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pharm exam 1 > Anesthesia Exam 1 Week 1 - Diana > Flashcards

Anesthesia Exam 1 Week 1 - Diana Flashcards

(79 cards)

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1
Q

What is the mallampati classification definition?

A

Relationship between the size of the base of the tongue and the rest of the structures of the pharynx
ACRONYM PUSH
Remember that it is not a good predictor if used by itself

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2
Q

What are the Mallampati classes?

A

Class I: pillars, uvula, soft palate, hard palate
Class II: barely see pillars, half of uvula, soft palate and hard palate
Class III: soft palate and hard palate visible
Class IV: only hard palate visible

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3
Q

Thyromental distance

A

Distance from the mentum to the thyroid notch.
Ideally done with the neck fully extended. Can be done in-line
Helps determine how readily the laryngeal axis will fall in line with the pharyngeal axis.

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4
Q

What are the measurements of the thyromental distance

A

6.5 cm = no problem with laryngoscopy/
intubation
6 – 6.5 cm = difficult but possible laryngoscopy
< 6 cm = impossible laryngoscopy

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5
Q

What is the mandibular protrusion test?

A

Assesses the function of the temporomandibular joint
Class I: Patient can move lower incisors
Class II: Patient can move lower incisors in line with upper incisors
Class III: Patient cannot move lower incisors past upper incisors (risk for difficult intubation)

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6
Q

Where can you find the larynx anatomically?

A

the position of the hyoid bone marks the entrance to the larynx

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7
Q

where can you find the epiglottis?

A

Epiglottis arises from the thyroid and remains dorsal to the hyoid

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8
Q

MEDICAL HISTORY predictors of difficult airway

A

Joint disease, acromegaly, thyroid or major neck surgeries, tumors, genetic anomalies, epiglottitis, previous problems in surgery, diabetes, pregnancy, obesity, pain issues

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9
Q

What does MOANS stand for?

A 
Mask seal
Obese
Aged
No teeth/edentulousness
Snores or Stiff
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10
Q

What is the Atlanto Occipital Joint Mobility?

A

Assess alignment of oral, pharyngeal and laryngeal axis into a straight line by placing patient into the sniffing position.
Normal AO flexion and extension= 90-165 degrees
Normal AO extension= 35 degrees (laryngoscopy will be difficult if <23 degrees)

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11
Q

Conditions that impair AO mobility

TRAKSDD

A

Degenerative joint disease, Rheumatic arthritis, ankylosing spondylitis, trauma, surgical fixation, Klippel -Feil, Down syndrome, diabetes mellitus (joint glycosylation)

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12
Q

What is the Cormack and Lehane grading system?

A

helps us measure the view we obtain during direct vision laryngoscopy

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13
Q

Grade I

A

Complete or nearly complete view of the glottic opening

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14
Q

Grade 2

A

See-Posterior region of the glottic opening

Not see-anterior commisure

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15
Q

Grade 3

A

See-epiglottis only

Not see- any part of the glottic opening

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16
Q

Grade 4

A

see-Soft palate only

not see-any part of the larynx

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17
Q

LEMON

A 
Look externally
Evaluate 3-3-2
Mallampati
Obstruction
Neck mobility
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18
Q

RISK FACTORS for difficult intubation

A 
Long incisors
Overbite
Inability to sublux jaw
Retrognathic jaw or receding
Mallampati class 3 or 4
Decreased thyromental distance
Short thick neck
Reduced cervical mobilty
Small mouth opening
Arched and high palate
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19
Q

RISK FACTORS of difficult SGA placement

A 
Upper airway obstruction
Lower airway obstruction
Limited mouth opening
Poor lung compliance requiring high PIP
Increased airway resistance
Different pharyngeal anatomy which may prevent seal
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20
Q

RISK FACTORS for invasive airway airway placement (trach)

A 
Obesity
Short neck
Abnormal neck anatomy
Laryngeal edema
Hard access to crycothyroid membrane
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21
Q

NPO Guidelines

A

2 hours clear liquids
4 hours breast milk
6 hours nonhuman milk, infant formula, solid food
8 hours fried food

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22
Q

Angioedema

A

Results from increased vascular permeability that can lead to swelling of the face tongue and airway

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23
Q

Causes for angioedema

A
  1. ACE inhibitors- treat epinephrine, antihistamines, steroids
  2. Hereditary angioedema-C1 deficiency treat with C1 esterase concentrate or FFP
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24
Q

Ludwigs angina

A

Bacterial infection characterized by a rapidly progressing cellulitios in the floor of the mouth. Consequently compressing the submandibular, submaxillary, and sublingual spaces

