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My Anesthesiology > Airway Management > Flashcards

Airway Management Flashcards

1
Q

Definition of difficult mask ventilation

A

Inability to maintain O2sat > 90%

Inability to prevent/reverse signs of inadequate ventilation

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2
Q

Definition of difficult intubation/laryngoscopes

A

Successful intubation requiring more 3 attempts or taking longer than 10min

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3
Q

What innervates the hard and soft palate?

A

Palantine nerves

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4
Q

Innervation of the anterior 2/3 of tongue

A

Lingual n.

From mandibular branch of trigeminal

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5
Q

Innervates the posterior 1/3 tongue, soft palate, and oropharynx

A

Glossopharyngeal

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6
Q

What demarcates the border between the oropharynx and the hypopharynx?

A

Epiglottis

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7
Q

What separates the nasopharynx from the oropharynx

A

Soft palate

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8
Q

What innervates the hypopharynx?

A

Vagus via superior laryngeal n

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9
Q

Tongue obstruction during anesthesia is due to relaxation of which tongue muscle?

A

Genioglossus

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10
Q

Between what levels of cervical vertebrae does the larynx reside?

A

C3-C6

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11
Q

What is the function of the larynx?

A

Separate trachea from esophagus

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12
Q

Describe the areas of the larynx

A 
Epiglottis
Supra glottis
Vocal cords 
Glottis
Subglottis
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13
Q

What ligaments form the vocal cords?

A

Thyroarytenoid ligaments

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14
Q

What is the narrowest part of the adult airway

A

Vocal cords

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15
Q

Anatomical points where the trachea starts and ends

A

From C6 to carina
Carina overlies T5
10-15cm long

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16
Q

Nonreassuring interincisor distance?

A

<3 cm

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17
Q

Difficult Airway Algorithm:

Assess the likelihood and clinical impact of basic management problems: (A-D)

A

A. Difficult ventilation
B. Difficult intubation
C. Difficulty with pt cooperation or consent
D. Difficult tracheostomy

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18
Q

Difficult Airway Algorithm:

What’s step 2?

A

Actively pursue opps to deliver supplemental O2

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19
Q

What is Step 3 of the Difficult Airway Algorithm?

A

Consider the relative merits/feasibility of basic mgt choices:

A. Awake or GA intubation?
B. Noninvasive or invasive?
C. Spontaneous ventilation or not?

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20
Q

You induce GA and still can’t intubate. What now?

A

Difficult Airway Algorithm:

  1. Call for help
  2. Consider returning spontaneous V
  3. Awaken pt
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21
Q

You induce GA and can’t intubate and now can’t bag mask. What now?

A

Difficult Airway Algorithm:

Consider/attempt LMA

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22
Q

Induce GA and can’t intubate and now can’t place LMA now what?

A

Call for help if haven’t already
Emergency pathway!
Either noninvasive or invasive

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23
Q

How do you confirm successful intubation or LMA placement?

A

EtCO2
Watch for awhile in case it was a puff of gastric gases could imitate
PCO2 > 30 for 3-5 consecutive breaths

Symmetrical chest rise
Bilateral equal breath sounds
Fogging of tube

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24
Q

How to check neck ROM?

A

“Can you touch your chin to your chest?”

“How far can you bend your neck back?”

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25
Q

Mallampati System

A

System to correlate the oropharyngeal space with ease of intubation

26
Q

How do you check Mallampati score?

A

Eye level
Open mouth maximally w/ head in neutral position
Protrude tongue W/O phonating

27
Q

Class I Mallampati

A

TONSILLAR PILLARS visible

+ soft palate, uvula

28
Q

Class II Mallampati

A

No tonsillar pillars but can still see uvula

29
Q

Class III Mallampati

A

Only base of uvula visible

30
Q

Class IV Mallampati

A

Soft palate not visible

31
Q

What is the Cormack and Lehane score?

A

Correlate laryngoscopic view with oropharyngeal space

32
Q

Why should you never use nasotracheal intubation in basilar skull fractures?

A

Can result in intracranial tube placement

33
Q

Airway considerations for lower airway tumors (trachea, bronchi, mediastinal)

A

Airway obstruction may not be relieved by tracheal intubation

34
Q

Airway considerations for radiation management

A

Fibrosis may distort the airway or make manipulation difficult

35
Q

Airway considerations for Rheumatoid Arthritis

A 
TMJ arthritis
Immobile cervical vertebra
Laryngeal rotation
Cricoarytenoid arthritis
Mandibular hypoplasia
36
Q

Why do you need flexion of the NECK and extension of the HEAD?

