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N928 Basic Principles of Anesthesia > Final exam review part II- preop evaluation & airway anatomy > Flashcards

Final exam review part II- preop evaluation & airway anatomy Flashcards

1
Q

Describe the AANA standards of care.

A
  1. Patient’s Rights
  2. Preanesthesia Patient Assessment and Evaluation
  3. Plan for Anesthesia care
  4. informed consent for anesthesia care and related services
  5. documentation
  6. equipment
  7. anesthesia Plan implementation and management
  8. patient positioning
  9. monitoring, alarms
  10. transfer of care
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2
Q

What is the calculation for BMI?

A

(weight (lbs)/ height (in)^2 x 703

kg/m2

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3
Q

Essential components of the anesthesia interview include:

A 
BMI
allergies
NPO instructions
medications
Previous anesthetics/complications
family history of malignant hyperthermia
possibility of pregnancy
systems review
baseline level of cognition 
airway assessment
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4
Q

Describe the NPO guidelines.

A

Clear liquid (water, black coffee, tea, pulp-free juice, carbonated beverages)- 2 hours
breast milk- 4 hours
formula or cow’s milk, light meal- 6 hours
full meal, fried or fatty food- 8 hours

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5
Q

Emergency cases are considered to have

A

a full stomach

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6
Q

Patients with longer stomach emptying times include

A

diabetes, recent injuries, obesity, abdominal complaints, GERD, pregnant or recently delivered

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7
Q

How much force needs to be applied when doing Selleck’s maneuver?

A

3 lbs to start

progress to 6-8 lbs

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8
Q

Describe the mallampati classes.

A

Class 1: PUSH- pillars, uvula, hard and soft palate
Class 2: PUS- pillars, part of uvula, soft palate
Class 3: US- soft palate and base of uvula
Class 4: hard palate only

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9
Q

Thryomental distance is

A

the mandibular space or Patil’s test
head full extended from the mentum to the thyroid notch (upper edge of thyroid cartilage to chin)
Short TM distance implies more difficult intubation because less space for the tongue
7 cm is ideal

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10
Q

Describe the prayer sign.

A

indicative of decreased joint and cartilage mobility

positive prayer sign is limited atlanto-occipital joint motion

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11
Q

Airway assessments include:

A

Mallampati, thyromental distance, cervical range of motion, prayer sign, dentition, upper lip bite test, mouth opening, neck circumference

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12
Q

A neck circumference of ______ is indicative of a difficult intubation.

A

40 cm.

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13
Q

What needs to be assessed in female patients?

A

Female patients of child-bearing age need to be assessed for possible pregnancy

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14
Q

What medications should be taken the day of surgery?

A

beta-blockers, GERD medications, Ca+ channel blockers, bronchodilators, antiarrhythmics, steroids, diuretics (if history of CHF) antipsychotics, thyroid medications

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15
Q

What medications should be held on the day of surgery?

A

oral hypoglycemics, ACE-I, ARBs, diuretics, herbal supplements

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16
Q

The system review includes:

A

CV, respiratory, neurological, GI, endocrine, musculoskeletal, hepatic, renal, alcohol/drugs, hematologic/coagulation, autoimmune

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17
Q

Patients over age _____ need an EKG

A

50-60

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18
Q

Important cardiac considerations include

A

hypertension, angina, coronary artery disease, myocardial infarction, valvular disease, syncope, congestive heart failure, edema and/or dyspnea of cardiac origin, cardiac arrhythmias

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19
Q

Patients with angina, CAD, or hx. of MI should have

A

EKG, echo, possible cardiac cath and cardiac clearance

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20
Q

Important respiratory considerations include

A

asthma, chronic bronchitis, emphysema, recent URI, pneumonia, tuberculosis, obstructive sleep apnea, & tobacco use

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21
Q

Describe how to calculate pack years.

A

number of years smoked x packs/day

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22
Q

Neurological consideratios include:

A

stroke, TIA, HAs, seizures, neuropathy

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23
Q

With any GI diseases, there is concern for

A

aspiration

think GERD, hiatal hernia/bowel obstruction

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24
Q

What endocrine considerations are there?

