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Priniclpes Of Anesthesia > Week 2: AIrway Assessment > Flashcards

Week 2: AIrway Assessment Flashcards

1
Q

Upper airway obstruction - primary cause

A

Tongue obstructs the airway - genioglossus muscle relaxes and allows the younger to obstruct the airway

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2
Q

Nasopharynx position

A

Lies anterior to C1 bound superiority by the base of the skull

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3
Q

Nasopharynx sensory inner action

A

Trigeminal nerve

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4
Q

Oropharynx position

A

C2-C3

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5
Q

Hypopharynx position

A

Posterior to the larynx
Bound by superior border of epiglottis and the inferior border of the cricoid cartilage at C5-C6

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6
Q

Hypopharynx is innervated by

A

2 branches of the vagus nerve

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7
Q

Internal branch of superior laryngeal nerve (SLN)

A

Sensory input Hypopharynx above chords

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8
Q

External branch SLN

A

Motor function to cricothyroid muscle of larynx

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9
Q

Recurrent Laryngeal Nerve (RLN)

A

Sensory innervation to the subglottic area and treachea

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10
Q

Right RLN branches

A

From the vagus and loops around the innominate artery

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11
Q

Left RLN branches from —->

A

Vagus and loops around the aorta

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12
Q

Traction on Right or Left RLN can cause

A

Hoarseness or stridor

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13
Q

Motor innervation of RLN provides function to:

A

All muscles of larynx EXCEPT the cricothyroid muscle

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14
Q

Superior laryngeal nerve (SLN) and Recurrent Laryngeal Nerve (RLN) may be damaged by

A

Surgery or trauma

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15
Q

Bilateral recurrent laryngeal nerve (RLN) damage

A

Respiratory distress

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16
Q

Unilateral RLN damage causes

A

Hoarseness

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17
Q

Trigeminal nerve (CN V) components

A

Opthalmic (V1)
Maxilary (V2)
Mandibular(V3)

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18
Q

Opthalmic (V2) innervates:

A

Nares and anterior 1/3 of nasal septum

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19
Q

Maxillary (v2) innervates:

A

Turbinates and septum

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20
Q

Mandibular (V3) innervates

A

Anterior 2/3 of tongue

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21
Q

Glossopharyngeal (CN IX) innervates:

A

Soft palate
Oropharynx
Tonsils
Posterior 1/3 of tongue
Vallecula
Anterior side of epiglottis

*afferent limb of gag reflex

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22
Q

Superior Laryngeal (SLN) External branch (motor vs. sensory)

A

Motor only
NO SENSORY

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23
Q

SLN internal branch (sensory vs motor)

