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Ch 27: Airway Management > General > Flashcards

Flashcards in General Deck (123)
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1

List the anatomic differences between paediatric and adult airways (8).

1) Proportionately smaller infant/child larynx 2) Narrowest portion: Cricoid cartilage in infant/child; vocal folds in adult 3) Relative vertical location: C3–C5 in infant/child; C4–C6 in adult 4) Epiglottis: Longer, narrower, and stiffer in infant/child 5) Aryepiglottic folds closer to midline in infant/child 6) Vocal folds: Anterior angle with respect to perpendicular axis of larynx in infant/child 7) Pliable laryngeal cartilage in infant/child 8) Mucosa more vulnerable to trauma in infant/child

2

What are the main laryngeal muscle groups?

1) extrinsic - move the larynx as a whole 2) intrinsic - move the various cartilages in relation to each other

3

What is the innervation of the larynx?

2 branches of each vagus nerve a) superior laryngeal b) recurrent laryngeal

4

The ____________ nerve supply all of the intrinsic muscles of the larynx except for the ____________

recurrent laryngeal, cricothyroid

5

List the characteristics of the cricothryoid membrane

1) joins the superior aspect of the cricoid cartilage and the inferior edge of the thyroid cartilage 2) 8-12mm in width, 10.4-13.7mm in height 3) 1-1.5 finger breadths below the laryngeal prominence/thyroid notch 4) central portion known as the conus elasticus and two lateral thinner portions 5) proximity to the vocal folds (which may be 0.9 cm above the ligaments’ upper border) *** any incisions should be made in the lower 1/3 and pointed posteriorly, to his the back side of the cricoid cartilage ring

6

In the adult, the first tracheal ring is anterior to the ________ cervical vertebrae.

sixth

7

The trachea ends at the carina, opposite the _______ thoracic vertebra)

fifth

8

Cartilaginous rings support the first _____ generations of the bronchi.

seven

9

What airway anomalies are associated with Pierre Robin syndrome

Micrognathia, macroglossia, glossoptosis, cleft soft palate

10

What airway anomalies are associated with Treacher Collins syndrome

Auricular and ocular defects; malar and mandibular hypoplasia, microstomia, choanal atresia

11

What airway anomalies are associated with Goldenhar syndrome

Auricular and ocular defects; malar and mandibular hypoplasia; occipitalization of atlas

12

What airway anomalies are associated with Down syndrome

Poorly developed or absent bridge of the nose; macroglossia, microcephaly, cervical spine abnormalities

13

What airway anomalies are associated with Klippel–Feil syndrome

Congenital fusion of a variable number of cervical vertebrae; restriction of neck movement

14

What airway anomalies are associated with Alpert syndrome

Maxillary hypoplasia, prognathism, cleft soft palate, tracheobronchial cartilaginous anomalies

15

What airway anomalies are associated with Beckwith syndrome

Macroglossia

16

What airway anomalies are associated with Cretinism

Absent thyroid tissue or defective synthesis of thyroxine; macroglossia, goiter, compression of trachea, deviation of larynx/trachea

17

What airway anomalies are associated with Cri du chat syndrome

Microcephaly, micrognathia, laryngomalacia, stridor

18

What airway anomalies are associated with Meckel syndrome

Microcephaly, micrognathia, cleft epiglottis

19

What airway anomalies are associated with von Recklinghausen disease

Increased incidence of pheochromocytoma; tumors may occur in the larynx and right ventricle outflow tract

20

What airway anomalies are associated with Hurler/Hunter syndrome

Stiff joints, upper airway obstruction due to infiltration of lymphoid tissue; abnormal tracheobronchial cartilages

21

What airway anomalies are associated with Pompe disease

Muscle deposits, macroglossia

22

What airway anomalies are associated with Rheumatoid arthritis

Temporomandibular joint ankylosis, cricoarytenoid arthritis, deviation of larynx, restricted mobility of cervical spine

23

What airway anomalies are associated with Ankylosing spondylitis

Ankylosis of cervical spine; less commonly ankylosis of temporomandibular joints; lack of mobility of cervical spine

24

What airway anomalies are associated with Acromegaly

Macroglossia; prognathism

25

What are the sensitivity and specificity of the Mallampati score?

49, 86

26

What are the sensitivity and specificity of the thyromental distance?

20, 94

27

What are the sensitivity and specificity of the sternomental distance?

62, 82

28

What are the sensitivity and specificity of mouth opening?

46, 89

29

What are the 4 conditions in which tracheal intubation should be considered non-routine?

(1) The presence of equally important priorities to the management of the airway (such as a full stomach or open globe) (2) abnormal airway anatomy (3) an emergency (4) direct injury to the upper airway and lar- ynx and/or trachea.

30

What are the criteria for difficult BMV?

1) Inability for one anesthesiologist to maintain oxygen saturation >92% 2) Significant gas leak around face mask 3) Need for ≥4 L/min gas flow (or use of fresh gas flow button more than twice) 4) No chest movement 5) Two-handed mask ventilation needed 6) Change of operator required