Pre-op eval

Question 1

Revised cardiac risk factor index (RCRI) risk factors

Answer 1

Ischemic heart disease, hx of of heart failure, hx of cerebrovascular dx (stroke, tia), DM on insulin, Cr > 2mg/dL:, intrathoracic, intra-abdominal, or suprainguinal vascular procedures.
MACE% (Major adverse CV event)
0 - 0.5%
1 - 1.3%
2 - 4%
3 - 9%
pts with >1% and less than 4 METS may need stress testing if it will have an impact on peri-operative care

Question 2

level of the larynx (c_ - c_)

Answer 2

c4-c6

Question 3

larynx is composed of three paired and three unpaired cartilages, what are they?

Answer 3

unpaired: thyroid, cricoid, epiglottis
paired: arytenoid, corniculate, and cuneiform

Question 4

which cartilage of the larynx is the only complete ring?

Answer 4

cricoid

Question 5

attachment of vocal cords posteriorly? anteriorly?

Answer 5

posteriorly: arytenoid cartilages
anteriorly: thyroid cartilage

Question 6

the superior laryngeal nerves (internal) innervates?

Answer 6

sensory to larynx above the vocal cords

branch of vagus

Question 7

the superior laryngeal nerves (external) innervates?

Answer 7

motor innervation to the cricothyroid muscle (vocal cord tensor)
branch of vagus

Question 8

the recurrent laryngeal nerve innervates?

Answer 8

sensory innervation below the vocal cords and motor innervation of posterior crico-arytenoid muscles (only abductors of the vocal cord)

Question 9

glossopharyngeal (9th cranial nerve) innervates?

Answer 9

sensory innervation to the vallecula and the base of the tongue

Question 10

arteries the supply the larynx?

Answer 10

superior laryngeal (branch of superior thyroid artery) and inferior laryngeal (branch of inferior thyroid artery)

Question 11

where would you block the glossopharyngeal nerve for an awake intubation?

Answer 11

at the base of the tonsillar pillars

Question 12

where would you block the superior laryngeal nerve for an awake intubation?

Answer 12

injection just below the greater cornu of the hyoid bone (aspirate before injection because this is carotid artery territory)

Question 13

what is the purpose of pre-oxygenation before induction of anesthesia

Answer 13

giving 100% oxygen washes out the FRC of N2 and fills in with O2, giving pts longer prior to desaturation. Fills their reservoir with 02