A

Flex neck to align pharyngeal and laryngeal axes

Extend head on AA to align oral and pharyngeal

= sniffing position

37
Q

Less than ideal thyromental distance

A

< 6-7cm
Receding mandible
Short neck
= more acute angle between oral and pharyngeal axes, harder to bring to alignment

38
Q

What is the end point of the difficult airway algorithm?

A

Emergency invasive access

Cricothyrotomy

39
Q

Describe anatomical landmarks for a cricothyrotomy

A

Find thyroid cartilage

Slide down to locate membrane right below

40
Q

Inability to intubate is not the biggest problem. What is?

A

Inability to oxygenate or ventilate
Aspiration complications
Combo of these factors

41
Q

Predictors of Difficult Facemask Ventilation:

What age?

A

> 55 yo

42
Q

Predictors of Difficult Facemask Ventilation:

What BMI?

A

> 26 BMI

43
Q

Predictors of Difficult Facemask Ventilation:

What gender?

A

Make

44
Q

Predictors of Difficult Facemask Ventilation:

What facial factors?

A

Beard
Lack of teeth
Limited ability to protrude mandible

45
Q

Predictors of Difficult Facemask Ventilation:

List 4 more factors

A

History of snoring
Repeated attempts at laryngoscopy
Mallampati III and IV
Neck radiation

46
Q

Describe the placement of the facemask during bag ventilation

A

Upper border of the facemask should align with the pupils

Sides seal nasolabial folds

Bottom between lower lip and chin

47
Q

DAWD

A

Preoxygenation allows for Duration of Apnea Without Desaturation

48
Q

What is the ideal minute ventilation for O2 in an adult with IBW?

A

3mL/kg/min

49
Q

T or F: DAWD is a function of MVO2 and the O2 reservoir of the FRC (~30-35 mL/kg)

A

T

50
Q

What parameter indicates sufficient preoxygenation?

A

EtO2 > 90%

Ideally 3min

51
Q

A healthy non-obese patient can maintain a SaO2 >90% for how long after preoxygenation?

A

~8.5min

52
Q

Obesity can severely decrease DAWD. What measures can you take to address this?

A

100% O2 head up
10cm CPAP
Followed by PPV
(Set at peak P 14cm, PEEP 10)

This can increase DAWD another min or so
Decreases atelectasis and improves mismatch

53
Q

Grabbing mask and face and doesn’t seem like air is passing through? What issue with hand placement

A

Make sure your L hand is not compressing airway (not mashing mask into face) instead using fingers to pull up

54
Q

What is your R hand doing during bag mask ventilation?

A

Generating positive pressure by compressing reservoir bag

ventilating P should not exceed 20 to not insufflate stomach

55
Q

List indications for endotracheal intubation

A 
Patent airway
Prevent aspiration
Facilitate positive P ventilation
Operative position other than supine
Operative site near upper airway
Mask airway difficult
Need for frequent suctioning
56
Q

Ideal height of table for intubation

A

Bottom of table at belly button

Face near your xiphoid when standing

57
Q

Describe Sellicks Maneuver

A

Cricoid pressure
Downward pressure with your THUMB and INDEX finger
Compress esophagus to prevent aspiration
30 Newtons of Force

58
Q

Endotracheal tube sizes are based on what?

A

Internal diameter

Available in 0.5 increments

59
Q

Indications for fiber optic intubation?

A

When difficult intubation by direct laryngoscopy is anticipated
- can be done awake to elim risk of failed intubation and ventilation

Unstable cervical spines
- allows for assessment of neuro fxn

Upper airway trauma

60
Q

Contraindications of fiber optic intubation?

A

Lack of time
Anything that impinges size of airway to prevent visualization
Excessive blood and secretions
Pharyngeal abscess
- don’t want aspiration of purulent material

61
Q

Style points for fiber optic intubation

A 
Antisialogogue
(Glyco 0.2mg IV)
Lidocaine spray
GP nerve blocks
(2 mL 2% lido inject @ depth 0.5 cm)
62
Q

In tracheal extubation what are some signs of light anesthesia?

A

Disconjugate gaze
Breath holding or coughing
Not responsive to commands
= inc risk of laryngospasm

My Anesthesiology (3 decks)

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