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Basics of Anesthesia II > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Mnemonic for tense and relaxing vocal cords

A

CricoThyroid “cords tense” THyroaRytenoid “they relax”

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2
Q

Mnemonic for abduct/adduct vocal cords

A

Posterior CricoArytenoid “please come apart” Lateral CricoArytenoid “lets close airway”

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3
Q

Name these structures

A
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4
Q

Name these structures

A
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5
Q

What are the unpaired cartilages?

A

epiglottis, thyroid, cricoid

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6
Q

What are the paired cartilages?

A

corniculate, cuneiform, arytenoid

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7
Q

What is the LEMON law?

A

Look at airway, Examine airway, Mallampati, Obstructions, Neck mobility

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8
Q

What are some anatomy features associated with airway complications?

A

obesity, pregnancy, facial hair, large/jagged teeth, narrow face with high arch palate (small diameter), large tongue, false teeth

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9
Q

What should the thyromental distance be?

A

5-6 cm or 3 fingerbreadths

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10
Q

What is the PUSH mnemonic for Mallampati?

A

Class I: Pillars, Uvula, Soft, Hard palates Class II: Uvula, Soft, Hard palate Class III: Soft, and Hard palate Class IV: hard palate

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11
Q

What can you see with different Cormack and Lehane scores?

A

Grade I: complete glottic opening Grade II: posterior region of glottic opening Grade III: epiglottis only Grade IV: soft palate only

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12
Q

What is the BONES mnemonic?

A

for difficult mask ventilation- Beard, Obese (BMI >26), No teeth, Elderly (>55), Snoring

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13
Q

What are characteristics with Treacher Collins that make them a difficult airway?

A

cheek hypoplasia, small mandible

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14
Q

What are some characteristics of Pierre Robins that make them a difficult airway?

A

mandible hypoplasia (micrognathia), cleft palate, glossoptosis (posteriorly displaced tongue)

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15
Q

What are some characteristics of Goldenhar’s Syndrome that make them a difficult airway?

A

micrognathia, asymmetry

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16
Q

What is Ludwigs angina?

A

infection of the airway

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17
Q

What are some airway considerations with penetrating neck trauma?

A

evidence of injury to air containing structures or vascular injury- use FOB if enough time, if not do RSI with surgeon readily available for possible cric

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18
Q

How do you intubate in a patient with cervical spine injury?

A

second provider provides in line immobilization (may take off front half of collar)- use Glidescope to prevent movement of neck

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19
Q

What is a consideration for patients with rheumatoid arthritis?

A

limited head and neck mobility- obtain neck films before surgery if possible

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20
Q

What are some considerations when intubating a patient with intracranial injury?

A

Avoid sudden increases in ICP- use IV lidocaine, fentanyl, and beta blockers if needed

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21
Q

What is a consideration with intraocular injury?

A

need to use defasciculation dose if using succs, as succs can increase IOP

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22
Q

What are some indications for an awake intubation?

A

history of difficult intubation, finding on H&P (neck mass, limited mouth opening), risk of aspiration, trauma, neuro case with halo/cervical collar

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23
Q

What are the essential features of RSI?

A

preoxygenation, administration of predetermined induction dose, succs/roc, application of cricoid pressure, avoidance of PPV until airway secured

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24
Q

What is a modified RSI?

A

uses gentle PPV (may be needed in cases of limited respiratory reserves or those with large beards)

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25
Q

Why is cricoid pressure used and what is it?

A

used in patients with full stomach, GERD, pregnancy, trauma, emergency case- pressure to cricoid cartilage with thumb and first finger to occlude the esopaghus

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26
Q

What is the BURP maneuver?

A

backward, upward, rightward pressure- it is NOT cricoid pressure

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27
Q

Should you apply cricoid pressure before or after loss of consciousness?

A

before, because loss of consciousness and NMBs relax the upper esophageal sphincter

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28
Q

Does cricoid pressure decrease lower esophageal pressure?

A

yes, cricoid pressure mimics food bolus

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29
Q

What should you keep peak airway pressures below when using an LMA?

A

20 cmH2O

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30
Q

What are some contraindications to LMA?

A

obesity, high pulmonary pressures, GERD, surgical positions, airway avoidance

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31
Q

What are some benefits to using an iGel?

