Airway In Anesthesia

Front 1

Which cranial nerve innervates the nasal mucosa?

Back 1

"CN V. It splits into the anterior ethmoidal, nasopalatine & sphenopalatine nerves."

Front 2

Which oral surfaces are innervated by CN IX?

Back 2

"Posterior third of the tongue, the soft palate and the oropharynx."

Front 3

Which protective mechanism can be problematic in the larynx?

Back 3

"The separation of the trachea from the esophagus when swallowing. When exaggerated, this movement becomes laryngospasm."

Front 4

What is the narrowest portion of the adult airway?

Back 4

The vocal cords.

Front 5

What is the Mallampati classification?

Back 5

A system that helps evaluate oropharyngeal anatomy to determine how difficult intubation and laryngoscopy are likely to be. Airways are termed Class I – IV depending on their structure.

Front 6

Describe a Class I airway.

Back 6

"Soft palate, fauces, uvula and tonsilar pillars are visible."

Front 7

D Describe a Class II airway.

Back 7

"Soft palate, fauces & uvula are visible."

Front 8

Describe a Class III airway.

Back 8

The soft palate and the base of the uvula are visible.

Front 9

Describe a Class IV airway.

Back 9

The soft palate is visible.

Front 10

Which congenital syndromes are associated with difficult ET intubation?

Back 10

"Trisomy 21 (Lg tongue, am mouth; frequent laryngospasm); Goldenhar (Sm jaw and C-spine abnormality); Klippel-Feil (Cervical vertebral fusion); Pierre Robin (Sm mouth, Lg tongue, mandibular anomaly); Treacher Collins (difficult laryngoscopy); Turner (Difficult to intubate)."

Front 11

What is the Cormack and Lehane score?

Back 11

A score that classifies laryngoscopic views accoriding to the airway structures visualized. The scores range from Grade I to grade IV.

Front 12

Describe a Grade I airway.

Back 12

Most of the glottis is visible.

Front 13

Describe a Grade II airway.

Back 13

Only posterior portion of glottis is visible.

Front 14

Describe a Grade III airway.

Back 14

"The epiglottis, but no part of the glottis is visible."

Front 15

Describe a Grade IV airway.

Back 15

No airway structures are visible.

Front 16

Name two conditions that might make it difficult to intubate a patient.

Back 16

"C-spine injury, because spinal manipulation may injure the cord."

Back 17

"Acromegaly, due to lg tongue & bony overgrowths."

Back 18

Airway tumors or abscesses may block the airway.

Front 19

Why would you want to avoid nasal intubation on a patient with a basilar skull fracture?

Back 19

"You might end up with intracranial intubation, which is not very helpful!"

Front 20

Which head position provides optimal alignment for intubation?

Back 20

"The elevated sniffing position aligns the laryngeal axis, the pharyngeal axis and the oral axes; the elevated sniffing position may not be possible if the patient has a c-spine injury or abnormality."

Front 21

What variables might predict difficult facemask ventilation?

Back 21

"Age >55; BMI >26 kg/m3; beard, lack of teeth, history of snoring."

Front 22

What is Selleck’s maneuver? Why would you use it?

Back 22

Cricoid pressure applied by an assistant as you are intubating a patient. It compresses the espophagus and may help prevent spillage of GI contents into the pharynx before a tube is placed.

Front 23

Why would you want to use a low volume of air in the balloon on an ET tube?

Back 23

"Because that reduces the likelihood of ischemic damage to the trachea; however, ciliary denudation can occur under the cuff site after just two hours of pressure at less than 25 mmHg."

Front 24

What is the most reliable confirmation of ETT placement?

Back 24

Capnography – end-tidal PCO2 >30 mmHg for three to five consecutive breaths.

Front 25

What is the general depth pf placement of the ETT in the adult male and female?

Back 25

23 cm at the teeth or gums for the male; 21 cm at teeth or gums for the female.

Front 26

What is an absolute contraindication to fiberoptic endotracheal intubation?

Back 26

"Lack of time. If immediate airway management is needed, another technique should be used."

Front 27

Name some relative contraindications to fiberoptic intubation.

Back 27

"Anything that impinges on airway size will make it more difficult to use the fiberoptic system; also, conditions that might cause soiling of the fiberoptic bronchoscope like bleeding will make this a difficult technique to use."

Front 28

What is the formula for determining the size of the ET tube for an infant or child?

Back 28

(Age + 16)/4 = ET tube size.

Front 29

What is the difference between a Miller and a Macintosh laryngoscope blade?

Back 29

The Macintosh blade is curved; the Miller blade is straight (may have a slight curve just at the tip).

Front 30

What are some physiologic responses to endotracheal intubation?

Back 30

Hypertension and tachycardia. Cardiac dysrhythmias (particularly vent. bigeminy) can indicate light anesthesia.

Front 31

What is the earliest manifestation of bronchial intubation?

Back 31

"An increase in Peak Inspiratory Pressure. Some other clues include unilateral breath sounds, unexpected hypoxia (although this isn’t reliable at high FIO2) or inability to palpate the cuff in the sternal notch during inflation."

Front 32

Why should you reposition the tube if you can palpate the cuff above the level of the cricoid cartilage?

Back 32

Because prolonged intralaryngeal location may result in post-op hoarseness and increases risk of accidental extubation.

Front 33

Why might you avoid extubating the pt during a light plane of anesthesia?

Back 33

There is an increased risk of laryngospasm. Any reaction to suctioning usually indicates a light plane of anesthesia.

Front 34

When would you want to avoid extubating an awake patient?

Back 34

"When coughing or “bucking” and the associated increased heart rate, BP, CVP, intracranial pressure, intraocular pressure or intrabdominal pressure might be problematic; i.e., large abdominal surgical sites, pt’s with head trauma."