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Intro To Anesthesia > Week 2- AIRWAY > Flashcards

Week 2- AIRWAY Flashcards

1
Q

Upper Airway

A
  • Nasal Passages (septum, turbinates, adenoids, Paranasal sinuses)
  • Oral Cavity (Teeth, tongue, HP, SP)
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2
Q

Function of Nasal Pasages

A

Upper Airway

  • Accounts 2/3 total upper airway resistance
  • Humidification
  • Filter
  • Warm
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3
Q

Innervation of the Nasal Pasages

A

Via Branches of Trigeminal Nerve CN V

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4
Q

Oral Cavity innervated by what CN?

A
  1. Trigeminal (CNV)- Sensory—-) Nose, chewing
    • HP, SP
    • Anterior 2/3 tongue
  2. Glossopharyngeal (CN IX)—) Swallow, Gag
    • Posterior 1/3 tongue
    • SP
    • Oropharynx
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5
Q

Pharynx

A
  1. Nasopharynx (border= SP)
  2. Oropharynx (Border= Epiglottis, Tonsils, Uvula)
  3. Hypo/Laryngopharynx
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6
Q

Innervation of the Pharynx

A
  1. Glossopharyngeal (CN IX)
  2. Vagus (CN X)

-swallow, gag, sensation

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7
Q

Larynx

A 
C4-C6 in adult
Functions: 
    - Airway protection (w/ epiglottis)
     -Respiration
     -Phonation
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8
Q

Cartilages of Larynx

A

9 Cartilages (3 paired) (3 Unpaired)

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9
Q

3 Paired Cartilages (Larynx)

A
  1. Arytenoid
  2. Cornice late
  3. Cuneiform
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10
Q

3 Unpaired Cartilages (Larynx)

A
  1. Thyroid
  2. Cricoid
  3. Epiglottis
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11
Q

Narrowest portion of the Adult Airway

A

-Glottic opening= Triangular fissure btn cords

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12
Q

Narrowest portion of Peds airway

A

Cricoid cartilage

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13
Q

Cricothyroid muscle innervated by what?

A
  • External Branch of Superior Laryngeal Nerve

- This is branch of Vagus Nerve (CN X)

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14
Q

Intrinsic Laryngeal Muscles

A

Control mvts of laryngeal cartilages (length, and tension of vocal cords & size of Glottic opening)

-Besides Crycothyroid muscle….ALL other Intrinsic Laryngeal Muscles Innervated by: RECURRENT LARYNGEAL NERVE= branch of Vagus nerve (CN X)

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15
Q

Damage to nerves is caused by blocking __________ sides of the neck.

A

Both

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16
Q

Intrinsic Muscles of Larnyx and ACTION

A

ADD Table 23-1 pic from slides….

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17
Q

Lower Airway consists of:

A
  • Trachea
  • Carina
  • Bronchi
  • Bronchioles
  • Terminal bronchioles
  • Respiratory Bronchioles
  • Alveoli
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18
Q

Trachea

A
  • No Complete rings
  • Fibromuscular tube
  • Length:10-20cm
  • Diameter: 22mm in Adult
  • 16-20 Ushaped cartilages
  • Posterior lacks cartilages
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19
Q

Trachea Bifurcates at what place?

A

T4- Carina

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20
Q

How long and what angle is Right bronchus?

A

Length:2.5cm
Angle: 25 degrees

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21
Q

How long and what angle is Left bronchus?

A

Length: 5cm
Angle: 45 Degrees

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22
Q

Mallampati Score

A

ADD PIC SLIDE 18

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23
Q

What does Mallampati Score predict?

A

Correlates the oropharyngeal space with the ease of

direct laryngoscopy and tracheal intubation

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24
Q

What happens when tongue is disproportionally large?

A

tongue overshadows the larynx resulting in
difficult exposure of the vocal cords during
laryngoscopy

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25
Q

Characteristics of Mallampati Class I (Remember PUSH)

A

faucial Pillars, entire Uvula, Soft and

Hard palates

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26
Q

Characteristics of Mallampati Class II

A

Uvula tip masked by tongue, Soft and

Hard palates

27
Q

Characteristics of Mallampati Class III

A

Soft and Hard palates, uvula base

only

28
Q

Characteristics of Mallampati Class IV

A

Hard palate only

29
Q

Cormack and Lehane Score

A

-laryngoscopic view of the glottis
-Mallampati class is correlated to what can be
seen on direct laryngoscopy

30
Q

Cormack and Lehane Score (Grade I-IV) What doe you see?

