Lecture 3: Airway Assessment Flashcards
Why should every patient who receives any type of anesthesia receive an airway assessment? What three things must be considered?
- To have a back up plan and be able to predict the ease or difficulty of airway management.
- Must consider type of surgery, type of anesthetic, safety factors
Name 6 indications for intubation.
- Airway protection
- Maintenance of patent airway
- Application of PPV
- Maintenance of adequate oxygenation
- Deliver predictable FiO2
- Provide PEEP
Name the 7 indications for a mask case.
- No instrumentation of the airway is required (therefore will avoid trauma, CV stimulation.)
- Difficult airway not present
- Surgeon does not need to access head/neck (BMT-ok)
- No airway bleeding/secretions
- No table position changes-head available
- Ventilation by mask requires the ability to achieve a seal between the mask and face to overcome upper airway instruction. Obstruction should be easily relieved with airway/chin lift?
When assessing history during an airway assessment what 4 main questions should be asked?
- Any previous anesthesia history with airway management?
- Difficulty with prior anesthetics/intubations (past awake or fiberoptic intubation? Severe sore throat or dental damage?)
- Co-existing disease?
- Surgical history that may affect airway management?
What co-morbidities may a patient have that may effect airway management? What cold we do if we need to to evaluate?
Lesions of the larynx, thyroid disease, cancer, GERD, DM, OSA, Obesity, genetic do, RA, musculoskeletal (cervical stenosis, cervical fracture) or scleroderma
We could take cervical XRays, endoscopy looking for tumors/other shit
What surgical history may effect the airway management?
- Trach/scar (causes stenosis and fibrosis narrows the airway)
- Neck dissection
- UVPP (uvulo-palato-pharyngeo-plasty) for sleep apnea to take out redundant tissue
- Cervical neck instrumentation (fusion)
The examination of the airway during a pre-op assessment agrees with which standards of the AANA?
Standard I- A practitioner shall perform a thorough and complete pre-anesthesia assessment allowing the practitioner to Standard III- formulate a patient specific plan for anesthesia care.
What are the eleven general parts of the physical airway assessment?
- General appearance
- Mouth appearance
- Teeth appearance
- Mouth opening
- Size and mobility of tongue
- Size and shape of mandible; maxillary overgrowth
- TMJ
- Thyromental distance
- Hyoidmental distance
- Cervical ROM
- Listen to BBS/upper airway for snoring/stridor
As part of the general appearance aspect of the physical airway assessment what are we looking at?
Head (larger or smaller head-thinking about the mask size/equipment size), neck-size circumference (can be a predictor of a difficult airway over 16 inches (40cm) and length and the presence of heavy facial hair.
Is the trachea midline. Are there structures (breasts/large mass) that could push up on their airway when they lay supine
As part of the mouth appearance aspect of the physical airway assessment what are we looking for?
Looking at the lips, gums and tissues are the tissues friable? Bleed easy? Teeth. Longer incisors and if they protrude at all they will be harder to intubate.
When examining the teeth as part of the physical airway assessment what are we looking at?
Length of incisors, condition of the teeth (missing, protrusions, overbite),loose teeth, chipped teeth, capped, relationship of upper incisors (maxillary) to lower incisors (mandible) and whether dentures/bridges are out.
What is a normal mouth opening?
Over 4cm or >2 fingerbreadths *last year anything under 3 was considered difficult…guess that must have just changed over the last month :)
What is a normal thyromental distance?
6.5cm (50mm) or 3 fingerbreadths
What is the normal hyoidmental distance?
2 fingerbreadths
When assessing cervical range of motion what joint are we looking at? What is full ROM?
- Atlanto-occipital joint
- 90-165 degrees. Should be able to touch chin to chest.
- Ears to shoulder
