Week 5 Handout Airway Flashcards
1
Q
What are intrinsic laryngeal muscles?
A
Intrinsic muscles control vocal cord tension, length, position, and glottic opening/closure.
2
Q
Name the intrinsic laryngeal muscles.
A
Cricothyroid, Vocalis, Thyroarytenoid, Lateral Cricoarytenoid, Posterior Cricoarytenoid, Aryepiglottic, Interarytenoid.
3
Q
What innervates the intrinsic laryngeal muscles?
A
All intrinsic muscles are innervated by the recurrent laryngeal nerve, except the cricothyroid, which is innervated by the external branch of the superior laryngeal nerve.
4
Q
What is the function of the cricothyroid muscle?
A
It tenses and elongates vocal cords by tilting the thyroid cartilage.
5
Q
What innervates the cricothyroid muscle?
A
External branch of the superior laryngeal nerve.
6
Q
What is unique about the cricothyroid muscle’s innervation?
A
It is the only intrinsic muscle not innervated by the recurrent laryngeal nerve.
7
Q
What is the function of the vocalis muscle?
A
It provides fine control of pitch by adjusting vocal cord tension.
8
Q
What innervates the vocalis muscle?
A
Recurrent laryngeal nerve.
9
Q
What is the function of the thyroarytenoid muscle?
A
It relaxes and shortens vocal cords, lowering pitch.
10
Q
What innervates the thyroarytenoid muscle?
A
Recurrent laryngeal nerve.
11
Q
What is the function of the lateral cricoarytenoid muscle?
A
It adducts the vocal cords (closes the glottis).
12
Q
What innervates the lateral cricoarytenoid muscle?
A
Recurrent laryngeal nerve.
13
Q
What is the clinical relevance of the lateral cricoarytenoid muscle?
A
It assists with voice production and airway protection.
14
Q
What is the function of the posterior cricoarytenoid muscle?
A
It abducts the vocal cords (opens the glottis/widening the rima glottidi).
15
Q
What innervates the posterior cricoarytenoid muscle?
A
Recurrent laryngeal nerve.
16
Q
What is the clinical relevance of the posterior cricoarytenoid muscle?
A
It is the only vocal cord abductor; dysfunction can cause airway obstruction.
17
Q
Where is the aryepiglottic muscle located?
A
Within the aryepiglottic folds.
18
Q
What is the function of the aryepiglottic muscle?
A
It assists in closing the laryngeal inlet during swallowing.
19
Q
What innervates the aryepiglottic muscle?
A
Recurrent laryngeal nerve.
20
Q
What is the clinical significance of the aryepiglottic muscle?
A
Helps protect the airway from aspiration.
21
Q
What is the structure of the interarytenoid muscle?
A
Composed of transverse and oblique fibers.
22
Q
What is the function of the interarytenoid muscle?
A
It adducts arytenoid cartilages, facilitating vocal cord closure.
23
Q
What innervates the interarytenoid muscle?
A
Recurrent laryngeal nerve.
24
Q
What is the clinical significance of the interarytenoid muscle?
A
Essential for full glottic closure during phonation and swallowing.
25
What is the largest laryngeal cartilage?
Thyroid cartilage.
26
What is another name for the thyroid cartilage?
Adam’s apple.
27
What is the shape of the thyroid cartilage?
Shield-like with two laminae meeting anteriorly.
28
What type of cartilage is the thyroid cartilage?
Unpaired.
29
What is the function of the thyroid cartilage?
Provides structural protection for vocal cords and other laryngeal structures.
30
Where is the cricoid cartilage located?
Below the thyroid cartilage.
31
What is the shape of the cricoid cartilage?
Ring-like; broad posteriorly and narrow anteriorly.
32
What type of cartilage is the cricoid cartilage?
Unpaired.
33
What is the function of the cricoid cartilage?
Forms the base of the larynx and provides attachment sites for other cartilages and muscles.
34
What is the shape of the arytenoid cartilages?
Small and pyramid-shaped.
35
What type of cartilage are the arytenoid cartilages?
Paired.
36
Where are the arytenoid cartilages located?
Sit on the superior posterior cricoid cartilage.
37
What is the function of the arytenoid cartilages?