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25
Pierre Robin
Small underdeveloped mandible A tongue that falls back and downwards Cleft palate Neonate often requires intubation
26
Treacher Collins
Small mouth, small/underdeveloped mandible Nasal airway is blocked by tissue Ocular and auricular anomalies
27
Trisonomy 21
Small mouth Large tongue AO instability Small subglottic diameter
28
klippel-Feil
Congenital fusion of cervical vertebrae leads to neck rigidity
29
Goldenhar
Small/underdeveloped mandible | cervical spine abnormality
30
Beckwith syndrome
Large tongue
31
Cri du chat
Small underdeveloped mandible Softening of the tissues of the larynx stridor
32
Adjust length of the vocal ligaments Vocalis Thyroarytenoid
Cricothyroid (enlongates) Shortens Shortens
33
Adducts vocal folds (glottic diameter)
Thyroarytenoid | Lateral crycogthyroid
34
Abducts vocal folds
Posterios cricoarytenoid
35
Sphincter function
Aryepiglottic-closes laryngeal vestibule | Interararytenoid-closes posterior commissure of glottis
36
Muscles that elevate the larynx
``` Stylohyoid Geniohyoid Mylohyoid Thyrohyoid Digastric Stylopharyngeous ```
37
Muscles that depress the larynx
Omohyoid Sternohyoid Sternothyroid
38
Glossopharyngel nerve IX
``` Posterior 1/3 of the tongue Roof of the pharynx Tonsils Soft palate Motor fibers to the stylopharyngeal muscle anterior side of the epiglottis EFFERENT LIMB OF THE GAG REFLEX ```
39
Trigeminal nerve
V1- anterior ethmoidal/ophthalmic-nares and 1/3 of nasal septum SENSORY V2-maxillary/sphenopalatine-turbinates and posterioir 2/3 of nasal septum and lateral wall SENSORY V3-lingual/mandibular-anterior two thirds of the toungue SENSORY AND MOTOR
40
Vagus nerve X
Innervates between epiglottis and vocal cords Superior laryngeal nerve 1. Internal laryngeal nerve (sensory) 2. External laryngeal nerve (motor)
41
Superior laryngeal nerve internal | BETCH
SENSORY-epiglottis, base of the toungue, supraglottic mucosa (hypopharynx), thyroepyglottic joint, cricothyroid joint NO MOTOR
42
Superior laryngeal external
SENSORY-anterior subglottic mucosa | MOTOR-cricothyroid
43
recurrent laryngeal nerve | PLIT
SENSORY-subglottic mucosa and muscle spindles | MOTOR-thyroarytenoid, lateral cricothyroid, interarytenoid, posterior cricoaretynoid
44
Recurrent laryngeal nerve
Innervates the larynx below vocal cords
45
Lateral cricoarytenoid muscles
Abducts vocal cords
46
Posterior cricoarytenoid muscles
Adducts vocal cords
47
Laryngeal nerve injury-VAGUS
Unilateral-hoarseness | Bilateral-aphonia (loss ability to speak)
48
Superior laryngeal nerve injury
Unilateral-minimal effects | Bilateral-hoarseness, tiring voice
49
Recurrent laryngeal nerve injury
unilateral-hoarseness Bilateral- acute:stridor, respiratory distress chronic:aphonia
50
Glossopharyngeal block
Needle is inserted at the base of the palatoglossal arch anterior tonsillar pillar at a deptj of 0.25-0.5 cm. Aspiration of air means that the needle is too deep. and should be withdrawn and redirected medially After correct positioning, 1-2 ml of local anesthetic is injected on both sides. There is a 5% incidence of intracarotid injection (risk of seizure)
51
Transtracheal block (recurrent laryngeal nerve) All intrinsic muscles except cricothyroid muscle)
The needle is advanced in a caudal direction as it penetrates the cricothyroid membrane. After aspiration and before injection, the patient should take a deep breath. During that inspiration 3-5 ml of local anesthetic is injected. The patient will cough, spraying the local up through the cords.
52
Superior laryngeal nerve block (posterior side of epiglottis level of vocal cords)
Anesthetic is injected at the inferior border of the greater cornu of the hyoid bone. 1 ml is injected above the thyrohyoid membreane, then 2 ml is injected 2-3 mm beneath the thyroid membrane. Aspiration of air means the needle is to deep.
53
Laryngospasm
The sensory innervation is held by the superior laryngeal nerve internal branch
54
Pre-anesthetic
Acute or recent upper airway respiratory infection (2 weeks) Exposure to second hand smoke Reactive airway disease GERD, age less than 1 year
55
Signs
Inspiratory stridor Suprasternal and supraclavicular retraction during inspiration, rocking hornse appearance of chest wall, increased diaphragmatic excursion, lower rib flailing
