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AS - N928 Basic Principles of Anesthesia > Airway > Flashcards

Airway Flashcards

(59 cards)

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1
Q

Posterior Cricoarytenoid

A

Larynx INTRINSIC

Abducts (opens) the vocal cords and opens the glottis

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2
Q

Lateral Cricoarytenoid

A

Larynx INTRINSIC

Adducts (closes) the vocal cords

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3
Q

Arytenoids

A

Larynx INTRINSIC

Adducts (closes) the vocal cords

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4
Q

Cricothyroid

A

Larynx INTRINSIC
Produces cord tension, closure, & elongates the vocal cords
Laryngospasm results in total & profound glottic closure

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5
Q

Thyroarytenoid

A

Larynx INTRINSIC

Shortens & relaxes the vocal cords

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6
Q

Sternohyoid

A

Larynx EXTRINSIC

Draws hyoid bone inferiorly

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7
Q

Sternothyroid

A

Larynx EXTRINSIC

Draws thyroid cartilage caudal

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8
Q

Thyrohyoid

A

Larynx EXTRINSIC
Connects thyroid cartilage w/ hyoid bone
Draws hyoid bone inferiorly
Internal SLN penetrate the membrane at hyoid cornu

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9
Q

Omohyoid

A

Larynx EXTRINSIC

Draws hyoid bone caudal

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10
Q

Stylohyoid

A

Larynx EXTRINSIC

Elevates the larynx

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11
Q

Mylohyoid

A

Larynx EXTRINSIC

Elevates the larynx

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12
Q

Trigeminal

A

Cranial nerve V
Lingual nerve (mandibular division)
Sensory & motor
Anterior 2/3 tongue

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13
Q

Facial Nerve

A 
Cranial nerve VII
Sensory & motor
Taste to anterior 2/3 tongue
Facial muscles - expression
Motor control stylohyoid laryngeal muscle
Salivary glands (PSNS stimulation)
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14
Q

Glossopharyngeal

A

Cranial nerve IX
Sensory & motor
Posterior 1/3 tongue

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15
Q

Vagus

A

Cranial nerve X
Sensory & motor
Innervates airway below the epiglottis
SLN & RLN

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16
Q

Hypoglossal

A

Cranial nerve XII
Motor below/behind the tongue
Impaired nerve or injury → airway obstruction d/t tongue relaxation

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17
Q

Nasopharynx

A

Anterior to C1

Contains nasal septum, turbinates, & adenoids

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18
Q

Oropharynx

A

C2-C3 level
Opens into mouth anteriorly
1° obstruction = tongue d/t ↓genioglossus muscle tone

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19
Q

Hypopharynx

A

Posterior to larynx
Leads to the esophagus
Superior border - epiglottis
Inferior border - cricoid cartilage

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20
Q

Cricoid Cartilage

A

COMPLETE RING
C5-C6
Narrowest portion in pediatric airway
Sellick’s maneuver (cricoid pressure) site

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21
Q

Waldeyer’s Tonsillar Ring

A

Pharyngeal tonsils (adenoids) located in nasopharynx
Palatine tonsils located in oropharynx
Lingual tonsils located at tongue base
(Tubal tonsils)

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22
Q

Larynx

A

Adults C3-C6
Infants/children C2-C4 (descends to C4-C5 by age 5)
Phonation & valve to protect lower airways
Located at junction b/w airway & esophagus

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23
Q

NINE Cartilages

A 
Thyroid
Cricoid
Epiglottic
Arytenoid (posterior pair)
Corniculate (middle pair)
Cuneiform (lateral pair)
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24
Q

Epiglottis

Study These Flashcards
A

Broad leaf-shape
Sits at tongue base & separates hypopharynx from larynx
Covers laryngeal opening during swallowing to protect against aspiration
Vascular area → trauma & swelling

