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Questions and Answers
What is the recommended action for patients on daily dosing of GLP-1 agonists before elective surgery?
What is the recommended action for patients on daily dosing of GLP-1 agonists before elective surgery?
- Hold the medication on the day of the procedure/surgery (correct)
- Hold the medication for 2 days
- Continue the medication as usual before the procedure/surgery
- Hold the medication for 1 week prior to the procedure/surgery
What is the gold standard for diagnosing Obstructive Sleep Apnea?
What is the gold standard for diagnosing Obstructive Sleep Apnea?
- Pulmonary function test
- Sleep study
- Apnea-hypopnea index
- Polysomnography (correct)
What is the risk factor for difficult or failed intubation?
What is the risk factor for difficult or failed intubation?
- Hypertension
- Glaucoma
- Asthma
- Obstructive Sleep Apnea (correct)
What is the criterion for diagnosing Obstructive Sleep Apnea in adult patients when using the STOP-BANG questionnaire?
What is the criterion for diagnosing Obstructive Sleep Apnea in adult patients when using the STOP-BANG questionnaire?
What is the recommended action for patients on weekly dosing of GLP-1 agonists before elective surgery?
What is the recommended action for patients on weekly dosing of GLP-1 agonists before elective surgery?
What is the characteristic of Obstructive Sleep Apnea in pediatric patients?
What is the characteristic of Obstructive Sleep Apnea in pediatric patients?
What is the function of the cricoid cartilage in the upper respiratory tract?
What is the function of the cricoid cartilage in the upper respiratory tract?
Which of the following congenital conditions is associated with hemifacial microsomia, mandibular hypoplasia, incomplete/fused/missing vertebrae and cervical spine abnormalities?
Which of the following congenital conditions is associated with hemifacial microsomia, mandibular hypoplasia, incomplete/fused/missing vertebrae and cervical spine abnormalities?
What is the term for the downward displacement of the tongue in Pierre-Robin Syndrome?
What is the term for the downward displacement of the tongue in Pierre-Robin Syndrome?
Which of the following medications can increase the risk of delayed gastric emptying and nausea or vomiting?
Which of the following medications can increase the risk of delayed gastric emptying and nausea or vomiting?
What is the term for the distance between the hyoid bone and the chin?
What is the term for the distance between the hyoid bone and the chin?
Which of the following is a characteristic feature of Down Syndrome?
Which of the following is a characteristic feature of Down Syndrome?
Which obesity-related complication can increase the risk of anesthesia-related complications?
Which obesity-related complication can increase the risk of anesthesia-related complications?
What is the classification of obesity with a BMI of 35-39.9 kg/m2?
What is the classification of obesity with a BMI of 35-39.9 kg/m2?
Which of the following is NOT a component of the upper respiratory tract?
Which of the following is NOT a component of the upper respiratory tract?
What is the primary purpose of the Cormack and Lehane Grading System?
What is the primary purpose of the Cormack and Lehane Grading System?
What is the characteristic of a Grade IIb view in the Cormack and Lehane Grading System?
What is the characteristic of a Grade IIb view in the Cormack and Lehane Grading System?
Which of the following is NOT a sign of correct ETT placement?
Which of the following is NOT a sign of correct ETT placement?
What is the primary mechanism underlying laryngospasm?
What is the primary mechanism underlying laryngospasm?
What is the first step in treating laryngospasm?
What is the first step in treating laryngospasm?
What is the term for the abnormal stiffening of the TMJ, leading to a small mouth opening?
What is the term for the abnormal stiffening of the TMJ, leading to a small mouth opening?
Which of the following conditions can cause limited atlanto-occipital extension?
Which of the following conditions can cause limited atlanto-occipital extension?
What is the normal value for inter-incisor gap?
What is the normal value for inter-incisor gap?
What is the purpose of the upper lip bite test (ULBT)?
What is the purpose of the upper lip bite test (ULBT)?
What is the measurement of the vertical distance from the angle of the mandible to the hyoid bone?
What is the measurement of the vertical distance from the angle of the mandible to the hyoid bone?
What is the purpose of the prayer sign?
What is the purpose of the prayer sign?
What is the term for the abnormal fusion of the vertebrate and cervical spine?
What is the term for the abnormal fusion of the vertebrate and cervical spine?
What is the 3-3-2 rule used to evaluate?
What is the 3-3-2 rule used to evaluate?
What is a common cause of OSA?
What is a common cause of OSA?
What is a characteristic of Acromegaly?
What is a characteristic of Acromegaly?
What is a benefit of using regional techniques for OSA patients?
What is a benefit of using regional techniques for OSA patients?
What is the primary function of the Inspire implanted stimulator device?
What is the primary function of the Inspire implanted stimulator device?
Why is postoperative monitoring important for OSA patients?
