchi
➜ 12-15: Bronchioles
➜ 16: Terminal bronchioles
◉ Cartilaginous airways: 0-11
◉ Non-cartilaginous: 12-16
Name the structures that compose the respiratory zone of the tracheobronchial tree.
◉ Airways generations 17-23
➜ 17-19: Respiratory bronchioles
➜ 20-22: Alveolar ducts
➜ 23: Alveolar sacs
Describe the sensory innervation of the mucous membranes of the nasal passages.
Sensory innervation of the upper and lower airway.
- Anteriorly: ophthalmic division of the trigeminal nerve;
- Posteriorly: maxillary division of the trigeminal nerve.
Sensory innervation of the upper and lower airway.
Describe the sensory innervation of the soft and hard palate.
The palatine nerves.
Sensory innervation of the upper and lower airway.
Describe the sensory innervation of the tongue.
- Anterior two-thirds of the tongue: lingual nerve (the mandibular branch of trigeminal nerve);
- Posterior one-third of the tongue: glossopharyngeal nerve.
Sensory innervation of the upper and lower airway.
Describe the sensory innervation of the:
- Tonsils
- Pharyngeal roof
- Parts of the soft palate
The glossopharyngeal nerve.
Sensory innervation of the upper and lower airway.
Describe the sensory innervation of the upper airway below the epiglottis.
Branches of the vagus nerve.
Sensory innervation of the upper and lower airway.
Describe the sensory innervation between the epiglottis
and larynx.
The superior laryngeal nerve.
Sensory innervation of the upper and lower airway.
Describe the sensory innervation between the larynx and trachea.
Recurrent laryngeal nerve.
What components of the physical examination are important in airway evaluation during the preoperative assessment?
➜ Inspection of the patient’s physical appearance noting:
- Morbid obesity,
- Frailty,
- Mental status.
➜ Inspection of the face and neck for anything suggestive of a difficult airway:
- Short neck,
- Inability to fully flex and/or extend the neck,
- Large neck circumference (>42 cm),
- Evidence of prior operations (especially tracheostomy),
- Abnormal neck masses (including but not limited to tumor, goiter, hematoma, abscess, or edema).
➜ Mouth:
- Small mouth opening (interincisor distance <3 cm);
- Large tongue;
- Micrognathia;
- Short thyromental distance (<3 finger breadths);
- Mallampati score of III or IV;
- Inability to bite the upper lip.
➜ Dentition:
- Document teeth that are chipped, missing, or loose;
- Elective case and high risk for tooth dislodgement: see a dentist for extraction before the case;
- Loose or removable dental appliances: removed before anesthesia (can impede airway management or pose an aspiration risk);
- Edentulous: direct laryngoscopy and intubation may be easier, but mask ventilation may prove more challenging.
What components of the patient history are important in airway evaluation during the preoperative assessment?
◉ Ask the patient about prior anesthetics
- May provide important information that could alert the practitioner to have additional personnel or airway management equipment immediately available.
◉ Previous anesthetic records (if available)
➜ Can provide information about airway management problems in the past including:
- Mask ventilation;
- Intubation;
- Special airway techniques or equipment required for successful airway management.
◉ Inquire about previous medical interventions or trauma that may have implications on airway management
- Cervical spine injury or surgery;
- History of tracheostomy;
- Head and neck surgery;
- Head and neck radiation treatment;
- Congenital craniofacial abnormalities;
- Predisposition to atlantoaxial instability (e.g., rheumatoid arthritis, achondroplasia, Down syndrome).