25
Vestibular Folds
False vocal cords | Narrow bands fibrous tissue on either side larynx
26
Vocal Cords
True cords Pale, white ligamentous structures Attach to thyroid anteriorly & arytenoids posteriorly
27
Glottic Opening
Narrowest portion in adult airway Average width 6-9mm (able to stretch up to 12mm) *Children narrowest airway portion lies just below the vocal cords at the cricoid ring
28
Thyroid Cartilage
Anterior neck thyroid notch Largest larynx cartilage Vocal cords are attached anteriorly
29
Cricothyroid Membrane
Relatively avascular Attaches thyroid cartilage to the cricoid cartilage anteriorly Emergency airway
30
Trachea
Begins at C6 at inferior cricoid cartilage border & extends to carina Approximately 10-15cm Cricoid cartilage = only complete ring 16-20 cartilagenous rings anteriorly Bifurcates to R/L maintain bronchus at T5 level - R bronchus 25-30° angle - L bronchus 45°
31
Pediatric Airway
- Larynx positioned higher - Tongue larger relative to mouth size - Epiglottis large, stiffer, angled more posteriorly (omega shape) - Head & occiput larger relative to body size - Short neck - Narrow nares - Cricoid ring = narrowest region
32
INTRINSIC Larynx Muscles
Open, close, & control vocal cord tension
33
EXTRINSIC Larynx Muscles
Connect larynx w/ hyoid bone & other structures | Serve to move larynx as whole (elevating & depressing) during phonation, swallowing, & breathing
34
SLN
- Internal sensation SIS to larynx epiglottis to vocal cords (ABOVE) - External motor SEM innervation to cricothyroid muscle → laryngospasm
35
RLN
Sensory: - Provides sensation to larynx BELOW vocal cords & upper esophagus Motor: - Innervates all larynx muscles EXCEPT cricothyroid - R leaves Vagus at subclavian level & loops UP - L leaves Vagus at aortic arch level & loops UP - Runs in groove alongside the trachea
36
Laryngeal Nerve Injury
SLN Unilateral - minimal effects Bilateral - hoarseness & vocal tiring ``` RLN Unilateral - hoarseness Bilateral - Acute → stridor & respiratory distress d/t unopposed cricothyroid muscle tension - Chronic → aphonia ```
37
Laryngeal Blood Supply
Superior laryngeal artery - Blood supply to supraglottic laryngeal structures - Carotid to superior thyroid artery to SLA Inferior laryngeal artery - Blood supply to infraglottic laryngeal structures - Subclavian to inferior thyroid artery to ILA Venous drainage - Superior/inferior thyroid veins to SVC
38
Atlanto-Occipital Joint
"Sniffing position" Align oral, pharyngeal, & laryngeal axes → optimal cord visualization PiLlow aligns pharyngeal & laryngeal axes then extend to head to align the oral axis Creates the shortest distance to intubate - straight line from incisor teeth to the glottic opening Normal extension = 35° Limited neck mobility <12° extension
39
Temporomandibular Mobility
Mouth opening or inter-incisor gap Normal 30-40mm or 2-3 fingerbreadths <2 fingerbreadths indicates difficult airway 3 fingerbreadths = ideal
40
Mallampati Sensitivity
True positive | 60-80%
41
Mallampati Specificity
True negative | 50-80%
42
Mallampati I
CLASS I | Hard & soft palate, tonsillar pillars, & uvula visible
43
Mallampati II
CLASS II | Hard & soft palate, tonsillar pillars, & partial uvula
44
Mallampati III
CLASS III | Hard & soft palate w/ uvula base visible
45
Mallampati IV
CLASS IV | Only hard palate visible
46
Upper Lip Bite Test
Assesses mandible mobility (protrusion)
47
Thyromental Distance
``` Patil's test Reflects amount space to displace the tongue Sniffing position w/ mouth closed Distance from thyroid cartilage notch to mentum tip Normal >6cm Retrognathia <6cm ↑risk difficult airway 6-7cm = questionable 7-8cm typically easy intubation ``` Considerations: - Chin implant (assess for scar) - Plastic surgery potential to distort anatomy
48
Sternomental Distance
Sniffing position w/ mouth closed Distance between sternal notch & mentum Normal > 13.5cm
49
Prayer Sign
Assesses joints & ability to align oropharyngeal & laryngeal axes Negative - palms flat together Positive - unable to place palms flat
50
Neck Circumference
> 45cm indicates difficult intubation Average male 38cm Literature varies 42-50cm
51
STOP BANG
``` Snoring Tired Observed apnea Pressure HTN BMI >35kg/m^2 Age >50yo Neck circumference >45cm Gender M ```
52
Cormack-Lehane I
GRADE I | Full view glottic opening & arytenoid cartilages
53
Cormack-Lehane II
GRADE II Posterior portion glottic opening & arytenoid cartilage visible Unable to visualize full vocal cords
54
Cormack-Lehane III
GRADE III Only epiglottis visible Unable to visualize glottic opening or cords
55
Cormack-Lehane IV
GRADE IV Only soft palate visible No recognizable laryngeal structures
56
Difficult Mask Ventilation
``` Beard Obesity BMI > 26kg/m^2 Neck circumference Age > 55yo Edentulous - no teeth especially upper unable to obtain/maintain proper mask seal OSA or snores ```
57
Predicting Difficult Intubation
``` Look externally Evaluate the mandibular space Mallampati classification Obstructions Neck mobility ROM ```
58
Sellick's Maneuver
Cricoid Pressure Protects against passive aspiration Compress/occlude esophageal lumen b/w cricoid cartilage & cervical spine RSI apply 3lbs initially when push induction drugs then ↑6.6-8.8lbs or 3-4kg
59
Cricoid Pressure Contraindications
``` Neck injury (C-collar) Esophageal rupture/tear Active emesis (opposing forces → esophageal rupture) ```

AS - N928 Basic Principles of Anesthesia (18 decks)

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