A

diabetes, thyroid disease

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25
Autoimmune disorders such as
rheumatoid arthritis can cause difficulty due to decreased cervical spine mobility
26
Musculoskeletal disorders include
muscular dystrophies, MS, myasthenia gravis, myopathy, fibromyalgia, myotonias, obesity, Sjogrens syndrome
27
For patients with hepatic disease, consider (studies)
PT/PTT, liver panel, and EKG
28
For patients with ESRD consider (studies)
electrolytes, CBC, PT/PTT, LFTs, and EKG
29
Describe the ASA classes.
Class 1- normal healthy patient Class 2- patient with mild systemic disease Class 3- patient with severe systemic disease Class 4- patient with severe systemic disease that is a constant threat to life Class 5- moribund patient not expected to survive without surgery Class 6- declared brain-dead; anticipating organ procurement (donor) E- emergency surgery
30
What leads detect arrhythmias and which leads detect ischemia?
arrhythmias- II | Ischemia- V
31
The pharynx is composed of the
nasopharynx, oropharynx, and hypopharynx
32
The cricoid cartilage is at the level of
C6
33
What is the significance of Waldeyer's Tonsillar Ring?
lymphoid tissue ring in the pharynx that is at high risk for bleeding, especially with nasal intubation- highly vascular area
34
The Waldeyer's Tonsillar ring is made up of:
``` pharyngeal tonsils (adenoids) Palatine tonsils (located in oropharynx) Lingual tonsils (located at base of tongue) ```
35
Where is the larynx in adults vs. children?
Larynx: C3-C6 in adults | C2-C4 in infants and children
36
Describe the 9 cartilages of the upper airway.
Single: thyroid, cricoid, epiglottic Paired: arytenoid, corniculate, cuneiform
37
Describe the significance of the epiglottis.
broad/leaf shaped VASCULAR area can be traumatized and swell incredibly protects against aspiration by covering the glottis during swallowing
38
The _____ attaches to the cords
arytenoids- most commonly seen paired cartilages on laryngoscopy
39
The vestibular folds are known as
the false vocal cords; they are a narrow band of fibrous tissue on each side of the larynx
40
The only complete cartilage is
the cricoid cartilage | it sits at C6
41
The narrowest portion of an adult airway vs. a children's airway is
glottic opening is the narrowest portion of an adult airway | in children, the narrowest portion of the airway lies just below the cords at the cricoid ring
42
Describe the cricothyroid membrane.
relatively AVASCULAR | site of emergency airway
43
The trachea is composed of
16-20 cartilaginous rings that sit anteriorly
44
Describe the differences between the adult & infant/pediatric airways is:
Pediatrics have larynx positioned higher in the neck, tongue larger relative to mouth size, epiglottis larger, stiffer, angled more posteriorly; head and occiput larger relative to body size; short neck; narrow nares; cricoid ring is narrowest region
45
The intrinsic muscles of the larynx include:
``` posterior cricoarytenoid lateral cricoarytenoid arytenoids cricothyroid thyroarytenoid ```
46
What adducts the vocal cords:
lateral cricoarytenoid | arytenoids
47
What abducts the vocal cords:
posterior cricoarytenoid
48
The cricothyroid produces
cord tension, closure and elongates the vocal cords | can result in laryngospasm
49
The thyroarytenoids
shorten and relax the vocal cords
50
What muscles elevate the larynx?
stylohyoid | mylohyoid
51
What muscles draw the hyoid bone inferiorly?
sternohyoid, thyrohyoid
52
What muscle draws the thyroid cartilage caudad?
sternothyroid
53
What muscles draws the hyoid bone caudad?
omohyoid
54
Describe the nerve innervation of the airway.
the superior laryngeal nerve innervates above the vocal cords- internal branch provides sensation above and external branch is a motor nerve (SIS & SEM) the recurrent laryngeal nerve provides sensation below the vocal cords
55
