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pharm exam 1 > Anesthesia Exam 1 Week 1 - Diana > Flashcards

Anesthesia Exam 1 Week 1 - Diana Flashcards

1
Q

What is the mallampati classification definition?

A

Relationship between the size of the base of the tongue and the rest of the structures of the pharynx
ACRONYM PUSH
Remember that it is not a good predictor if used by itself

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2
Q

What are the Mallampati classes?

A

Class I: pillars, uvula, soft palate, hard palate
Class II: barely see pillars, half of uvula, soft palate and hard palate
Class III: soft palate and hard palate visible
Class IV: only hard palate visible

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3
Q

Thyromental distance

A

Distance from the mentum to the thyroid notch.
Ideally done with the neck fully extended. Can be done in-line
Helps determine how readily the laryngeal axis will fall in line with the pharyngeal axis.

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4
Q

What are the measurements of the thyromental distance

A

6.5 cm = no problem with laryngoscopy/
intubation
6 – 6.5 cm = difficult but possible laryngoscopy
< 6 cm = impossible laryngoscopy

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5
Q

What is the mandibular protrusion test?

A

Assesses the function of the temporomandibular joint
Class I: Patient can move lower incisors
Class II: Patient can move lower incisors in line with upper incisors
Class III: Patient cannot move lower incisors past upper incisors (risk for difficult intubation)

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6
Q

Where can you find the larynx anatomically?

A

the position of the hyoid bone marks the entrance to the larynx

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7
Q

where can you find the epiglottis?

A

Epiglottis arises from the thyroid and remains dorsal to the hyoid

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8
Q

MEDICAL HISTORY predictors of difficult airway

A

Joint disease, acromegaly, thyroid or major neck surgeries, tumors, genetic anomalies, epiglottitis, previous problems in surgery, diabetes, pregnancy, obesity, pain issues

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9
Q

What does MOANS stand for?

A 
Mask seal
Obese
Aged
No teeth/edentulousness
Snores or Stiff
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10
Q

What is the Atlanto Occipital Joint Mobility?

A

Assess alignment of oral, pharyngeal and laryngeal axis into a straight line by placing patient into the sniffing position.
Normal AO flexion and extension= 90-165 degrees
Normal AO extension= 35 degrees (laryngoscopy will be difficult if <23 degrees)

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11
Q

Conditions that impair AO mobility

TRAKSDD

A

Degenerative joint disease, Rheumatic arthritis, ankylosing spondylitis, trauma, surgical fixation, Klippel -Feil, Down syndrome, diabetes mellitus (joint glycosylation)

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12
Q

What is the Cormack and Lehane grading system?

A

helps us measure the view we obtain during direct vision laryngoscopy

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13
Q

Grade I

A

Complete or nearly complete view of the glottic opening

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14
Q

Grade 2

A

See-Posterior region of the glottic opening

Not see-anterior commisure

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15
Q

Grade 3

A

See-epiglottis only

Not see- any part of the glottic opening

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16
Q

Grade 4

A

see-Soft palate only

not see-any part of the larynx

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17
Q

LEMON

A 
Look externally
Evaluate 3-3-2
Mallampati
Obstruction
Neck mobility
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18
Q

RISK FACTORS for difficult intubation

A 
Long incisors
Overbite
Inability to sublux jaw
Retrognathic jaw or receding
Mallampati class 3 or 4
Decreased thyromental distance
Short thick neck
Reduced cervical mobilty
Small mouth opening
Arched and high palate
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19
Q

RISK FACTORS of difficult SGA placement

A 
Upper airway obstruction
Lower airway obstruction
Limited mouth opening
Poor lung compliance requiring high PIP
Increased airway resistance
Different pharyngeal anatomy which may prevent seal
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20
Q

RISK FACTORS for invasive airway airway placement (trach)

A 
Obesity
Short neck
Abnormal neck anatomy
Laryngeal edema
Hard access to crycothyroid membrane
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21
Q

NPO Guidelines

A

2 hours clear liquids
4 hours breast milk
6 hours nonhuman milk, infant formula, solid food
8 hours fried food

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22
Q

Angioedema

A

Results from increased vascular permeability that can lead to swelling of the face tongue and airway

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23
Q

Causes for angioedema

A
  1. ACE inhibitors- treat epinephrine, antihistamines, steroids
  2. Hereditary angioedema-C1 deficiency treat with C1 esterase concentrate or FFP
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24
Q

Ludwigs angina

A

Bacterial infection characterized by a rapidly progressing cellulitios in the floor of the mouth. Consequently compressing the submandibular, submaxillary, and sublingual spaces

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25
Q

Pierre Robin

A

Small underdeveloped mandible
A tongue that falls back and downwards
Cleft palate
Neonate often requires intubation

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26
Q

Treacher Collins

A

Small mouth, small/underdeveloped mandible
Nasal airway is blocked by tissue
Ocular and auricular anomalies

