Airway Management Flashcards
What is denitrogenation, how is it performed, and
what are the signs that it has been performed
correctly?
Proper denitrogenation should be performed using a high flow
of oxygen with a fully-open pop-off valve, a leak-free mask fit,
and the allowance of tidal breathing for 2-3 minutes or a series
of 4 vital capacity breaths. Signs that denitrogenation is being
accomplished include: noticing the reservoir bag emptying and
refilling, end-tidal CO2 approaches 40 mmHg, and end-tidal O2
approaches 85%.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 551.
Are the relationships between the risk of airway
difficulty and Mallampati scores, body mass index,
tongue size, and thyromental distance considered
direct or indirect relationships?
Airway management risk increases as the Mallampati score,
body mass index, and size of the patient’s tongue increase (a
direct relationship). The risk also increases as the thyromental
distance decreases (inverse relationship).
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 431-433.
Tonic activity in which muscles is responsible for
preventing the soft palate from falling back against
the posterior pharynx and occluding the airway?
The tensor palati, levator palati, palatopharyngeus, and
palatoglossus keep the soft palate from falling back against the
posterior pharynx. The genioglossus prevents the tongue from
falling back against the posterior pharynx.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 489.
The tongue falls back against the posterior pharynx
resulting in airway obstruction when what muscle
relaxes?
Loss of motor tone to the genioglossus allows the tongue to fall
back against the posterior pharynx resulting in airway
obstruction.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 314.
What are three factors that can reduce the incidence
of post-operative hoarseness due to intubation?
The use of a smaller endotracheal tube, and using low-pressure
cuffs will decrease the incidence of postoperative hoarseness
due to intubation. Studies have demonstrated that the use of a
water-soluble lubricant or gel containing local anesthetic
solution applied to the tip or cuff of the ETT does not decrease
the incidence of sore throat or hoarseness.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 335.
What is a probable contraindication to nasotracheal
intubation?
Nasotracheal intubation may be contraindicated in a patient with
severe mid-facial trauma (such as a maxillary fracture) which
may represent an existing cribriform plate fracture. If the
cribriform plate is unstable, the tracheal tube could potentially
pass through it into the cranial vault.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 330.
What are the contraindications to blind nasal
intubation? In what circumstances would it be less
likely to be successful? Is general anesthesia
required for this procedure?
Contraindications to blind nasal intubation include nasal
pathology, coagulopathy, thrombocytopenia, severe midface
trauma, and previous transphenoidal surgery (the latter two of
which could permit intracranial intubation). Blind nasal
intubation is not contraindicated but likely to be less successful
in patients with laryngeal masses, edema, or scarring from a
previous surgery. Blind nasal intubation is possible in an awake
patient, and can even be easier as a patient encouraged to
breathe rapidly may facilitate introduction of the endotracheal
tube through the larynx.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 570.
What are the indications for a cricothyrotomy?
Indications for a cricothyrotomy include: cannot intubate-cannot
ventilate scenarios, traumatic head, neck or facial injuries that
make intubation difficult or impossible, upper airway obstruction,
or definitive airway management when intubation is not possible.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 459.
How is a cricothyrotomy performed?
A cricothyrotomy is performed by inserting a large-bore
intravenous catheter or cannula into the cricothyroid membrane
which lies between the inferior border of the thyroid cartilage
and the superior border of the cricoid cartilage.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 332-333.
What are the primary advantages of a cricothyrotomy
over a surgical tracheostomy during emergency
airway management?
A cricothyrotomy can result in patient ventilation in about 1-2
minutes and can be performed by a skilled anesthesia provider.
A surgical airway requires a skilled surgeon and can take up to
30 minutes to perform.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 459-461.
Where on the neck is a tracheotomy usually
performed?
It is typically performed at the level of the fourth to sixth tracheal
ring.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 461.
Can an anesthetist perform an emergency surgical
tracheotomy?
No, a tracheotomy is not a procedure to be performed by an
anesthesia provider. It requires a surgically-trained professional.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 460.
What are the effects of unilateral paralysis of the
recurrent laryngeal nerve? Bilateral paralysis of the
recurrent laryngeal nerve?
Unilateral paralysis of the recurrent laryngeal nerve can result in
changes in phonation and hoarseness. Stridor and acute
airway compromise can result from bilateral paralysis of the
recurrent laryngeal nerve.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 312.
