NUR-729 Anesthesia Airway Assessment
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Questions and Answers

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?

  • Pulmonary function test
  • Sleep study
  • Apnea-hypopnea index
  • Polysomnography (correct)

    • 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?

    <p>Yes to 3 or more questions on the screening questionnaire</p> Signup and view all the answers

    What is the recommended action for patients on weekly dosing of GLP-1 agonists before elective surgery?

    <p>Hold the medication for 1 week prior to the procedure/surgery</p> Signup and view all the answers

    What is the characteristic of Obstructive Sleep Apnea in pediatric patients?

    <p>Not necessarily associated with obesity and snoring</p> Signup and view all the answers

    What is the function of the cricoid cartilage in the upper respiratory tract?

    <p>To separate the upper and lower respiratory tracts</p> Signup and view all the answers

    Which of the following congenital conditions is associated with hemifacial microsomia, mandibular hypoplasia, incomplete/fused/missing vertebrae and cervical spine abnormalities?

    <p>Goldenhar Syndrome</p> Signup and view all the answers

    What is the term for the downward displacement of the tongue in Pierre-Robin Syndrome?

    <p>Glossoptosis</p> Signup and view all the answers

    Which of the following medications can increase the risk of delayed gastric emptying and nausea or vomiting?

    <p>Ozempic (semaglutide)</p> Signup and view all the answers

    What is the term for the distance between the hyoid bone and the chin?

    <p>Hyoid-Mental Distance</p> Signup and view all the answers

    Which of the following is a characteristic feature of Down Syndrome?

    <p>All of the above</p> Signup and view all the answers

    Which obesity-related complication can increase the risk of anesthesia-related complications?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    What is the classification of obesity with a BMI of 35-39.9 kg/m2?

    <p>Class II obesity</p> Signup and view all the answers

    Which of the following is NOT a component of the upper respiratory tract?

    <p>Trachea</p> Signup and view all the answers

    What is the primary purpose of the Cormack and Lehane Grading System?

    <p>To objectively assess the pharyngeal and glottic structures during laryngoscopy</p> Signup and view all the answers

    What is the characteristic of a Grade IIb view in the Cormack and Lehane Grading System?

    <p>Only the posterior portion of the glottic opening can be visualized</p> Signup and view all the answers

    Which of the following is NOT a sign of correct ETT placement?

    <p>Unilateral chest expansion</p> Signup and view all the answers

    What is the primary mechanism underlying laryngospasm?

    <p>An exaggerated manifestation of the gag reflex provoked by irritation or obstruction</p> Signup and view all the answers

    What is the first step in treating laryngospasm?

    <p>Remove irritants</p> Signup and view all the answers

    What is the term for the abnormal stiffening of the TMJ, leading to a small mouth opening?

    <p>TMJ ankylosis</p> Signup and view all the answers

    Which of the following conditions can cause limited atlanto-occipital extension?

    <p>Ankylosing spondylitis</p> Signup and view all the answers

    What is the normal value for inter-incisor gap?

    <p>&gt; 5 cm</p> Signup and view all the answers

    What is the purpose of the upper lip bite test (ULBT)?

    <p>To determine the presence of difficult airway secondary to maxilla and mandibular movement</p> Signup and view all the answers

    What is the measurement of the vertical distance from the angle of the mandible to the hyoid bone?

    <p>Mandibulohyoid distance</p> Signup and view all the answers

    What is the purpose of the prayer sign?

    <p>To determine the presence of stiff joints</p> Signup and view all the answers

    What is the term for the abnormal fusion of the vertebrate and cervical spine?

    <p>Ankylosing spondylitis</p> Signup and view all the answers

    What is the 3-3-2 rule used to evaluate?

    <p>Upper airway geometry (oral access, TMD, Thyroid to hyoid)</p> Signup and view all the answers

    What is a common cause of OSA?

    <p>Enlarged tonsils and adenoids</p> Signup and view all the answers

    What is a characteristic of Acromegaly?

    <p>All of the above except a</p> Signup and view all the answers

    What is a benefit of using regional techniques for OSA patients?

    <p>Reduced risk of respiratory depression</p> Signup and view all the answers

    What is the primary function of the Inspire implanted stimulator device?

    <p>Stimulation of the hypoglossal nerve and prevents tongue from blocking airway</p> Signup and view all the answers

    Why is postoperative monitoring important for OSA patients?

    <p>Risk of respiratory depression</p> Signup and view all the answers

    What is a characteristic of Rheumatoid Arthritis?

    <p>Chronic inflammatory autoimmune disease</p> Signup and view all the answers

    What is the primary purpose of the LEMON assessment in airway assessment?