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27
Q

Trisonomy 21

A

Small mouth
Large tongue
AO instability
Small subglottic diameter

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28
Q

klippel-Feil

A

Congenital fusion of cervical vertebrae leads to neck rigidity

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29
Q

Goldenhar

A

Small/underdeveloped mandible

cervical spine abnormality

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30
Q

Beckwith syndrome

A

Large tongue

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31
Q

Cri du chat

A

Small underdeveloped mandible
Softening of the tissues of the larynx
stridor

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32
Q

Adjust length of the vocal ligaments
Vocalis
Thyroarytenoid

A

Cricothyroid (enlongates)
Shortens
Shortens

33
Q

Adducts vocal folds (glottic diameter)

A

Thyroarytenoid

Lateral crycogthyroid

34
Q

Abducts vocal folds

A

Posterios cricoarytenoid

35
Q

Sphincter function

A

Aryepiglottic-closes laryngeal vestibule

Interararytenoid-closes posterior commissure of glottis

36
Q

Muscles that elevate the larynx

A 
Stylohyoid
Geniohyoid
Mylohyoid
Thyrohyoid
Digastric
Stylopharyngeous
37
Q

Muscles that depress the larynx

A

Omohyoid
Sternohyoid
Sternothyroid

38
Q

Glossopharyngel nerve IX

A 
Posterior 1/3 of the tongue
Roof of the pharynx
Tonsils
Soft palate  
Motor fibers to the stylopharyngeal muscle
anterior side of the epiglottis
EFFERENT LIMB OF THE GAG REFLEX
39
Q

Trigeminal nerve

A

V1- anterior ethmoidal/ophthalmic-nares and 1/3 of nasal septum SENSORY
V2-maxillary/sphenopalatine-turbinates and posterioir 2/3 of nasal septum and lateral wall SENSORY
V3-lingual/mandibular-anterior two thirds of the toungue SENSORY AND MOTOR

40
Q

Vagus nerve X

A

Innervates between epiglottis and vocal cords
Superior laryngeal nerve
1. Internal laryngeal nerve (sensory)
2. External laryngeal nerve (motor)

41
Q

Superior laryngeal nerve internal

BETCH

A

SENSORY-epiglottis, base of the toungue, supraglottic mucosa (hypopharynx), thyroepyglottic joint, cricothyroid joint
NO MOTOR

42
Q

Superior laryngeal external

A

SENSORY-anterior subglottic mucosa

MOTOR-cricothyroid

43
Q

recurrent laryngeal nerve

PLIT

A

SENSORY-subglottic mucosa and muscle spindles

MOTOR-thyroarytenoid, lateral cricothyroid, interarytenoid, posterior cricoaretynoid

44
Q

Recurrent laryngeal nerve

A

Innervates the larynx below vocal cords

45
Q

Lateral cricoarytenoid muscles

A

Abducts vocal cords

46
Q

Posterior cricoarytenoid muscles

A

Adducts vocal cords

47
Q

Laryngeal nerve injury-VAGUS

A

Unilateral-hoarseness

Bilateral-aphonia (loss ability to speak)

48
Q

Superior laryngeal nerve injury

A

Unilateral-minimal effects

Bilateral-hoarseness, tiring voice

49
Q

Recurrent laryngeal nerve injury

A

unilateral-hoarseness
Bilateral- acute:stridor, respiratory distress
chronic:aphonia

50
Q

Glossopharyngeal block

A

Needle is inserted at the base of the palatoglossal arch anterior tonsillar pillar at a deptj of 0.25-0.5 cm. Aspiration of air means that the needle is too deep. and should be withdrawn and redirected medially After correct positioning, 1-2 ml of local anesthetic is injected on both sides.
There is a 5% incidence of intracarotid injection (risk of seizure)

51
Q

Transtracheal block (recurrent laryngeal nerve) All intrinsic muscles except cricothyroid muscle)

A

The needle is advanced in a caudal direction as it penetrates the cricothyroid membrane. After aspiration and before injection, the patient should take a deep breath. During that inspiration 3-5 ml of local anesthetic is injected. The patient will cough, spraying the local up through the cords.

52
Q

Superior laryngeal nerve block (posterior side of epiglottis level of vocal cords)

A

Anesthetic is injected at the inferior border of the greater cornu of the hyoid bone.
1 ml is injected above the thyrohyoid membreane, then 2 ml is injected 2-3 mm beneath the thyroid membrane. Aspiration of air means the needle is to deep.

53
Q

Laryngospasm

A

The sensory innervation is held by the superior laryngeal nerve internal branch

54
Q

Pre-anesthetic

A

Acute or recent upper airway respiratory infection (2 weeks)
Exposure to second hand smoke
Reactive airway disease
GERD, age less than 1 year

55
Q

Signs

A

Inspiratory stridor
Suprasternal and supraclavicular retraction during inspiration, rocking hornse appearance of chest wall, increased diaphragmatic excursion, lower rib flailing

56
Q

What can you do to reduce its incidence?

