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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
Q

Recurrent Laryngeal nerve (RLN) innervates

A

Below level of vocal cords —> Trachea

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26
Q

External Superior Laryngeal (SLN) motor innervation

A

Cricothyroid muscles (tense vocal chords)

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27
Q

Internal branch SLN motor innervation

A

None

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28
Q

Recurrent Laryngeal (RLN) Motor innervation

A

All intrinsic muscles EXCEPT Cricothyroid

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29
Q

Larynx is composed of:

A

3 single cartilages
-Thyroid
-Cricoid
-Epiglottis

3 paired cartilages:
-arytenoid
-corniculate
-cuneiform

INTRINSIC and EXTRINSIC muscles

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30
Q

ABduction

31
Q

ADDuction

32
Q

Thyroarytenoid (AB/AD)

A

ADDucts (narrows) and relaxes
“They Relax”

33
Q

Lateral Cricoarytenoid

A

ADDucts (narrows)
“Let’s Close Airway”

34
Q

Posterior cricoarytenoid

A

ABducts (tenses, widens)
“Please Come Apart”

35
Q

Cricothyroid (tense or relax)

A

“Cords Tense”

36
Q

Thyrorytenoid

A

“They Relax”

37
Q

Extrinsic muscles of the larynx

A

all ‘hyoids
Digastric
Stylopharyngeus

Stylohyoid
Geniohyoid
Mylohyoid
Thyrohyoid

38
Q

Intrinsic muscles of Larynx

A

All ‘arytenoids plus
Aryepiglottic
Vocalis

Interarytenoid
Lateral cricoarytoid
Thyroarytenoid
Aryepiglottic
Vocalis

39
Q

Trachea location

A

Begins at C6 —> T4-5

40
Q

Carina Location

41
Q

R main stem bronchi

A

Takeoff angle 25 deg, 2.5 cm long

42
Q

L mainstem bronchi

A

45 deg takeoff, 5 cm long

43
Q

Increases as airway bifurcates:

A

-Number of airways
-Cross-sectional area
-Muscular layer

44
Q

Decreased as airway bifurcates:

A

-Airflow velocity
-Amount of cartilage
-Goblet cells (mucous)
-Ciliated cells (clear mucous)

45
Q

Difficult airway assessment

A
  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
Q

3-3-2 rule

A

-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
Q

Mallampati evaluation

A

P.U.S.H
Pillars
Uvula
Soft pallet
Hard Pallet

48
Q

Mallampati class 1

A

PUSH
Pillars, uvula, soft palate, hard palate

49
Q

Mallampati class II

A

Fauces
Soft palate
Uvula

50
Q

Mallampati class III

A

Soft palate
BASE of uvula
Hard palate

51
Q

Mallampati IV

A

Only hard palate visible

52
Q

Tests for difficult airway

A

-Mandibular protrusion test (lower teeth in front of upper teeth)
-Atlanto-occipital joint mobility (neck ROM)

53
Q

Indications of difficult supraglottic airway device placement and ventilation

A

RODS
-Restricted mouth opening
-Obstruction of upper airway
-Distortion of airway anatomy presenting adequate seal
-Stiff lungs

54
Q

Pressure for ventilation with LMA

A

No more than 20 cm H2O

55
Q

Conditions known for difficult airway management risk (bonus)

A

Pierre Robin
Treacher collins
Goldehar
Mucopolysacchar
Kipper feel
Down syndrome

Acquired issues

56
Q

Difficult bag-mask ventilation

A

BONES
Beard
Obesity
No teeth
Elderly
Sleep apnea, snoring

57
Q

Pro seal LMA

A

Has gastric drain tube for gastric decompression
Can inflate to 30 cm H2O because of ^

58
Q

LMA supreme

A

Disposable version, no gastric port

59
Q

Indications for tracheal intubation

A

-Anesthesia and surgical
-Surgical
-Medical

60
Q

Basic steps for planned difficult intubation

A

-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
Q

Patient Positioning for optimal intubation

A

Axes line up:
Oral axis
Pharyngeal Axis
Laryngeal Axis

62
Q

Difficult intubation basics

A
  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
Q

Extubating difficult airway

A

Extubate fully awake

64
Q

Complications of tracheal extubation

A

-Residual Neuromuscular blockade
-Laryngospasm
-Laryngotracheobronchitis

65
Q

Laryngospasm Pathway:

A

-Affferent limb: SLN internal branch
-Efferent limb: SLN external branch and RLN

66
Q

Signs of Laryngospasm

A

-Inspiratory strider
- SUprasternal and subraclavicular retraction during inspiration
-rocking horse appearance of chest wall
-lower rib flailing

67
Q

Factors that reduce likelihood of laryngopasms

A

-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
Q

Laryngospasm treatment

A
  1. 100% FiO2
  2. Remove noxious stimuli
  3. Deepen anesthesia
  4. CPAP 15-20 cm H2O with larson’s maneuver
  5. Administer such
69
Q

Laryngospasm risk factors (pre anesthetic)

A
  • active or recent upper respiratory tract infection
    -exposure to smoke
    -reactive airway dz
    -GERD
    -age less than 1
70
Q

Laryngospasm risk factors (in OR)

A

-Light anesthesia esp. with airway manipulation
-Saliva or blood in airway
-hyperventilation
-hypocapnia
-Surgical procedures involving the airway

71
Q

Larson’s Manuever

A

Laryngospasm notch
-displaces mandible
-causes pt to sigh

72
Q

Laryngospasm tax

A

-Larson’s
-Valsalva (exhalation against closed glottis)
-Muller (inhalation against closed glottis)

73
Q

Basic airway skills:

A

-Assess
-Plan AND backup plan
-anticipate
-recognize, implement, treat

Priniclpes Of Anesthesia (19 decks)

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