Airway Management Flashcards
(49 cards)
Where is the larynx located in relation to cervical vertebrae in adults?
C4-6 (maybe C3 in women)
1st tracheal ring at C6
How many cartilages make up the larynx?
9
- 3 single (epiglottic, thyroid, cricoid)
- 3 pairs (arytenoid, corniuclate, cuneiform)
What is the approximate length of the trachea?
15cm
Where is the carina located in relation to thoracic vertebrae in adults?
T5
What are the most significant difference in the anatomy of the airway between kids and adults?
larynx is at C3-C4
narrowest part of the airway is = cricoid cartilage
epiglottis is longer, narrower and stiffer
vocal folds have a more anterior angle.
What nerves provide sensory and motor innervation to the pharynx?
Sensory = glossopharyngeal (IX) posterior 2/3 of tongue
Motor = accessory (XI)
Which nerves innervate the larynx?
Superior and recurrent laryngeal (X)
What areas/muscles of the larynx does the recurrent laryngeal nerve provide motor and sensory innervation?
all the intrinsic muscles of the larynx, except for the cricothyroid muscle
sensory below the vocal folds and trachea
What areas/muscles of the larynx does the external branch of the superior laryngeal nerve provide motor innervation?
cricothyroid muscle –> tenses the vocal cords
What areas/muscles of the larynx does the internal branch of the superior laryngeal nerve provide sensory innervation?
vocal cords
posterior surface of the epiglottis
aryepiglottic folds
arytenoids.
What nerve injury is associated with hoarseness?
Unilateral recurrent laryngeal nerve
What nerve injury is associated with respiratory distress?
Bilateral recurrent laryngeal nerve
What is the purpose or pre-oxygenation?
Replace nitrogen in lungs with oxygen –> FRC will be an O2 reservoir
Allows patient to tolerate apneic period without desaturating (O2 consumption ~250ml/min)
If unable to mask ventilate after induction, what is the next step?
Reassess patient positioning and masking technique
2 handed mask
oral or nasal airway
LMA
Name 4 advantages to doing an awake intubation
maintain spontaneous ventilation
decreased likelihood of airway obstruction
decreased risk of aspiration (depending on the block technique used)
performing a neurological examination after intubation if needed
What is the definition of a difficult airway?
the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation, difficulty with tracheal intubation, or both
What factors may predict difficult mask ventilation?
Obesity BMI >30 Mallampati 3-4 Beard Edentulous Limited mouth opening Snoring/OSA Age >55
Name some techniques available for difficult intubation
different laryngoscope blades awake intubation blind oral or nasal fiberoptic video laryngoscopy intubating stylet or tube changes rigid bronchoscope lightwand supraglottic airways as intubating conduits
What are some drugs used for tracheal intubation under spontaneous ventilation?
Sevo - fast onset, minimal irritation
What are keys to successful awake intubation?
Explain procedure
Develop rapport
Topical airway anesthesia
Anxiolysis w/ dex, ketamine, midaz, propofol, fentanyl
List some techniques in topical airway anesthesia
Nebulizers Topical sprays Gels Transtracheal injection of local Nerve blocks
What is the purpose of retrograde intubation?
Wire/catheter through cricothyroid membranr - pass tube over and advanced
Means to establish definitive airway when conventional techniques have failed
When might a Miller blade be considered a better option for intubation?
Laryngeal lesions
hypoplastic mandible
large, floppy epiglottis
What are the 5 elements of a cuffed endotracheal tube?
Valve - prevent air loss after inflation Pilot balloon Inflating tube Cuff Murphy eye - opening just proximal to tip to allow gas flow if distal tip obstructed