    <p>To identify potential airway difficulties and guide further evaluation</p> Signup and view all the answers

    What is the primary indicator of difficult mask ventilation?

    <p>Obesity</p> Signup and view all the answers

    What is the characteristic of Treacher-Collins syndrome affecting the airway?

    <p>All of the above</p> Signup and view all the answers

    What is the primary indication for using regional anesthesia in patients with Obstructive Sleep Apnea (OSA)?

    <p>To reduce the risk of respiratory complications</p> Signup and view all the answers

    What is the purpose of the thyromental distance measurement in airway assessment?

    <p>To measure the anterior mandibular space</p> Signup and view all the answers

    What is a benefit of using regional techniques for OSA patients?

    <p>Reduced risk of respiratory depression</p> Signup and view all the answers

    What are the structures of the upper respiratory tract?

    <p>Nose, mouth, pharynx, hypopharynx, larynx, and cricoid cartilage</p> Signup and view all the answers

    What structures comprise the lower respiratory tract?

    <p>Trachea, bronchi, bronchioles (terminal, respiratory), alveoli</p> Signup and view all the answers

    What separates the upper airway structures from the lower airway structures?

    <p>Cricoid cartilage</p> Signup and view all the answers

    The larynx serves as the inlet to what structure?

    <p>Trachea</p> Signup and view all the answers

    What are the three paired cartilages in the larynx?

    <p>Arytenoid, Corniculate, and Cuneiform</p> Signup and view all the answers

    What are the three unpaired (single) cartilages in the larynx?

    <p>Epiglottis, thyroid, cricoid</p> Signup and view all the answers

    What is micrognathia?

    <p>A condition characterized by an abnormally small jaw</p> Signup and view all the answers

    What is macroglossia?

    <p>Enlargement of the tongue</p> Signup and view all the answers

    What are the characteristic airway structure features in patients with Down's syndrome?

    <p>All of the above</p> Signup and view all the answers

    What are the characteristics of Treacher Collins syndrome as it relates to airway structures?

    <p>Mandibular hypoplasia (micrognathia), facial bone hypoplasia, choanal atresia, cleft palate</p> Signup and view all the answers

    What is hypoplasia?

    <p>Underdevelopment or incomplete development of a tissue or organ.</p> Signup and view all the answers

    What are the characteristics of Goldenhar syndrome as it relates to airway structures?

    <p>hemifacial microsomia, mandibular hypoplasia, cervical spine abnormalities, vertebrae incomplete/fused/missing</p> Signup and view all the answers

    What are the characteristics of Pierre Robin syndrome as it relates to airway structures?

    <p>Micrognathia, retrognathia, glossoptosis, macroglossia, cleft palate</p> Signup and view all the answers

    What is glossoptosis?

    <p>Downward tongue displacement</p> Signup and view all the answers

    What is retrognathia?

    <p>A condition where the lower jaw (mandible) is positioned further back than the upper jaw (maxilla</p> Signup and view all the answers

    What are the characteristics of Klippel-Feil syndrome as it relates to airway structures?

    <p>Fusion of C2 and C3 vertebrae, causing limited neck mobility and ROM</p> Signup and view all the answers

    What is choanal atresia?

    <p>A congenital anomaly causing blockages of the nasal passages</p> Signup and view all the answers

    What are the characteristics of rheumatoid arthritis as it relates to airway structures?

    <p>Mouth opening limitation secondary to TMJ stiffness, hypoplastic mandible, limited cervical spine movement/instability, cricoarytenoid arthritis, sublaxation of cricoarytenoid joint</p> Signup and view all the answers

    What can cricoarytenoid arthritis cause?

    <p>Stridor</p> Signup and view all the answers

    What are the characteristics of ankylosing spondylitis as it relates to airway structures?

    <p>Limited atlantooccipital extension, limited mouth opening, hunched forward positioning, inability to lie supine, decreased chest expansion</p> Signup and view all the answers

    What is ankylosing spondylitis?

    <p>A type of inflammatory rheumatoid disorder that causes chronic inflammation that can lead to vertebral fusion and ankylosis</p> Signup and view all the answers

    What is ankylosis?

    <p>Abnormal stiffening</p> Signup and view all the answers

    How does acromegaly affect the airway?

    <p>It causes tissue enlargement, leading to macroglossia, prognathism, vocal cord swelling, enlarged face/hands/nose/lips</p> Signup and view all the answers

    What causes acromegaly?

    <p>Excess growth hormone production from the pituitary gland</p> Signup and view all the answers

    During DL, you may see nodules in patients that have RA

    <p>True</p> Signup and view all the answers

    Rheumatoid arthritis causes many airway abnormalities

    <p>True</p> Signup and view all the answers

    What is rheumatoid arthritis?

