Equipment

Question 1

Oral Airway Sizes

Answer 1

Small 80mm
Medium 90mm
Large 100mm

Question 2

Oral Airway Contraindications

Answer 2

Prone positioning

Light sedation → gag reflex, cough, emesis, laryngospasm, or bronchospasm

Question 3

Nasal Airway Sizes

Answer 3

INTERNAL diameter

Question 4

NP Contraindications

Answer 4

Coagulopathy or hemorrhagic disorders
Anticoagulant therapy
Pregnancy
Basilar skull fractures
Nasal infections
Nasal deformities
History epistaxis requiring treatment

Question 5

Nasopharyngeal Airway

Answer 5

Light to moderate sedation

Less stimulating

Question 6

Face Masks

Answer 6

Uses smallest mask possible
↓dead space
Easier to hold
↓risk corneal abrasion or injury
Standard opening 15mm (internal diameter)
22mm external connects w/ anesthesia circuit

Question 7

Mask Ventilation

Answer 7

Head-tilt chin lift
C-E
Place fingers on boney prominences
Pull mandible up into the mask

Question 8

Unable to Ventilate?

Answer 8

Reposition
Place oral airway or NP
Two-handed technique

Question 9

Difficult Mask Ventilation

Answer 9

Beards
Obesity
Neck circumference
Edentulous
Snoring
Mask seal
Age >55yo
Facial edema
Prominent nares
Receding jaw
Tumor(s)
OG/NG tubes

Question 10

Face Mask Advantages

Answer 10

↓incidence sore throat
Less anesthetic depth required
No muscle relaxants
Short cases = cost effective

Question 11

Face Mask Disadvantages

Answer 11

Hands tied up
Use fatigue
Requires higher FGF
More difficult to maintain airway vs. LMA
Unprotected airway

Complications - skin problems, nerve injury, aspiration, corneal injury, cervical spine movement, latex allergy, lack PaCO2 & ETCO2 correlation environmental pollution

Question 12

Laryngeal Mask Airway

Answer 12

LMA
Supraglottic airway device
Circumferential seal around the laryngeal inlet w/ an inflatable cuff
*Airway reflexes must be obtunded prior to insertion attempt
*Keep airway pressures <20cmH2O

Question 13

Aperture Bars

Answer 13

Prevent epiglottis from obstructing the mask in LMA

Question 14

LMA Sizes

Answer 14

3 (30-50kg) 20cc/30cc
4 (50-70kg) 30cc/45cc
5 (70-99kg) 40cc/60cc

Question 15

LMA Contraindications

Answer 15

Aspiration risk
Patient w/ delayed gastric emptying
Hiatal hernia
Morbid obesity
>14wks pregnant
Glottic or subglottic obstruction
Limited mouth opening
Trauma
Acute abdomen
Thoracic injury
↓pulmonary compliance

Question 16

ETT Sizes

Answer 16

Number according to internal diameter 2.5-9.0mm
Male 8.0 or 9.0 at 24-26cm at the lip
Female 7.0 or 8.0 at 20-22cm at the lip
Nasal intubation + 3-4cm

Question 17

Endotracheal Tubes

Answer 17

Polyvinyl chloride (PVC)
Cuff provides seal b/w ETT & tracheal wall
Recommended pressure 20-25mmHg
Uncuffed ETT <8yo
Ensure stylet does not pass Murphy eye

Question 18

Mac (Blade)

Answer 18

Curved blade
Enter on the R & sweep the tongue
Indirectly lifts epiglottis

Question 19

Miller (Blade)

Answer 19

Straight blade
Place the blade midline
Directly lifts epiglottis
Ideal choice w/ floppy epiglottis or anterior airway

Question 20

Cormack-Lehane

Answer 20

Grade I
Grade II
Grade III
Grade IV

Question 21

ETT Placement Confirmation

Answer 21

Chest rise & fall
Equal, bilateral breath sounds
No gurgling over stomach
Condensation (fogging) presenting in ETT
Continuous ETCO2
Anesthesia reservoir bag refilling w/ exhalation

Question 22

Deep Extubation

Answer 22

Muscle relaxants fully reversed
Patient breathing spontaneously w/ adequate minute ventilation
No response to suctioning

Question 23

Deep Extubation Contraindications

Answer 23

Patients w/ difficult airway, aspiration risk, & surgeries that produce airway edema

Question 24

Awake Extubation

Answer 24

Patient able to maintain & protect airway
Purposeful movement
Eyes open
Reaction to suctioning

Question 25

Awake Extubation SUBJECTIVE Criteria

Answer 25

Follows commands Clear oropharynx (no active bleeding & secretions cleared) Intact gag reflex Sustained head lift for 5 seconds Sustained hand grasp Adequate pain control Minimal end expiratory concentration inhaled anesthetics

Question 26

Awake Extubation OBJECTIVE Criteria

Answer 26

``` Vital capacity >15mL/kg Peak voluntary negative inspiratory pressure >25cmH2O Vt >6mL/kg Sustained tetanic contraction SpO2 >90% PaO2 >60mmHg RR <35bpm PaCO2 <45mmHg ```

Question 27

Nasal Intubation

Answer 27

Maxillofacial or mandibular surgery Oral/dental surgery Facial trauma

Question 28

Nasal Intubation Contraindications

Answer 28

``` Coagulopathy Basilar skull fracture Severe intranasal disorder CSF leak Extensive facial fractures ```

Question 29

Nasal Intubation Supplies

Answer 29

``` Laryngoscope handle & blades MAGILL FORCEPS Oral & NP airways Neo-synephrine spray Nasal tubes Tape Suction Stethoscope ```

Question 30

Nasal Intubation Complications

Answer 30

``` Epistaxis Tracheal or esophageal trauma Displaced adenoids or polyps → bleeding & airway obstruction Bacteremia Sinusitis (long-term nasal intubation) ```

Question 31

Airway Emergency

Answer 31

Cannot ventilate, cannot intubate

Question 32

Difficult Airway Adjuncts

Answer 32

``` Intubating LMA (Fastrach) Video laryngoscope (Glidescope) C-mac or McGrath Fiberoptic intubation Bullard scope Wu scope UpsherScope Lightwand Bougie Combitube Transtracheal jet ventilation Retrograde intubation Cricothyrotomy ```

Question 33

Airway Management Pearls

Answer 33

BE PREPARED Perform thorough preop interview & detailed airway exam 1st view = best view Plan A, B, C... Z Practice adjuncts before an emergency situation Continuous monitoring VIGILENCE Assess, intervention, & REASSESS Unable to ventilate or intubate → wake up the patient When unsure about able to secure airway keep the patient breathing