A

Grade I: most of the glottis visible
Grade II: Only the posterior portion of glottis visible
Grade III: Only epiglottis visible
Grade IV: No airway structures visualized
ADD PIC slide 21

31
Q

Thyromental Distance

A
  • Lower border mandible to thyroid notch with neck fully extended
  • Normal: 6- 6.5cm or (4 FINGER BREADTHS)
  • Difficult: (LESS THAN 3 FINGERS
32
Q

Sniffing Position

A
  • Aligns 3 axis (Oral Pharyngeal Laryngeal axis

- ADD PIC

33
Q

Describe Airway set up

A

-Appropriate sized face mask*
- Means of Positive Pressure Ventilation (PPV)-> ambubag,
machine circuit
- Suction on and easily accessible
- Tongue depressor
- Appropriate sized oral and nasal airways*
- Laryngoscope handle*
- 2 different blades*
- Endotracheal Tube (ETT)- 2 sizes*
- Stylet
- Syringe
- Appropriate sized Laryngeal Mask Airway (LMA)
(difficult airway)*
- Tape

34
Q

Describe Hand placement for Use of face masks

A
  • Mask in Left Hand
  • Reservoir Bag in Right
  • Thumb on upper aspect of mask, index and middle fingerson lower aspect, and 4th/5th fingers under chin for chinlift/jaw thrust
35
Q

What is a common problem with induction and why does it happen?

A

airway obstruction by the
tongue and epiglottis due to relaxation of the
genioglossus muscle

36
Q

Order to correct issues with Airway patency…

A
  1. Airway Maneuvers
    ◦ Head tilt/chin lift
    ◦ Jaw Thrust
  2. Adjuncts
    ◦ Nasopharyngeal Airway-lubricate
    ◦ Oralpharyngeal Airway-tongue blade
     3. 2 handed mask with bagging assistance
37
Q

Types of Oral Airways

A

Berman (BOA) and Guedel

38
Q

How do you measure Oral Airway?

A
  • From center of mouth to angle of jaw

- OR from mouth to earlobe

39
Q

Complications/Precautions of Oral Aiways

A

Laryngospasm*
◦ Bleeding
◦ Soft tissue damage
- Pt must be unconscious (heavily sedated with NO GAG)

40
Q

Describe process for Nasal trumpet airway insertion and sizing

A

-Must LUBRICATE
-Used in series (small to large) to dilate prior to
elective nasal intubation

41
Q

Complications/Pxns for Nasal AIRWAY

A

-epistaxis, nasal or basal skull fractures, adenoid
hypertrophy, anticoagulants?
-BEST used in Light anesthesia

42
Q

Laryngoscopes: Name 2 types…

A
  • Macintosh (1-4)

- Miller (0-4)

43
Q

Macintosh blade sits where when used to open airway?

A

Into the Valeculla

-Lifts epiglottis and folds up

44
Q

Miller blade sits where when used to open airway?

A

Sits on top of epiglottis

***best used with stiff pediatric epiglottis

45
Q

Ideal Position of the ETT?

A 
4 cm above the carina and 2 cm below the vocal
cords
–( Males approximately 23 cm
– Females approximately 21 cm
– IDx3= approximate depth)
46
Q

What will you ALWAYS do after ETT insertion?

A

ALWAYS Listen for bilateral breath sounds

-Look for bilateral chest rise and presence of end-tidal CO2!

47
Q

What is the standard size Diameter for ETT connectors?

