"Big Airway Lecture"

Respiratory System and Airway Management

• The primary function of the nose in the respiratory system is to filter, warm, and humidify the air before it enters the lungs.
• The oropharynx does not contain the epiglottis; it primarily includes the soft palate, uvula, and posterior tongue.
• The larynx is located in the neck, lying between the pharynx and trachea, and plays a crucial role in voice production and protection of the airway.
• Turbinates are structures responsible for resistance to airflow in the respiratory system, increasing air turbulence and conditioning.
• A disadvantage of supraglottic airways (SGA) compared to face mask ventilation is limited control of ventilation and inability to secure the airway as effectively as an endotracheal tube.
• A relative contraindication for using a supraglottic airway in elective settings includes the presence of gastrointestinal obstruction.
• The LMA (Laryngeal Mask Airway) has a second lumen that functions as an esophageal vent to prevent gastric inflation.
• Elevating a patient's head for the sniffing position optimizes the alignment of the oral, pharyngeal, and laryngeal axes for easier intubation.
• A common complication of extubation is airway obstruction due to edema or residual secretions.
• The main purpose of the LMA Fastrach device is to facilitate rapid intubation in difficult airway scenarios.
• Patients with obesity or limited cervical spine mobility may struggle to assume the sniffing position effectively.
• Prior to extubation, it is essential to ensure adequate reversal of neuromuscular blockade to allow for spontaneous breathing.
• The LMA is typically not associated with aspiration; this is one of its advantages in airway management.
• The Combitube is primarily used for airway management in cases of unknown or difficult intubation situations.
• The double-lumen tube and bronchial blocker are positioned using the fiberoptic laryngoscopy technique for precise placement.
• A potential complication of translaryngeal nerve block includes inadvertent injury to surrounding structures, leading to additional complications.
• During intubation, a bougie is utilized to navigate difficult airways and guide the placement of an endotracheal tube.
• A localized glow observed with a lighted stylet during intubation indicates proper placement near the tracheal opening.
• The Glidescope provides a better visual angle for intubation, enhancing visualization in challenging cases.
• A superior laryngeal nerve block affects sensation below the vocal cords while stimulating the cough reflex.
• A recurrent laryngeal nerve block anesthetizes the region from the inferior aspect of the epiglottis to the vocal cords.
• The McGrath laryngoscope is recommended for patients requiring minimal neck movement or those with small mouth openings.
• The start position for the Bullard technique involves the patient being placed supine with their neck in a neutral position.
• Percutaneous airway insertion becomes necessary in cases of severe obstruction or failure to intubate quickly.
• Surgical cricothyrotomy is advantageous due to its quicker access compared to a tracheotomy in emergency scenarios.
• Serious complications during retrograde intubation/Seldinger cricothyrotomy can include injury to the surrounding vessels or tissues.
• Using low-pressure systems during percutaneous translaryngeal jet ventilation may lead to inadequate ventilation and hypoxia.
• Pierre Robin syndrome is characterized by micrognathia, glossoptosis, and a cleft soft palate, affecting airway management.
• Congenital hypothyroidism is associated with absent thyroid tissue or impaired synthesis of thyroxine.
• Down syndrome features can include potential airway obstruction due to anatomical variations such as macroglossia.
• Beckwith-Wiedemann syndrome is marked by muscle deposits and macroglossia, leading to potential airway challenges.
• Multiple Endocrine Neoplasia (MEN) syndrome is associated with a higher incidence of pheochromocytomas and laryngeal tumors.
• Systemic sclerosis can lead to stiff joints and upper airway obstruction due to lymphoid tissue infiltration.
• The cricoid cartilage is the only complete ring of the trachea, providing structural support.
• The primary function of the vocal cords is to modulate airflow and produce sound during phonation.
• The internal branch of the superior laryngeal nerve provides sensory innervation above the vocal cords and to the epiglottis.
• The posterior cricoarytenoid muscle is responsible for abducting the vocal cords, crucial for breathing.
• Unilateral injury to the recurrent laryngeal nerve may result in hoarseness or breathiness due to vocal cord immobility.
• The main indication for using an oral endotracheal tube (ETT) is for secure airway access and ventilation during surgical procedures.
• Before passing the laryngoscope blade into the hypopharynx during direct visual laryngoscopy (DVL), proper positioning and neck extension should be ensured.
• A contraindication for using nasal airways includes facial trauma or suspected basilar skull fracture.
• Cormack & Lehane Grade II laryngoscopy view shows partial visualization of the vocal cords, indicating moderate difficulty.
• Miller and Macintosh blades can be used on adults for laryngoscopy, depending on the preferred technique.
• The size of an endotracheal tube (ETT) is generally calculated based on the patient's age or suitable airway diameter.
• Cricoid pressure should be released during the intubation process once tube placement is confirmable and ventilation is assured.
• Contraindications for nasal endotracheal intubation (NETT) include nasal fractures or severe coagulopathy.
• Equipment required for NETT includes nasal tubes, a laryngoscope, and lubricating jelly for easier passage.
• Potential complications of laryngoscopy may include dental injury, airway trauma, or difficulty in visualization.
• Bougies assist in intubation by acting as a guide for the ETT, especially in difficult airways.
• No risk of aspiration occurs with tight and proper positioning of the ETT during intubation, given secured placement.

Test your knowledge on the sniffing position and its impact on airway alignment during intubation. Explore the controversies and benefits associated with the sniffing position, as well as its effects on pharyngeal patency in patients with sleep apnea.