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
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
What is the innervation of the larynx?
2 branches of each vagus nerve a) superior laryngeal b) recurrent laryngeal
The ____________ nerve supply all of the intrinsic muscles of the larynx except for the ____________
recurrent laryngeal, cricothyroid
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
In the adult, the first tracheal ring is anterior to the ________ cervical vertebrae.
The trachea ends at the carina, opposite the _______ thoracic vertebra)
Cartilaginous rings support the first _____ generations of the bronchi.
What airway anomalies are associated with Pierre Robin syndrome
Micrognathia, macroglossia, glossoptosis, cleft soft palate
What airway anomalies are associated with Treacher Collins syndrome
Auricular and ocular defects; malar and mandibular hypoplasia, microstomia, choanal atresia
What airway anomalies are associated with Goldenhar syndrome
Auricular and ocular defects; malar and mandibular hypoplasia; occipitalization of atlas
What airway anomalies are associated with Down syndrome
Poorly developed or absent bridge of the nose; macroglossia, microcephaly, cervical spine abnormalities
What airway anomalies are associated with Klippel–Feil syndrome
Congenital fusion of a variable number of cervical vertebrae; restriction of neck movement
What airway anomalies are associated with Alpert syndrome
Maxillary hypoplasia, prognathism, cleft soft palate, tracheobronchial cartilaginous anomalies
What airway anomalies are associated with Beckwith syndrome
What airway anomalies are associated with Cretinism
Absent thyroid tissue or defective synthesis of thyroxine; macroglossia, goiter, compression of trachea, deviation of larynx/trachea
What airway anomalies are associated with Cri du chat syndrome
Microcephaly, micrognathia, laryngomalacia, stridor
What airway anomalies are associated with Meckel syndrome
Microcephaly, micrognathia, cleft epiglottis
What airway anomalies are associated with von Recklinghausen disease
Increased incidence of pheochromocytoma; tumors may occur in the larynx and right ventricle outflow tract
What airway anomalies are associated with Hurler/Hunter syndrome
Stiff joints, upper airway obstruction due to infiltration of lymphoid tissue; abnormal tracheobronchial cartilages
What airway anomalies are associated with Pompe disease
Muscle deposits, macroglossia
What airway anomalies are associated with Rheumatoid arthritis
Temporomandibular joint ankylosis, cricoarytenoid arthritis, deviation of larynx, restricted mobility of cervical spine
What airway anomalies are associated with Ankylosing spondylitis
Ankylosis of cervical spine; less commonly ankylosis of temporomandibular joints; lack of mobility of cervical spine
What airway anomalies are associated with Acromegaly
What are the sensitivity and specificity of the Mallampati score?
What are the sensitivity and specificity of the thyromental distance?
What are the sensitivity and specificity of the sternomental distance?
What are the sensitivity and specificity of mouth opening?
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.
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