The Airway

  1. Where is the upper esophageal sphincter??? What is its job??
    at the lower edge of the hypopharynx

    acts as barrier to regurgitation
  2. What is CN 7 and what does it innervate??
    facial nerve

    innervates taste on the anterior 2/3 of the tongue
  3. What is CN 9? What does it innervate??

    • -sensory and taste to the posterior 1/3 of tongue & pharynx
    • -sensory to tonsils, pillars, oropharyngeal mucosa
    • -Gag reflex
  4. What is CN 10?? It divides into two parts.. what are they??
    Vagus nerve

    divides into superior laryngeal nerve and recurrent laryngeal nerve
  5. What does the superior laryngeal nerve innervate??
    internal division --- sensory info above the vocal cords

    external division --- cricothyroid muscles
  6. What does the recurrent laryngeal nerve innervate?
    • sensory below vocal cords &
    • all musculature of larynx except above the cicrothyroid
  7. What is CN 12?? and what does it innervate?

    motor function of tongue
  8. Together what do CN 9, 10 and 11 do...
    innervate all the muscles of the pharynx, larynx and soft palate
  9. Unilateral injury to the recurrent laryngeal nerves causes what??
  10. Bilateral injury to the recurrent laryngeal nerve causes what??
    stridor, resp. distress from unopposed adduction and tension of the cricothyroid muscles-- (Come together and you can't get them apart)
  11. The larynx extends from _____ to _____.
    epiglottis to cricoid cartlidge
  12. What are the 3 single and paired cartilages of the larynx??
    • 3 single --- cricoid, thyroid, epiglottic
    • 3 paired --- arytenoids, corniculate, cuneiform
  13. What are the only cartilages that are completely circular???  What are the rest of the cartilages shaped like??

  14. What is the carina???
    the point at which the left and right main stem bronchi divide
  15. Where does the trachea begin and end?
    at the cricoid cartilage and ends at the carina
  16. What kind of cartilage is the trachea composed of??
    c-shaped cartilage anteriorly
  17. What is the angle of the right mainstem??? left mainstem???
    25 degrees

    45 degrees
  18. What are the Han's Mask Ventilation classifications???
    Grade 0
    Grade 1
    Grade 2
    Grade 3
    Grade 4
    • 0 = ventilation by mask not attempted
    • 1 = ventilated by mask
    • 2 = ventilated by mask with oral airway or other adjuvant
    • 3 = difficult mask ventilation (inadequate, unstable or requiring two people)
    • 4 = unable to mask ventilate
  19. Name some predictors of a DIFFICULT MASK ventilation...
    • NG tube
    • facial hair
    • edentulous (no teeth)
    • obesity
    • OSA (obstructive sleep apnea)
    • abnormal anatomy (tonsils, tumors, radiation)
  20. Airway classification
    Possibly difficult:
    Probably difficult:
    Very difficult:
    Easy--- soft palate, fauces, uvula, and anterior and posterior tonsilar pillars seen

    Possibly difficult --- tonsillary pillars hidden by tongue

    Probably difficult --- only base of uvula seen

    Very difficult --- even uvula not visualized
  21. If you can not ventilate a patient, you can not ____ a patient.
  22. When you intubate a patient you want them to be in the _____ position.

    head flex to 35 degrees, extended to 80 degrees
  23. What are some signs you will notice if you patient is not receiving adequate ventilation??
    air leaking, cyanosis, decreased O2 sat, absent breath sounds, gastric distension (blowing air into belly)
  24. How would you define a difficult intubation??
    • 1. best attempt by a reasonably experienced anesthetist fails
    • 2. usually 3 attempts at this
    • 3. greater than 10 mins of struggle
  25. If you expect a patient to be a difficult intubation it is most important to remember that your.....
    1st shot is the best shot!!!
  26. What is cricoid pressure?
    increased pressure placed in the cricoid area to prevent regurg... this doesn't help you see things just prevents aspiration
  27. If cords are not in view what should you aim for??
    bubbles -- lets you know this is where the opening is
  28. What is OELM?  What does it mean??
    optimal esophageal laryngeal manipulation

    • posterior, cephalad pressure on the larynx
    • can improve visualization by a whole grade

    means you're doing external manipulation to make the vocal cords bubble
  29. What is BURP??? what does it mean???
    Backwards, upwards, rightwards pressure

    means -- to get things more into a view where you can see!
  30. What are some AIRWAY characteristics of a difficult intubation???
    • decreased mouth opening
    • short thyromental distance
    • poor visualization of hypopharynx
    • limited neck extension
  32. You want the mouth opening to be > than???
    2 cm or 3 fingerbreadths
  33. What should the thyromental distance be??
    >6cm or 3 fingerbreadths
  34. Name some techniques you should think about when you know a patient will be difficult to ventilate...
    • 1. oral/nasal adjuncts (think about this first)
    • 2. two person mask
    • 3. laryngeal mask
    • 4. combitube
    • 5. rigid ventilating bronchoscope
    • 6. transtracheal jet ventilation (using 100% o2, trying to oxygenate not ventilate)
    • 7. invasive airway access (trach)
  35. What are some things you can do when you need to intubate someone who you know will be difficult....
    • 1. use alternative laryngoscope blades
    • 2. use fiberoptic intubation
    • 3. blind intubations (patient must be spontaneously breathing)
    • 4. LMA conduit
    • 5. light wand
    • 6. retrograde wire
    • 7. invasive airway access
  36. LMAs do not protect the patient from....
    aspiration and regurg
  37. Where should the tip of your LMA sit??
    tip of cuff rests in inferior recess of hypopharynx above esophageal sphincter

    sides of cuff face into pyriform fossae

    upper borders of lma rest against the base of the tongue
  38. What are 3 keys to success with LMA placement??
    • 1. get the tongue out of the way (give them a big dose of diprivan)
    • 2. lubricate LMA (NO LIDOCAINE)
    • 3. put pressure on hard palate to help slide LMA in
  39. What are 3 limitations of using an LMA??
    • 1. it is temporary
    • 2. does not protect against regurg and aspiration
    • 3. long term use can lead to supraglottic swelling
  40. What is the kink test??
    bending of the LMA to make sure the tube doesn't collapse when it is inserted

    this is only used for classic and unique LMAs
Card Set
The Airway
Anesthesia Exam 2