Anesthesia Airway Management and Pre-op Eval

Question 1

1. Describe the components of basic airway exam.

Answer 1

Mallampati
mouth opening (3 fingers)
thyro-mental distance (3 fingers)
jaw motility
head motility/head rotation
teeth (buck teeth, loose teeth)
obesity
effect of disease (cervical mobility, fixed airway tissue, decreased lower airway space)

Question 2

2. Describe the process of placing and endotrachael tube via direct laryngoscopy.

Answer 2

1. place pt in sniffing position
2. open mouth with R hand
3. insert blade with L hand
4. lift sweep tongue out of the way and advance blade
5. find epiglottis, lift up, DONT tilt
6. visualize cords, insert tube with R hand, remove stylet and inflate balloon.

Question 3

3. Management: Cant intubate via direct by can ventilate with BVM.

Answer 3

wake up the patient
use fiberoptic
Eshmann stylet (use curved end to feel endotracheal rings
alternate airways: LMA, combitube

Question 4

3. Management: Cant intubate via direct, cant ventilate with BVM.

Answer 4

call for help, optimize situation:
try for airway
oxygenation with 2 handed BVM, jaw thrust, oral airways
surgical airway

Question 5

4. Describe indications for an emergency surgical airway.

Answer 5

can intubate, cant ventilate, can’t oxygenate

Question 6

5. Describe the indications for RSI.

Answer 6

indications include neck instability, lot of blood/secretions, distorted anatomy, full stomach, trauma

(can do awake or asleep)

RSI: pre-oxygenate, crycoid pressure; AVOID mask ventilation (induction agent, flush line, NM blocker (chose NMB that is hemodynamically stable)

Question 7

1. Summarize a preoperative history focusing on anesthetic concerns.

Answer 7

past surgical history, FH of anesthetic disorders
TMJ problems, snoring/OSA, swallowing problems, previous neck injury

neuro/psych **SEIZURE, HA, syncope, neuropathy, TIA/CVA, cerebrovascular insufficiency

resp: cough, SOB, wheezing or COPD (hx of ventilator/ use of inhalers/frequency)

CV:** exercise tolerance; HTN, CAD, murmurs/valvular disease (get recent stress test or echo if CAD hx)

GU/GI: decreased renal function (metabolism) gastroparesis, hiatal hernia, cirhoisis, hepatitis

Other: bleeding hisotry; IDDM, thyroid disease, baseline pain; substance use, medications, allergies

Question 8

1. Summarize a preoperative physical focusing on anesthetic concerns.

Answer 8

wt, ht, temp BP, teeth exam, mouth open, TM distance, neck extension, mallampati score

Question 9

2. List anesthetic techniques and alternatives.

Answer 9

general: protect airway with ET or LMA
Regional: bier block, plexus, femoral, sciatic for extremities
Neuraxial: spinal and epidural
local: field block
Conscious sedation: (MAC) make sure do not over sedate

Question 10

3. Describe medical management of systemic illnesses in changing anesthetic risk.

Answer 10

cardiovascular- activity level, check EKG
respiratory: h/o RAD, get CXR, consider nebs ahead of time
neuro- seizures
GI- liver disease (metabolism)/ bleeding risk
GU: electrolyte balance, GERD, hiatal hernia or DM (risk of aspiration)

Question 11

4. Explain the role of perioperative beta blockade.

Answer 11

evidence supports perioperative admin of b-blockers to decrease cardiac events and mortality– it decreases CV mortality and leads to higher event free survival rates; B-blocker should be titrated to a target rest ing HR Of less than 65 bpm