    <p>A chronic autoimmune disease that causes inflammation of the joints and joint erosion</p> Signup and view all the answers

    How does Ludwig's angina affect the airway?

    <p>It causes trismus making it difficult to open mouth</p> Signup and view all the answers

    What is Ludwig's angina?

    <p>A bacterial infection of the submandibular space</p> Signup and view all the answers

    What is the atlantooccipital angle and its relation to mobility?

    <p>The angle formed by the junction of the atlas and the occipital bone, extension needed to place patient in sniffing position</p> Signup and view all the answers

    What does extension at the atlanto-occipital joint provide for the airway?

    <p>Increased mouth opening facilitating better visualization of the airway</p> Signup and view all the answers

    Mallampati is the gold standard for identifying difficult intubations

    <p>False</p> Signup and view all the answers

    What items are assessed in the Mallampati test?

    <p>Mouth opening, size of tongue, size of oropharynx and visualization of posterior oropharyngeal structures</p> Signup and view all the answers

    What does the PUSH acronym mean as it relates to the Mallampati test?

    <p>P: Pillars, U: Uvula, S:Soft palate, H: Hard palate</p> Signup and view all the answers

    You can visualize the patient's soft palate only. What is the patient's Mallampati score?

    <p>III</p> Signup and view all the answers

    How is the Mallampati test performed?

    <p>The patient is seated upright with their head in a neutral position, and then asked to open their mouth as wide as possible with tongue protruded</p> Signup and view all the answers

    Phonation is is the last part of the Mallampati test

    <p>False</p> Signup and view all the answers

    When you can see a patient's facial pillars, uvula, and palate, what is the patient's Mallampati score?

    <p>Class I</p> Signup and view all the answers

    What are the components of the LEMON assessment in airway evaluation

    <p>Look externally, Evaluate 3-3-2 Rule, Mallampati, Obstruction, Neck mobility</p> Signup and view all the answers

    What does the 'O' in the LEMON assessment stand for?

    <p>Obstruction - presence of injuries or conditions affecting epiglottis</p> Signup and view all the answers

    What is the purpose of the sniffing position?

    <p>To facilitate tracheal intubation by aligning the oral, pharyngeal, and laryngeal axes via neck flexion with upper cervical extension</p> Signup and view all the answers

    What is the purpose of ramping in achieving the sniffing position?

    <p>To elevate shoulders, neck, and head to optimize patient positioning for DL</p> Signup and view all the answers

    What does the thyromental distance (TMD) measure?

    <p>The distance from the thyroid cartilage to the mental protuberance (anterior mandibular space)</p> Signup and view all the answers

    How do you assess the thyromental distance?

    <p>Measure the distance from the thyroid notch to the mentum with patient's head extended and mouth closed</p> Signup and view all the answers

    What thyromental distance is indicative of potentially difficult intubating?

    <p>&lt; 6 cm and &gt;9cm</p> Signup and view all the answers

    What does the thyromental distance reflect?

    <p>Neck mobility and degree of retrognathia</p> Signup and view all the answers

    In the upper lip bite test, what score indicates the least mobility?

    <p>3 - unable to bite upper lip</p> Signup and view all the answers

    A patient is able to bite the vermillion border of upper lip with their lower incisors. What would be the ULBT score?

    <p>2</p> Signup and view all the answers

    How do you perform the mandibular protrusion test?

    <p>Ask the patient to thrust their jaw forward as far as possible</p> Signup and view all the answers

    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?

    <p>B</p> Signup and view all the answers

    The patient is unable to place lower teeth in alignment with upper teeth. What is their Mandibular Protrusion grade?

    <p>C</p> Signup and view all the answers

    What is a normal atlanto-occipital joint angle?

    <p>35 degrees</p> Signup and view all the answers

    An atlanto-occipital joint less than ___ indicates difficulty visualizing glottic structures

    <p>23</p> Signup and view all the answers

    What does the sternomental distance (SMD) measure?

    <p>The distance from the sternal notch to the mentum (chin) with mouth closed</p> Signup and view all the answers

    A SMD of less than ___ cm is a predictor of difficulty intubating

    <p>12.5</p> Signup and view all the answers

    What are the components of the 3-3-2 rule?

    <p>3 fingerbreadths for oral access, 3 fingerbreadths for TMD, 2 fingerbreadths for thyroid-hyoid notch</p> Signup and view all the answers

    The TMD is also known as the ___ length

    <p>Mandibular length</p> Signup and view all the answers

    What acronym is used to predict difficult mask ventilation?