A
  1. Avoidance of airway manipulation during light anesthesia
  2. CPAP 5/10 during inhalation induction as well as immediately post extubation
  3. Removal of pharyngeal secretions and blood prior to extubation
  4. tracheal extubation when fully anesthetized or fully awake not in between
  5. Laryngeal lidocaine/IV lidocaine prior extubation
  6. Hypercapnia/Hypoventilation
57
Q

Treatment

A
  1. Fio2 100%
  2. Remove noxious stimulation
  3. Deepen anesthesia by increasing the concentration of inhalation agent or with a small dose of propofol or lidocaine
  4. CPAP 25-20 while instituting maneuverst that open the airway
  5. If IV sccess succx 5
    If no IV access
58
Q

Trachea facts

A

Begins at C6, ends at T4-T5 at the carina, 2.5 cm wide, 10-13 cm long, cricoid cartilage is only complete ring, semicirular rings open posteriorly ciliated columnar eputhelum
Sensory innervation:Vagus

59
Q

Trachea blood supply

A

Inferior thyroid artery
Superior thyroid artery
Bronchial artery
Internal thoracic artery

60
Q

Pores of khon

A

allow air movement between alveoli

61
Q

Pneumocytes Type I cells

A

flat squamous cells covering 80% of alveolar surface froming tight juctions

62
Q

Pneumocytes Type 2 cells

A

Produce surfactant resistant to oxygen toxicity, capable of cell division, can produce type I cells

63
Q

Pneumocytes Type 3

A

Macrophages, fight lung infection, produce inflammatory response. Neutrophils are present in the alveolus in smokers and with acute lung injury

64
Q

Airway equipment

A
  1. 2 cuffed endotracheal tubes
  2. Laryngoscope blades and handles
  3. Face mask of adequate fit. Back up AMBU BAG
  4. Face strap
  5. suction
  6. Machine check
  7. Laryngeal mask
  8. NPA and OPA
  9. Tongue blade
  10. Difficult airway cart
65
Q

Face mask

A

Ventilate the anesthetized patient
Create a tight seal with patient’s face for effective ventilation
Eyes = corneal abrasions
Deflation of breathing bag indicates leakage (CHECK YOUR PATIENT)
High breathing circuit pressures without chest movement indicate obstruction of the airway
Limit ventilation pressures to <20cm H20

66
Q

OPA/NPA

A

Used to create an air passage in the anesthetized patient after loss of muscle tone

Oral airways: 3 sizes for adults (80, 90, 100mm)

Nasal airways: several sizes, estimate length from nares to the ear meatus

Nasal airways are tolerated better by the lightly anesthetized patient

67
Q

LMA

A

Inserted in the hypopharynx
Inflate to create a low pressure seal at entrance of larynx
LMA protects the larynx from pharyngeal secretions only
Ideal for short cases
Not a definitive airway – supraglottic device
No aspiration protection
May use Proseal LMA if concerned about gastric contents

68
Q

BVM

A

With the middle, ring, and pinkie fingers placed along the madibular bone, the mandible is pulled up into the mask. The index and thumb are used to create a tight seal around the mouth and nose.

69
Q

Airway support during induction

A
  1. Assure ability to bag mask ventilate prior to administering muscle relaxant
  2. keep the airway open- sniffing position-jaw trust, insert correct fitting OPA/NPA
  3. keep the APL pressure less than 20 cmh20
70
Q

Large tongue non reassuring airway finding

A

Big Tongue

Beck with syndrome, Trisonomy 21

71
Q

Small underdeveloped mandible non reassuring airway finding

A 
Please Get That Chin
Pierre Robin
Goldenhar
Treacher Collins
Cri du Chat
72
Q

Cervical Spine Anomaly non reassuring airway finding

A

Kids Try Gold
Klippel-Feil
Trisonomy 21
Goldehar

73
Q

Modifications for Obesity

A

Place chest higher than the head

Utilize HELP postion

74
Q

NPA contraindications

A 
Cribiform plate injury
Coagulopathy
Previous transphenoidal hypophysectomy
Previous Cadwell Luc procedure
Nasal fracture
75
Q

Large Toungue

A

Big Tongue
Beckwith Syndrome
Trisonomy 21

76
Q

Small underdeveloped mandible

A 
Please Get That Chin
Pierre Robin
Goldenhar
Treacher Collins
Cri du Chat
77
Q

Cervical Spine Anomaly

A

Kids Try Gold
Klkippel-Feil
Trisonomy 21
Goldenhar

78
Q

OPA types

A

Guedel
Berman
Williams-blind orotracheal intubation and fiberoptic
Ovaspassapian-fiberoptic

79
Q

ETT design

A

Inflating the cube occludes the trachea permitting positive pressure ventilation and protects lungs from aspuration of gastric contents. CUFF PRESSURE SHOULD BE LESS THAN 25 CM H20

pharm exam 1 (12 decks)

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