Why is postoperative monitoring important for OSA patients?
What is a characteristic of Rheumatoid Arthritis?
What is a characteristic of Rheumatoid Arthritis?
What is the primary purpose of the LEMON assessment in airway assessment?
What is the primary purpose of the LEMON assessment in airway assessment?
What is the primary indicator of difficult mask ventilation?
What is the primary indicator of difficult mask ventilation?
What is the characteristic of Treacher-Collins syndrome affecting the airway?
What is the characteristic of Treacher-Collins syndrome affecting the airway?
What is the primary indication for using regional anesthesia in patients with Obstructive Sleep Apnea (OSA)?
What is the primary indication for using regional anesthesia in patients with Obstructive Sleep Apnea (OSA)?
What is the purpose of the thyromental distance measurement in airway assessment?
What is the purpose of the thyromental distance measurement in airway assessment?
What is a benefit of using regional techniques for OSA patients?
What is a benefit of using regional techniques for OSA patients?
What are the structures of the upper respiratory tract?
What are the structures of the upper respiratory tract?
What structures comprise the lower respiratory tract?
What structures comprise the lower respiratory tract?
What separates the upper airway structures from the lower airway structures?
What separates the upper airway structures from the lower airway structures?
The larynx serves as the inlet to what structure?
The larynx serves as the inlet to what structure?
What are the three paired cartilages in the larynx?
What are the three paired cartilages in the larynx?
What are the three unpaired (single) cartilages in the larynx?
What are the three unpaired (single) cartilages in the larynx?
What is micrognathia?
What is micrognathia?
What is macroglossia?
What is macroglossia?
What are the characteristic airway structure features in patients with Down's syndrome?
What are the characteristic airway structure features in patients with Down's syndrome?
What are the characteristics of Treacher Collins syndrome as it relates to airway structures?
What are the characteristics of Treacher Collins syndrome as it relates to airway structures?
What is hypoplasia?
What is hypoplasia?
What are the characteristics of Goldenhar syndrome as it relates to airway structures?
What are the characteristics of Goldenhar syndrome as it relates to airway structures?
What are the characteristics of Pierre Robin syndrome as it relates to airway structures?
What are the characteristics of Pierre Robin syndrome as it relates to airway structures?
What is glossoptosis?
What is glossoptosis?
What is retrognathia?
What is retrognathia?
What are the characteristics of Klippel-Feil syndrome as it relates to airway structures?
What are the characteristics of Klippel-Feil syndrome as it relates to airway structures?
What is choanal atresia?
What is choanal atresia?
What are the characteristics of rheumatoid arthritis as it relates to airway structures?
What are the characteristics of rheumatoid arthritis as it relates to airway structures?
What can cricoarytenoid arthritis cause?
What can cricoarytenoid arthritis cause?
What are the characteristics of ankylosing spondylitis as it relates to airway structures?
What are the characteristics of ankylosing spondylitis as it relates to airway structures?
What is ankylosing spondylitis?
What is ankylosing spondylitis?
What is ankylosis?
What is ankylosis?
How does acromegaly affect the airway?
How does acromegaly affect the airway?
What causes acromegaly?
What causes acromegaly?
During DL, you may see nodules in patients that have RA
During DL, you may see nodules in patients that have RA
Rheumatoid arthritis causes many airway abnormalities
Rheumatoid arthritis causes many airway abnormalities
What is rheumatoid arthritis?
What is rheumatoid arthritis?
How does Ludwig's angina affect the airway?
How does Ludwig's angina affect the airway?
What is Ludwig's angina?
What is Ludwig's angina?
What is the atlantooccipital angle and its relation to mobility?
What is the atlantooccipital angle and its relation to mobility?
What does extension at the atlanto-occipital joint provide for the airway?
What does extension at the atlanto-occipital joint provide for the airway?
Mallampati is the gold standard for identifying difficult intubations
Mallampati is the gold standard for identifying difficult intubations
What items are assessed in the Mallampati test?
What items are assessed in the Mallampati test?
What does the PUSH acronym mean as it relates to the Mallampati test?
What does the PUSH acronym mean as it relates to the Mallampati test?
You can visualize the patient's soft palate only. What is the patient's Mallampati score?
You can visualize the patient's soft palate only. What is the patient's Mallampati score?
How is the Mallampati test performed?
How is the Mallampati test performed?
Phonation is is the last part of the Mallampati test
Phonation is is the last part of the Mallampati test
When you can see a patient's facial pillars, uvula, and palate, what is the patient's Mallampati score?
When you can see a patient's facial pillars, uvula, and palate, what is the patient's Mallampati score?
What are the components of the LEMON assessment in airway evaluation
What are the components of the LEMON assessment in airway evaluation
What does the 'O' in the LEMON assessment stand for?