Describe the innervation of the tongue.
Anterior 2/3rds is cranial nerve 5 | Posterior 1/3rd is cranial nerve 9
56
Damage to the hypoglossal nerve can cause
the tongue to relax and fall back leading to an obstruction
57
Innervation for all muscles of the larynx is provided by:
superior laryngeal nerve- external branch provides motor innervation to cricothyroid muscle recurrent laryngeal nerve- innervates all muscles of the larynx EXCEPT for the cricothyroid
58
What nerve is responsible for laryngospasm?
superior laryngeal nerve | -specifically external since it is motor
59
Describe a unilateral vs. bilateral superior laryngeal nerve damage.
unilateral- minimal effects | bilateral- hoarseness, vocal tiring
60
Describe a unilateral vs. bilateral recurrent laryngeal nerve damage.
unilateral hoarseness bilateral- acute stridor, respiratory distress from unopposed tension of the cricothyroid muscle chronic will cause aphonia
61
A vagus nerve injury will
affect both the SLN and RLN | producing flaccid, malpositioned cords resulting in aphonia
62
What axes are we aligning when we place the patient in 'sniffing' position?
the oral, pharyngeal, and laryngeal axis | OPL
63
How do you align the different axes?
PiLlow- pharyngeal and laryngeal | head extension will align the oral axis
64
What is the normal atlanto-occipital joint mobility?
35 degrees | greater than 2/3rds decrease is associated with a grade III or IV
65
A short thyromental distance creates
difficulty in aligning pharyngeal and laryngeal axes
66
Describe the different laryngoscopic view:
grade 1 view: full view of the glottic opening grade 2 view: posterior portion of the glottic opening and arytenoid cartilage visible grade 3: only tip of epiglottis is visible grade 4: soft palate visible; no recognizable laryngeal structures
67
How do we treat a laryngospasm?
remove the stimulus positive pressure deepen anesthetic muscle relaxants
68
A soft tissue obstruction is treated by
head-tilt, chin-lift maneuver or by jaw thrust. this moves the hyoid bone anteriorly and lifts the epiglottis to clear the obstruction
69
Describe MOANS & BONEs
beard, BMI >25, age >55, edentulous, snores | mask seal, obesity, age, no teeth, snores
70
What is the "lemon" rule?
look externally, evaluate the mandibular space, mallampati classification, obstructions, neck mobility
71
Oral airways are not well tolerated in
lightly anesthetized patients- may provoke, gag reflex, cough, vomiting, laryngospasm or bronchospasm
72
Describe LMA size 3
used for patients 30-50 kg cuff volume test 30 cc max cuff volume 20 cc
73
Describe LMA size 4
used for patients 50-70 kg cuff volume test 45 max cuff volume 30 cc
74
Describe LMA size 5
used for patients 70-99 kg cuff volume test 60 cc maximum cuff volume 40 cc
75
What is the maximum airway pressure when using an LMA?
<20cmH2O
76
Describe the size and depth of insertion for ETT for men & women
men: 8 or 9; 24-26 cm at lip women: 7-8; 20-22 cm at lip
77
Describe the size ad depth of insertion of ETT for children
size 4+ age/4 | depth: 12 + age/2
78
The cuff pressure of the ETT should be
20-25 mmHg | tracheal mucosal perfusion pressure= 25-30 mmHg
79
Describe how the ETT can move with head flexion, extension & rotation
flexion 1.9 cm down extension 1.9 cm up rotation 0.7 cm
80
Describe the subjective criteria for "awake" extubation:
``` follows commands clear oropharynx intact gag reflex sustained head lift for 5 seconds sustained hand grasp adequate pain control minimal end expiratory concentration of inhaled anesthetics ```
81
Describe the objective criteria for "awake" extubation:
``` vital capacity >15 mL/kg peak voluntary negative inspiratory pressure >25 cmH20 tidal volume >6 mL/kg sustained tetanic contraction SPO2 >90% RR <35 PaCO2 <45 ```

N928 Basic Principles of Anesthesia (16 decks)

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