    <p>BOOTS</p> Signup and view all the answers

    BOOTS = Bearded, Obese, Old, Toothless, Snoring

    <p>True</p> Signup and view all the answers

    In positioning obese patients, try to align the ear with the sternal notch

    <p>True</p> Signup and view all the answers

    What is a normal BMI range?

    <p>18.5-24.9</p> Signup and view all the answers

    What BMI is considered overweight?

    <p>25-29.9</p> Signup and view all the answers

    What BMI is considered Class 1 obesity?

    <p>30.0-34.9</p> Signup and view all the answers

    Class 2 obesity corresponds to what BMI?

    <p>35-39.9 kg/m2</p> Signup and view all the answers

    A BMI greater than 40 is considered what class of obesity?

    <p>Class 3 obesity</p> Signup and view all the answers

    What acronym is used to predict difficulty with supraglottic airway placement?

    <p>RODS</p> Signup and view all the answers

    What does RODS stand for in predicting difficulty with SGA placement?

    <p>Restriction, Obstruction, Distortion, Stiff lungs/spine</p> Signup and view all the answers

    What does FONA stand for in anesthesia?

    <p>Front-of-Neck Access</p> Signup and view all the answers

    What acronym is used to predict difficulty with FONA?

    <p>SHORT</p> Signup and view all the answers

    What does SHORT stand for in predicting difficulty with FONA?

    <p>Surgery, Hematoma, Obesity, Radiation/distortion, Tumor</p> Signup and view all the answers

    What is the purpose of the Cormack and Lehane grading system?

    <p>To assess the pharyngeal and glottic structures during laryngoscopy</p> Signup and view all the answers

    Most of the glottis can be seen during DL. What is the patient's Cormack and Lehane Grade?

    <p>I</p> Signup and view all the answers

    The vocal cords can be partially seen during DL. What is the patient's Cormack and Lehane Grade?

    <p>II</p> Signup and view all the answers

    Only the epiglottis can be seen during DL. What is the patient's Cormack and Lehane Grade?

    <p>III</p> Signup and view all the answers

    The epiglottis cannot be seen during DL. What is the patient's Cormack and Lehane Grade?

    <p>IV</p> Signup and view all the answers

    What does POGO stand for in anesthesia?

    <p>Percentage of Glottic Opening</p> Signup and view all the answers

    What are the 3 POGO scores?

    <p>100, 33, 0</p> Signup and view all the answers

    A POGO score of 100 indicates

    <p>entire glottic structures are visible</p> Signup and view all the answers

    A POGO score of 33 indicates

    <p>Only lower third of vocal cord and arytenoid visible</p> Signup and view all the answers

    How do you confirm ETT placement?

    <p>Observation of tube passing through vocal cords, condensation in tube, bilateral chest expansion, bilateral breath sounds, ETCO2 waveform</p> Signup and view all the answers

    What are the methods to treat laryngospasm?

    <p>Remove irritants, deepen anesthetic, PPV, bilateral pressure at laryngospasm notch, NMBA</p> Signup and view all the answers

    Short length of upper incisors can indicate difficulty managing airway

    <p>False</p> Signup and view all the answers

    Palm mobility is not associated with overall joint mobility

    <p>False</p> Signup and view all the answers

    Patients with a high risk of OSA answer yes to 2 or more questions in the STOP-BANG questionnaire

    <p>False</p> Signup and view all the answers

    STOP-BANG = Snoring, Tired, Observed, Pressure (HTN), BMI>35, Age>50, Neck>40, Gender - male

    <p>True</p> Signup and view all the answers

    Regional techniques should be used in when possible with patients with OSA

    <p>True</p> Signup and view all the answers

    What is the preferred method of extubation in OSA patients?

    <p>Awake extubation</p> Signup and view all the answers

    Apert syndrome is a congenital condition characterized by underdevelopment of the tongue, maxilla, and mandible resulting in upper airway obstruction

    <p>True</p> Signup and view all the answers

    How does angioedema affect the airway?

    <p>It leads to swelling of the airway, which can cause obstruction.</p> Signup and view all the answers

    What separates the larynx from the pharynx?

    <p>Epiglottis</p> Signup and view all the answers

    What parts comprise the larynx?

    <p>Epiglottis, Glottis, and Vocal folds</p> Signup and view all the answers

    What is the primary difference between acromegaly and gigantism?

    <p>Age of onset of excessive growth hormone production</p> Signup and view all the answers

    What Mallampati score indicates the potential for difficulty in airway management?

    <p>III and IV</p> Signup and view all the answers

    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/π) 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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    Description

    Assess your knowledge of airway assessment tests and procedures in anesthesia, including the LEMON assessment, Mallampati score, and more. This quiz is ideal for nurse anesthetists and anesthesia students.

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