Anchor and move the vocal cords—critical for phonation and respiration.
38
What is the shape of the cuneiform cartilages?
Small and rod-shaped.
39
What type of cartilage are the cuneiform cartilages?
Paired.
40
Where are the cuneiform cartilages located?
Within the aryepiglottic folds.
41
What is the function of the cuneiform cartilages?
Support and stiffen the aryepiglottic folds.
42
What is the shape of the corniculate cartilages?
Small and horn-shaped.
43
What type of cartilage are the corniculate cartilages?
Paired.
44
Where are the corniculate cartilages located?
Sit on the apex of the arytenoid cartilages.
45
What is the function of the corniculate cartilages?
Help reinforce and close the laryngeal inlet during swallowing.
46
What are extrinsic laryngeal muscles?
Muscles that move the larynx as a whole, especially during swallowing and phonation.
47
Name the extrinsic laryngeal muscles.
Sternothyroid, Thyrohyoid, Inferior pharyngeal constrictor.
48
What innervates the extrinsic laryngeal muscles?
Primarily via cervical spinal nerves and other cranial nerves (not recurrent laryngeal nerve).
49
What is the clinical role of extrinsic laryngeal muscles?
Stabilize and elevate/depress the larynx; do not directly affect vocal cord movement.
50
What is the sensory innervation provided by the trigeminal nerve (CN V)?
Anterior 2/3 of the nasal cavity, nasal septum, anterior mouth, soft palate, and anterior tongue.
51
Which branches of the trigeminal nerve are involved?
Maxillary (V2) and Mandibular (V3) divisions.
52
What is the primary function of the facial nerve (CN VII)?
Motor for facial expressions.
53
What does the facial nerve provide taste to?
Anterior 2/3 of the tongue (via chorda tympani).
54
What is the sensory innervation provided by the glossopharyngeal nerve (CN IX)?
Posterior 1/3 of tongue, tonsils, pharynx, middle ear.
55
What is the function of the vagus nerve (CN X)?
Motor and sensory to most of the pharynx and larynx.
56
What are the branches of the vagus nerve?
Superior Laryngeal Nerve (SLN) and Recurrent Laryngeal Nerve (RLN).
57
What does the internal branch of the superior laryngeal nerve (SLN) provide?
Sensory to larynx above the vocal cords, including epiglottis and aryepiglottic folds.
58
What does the external branch of the superior laryngeal nerve (SLN) innervate?
Motor to the cricothyroid muscle (tenses vocal cords).
59
What are the consequences of injury to the superior laryngeal nerve?
Impaired pitch modulation and swallowing difficulties (due to impaired vocal cord tension).
60
What is the pathway of the right recurrent laryngeal nerve (RLN)?
Loops around subclavian artery.
61
What is the pathway of the left recurrent laryngeal nerve (RLN)?
Loops around aortic arch → longer, more vulnerable.
62
What does the recurrent laryngeal nerve (RLN) innervate?
Motor to all intrinsic laryngeal muscles except cricothyroid; sensory to larynx below the vocal cords.
63
What are the consequences of injury to the recurrent laryngeal nerve?
Vocal cord paralysis, weak or absent cough, risk of aspiration.
64
What is the pathway of the Right Recurrent Laryngeal Nerve (RLN)?
Loops around the subclavian artery.
65
What is the pathway of the Left Recurrent Laryngeal Nerve (RLN)?
Loops around the aortic arch; it is longer and more vulnerable.
66
What does the Recurrent Laryngeal Nerve (RLN) innervate?
Motor to all intrinsic laryngeal muscles except cricothyroid; sensory to larynx below the vocal cords.
67
What are the clinical significances of RLN injury?
Can cause vocal cord paralysis, weak or absent cough, and risk of aspiration.
68
What causes Unilateral Vocal Cord Paralysis?
RLN injury due to surgery, tumors, or trauma.
69
What are the symptoms of Unilateral Vocal Cord Paralysis?
Hoarseness, breathy voice, weak cough, and aspiration risk.
70
What is the management for Unilateral Vocal Cord Paralysis?
Voice therapy, injection laryngoplasty or thyroplasty, observation or surgery depending on severity.
