Airway management 6

Question 1

Following induction of general anesthesia, initial intubation attempts are unsuccessful and face mask ventilation is not adequate. According to the ASA difficult airway algorithm, what is the NEXT immediate step?
a. place a supraglottic airway device
b. wake up the patient
c. perform a cricothyroidotomy
d. call for help

Answer 1

d. call for help

Question 2

The ASA difficult airway algorithm includes a decision tree to help you choose between

Answer 2

awake intubation or airway management after anesthetic induction

Question 3

If you proceed with anesthetic induction, consider

Answer 3

rocuronium (+ sugammadex if needed) instead of succinylcholine

Question 4

Within the airway algorithm, there is a strong emphasis on

Answer 4

optimizing oxygenation throughout the entire airway management process
limiting attempts
being keenly aware of the passage of time and oxygen saturation

Question 5

In the “can’t ventilate and can’t intubate” scenario, your primary objectives include

Answer 5

calling for help
placing a supraglottic airway device
possibly awakening the patient

Question 6

If a supraglottic airway device does not solve a “can’t ventilate and can’t intubate” situation, then attempt

Answer 6

alternative intubation approaches as you prepare for an emergency invasive airway

Question 7

Emergency invasive airway access options include

Answer 7

surgical cricothyrotomy
percutaneous cricothyrotomy with jet ventilation
rigid bronchoscopy
ECMO

Question 8

Strategies for extubation in a difficult intubation include

Answer 8

enlisting skilled help
optimizing oxygenation
using an airway exchange catheter (in adults)
consideration of elective tracheostomy

Question 9

Consider awake intubation if you anticipate difficulty with laryngoscopy or intubation coupled with any of the following:

Answer 9

1. suspected difficult ventilation with facemask or supraglottic airway device
2. significantly increased risk of aspiration
3. increased risk of rapid desaturation

Question 10

Deep extubation provides the MOST significant benefit in the patient with: (Select 2)
a. asthma
b. obstructive sleep apnea
c. Parkinson’s disease
d. coronary artery disease

Answer 10

a. asthma
d. coronary artery disease

Question 11

Pros of deep extubation include:

Answer 11

decreased CV & SNS stimulation
decreased coughing and airway irritation

Question 12

Cons of deep extubation include

Answer 12

ineffective airway reflexes
increased risk of airway obstruction (caution with OSA)
increased risk of aspiration (Caution with Parkinson’s)

Question 13

Extubation should be performed when

Answer 13

the patient is deep or awake- NOT in-between

Question 14

The decision of when to extubate should be

Answer 14

made on a patient-to-patient basis

Question 15

Risks associated with awake extubation include

Answer 15

increased SNS stimulation
increased ICP
increased IOP
increased IAP

Question 16

Techniques for extubating the difficult airway include

Answer 16

extubating fully awake
extubating over a flexible fiberoptic bronchoscope
extubating asleep and then placing an LMA
using an airway exchange catheter

Question 17

A light plane of anesthesia is categorized by

Answer 17

disconjugate gaze
breath holding
unable to follow commands

Question 18

To prevent coughing on awake extubation consider

Answer 18

lidocaine (IV or inside the ETT cuff)
opioids

Question 19

To prevent CV and SNS stimulation for awake extubation consider

Answer 19

beta-blockers
calcium channel blockers
vasodilators

Question 20

What is the BEST technique to manage the patient at high risk of failed extubation?
a. Eschmann introducer
b. airway exchange catheter
c. nasal airway
d. Shikani stylet

Answer 20

b. airway exchange catheter

Question 21

The airway exchange catheter is a

Answer 21

long, thin, flexible, hollow tube that maintains direct access to the airway following tracheal extubation

Question 22

If a patient requires re-intubation, the airway exchange catheter is used

Answer 22

as a stylet for reintubation via the Seldinger technique

Question 23

The lumen of the airway exchange catheter can be used to

Answer 23

measure EtCO2
jet ventilate (the patient requires a patent upper airway)
insufflate O2

Question 24

The airway exchange catheter can be kept in place for

Answer 24

up to 72 hours

Question 25

Complications of the airway exchange catheter include

Answer 25

barotrauma/pneumothorax - if you use jet ventilation w/ a patient with an obstructed upper airway
inability to replace the ETT

Question 26

Replacing the ETT with an airway exchange catheter requires

Answer 26

laryngoscopy to displace the supraglottic tissue