Peds Ch 14 (Airway)

Question 1

larynx position in the infant vs adult

Answer 1

is more cephalad than in the adult, classically described at the level of C3-4 in the former compared with C4-5 in the latter

Question 2

blade used in peds

Answer 2

straight blade which lifts the tongue from the field of view during laryngoscopy, facilitates visualization of an infant’s larynx.

Question 3

epiglottis in infant patients

Answer 3

The epiglottis in the infant is narrow, omega shaped, and angled away from the axis of the trachea, which contrasts with that in the adult, which is flat and broad, and its axis is parallel to the trachea

Question 4

vocal fold angles in an infant

Answer 4

are angled such that the anterior insertion is more caudad than the posterior insertion, whereas the axis of the folds in the adult is perpendicular to that of the trachea

Question 5

the only complete ring of cartilage in the laryngo-tracheobronchial tree

Answer 5

the cricoid

Question 6

what 2 branches of the vagus nerve supply both sensory and motor innervation to the larynx

Answer 6

the recurrent laryngeal and the superior laryngeal nerves

Question 7

The superior laryngeal nerve has two branches:

Answer 7

the internal branch & the external branch

Question 8

what does the internal branch of the superior laryngeal nerve supply

Answer 8

sensory innervation to the supraglottic region

Question 9

what does the external branch of the superior laryngeal nerve supply

Answer 9

motor innervation to the cricothyroid muscle

Question 10

what does the recurrent laryngeal nerve provide

Answer 10

• sensory innervation to the subglottic larynx
• motor innervation to all other laryngeal muscles.

Question 11

infants are obligatory ____________ breathers

Answer 11

nose

Question 12

Airway obstruction during anesthesia or loss of consciousness appears to be most frequently related to…

Answer 12

loss of muscle tone in the pharyngeal and laryngeal structures rather than apposition of the tongue to the posterior pharyngeal wall

Question 13

what 3 cavities must be aligned for optimal intubation positioning

Answer 13

oral, pharyngeal, tracheal

Question 14

factors associated with post extubation croup

Answer 14

• an ETT with an OD that is too large for the child’s airway (no leak at >25 cm H2O pressure or resistance at the time of insertion)
• changes in position during the procedure
• a position other than supine
• repeated attempts at intubation
• traumatic intubation
• patient age between 1 and 4 years
• duration of surgery greater than 1 hour
• coughing on the ETT
• previous history of croup

Question 15

treatment of post-extubation croup

Answer 15

nebulized epinephrine and dexamethasone

Question 16

most cases of laryngotracheal/subglottic stenosis are the result of..

Answer 16

tracheal intubation, particularly prolonged intubation