What does the 'O' in the LEMON assessment stand for?
What is the purpose of the sniffing position?
What is the purpose of the sniffing position?
What is the purpose of ramping in achieving the sniffing position?
What is the purpose of ramping in achieving the sniffing position?
What does the thyromental distance (TMD) measure?
What does the thyromental distance (TMD) measure?
How do you assess the thyromental distance?
How do you assess the thyromental distance?
What thyromental distance is indicative of potentially difficult intubating?
What thyromental distance is indicative of potentially difficult intubating?
What does the thyromental distance reflect?
What does the thyromental distance reflect?
In the upper lip bite test, what score indicates the least mobility?
In the upper lip bite test, what score indicates the least mobility?
A patient is able to bite the vermillion border of upper lip with their lower incisors. What would be the ULBT score?
A patient is able to bite the vermillion border of upper lip with their lower incisors. What would be the ULBT score?
How do you perform the mandibular protrusion test?
How do you perform the mandibular protrusion test?
The patient is able to place their lower teeth in alignment with the upper teeth while performing the Mandibular Protrusion Test. What is their grade?
The patient is able to place their lower teeth in alignment with the upper teeth while performing the Mandibular Protrusion Test. What is their grade?
The patient is unable to place lower teeth in alignment with upper teeth. What is their Mandibular Protrusion grade?
The patient is unable to place lower teeth in alignment with upper teeth. What is their Mandibular Protrusion grade?
What is a normal atlanto-occipital joint angle?
What is a normal atlanto-occipital joint angle?
An atlanto-occipital joint less than ___ indicates difficulty visualizing glottic structures
An atlanto-occipital joint less than ___ indicates difficulty visualizing glottic structures
What does the sternomental distance (SMD) measure?
What does the sternomental distance (SMD) measure?
A SMD of less than ___ cm is a predictor of difficulty intubating
A SMD of less than ___ cm is a predictor of difficulty intubating
What are the components of the 3-3-2 rule?
What are the components of the 3-3-2 rule?
The TMD is also known as the ___ length
The TMD is also known as the ___ length
What acronym is used to predict difficult mask ventilation?
What acronym is used to predict difficult mask ventilation?
BOOTS = Bearded, Obese, Old, Toothless, Snoring
BOOTS = Bearded, Obese, Old, Toothless, Snoring
In positioning obese patients, try to align the ear with the sternal notch
In positioning obese patients, try to align the ear with the sternal notch
What is a normal BMI range?
What is a normal BMI range?
What BMI is considered overweight?
What BMI is considered overweight?
What BMI is considered Class 1 obesity?
What BMI is considered Class 1 obesity?
Class 2 obesity corresponds to what BMI?
Class 2 obesity corresponds to what BMI?
A BMI greater than 40 is considered what class of obesity?
A BMI greater than 40 is considered what class of obesity?
What acronym is used to predict difficulty with supraglottic airway placement?
What acronym is used to predict difficulty with supraglottic airway placement?
What does RODS stand for in predicting difficulty with SGA placement?
What does RODS stand for in predicting difficulty with SGA placement?
What does FONA stand for in anesthesia?
What does FONA stand for in anesthesia?
What acronym is used to predict difficulty with FONA?
What acronym is used to predict difficulty with FONA?
What does SHORT stand for in predicting difficulty with FONA?
What does SHORT stand for in predicting difficulty with FONA?
What is the purpose of the Cormack and Lehane grading system?
What is the purpose of the Cormack and Lehane grading system?
Most of the glottis can be seen during DL. What is the patient's Cormack and Lehane Grade?
Most of the glottis can be seen during DL. What is the patient's Cormack and Lehane Grade?
The vocal cords can be partially seen during DL. What is the patient's Cormack and Lehane Grade?
The vocal cords can be partially seen during DL. What is the patient's Cormack and Lehane Grade?
Only the epiglottis can be seen during DL. What is the patient's Cormack and Lehane Grade?
Only the epiglottis can be seen during DL. What is the patient's Cormack and Lehane Grade?
The epiglottis cannot be seen during DL. What is the patient's Cormack and Lehane Grade?
The epiglottis cannot be seen during DL. What is the patient's Cormack and Lehane Grade?
What does POGO stand for in anesthesia?
What does POGO stand for in anesthesia?
What are the 3 POGO scores?
What are the 3 POGO scores?
A POGO score of 100 indicates
A POGO score of 100 indicates
A POGO score of 33 indicates
A POGO score of 33 indicates
How do you confirm ETT placement?
How do you confirm ETT placement?
What are the methods to treat laryngospasm?
What are the methods to treat laryngospasm?
