Week 1 - airway assessment Flashcards
(67 cards)
What is a Difficult Airway?
Failure to intubate with conventional laryngoscopy after three attempts and/or failure to intubate for more than 10 minutes
A difficult airway may present as difficulty with ventilation, rigid laryngoscopic tracheal intubation, or both.
What are the three categories of Difficult Airway?
- Recognized or known difficult airway
- Unrecognized or unexpected difficult airway
- Potential difficult airway
What is the difference between difficult airway and difficult intubation?
A difficult airway involves difficulty with mask ventilation or tracheal intubation, while difficult intubation requires more than 3 attempts or more than 10 minutes of laryngoscopy.
What percentage of difficult airway claims occur during the perioperative period?
67%
This statistic highlights the critical nature of airway management during anesthesia.
What is the purpose of the Closed Claims Analysis?
To identify patterns of liability associated with malpractice claims arising from management of the difficult airway.
What assessments are important for airway evaluation?
- Patient history
- Physical examination
- Mallampati score
- Atlanto-occipital joint extension
- Thyromental distance
- Inter-incisor distance
- Neck circumference
What does the Mallampati score assess?
The relative size of the base of the tongue compared to the oropharyngeal opening to predict a difficult airway.
What is the Cormack-Lehane Classification used for?
A grading system for laryngoscopy that describes the best view of the glottis.
What are the grades defined in the Cormack-Lehane Classification?
- Grade 1: The entire laryngeal aperture
- Grade 2: Only the posterior aperture
- Grade 3: Arytenoids
- Grade 4: Epiglottis
What are key anatomical features that may indicate a difficult airway?
- Small mouth
- Receding chin
- High arched palate
- Large tongue
- Morbid obesity
What conditions can predispose a patient to a difficult airway?
- Infections (e.g., epiglottitis)
- Trauma (e.g., maxillofacial trauma)
- Endocrine conditions (e.g., morbid obesity)
- Congenital conditions (e.g., Pierre Robin Syndrome)
- Physiologic conditions (e.g., pregnancy)
What is the MOANS mnemonic used for?
Evaluation of Difficult Bag-Mask Ventilation:
* Mask seal
* Obstruction or obesity
* Age
* No teeth
* Stiff lungs
What is the significance of a short thyromental distance?
It is a predictor of a difficult airway.
What airway equipment is essential for managing a difficult airway?
- Suction
- Laryngoscope
- Endotracheal tubes
- Bougie
- Video laryngoscope
What are the components of the Airway Approach Algorithm?
- Rapid Sequence Induction
- Aspiration prophylaxis
- Optimize intubating conditions
- Denitrogenate - Pre-oxygenation
- IV induction agent + Succinylcholine
What are the factors contributing to airway difficulties in pregnancy?
- Mucosal vascular engorgement
- Laryngeal edema
- Immobility of the floor of the mouth
- Enlarged breast and general weight gain
What is the incidence of failed intubation during a c-section?
1 in 300
True or False: A large neck circumference is associated with an increased risk of aspiration.
True
Fill in the blank: A _______ is a clinical situation where an anesthesia provider has difficulty with mask ventilation or tracheal intubation.
[Difficult Airway]
What is the importance of assessing the airway in both sitting and supine positions?
To evaluate for potential airway difficulties, especially in obese patients.
What should be done if airway obstruction occurs and is not relieved by an oral airway?
Stop the Sevoflurane and establish an airway with the patient awake.
Sevoflurane is an inhalational anesthetic agent.
What does the MOANS mnemonic stand for in the evaluation of difficult bag-mask ventilation?
- M: Mask seal
- O: Obstruction or obesity
- A: Aged
- N: No teeth
- S: Stiffness (resistance to ventilation)
This mnemonic helps remember factors affecting mask ventilation.
What are the four endpoints provided by the Difficulty Airway Algorithm?
- Intubation awake or sleep
- Intubation emergent or nonemergent
- Approach supraglottic or subglottic
- Airway access surgical or nonsurgical
These endpoints guide the practitioner in managing difficult airways.
What is the purpose of the ASA Difficulty Airway Algorithm?
To facilitate the management of the difficult airway and reduce the likelihood of adverse outcomes.
Adverse outcomes include death, brain injury, and airway trauma.