A

Sensory only
NO MOTOR

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24
Q

SLN INTERNAL branch innervates

A

Posterior side of epiglottis —> level of the vocal chords

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25
Recurrent Laryngeal nerve (RLN) innervates
Below level of vocal cords —> Trachea
26
External Superior Laryngeal (SLN) motor innervation
Cricothyroid muscles (tense vocal chords)
27
Internal branch SLN motor innervation
None
28
Recurrent Laryngeal (RLN) Motor innervation
All intrinsic muscles EXCEPT Cricothyroid
29
Larynx is composed of:
3 single cartilages -Thyroid -Cricoid -Epiglottis 3 paired cartilages: -arytenoid -corniculate -cuneiform INTRINSIC and EXTRINSIC muscles
30
ABduction
Opens
31
ADDuction
Closes
32
Thyroarytenoid (AB/AD)
ADDucts (narrows) and relaxes “They Relax”
33
Lateral Cricoarytenoid
ADDucts (narrows) “Let’s Close Airway”
34
Posterior cricoarytenoid
ABducts (tenses, widens) “Please Come Apart”
35
Cricothyroid (tense or relax)
“Cords Tense”
36
Thyrorytenoid
“They Relax”
37
Extrinsic muscles of the larynx
all ‘hyoids Digastric Stylopharyngeus Stylohyoid Geniohyoid Mylohyoid Thyrohyoid
38
Intrinsic muscles of Larynx
All ‘arytenoids plus Aryepiglottic Vocalis Interarytenoid Lateral cricoarytoid Thyroarytenoid Aryepiglottic Vocalis
39
Trachea location
Begins at C6 —> T4-5
40
Carina Location
T4-5
41
R main stem bronchi
Takeoff angle 25 deg, 2.5 cm long
42
L mainstem bronchi
45 deg takeoff, 5 cm long
43
Increases as airway bifurcates:
-Number of airways -Cross-sectional area -Muscular layer
44
Decreased as airway bifurcates:
-Airflow velocity -Amount of cartilage -Goblet cells (mucous) -Ciliated cells (clear mucous)
45
Difficult airway assessment
1. Evaluate 3-3-2 rule 2. Mallampati score 3. Obstruction of upper airway 4. Obesity 5. Scarring/radiation/masses 6. Neck mobility 7. Operator expertise
46
3-3-2 rule
-3 fingerbreadths between incisors -3 fingerbreadths between tip of chin and TMD (chin-neck junction) (hyoid bone) -2 FBs between chin-neck junction (TMD, hyoid bone) and thyroid notch
47
Mallampati evaluation
P.U.S.H Pillars Uvula Soft pallet Hard Pallet
48
Mallampati class 1
PUSH Pillars, uvula, soft palate, hard palate
49
Mallampati class II
Fauces Soft palate Uvula
50
Mallampati class III
Soft palate BASE of uvula Hard palate
51
Mallampati IV
Only hard palate visible
52
Tests for difficult airway
-Mandibular protrusion test (lower teeth in front of upper teeth) -Atlanto-occipital joint mobility (neck ROM)
53
Indications of difficult supraglottic airway device placement and ventilation
RODS -Restricted mouth opening -Obstruction of upper airway -Distortion of airway anatomy presenting adequate seal -Stiff lungs
54
Pressure for ventilation with LMA
No more than 20 cm H2O
55
Conditions known for difficult airway management risk (bonus)
Pierre Robin Treacher collins Goldehar Mucopolysacchar Kipper feel Down syndrome Acquired issues
56
Difficult bag-mask ventilation
BONES Beard Obesity No teeth Elderly Sleep apnea, snoring
57
Pro seal LMA
Has gastric drain tube for gastric decompression Can inflate to 30 cm H2O because of ^
58
LMA supreme
Disposable version, no gastric port
59
Indications for tracheal intubation
-Anesthesia and surgical -Surgical -Medical
60
Basic steps for planned difficult intubation
-Plan ahead -intubate awake if suspicious -If you get intro trouble and can ventilate, wake them up -When making intubation choices, do what you do best
61
Patient Positioning for optimal intubation
Axes line up: Oral axis Pharyngeal Axis Laryngeal Axis
62
Difficult intubation basics
1. Face mask ventilation and Laryngoscopy for intubation 2. Supraglottic airway device (LMA) 3. Final attempt at face mask ventilation (succeed = wake patient up) 4. Cricothyroidotomy
63
Extubating difficult airway
Extubate fully awake
64
Complications of tracheal extubation
-Residual Neuromuscular blockade -Laryngospasm -Laryngotracheobronchitis
65
Laryngospasm Pathway:
-Affferent limb: SLN internal branch -Efferent limb: SLN external branch and RLN
66
Signs of Laryngospasm
-Inspiratory strider - SUprasternal and subraclavicular retraction during inspiration -rocking horse appearance of chest wall -lower rib flailing
67
Factors that reduce likelihood of laryngopasms
-Avoid airway manipulation during anesthesia -CPAP 5-10 cm/H2O during inhalation induction and post extubation -Remove pharyngeal secretions/blood before extubation -Tracheal extubation when deeply asleep or fully awake -IV lidocaine before extubation
68
Laryngospasm treatment
1. 100% FiO2 2. Remove noxious stimuli 2. Deepen anesthesia 4. CPAP 15-20 cm H2O with larson’s maneuver 5. Administer such
69
Laryngospasm risk factors (pre anesthetic)
- active or recent upper respiratory tract infection -exposure to smoke -reactive airway dz -GERD -age less than 1
70
Laryngospasm risk factors (in OR)
-Light anesthesia esp. with airway manipulation -Saliva or blood in airway -hyperventilation -hypocapnia -Surgical procedures involving the airway
71
Larson’s Manuever
Laryngospasm notch -displaces mandible -causes pt to sigh
72
Laryngospasm tax
-Larson’s -Valsalva (exhalation against closed glottis) -Muller (inhalation against closed glottis)
73
Basic airway skills:
-Assess -Plan AND backup plan -anticipate -recognize, implement, treat
74

Priniclpes Of Anesthesia (19 decks)

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