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My Anesthesiology > Airway Management > Flashcards

Airway Management Flashcards

(62 cards)

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1
Q

Definition of difficult mask ventilation

A

Inability to maintain O2sat > 90%

Inability to prevent/reverse signs of inadequate ventilation

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2
Q

Definition of difficult intubation/laryngoscopes

A

Successful intubation requiring more 3 attempts or taking longer than 10min

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3
Q

What innervates the hard and soft palate?

A

Palantine nerves

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4
Q

Innervation of the anterior 2/3 of tongue

A

Lingual n.

From mandibular branch of trigeminal

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5
Q

Innervates the posterior 1/3 tongue, soft palate, and oropharynx

A

Glossopharyngeal

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6
Q

What demarcates the border between the oropharynx and the hypopharynx?

A

Epiglottis

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7
Q

What separates the nasopharynx from the oropharynx

A

Soft palate

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8
Q

What innervates the hypopharynx?

A

Vagus via superior laryngeal n

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9
Q

Tongue obstruction during anesthesia is due to relaxation of which tongue muscle?

A

Genioglossus

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10
Q

Between what levels of cervical vertebrae does the larynx reside?

A

C3-C6

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11
Q

What is the function of the larynx?

A

Separate trachea from esophagus

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12
Q

Describe the areas of the larynx

A 
Epiglottis
Supra glottis
Vocal cords 
Glottis
Subglottis
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13
Q

What ligaments form the vocal cords?

A

Thyroarytenoid ligaments

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14
Q

What is the narrowest part of the adult airway

A

Vocal cords

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15
Q

Anatomical points where the trachea starts and ends

A

From C6 to carina
Carina overlies T5
10-15cm long

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16
Q

Nonreassuring interincisor distance?

A

<3 cm

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17
Q

Difficult Airway Algorithm:

Assess the likelihood and clinical impact of basic management problems: (A-D)

A

A. Difficult ventilation
B. Difficult intubation
C. Difficulty with pt cooperation or consent
D. Difficult tracheostomy

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18
Q

Difficult Airway Algorithm:

What’s step 2?

A

Actively pursue opps to deliver supplemental O2

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19
Q

What is Step 3 of the Difficult Airway Algorithm?

A

Consider the relative merits/feasibility of basic mgt choices:

A. Awake or GA intubation?
B. Noninvasive or invasive?
C. Spontaneous ventilation or not?

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20
Q

You induce GA and still can’t intubate. What now?

A

Difficult Airway Algorithm:

  1. Call for help
  2. Consider returning spontaneous V
  3. Awaken pt
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21
Q

You induce GA and can’t intubate and now can’t bag mask. What now?

A

Difficult Airway Algorithm:

Consider/attempt LMA

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22
Q

Induce GA and can’t intubate and now can’t place LMA now what?

A

Call for help if haven’t already
Emergency pathway!
Either noninvasive or invasive

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23
Q

How do you confirm successful intubation or LMA placement?

A

EtCO2
Watch for awhile in case it was a puff of gastric gases could imitate
PCO2 > 30 for 3-5 consecutive breaths

Symmetrical chest rise
Bilateral equal breath sounds
Fogging of tube

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24
Q

How to check neck ROM?

A

“Can you touch your chin to your chest?”

“How far can you bend your neck back?”