A

15mm outer diameter tip

48
Q

Name some indications for Tracheal Intubation

A

◦ Airway compromise
◦ Airway inaccessible
◦ Long surgical time
◦ Surgery of head, neck, check, or abdomen
◦ Need for controlled ventilation and/or positive endexpiratory
pressure
◦ Inability to maintain airway with mask/LMA
◦ Aspiration risk
◦ Airway/ lung disease

49
Q

LMA can be used for what kind of cases

A

Supraglottic airway device
–>Used for routine and difficult
airway management

50
Q

Considerations for LMA usage

A
  • Aspiration RISK
  • Can be used as Conduit for ETT placement
  • Placed blindly / Must be lubricated
  • NOT MEANT for PPV (Must keep pressures <15)
51
Q

LMA Sizing

A 
- Appropriate Size is based on
patient weight
◦ Adult sizes
– 30-50Kg--> LMA 3
– 50-70 Kg--> LMA 4
– 70-100 Kg--> LMA 5
– >100 Kg--> LMA 6
52
Q

Advantages for LMA over ETT

A

-Fast and ease of placement by inexperienced
personnel
-improved hemodynamic stability at induction and during emergence
-Decreased anesthetic requirements for airway tolerance
-Lower frequency of coughing during emergence
-Lower incidence of sore throats inadults (10% vs 30%)
- avoids “foreign body” in the trachea
**patient can be fully emerged prior to removal of LMA (good for asthmatic patients)

53
Q

Disadvantages of LMA

A
  •  lower seal pressure
  •  higher frequency of gastricinsufflation
  •  esophageal reflux more likely
  •  inability to use mechanical ventilation*
54
Q

Name some intubation complications (Potential Hazards)

A
  • Dental damage
  •  Soft tissue/mechanical injury
  •  Laryngospasm
  •  Bronchospasm
  •  Vomiting/Aspiration
  • Hypoxemia/Hypercarbia
  •  SNS stimulation
  •  Esophageal/Endobronchial intubation
  • ALSO SORE THROAT
55
Q

MAC Case (describe set up and what it is)

A

=Monitored Anesthesia care

  • Complete Airway Setup Ready to go
  •  Nasal Cannula- EVERYONE GETS O2
  • Spontaneously Breathing Patient
  •  Nasal airway if snoring (partially obstructed breathing)
56
Q

How much FiO2 delivered via Nasal Canula (from 1-4L)

A

1L
2L
3L
4L

57
Q

When would you use General Anesthesia (MASK CARE)

A
  • Difficult airway not present
  •  Surgeon does not need access to head/neck (BMT-ok)
  •  No airway bleeding/secretions
  •  Case of short duration
  •  No table position changes- head available…
  •  Obstruction easily relieved with oral nasal airway/ chin lift
  •  Patient will spontaneously breathe-no neuromuscular blocker used
58
Q

When would you use General Anesthesia (LMA CASE)

A 
-Difficult airway not present
◦ Surgeon does not need access to head/neck (?)
◦ No airway bleeding/secretions
◦ Case of short duration
◦ More reliable patent airway than mask
◦ Want hands free
59
Q

When would you use General Anesthesia (ETT)

A

◦ Airway compromise
◦ Airway inaccessible
◦ Long surgical time
◦ Alternate surgical positions
◦ Surgery of head, neck, check, or abdomen
◦ Need for controlled ventilation and/or PPV
◦ Inability to maintain airway with mask/LMA
◦ Aspiration risk
◦ Airway/ lung disease

60
Q

Induction of Anesthesia: STEP 1 is..?

A

PRE-OXYGENTATION

61
Q

What is the goal of Pre-Oxygenation?

A 
Increase O2 concentration in functional
residual capacity (FRC) by “washing out”
nitrogen (79% in RA) in the FRC with oxygen
FRC volume of air left in the lung at end of passive expiration
62
Q

Describe 2 Different Pre-oxygenation methods

A

1: 3-5 minutes of “tight” mask fit during normal

tidal breathing with100% FiO2 at> 6L/min flow
= 10 minutes of safe apnea time

#2: 4 vital capacity breaths within 30 seconds with
100% FiO2 at >6L/min= 5 minutes of safe
apnea time
63
Q

What is a Laryngospasm?

A

Severe, sudden, sustained contraction of the glottic
opening (vocal cords) in response to a stimulus (blood,
secretions, light anesthesia) characterized by complete
airway obstruction with retractions

64
Q

Describe Treatment of Laryngospasm…

A

◦ Jaw-Lift Maneuver and placement of mask
◦ Administration of oxygen with continuous Positive Pressure
–- Strong intermittent pressure applied manually to a bag full of oxygen can force gas effectively through the upper airway and adducted cords.
Immediate removal of the offending stimulus*****
◦ Small dose of short acting Muscle Relaxant Succinylcholine 20-40 mg IV

Intro To Anesthesia (5 decks)

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