A

easy insertion, reduced trauma, superior seal, integral bite block, non inflatable cuff, can use for bronchoscopy

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32
Q

Describe the combitube

A

Double lumen, placed blindly- lungs can be inflated no matter where the tip is, usual placement of tip is in the esophagus, may offer protection against aspiration when both balloons inflated

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33
Q

What are some contraindications to using a Combitube?

A

intact gag reflex, prolonged use, esophageal disease, ingestion of caustic substances

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34
Q

When do you know you’re in the trachea when using the Trachlight?

A

should have well defined, circumscribed glow below thyroid prominence

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35
Q

When should you avoid the Trachlight?

A

foreign body, tumor, polyps, soft tissue injuries, may be difficult in obese patients

36
Q

When do you know you’re in the trachea when using the Eschman stylet/bougie?

A

feel stylet “bounce” along tracheal rings

37
Q

What is the fiberoptic bronchoscope?

A

flexible laryngoscope that consists of multiple strands of tiny glass fibers that carry light; contains channels for suction, oxygen insufflation, and local anesthetics

38
Q

What are some limitations to FOB?

A

view may be limited with blood and other debris; contraindicated in epiglottitis, laryngotracheitis, bacterial tracheitis

39
Q

What are some considerations with nasal intubation?

A

high potential for bleeding, ETT is longer and narrower (more resistance)

40
Q

What are contraindications to nasal intubation?

A

cribiform plate injury (Lefort, basilar fracture), raccoon eyes, periorbital edema, coagulopathy, hypophysectomy, previous Caldwell Luc procedure, nasal fracture

41
Q

What are some indications for a double lumen ETT?

A

deflate lung for better operating conditions, decrease contamination, isolate unilateral pathology (bullae, cysts)

42
Q

Where should the tracheal lumen lie in the double lumen ETT?

A

above the carina

43
Q

Where does the distal portion of a double lumen ETT lie?

A

fits into appropriate mainstem bronchus

44
Q

What is the most common sided double lumen tube?

A

left (right is used rarely)

45
Q

What should the bronchial cuff of a DLT be inflated to?

A

no more than 3 cc (can rupture bronchial lumen)

46
Q

What can you use when you need one lung ventilation but cannot place a DLT due to nasal intubation, difficult airway, or trach?

A

bronchial blocking device- goes through single lumen ETT

47
Q

What are some desired and undesired effects of ketamine when using for awake intubation?

A

desired- potent bronchodilator with minimal respiratory depression, provides pain control undesired- increased HR and BP, increased salivation, can cause extreme dreams/nightmares

48
Q

What are some desired and undesired effects of precedex when using for awake intubation?

A

desired- strong sedation with minimal respiratory depression, analgesia, antisialagogue undesired- hypotension and bradycardia

49
Q

What are names and doses of drugs for antisialagogue effects?

A

glyco 0.2 mg, atropine 0.4 mg, scopolamine 0.4 mg (IV)

50
Q

What is a risk of using benzocaine and cetacaine spray?

A

methemoglobinemia

51
Q

What drug is usually used for topicalization of the airway due to its rare toxicity and effectiveness?

A

lidocaine 4%

52
Q

What is the treatment for methemoglobinemia?

A

methylene blue

53
Q

What might you use 4% cocaine for?

A

ENT cases for local anesthesia and vasoconstriction

54
Q

Who should you use caution in when using 4% cocaine?

A

CAD, HTN, pseudocholinesterase deficiency, preeclampsia, hyperthyroidism

55
Q

What provides sensory innervation to the nares and anterior 2/3 of the tongue?

A

trigeminal

56
Q

What provides sensory innervation to the soft palate, oropharynx, posterior 1/3 tongue, tonsils, vallecula, and top of epiglottis?

A

glossopharyngeal

57
Q

What provides sensory innervation from the posterior epiglottis to the vocal cords?

A

internal branch of SLN

58
Q

What provides sensory innervation below the vocal cords?

A

RLN

59
Q

What provides motor innervation to the cricothyroid?

A

external branch of SLN

60
Q

What provides motor innervation to all the intrinsic muscles except the cricothyroid?