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25
Mallampati System
System to correlate the oropharyngeal space with ease of intubation
26
How do you check Mallampati score?
Eye level Open mouth maximally w/ head in neutral position Protrude tongue W/O phonating
27
Class I Mallampati
TONSILLAR PILLARS visible | + soft palate, uvula
28
Class II Mallampati
No tonsillar pillars but can still see uvula
29
Class III Mallampati
Only base of uvula visible
30
Class IV Mallampati
Soft palate not visible
31
What is the Cormack and Lehane score?
Correlate laryngoscopic view with oropharyngeal space
32
Why should you never use nasotracheal intubation in basilar skull fractures?
Can result in intracranial tube placement
33
Airway considerations for lower airway tumors (trachea, bronchi, mediastinal)
Airway obstruction may not be relieved by tracheal intubation
34
Airway considerations for radiation management
Fibrosis may distort the airway or make manipulation difficult
35
Airway considerations for Rheumatoid Arthritis
``` TMJ arthritis Immobile cervical vertebra Laryngeal rotation Cricoarytenoid arthritis Mandibular hypoplasia ```
36
Why do you need flexion of the NECK and extension of the HEAD?
Flex neck to align pharyngeal and laryngeal axes Extend head on AA to align oral and pharyngeal = sniffing position
37
Less than ideal thyromental distance
< 6-7cm Receding mandible Short neck = more acute angle between oral and pharyngeal axes, harder to bring to alignment
38
What is the end point of the difficult airway algorithm?
Emergency invasive access | Cricothyrotomy
39
Describe anatomical landmarks for a cricothyrotomy
Find thyroid cartilage | Slide down to locate membrane right below
40
Inability to intubate is not the biggest problem. What is?
Inability to oxygenate or ventilate Aspiration complications Combo of these factors
41
Predictors of Difficult Facemask Ventilation: | What age?
> 55 yo
42
Predictors of Difficult Facemask Ventilation: | What BMI?
> 26 BMI
43
Predictors of Difficult Facemask Ventilation: | What gender?
Make
44
Predictors of Difficult Facemask Ventilation: | What facial factors?
Beard Lack of teeth Limited ability to protrude mandible
45
Predictors of Difficult Facemask Ventilation: | List 4 more factors
History of snoring Repeated attempts at laryngoscopy Mallampati III and IV Neck radiation
46
Describe the placement of the facemask during bag ventilation
Upper border of the facemask should align with the pupils Sides seal nasolabial folds Bottom between lower lip and chin
47
DAWD
Preoxygenation allows for Duration of Apnea Without Desaturation
48
What is the ideal minute ventilation for O2 in an adult with IBW?
3mL/kg/min
49
T or F: DAWD is a function of MVO2 and the O2 reservoir of the FRC (~30-35 mL/kg)
T
50
What parameter indicates sufficient preoxygenation?
EtO2 > 90% | Ideally 3min
51
A healthy non-obese patient can maintain a SaO2 >90% for how long after preoxygenation?
~8.5min
52
Obesity can severely decrease DAWD. What measures can you take to address this?
100% O2 head up 10cm CPAP Followed by PPV (Set at peak P 14cm, PEEP 10) This can increase DAWD another min or so Decreases atelectasis and improves mismatch
53
Grabbing mask and face and doesn't seem like air is passing through? What issue with hand placement
Make sure your L hand is not compressing airway (not mashing mask into face) instead using fingers to pull up
54
What is your R hand doing during bag mask ventilation?
Generating positive pressure by compressing reservoir bag | ventilating P should not exceed 20 to not insufflate stomach
55
List indications for endotracheal intubation
``` Patent airway Prevent aspiration Facilitate positive P ventilation Operative position other than supine Operative site near upper airway Mask airway difficult Need for frequent suctioning ```
56
Ideal height of table for intubation
Bottom of table at belly button | Face near your xiphoid when standing
57
Describe Sellicks Maneuver
Cricoid pressure Downward pressure with your THUMB and INDEX finger Compress esophagus to prevent aspiration 30 Newtons of Force
58
Endotracheal tube sizes are based on what?
Internal diameter | Available in 0.5 increments
59
Indications for fiber optic intubation?
When difficult intubation by direct laryngoscopy is anticipated - can be done awake to elim risk of failed intubation and ventilation Unstable cervical spines - allows for assessment of neuro fxn Upper airway trauma
60
Contraindications of fiber optic intubation?
Lack of time Anything that impinges size of airway to prevent visualization Excessive blood and secretions Pharyngeal abscess - don't want aspiration of purulent material
61
Style points for fiber optic intubation
``` Antisialogogue (Glyco 0.2mg IV) Lidocaine spray GP nerve blocks (2 mL 2% lido inject @ depth 0.5 cm) ```
62
In tracheal extubation what are some signs of light anesthesia?
Disconjugate gaze Breath holding or coughing Not responsive to commands = inc risk of laryngospasm

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