56
What can you do to reduce its incidence?
1. Avoidance of airway manipulation during light anesthesia 2. CPAP 5/10 during inhalation induction as well as immediately post extubation 3. Removal of pharyngeal secretions and blood prior to extubation 4. tracheal extubation when fully anesthetized or fully awake not in between 5. Laryngeal lidocaine/IV lidocaine prior extubation 6. Hypercapnia/Hypoventilation
57
Treatment
1. Fio2 100% 2. Remove noxious stimulation 3. Deepen anesthesia by increasing the concentration of inhalation agent or with a small dose of propofol or lidocaine 4. CPAP 25-20 while instituting maneuverst that open the airway 5. If IV sccess succx 5 If no IV access
58
Trachea facts
Begins at C6, ends at T4-T5 at the carina, 2.5 cm wide, 10-13 cm long, cricoid cartilage is only complete ring, semicirular rings open posteriorly ciliated columnar eputhelum Sensory innervation:Vagus
59
Trachea blood supply
Inferior thyroid artery Superior thyroid artery Bronchial artery Internal thoracic artery
60
Pores of khon
allow air movement between alveoli
61
Pneumocytes Type I cells
flat squamous cells covering 80% of alveolar surface froming tight juctions
62
Pneumocytes Type 2 cells
Produce surfactant resistant to oxygen toxicity, capable of cell division, can produce type I cells
63
Pneumocytes Type 3
Macrophages, fight lung infection, produce inflammatory response. Neutrophils are present in the alveolus in smokers and with acute lung injury
64
Airway equipment
1. 2 cuffed endotracheal tubes 2. Laryngoscope blades and handles 3. Face mask of adequate fit. Back up AMBU BAG 4. Face strap 5. suction 6. Machine check 7. Laryngeal mask 8. NPA and OPA 9. Tongue blade 10. Difficult airway cart
65
Face mask
Ventilate the anesthetized patient Create a tight seal with patient’s face for effective ventilation Eyes = corneal abrasions Deflation of breathing bag indicates leakage (CHECK YOUR PATIENT) High breathing circuit pressures without chest movement indicate obstruction of the airway Limit ventilation pressures to <20cm H20
66
OPA/NPA
Used to create an air passage in the anesthetized patient after loss of muscle tone Oral airways: 3 sizes for adults (80, 90, 100mm) Nasal airways: several sizes, estimate length from nares to the ear meatus Nasal airways are tolerated better by the lightly anesthetized patient
67
LMA
Inserted in the hypopharynx Inflate to create a low pressure seal at entrance of larynx LMA protects the larynx from pharyngeal secretions only Ideal for short cases Not a definitive airway – supraglottic device No aspiration protection May use Proseal LMA if concerned about gastric contents
68
BVM
With the middle, ring, and pinkie fingers placed along the madibular bone, the mandible is pulled up into the mask. The index and thumb are used to create a tight seal around the mouth and nose.
69
Airway support during induction
1. Assure ability to bag mask ventilate prior to administering muscle relaxant 2. keep the airway open- sniffing position-jaw trust, insert correct fitting OPA/NPA 3. keep the APL pressure less than 20 cmh20
70
Large tongue non reassuring airway finding
Big Tongue | Beck with syndrome, Trisonomy 21
71
Small underdeveloped mandible non reassuring airway finding
``` Please Get That Chin Pierre Robin Goldenhar Treacher Collins Cri du Chat ```
72
Cervical Spine Anomaly non reassuring airway finding
Kids Try Gold Klippel-Feil Trisonomy 21 Goldehar
73
Modifications for Obesity
Place chest higher than the head | Utilize HELP postion
74
NPA contraindications
``` Cribiform plate injury Coagulopathy Previous transphenoidal hypophysectomy Previous Cadwell Luc procedure Nasal fracture ```
75
Large Toungue
Big Tongue Beckwith Syndrome Trisonomy 21
76
Small underdeveloped mandible
``` Please Get That Chin Pierre Robin Goldenhar Treacher Collins Cri du Chat ```
77
Cervical Spine Anomaly
Kids Try Gold Klkippel-Feil Trisonomy 21 Goldenhar
78
OPA types
Guedel Berman Williams-blind orotracheal intubation and fiberoptic Ovaspassapian-fiberoptic
79
ETT design
Inflating the cube occludes the trachea permitting positive pressure ventilation and protects lungs from aspuration of gastric contents. CUFF PRESSURE SHOULD BE LESS THAN 25 CM H20

pharm exam 1 (12 decks)

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