Short length of upper incisors can indicate difficulty managing airway
Short length of upper incisors can indicate difficulty managing airway
Palm mobility is not associated with overall joint mobility
Palm mobility is not associated with overall joint mobility
Patients with a high risk of OSA answer yes to 2 or more questions in the STOP-BANG questionnaire
Patients with a high risk of OSA answer yes to 2 or more questions in the STOP-BANG questionnaire
STOP-BANG = Snoring, Tired, Observed, Pressure (HTN), BMI>35, Age>50, Neck>40, Gender - male
STOP-BANG = Snoring, Tired, Observed, Pressure (HTN), BMI>35, Age>50, Neck>40, Gender - male
Regional techniques should be used in when possible with patients with OSA
Regional techniques should be used in when possible with patients with OSA
What is the preferred method of extubation in OSA patients?
What is the preferred method of extubation in OSA patients?
Apert syndrome is a congenital condition characterized by underdevelopment of the tongue, maxilla, and mandible resulting in upper airway obstruction
Apert syndrome is a congenital condition characterized by underdevelopment of the tongue, maxilla, and mandible resulting in upper airway obstruction
How does angioedema affect the airway?
How does angioedema affect the airway?
What separates the larynx from the pharynx?
What separates the larynx from the pharynx?
What parts comprise the larynx?
What parts comprise the larynx?
What is the primary difference between acromegaly and gigantism?
What is the primary difference between acromegaly and gigantism?
What Mallampati score indicates the potential for difficulty in airway management?
What Mallampati score indicates the potential for difficulty in airway management?
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Study Notes
Airway Assessment
- Airway screening tests assess difficult airways, but most difficult airways are unanticipated.
- Mouth opening: normal value > 5 cm (at least 3 fingers).
- Dental assessment: assess for any chipped or broken teeth that could end up in the lung.
- Inter-incisor distance: assess for potential airway issues.
- Mallampati: assess mouth opening, size of tongue, size of oropharynx, and visual of posterior oropharyngeal structures.
- Thyromental distance: measure of anterior mandibular space; normal is 6 cm.
- Mandibular protrusion test: assess for airway mobility.
- Upper lip bite test: assess for upper lip mobility.
- Atlanto-occipital joint extension: assess for neck mobility.
- LEMON assessment: Look, Evaluate 3-3-2 rule, Mallampati, Obstruction, Neck mobility.
Airway Anatomy
- Upper respiratory tract: nose, mouth, pharynx, hypopharynx, larynx, cricoid cartilage.
- Larynx: 9 cartilages, 3 paired and 3 single.
- Lower respiratory tract: everything beneath the cricoid cartilage; trachea, bronchi, bronchioles, alveoli.
Congenital Abnormalities
- Pierre-Robin: underdevelopment and recessed chin.
- Goldenhar's syndrome: hemifacial macrosomia, mandibular hypoplasia, cervical spine abnormality.
- Klippel-Feil: fusion of 2+ cervical vertebrae, short/no neck.
- Treacher-Collins: mandibular hypoplasia, micrognathia, choanal atresia, cleft palate, facial bone hypoplasia.
- Down syndrome: micrognathia, macroglossia, narrow palate, large and thick lip, flattened nose, small ears, cervical spine abnormalities, small subglottic diameter, OSA.
Acquired Conditions
- Obesity: be familiar with BMI calculation, GLP-1 agonists, and anesthesia considerations.
- Obstructive Sleep Apnea: increased risk for difficult or failed intubation, STOP-BANG questionnaire, polysomnography diagnosis.
- TMJ: causes trismus, ankylosing spondylitis, and rheumatoid arthritis.
- Infections: Ludwig's angina, oral and retropharyngeal abscesses, epiglottis, croup, laryngeal papillomatosis.
- Angioedema: rapid swelling of mucosa, lips, and tongue.
Airway Management
- Predictors of difficult mask ventilation: pick one to memorize.
- Ramping: align airway for direct laryngoscopy.
- Cormack and Lehane Grading System: assess intubation difficulty.
- Difficulty with BVM: poor mask seal, airway obstruction, obesity, age > 55, no teeth, stiff lungs, sleep apnea, or snoring.
Respiratory Mechanics
- Resistance: 8 x length x (viscosity/Ï€) x radius^4.
- Laminar flow: function of viscosity of gas.
- Turbulent flow: function of density of gas.
- Reynold's number: > 2000 = turbulent.
Lung Volumes and Capacities
- Spirometry: can give all volumes except FRC, TLC, RV.
- Respiratory Mechanics: preop tests correlate with post-thoracotomy outcomes; FEV1, FVC, Max minute ventilation, RV/TLC, DLCO.
- DLCO: best test for determining surface area for gas exchange.
Pre-op Assessment
- Goal: plan implementations to improve outcomes.
- Functional assessments: respiratory mechanics, gas exchange, cardiopulmonary interaction, quality of life, exercise tolerance, and pulmonary function testing when indicated.
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