A

RLN

61
Q

Describe a sphenopalatine nerve block

A

needle inserted into greater palatine foramen of upper posterior palate- blocks greater and lesser palatine nerves (nasal turbinates and posterior 2/3 of septum)

62
Q

Describe a glossopharyngeal block

A

2 ml of lidocaine block placed at posterior of lower palate at back edge of the gutter of the mouth- blocks lingual branch of glossopharyngeal nerve (base of tongue, epiglottis, posterior pharynx)

63
Q

What are some complications of a glossopharyngeal block?

A

HA, pharyngeal abscess, paralysis of the pharyngeal muscles, airway obstruction, hematoma, dysrhythmias, seizures

64
Q

How do you confirm placement of your needle when you’re performing a glossopharyngeal block?

A

aspirate- should not aspirate air or blood

65
Q

Describe a SLN block

A

performed above thyroid and below hyoid bilaterally- blocks VC and above cords to base of tongue- 1 ml injected above thyrohyoid membrane and then 2 ml injected 2-3 mm beneath membrane

66
Q

Describe a transtracheal nerve block

A

enter space between thyroid and cricoid while aspirating for air at a caudal direction- when air bubbles are aspirated, the needle is in the lumen- inject LA, pt will cough (sprays up onto VC)

67
Q

Describe retrograde intubation

A

14 or 18 G needle through cricothyroid membrane in a cephalid direction- wire inserted until it goes up into nose/mouth, ETT is passed over wire and passed into trachea, pull out wire

68
Q

Describe transtracheal jet ventilation

A

large bore IV cath inserted through cricothyroid membrane in caudad direction, tubing is connected and oxygen is delivered through regulating valve

69
Q

What are some considerations of transtracheal jet ventilation?

A

requires a normal airway for passive expiration; if inspiratory cycles are too rapid, air trapping is possible (use I:E ratios of 1:2 or 1:3); assess frequently for crepitus

70
Q

Describe percutaneous cricothyrotomy

A

emergency method for can’t ventilate/can’t intubate situation- tube inserted over guidewire through cricothyroid membrane

71
Q

Where is a tracheotomy performed, and should it be used in an emergency?

A

4-6th tracheal ring below thyroid isthmus; no, can take 5-30 minutes

72
Q

What is a laryngospasm and what is it caused by?

A

spasm of laryngeal musculature (upper airway), vocal cords close- caused by secretions and noxious stimulus during light planes of anesthesia

73
Q

What do patients sound like with a partial laryngospasm?

A

high pitched phonation, crowing sounds

74
Q

What is the treatment for total laryngospasm?

A

get help, admin 100% FiO2, apply 15-20 cmH20 continues airway pressure, give 20 mg succs if persistent

75
Q

What are some complications of laryngospasm?

A

hypoxemia, aspiration, negative pressure pulmonary edema

76
Q

What is a bronchospasm?

A

lower airway obstruction; contraction of bronchial portion of respiratory tree- inability to ventilate in absence of upper airway obstruction

77
Q

What is the treatment for bronchospasm?

A

100% FiO2, beta agonists, proventil inhaler, epi, steroids, aminophylline

78
Q

What are some risk factors for aspiration pneumonitis?

A

increased gastric fluid volume, delayed gastric emptying, reduced LES pressure, loss of protective airway (LOC, stroke)

79
Q

Who are some populations at risk for delayed gastric emptying?

A

obese pts, pregnant, DM, PUD, trauma, stress, acute pain

80
Q

What are the current NPO guidelines?

A

clear liquids and carb drink 2 hours before, breast milk 4 hours, formula 6 hours, non-clear liquids 4-6 hours, light meal 6 hours, large meal 8 hours

81
Q

What does sodium citrate do?

A

neutralizes stomach acid, but very bitter- works if given earlier rather than later

82
Q

What does Bicitra do?

A

neutralizes tomach acid (not as well as sodium citrate), but also may increase gastric volume

83
Q

What does Pepcid do?

A

reduces gastric acid production

84
Q

What does Reglan do?

A

improves gastric emptying

85
Q

What are some complications of Reglan?

A

can cause severe anxiety if given without anxiolytic; can also cause tardive dyskinesias (give benadryl if this happens)

86
Q

What would be the only situation to strongly consider placing an NG before surgery?

A

bowel obstruction

87
Q

What should you do if you suspect aspiration?

A

supplemental O2, ventilatory support with CPAP and PEEP, use bronchodilators and prophylactic antibiotics if signs of infection

Basics of Anesthesia II (9 decks)

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