71
What causes Bilateral Vocal Cord Paralysis?
Bilateral RLN injury, which is rare and more serious.
72
What are the symptoms of Bilateral Vocal Cord Paralysis?
Airway obstruction, stridor, dyspnea, and voice often preserved.
73
What is the management for Bilateral Vocal Cord Paralysis?
Tracheostomy may be required acutely; surgical airway widening (e.g., cordotomy) for long-term care.
74
What is the Mallampati Classification used for?
A simple screening tool for predicting airway difficulty.
75
What is Class I in the Mallampati Classification?
Full visibility of tonsils, uvula, and soft palate.
76
What is Class II in the Mallampati Classification?
Hard and soft palate visible; upper uvula and tonsils seen.
77
What is Class III in the Mallampati Classification?
Only soft and hard palate, base of uvula visible.
78
What is Class IV in the Mallampati Classification?
Only hard palate visible.
79
What classes in the Mallampati Classification are associated with difficult intubation?
Class III and IV.
80
What is the Thyromental Distance (TMD) method?
Measured from the thyroid notch to mentum with the neck fully extended.
81
What does a TMD of ≥6–7 cm suggest?
Adequate; suggests easier intubation.
82
What does a TMD of <6 cm indicate?
Limited submandibular space; may indicate difficult laryngoscopy.
83
What is the Inter-incisor Gap method?
Measured as the maximum mouth opening between upper and lower incisors.
84
What does an Inter-incisor Gap of ≥3–4 cm indicate?
Normal jaw mobility.
85
What does an Inter-incisor Gap of <3 cm suggest?
Indicates restricted jaw movement; suggests difficult intubation.
86
What is the Mandibular Protrusion Test technique?
Ask patient to protrude lower jaw beyond the upper.
87
What does Class A (1) in the Mandibular Protrusion Test indicate?
Lower incisors can bite upper lip beyond vermilion line — easy intubation.
88
What does Class B (2) in the Mandibular Protrusion Test indicate?
Teeth edge-to-edge — moderate difficulty.
89
What does Class C (3) in the Mandibular Protrusion Test indicate?
Lower incisors can’t reach upper teeth — likely difficult airway.
90
What is the clinical relevance of Atlanto-occipital Joint Mobility?
Crucial for achieving the sniffing position for intubation; limited extension may impede airway visualization.
91
How is Atlanto-occipital Joint Mobility assessed?
Ask patient to flex/extend neck; check for arthritis, trauma, congenital defects.
92
What is the Cormack-Lehane Grading used for?
Assessed during direct laryngoscopy to guide decision on intubation aids.
93
What does Grade I in Cormack-Lehane Grading indicate?
Full glottic view.
94
What does Grade IIa in Cormack-Lehane Grading indicate?
Posterior glottis visible.
95
What does Grade IIb in Cormack-Lehane Grading indicate?
Only anterior glottis seen.
96
What does Grade III in Cormack-Lehane Grading indicate?
Only epiglottis seen.
97
What does Grade IV in Cormack-Lehane Grading indicate?
Neither glottis nor epiglottis visible.
98
What are the indications for Awake Intubation?
Difficult airway expected, aspiration risk, respiratory compromise, patient cooperation required.
99
What anatomical challenges indicate Awake Intubation?
Limited neck mobility, large tongue, Mallampati III–IV, history of difficult intubation, airway pathology.
100
What are the aspiration risks that indicate Awake Intubation?
Full stomach, GERD, bowel obstruction, emergency with unknown NPO status.
101
What is the technique commonly used for Awake Intubation?
Commonly performed using fiberoptic bronchoscope. Always have backup airway plans in place.
102
What is the decision point for Asleep Intubation?
Need to secure airway quickly? Yes → Rapid Sequence Induction (RSI), No → Regular Induction.
103
What are the indications for Rapid Sequence Induction (RSI)?
High aspiration risk, emergency surgery.
104
What is a key technique in Rapid Sequence Induction (RSI)?
No mask ventilation post-induction to avoid insufflation.
105
What are the considerations for Rapid Sequence Induction (RSI)?
Requires high skill, avoid ventilation before tube placement to prevent hypoxia.
106
What are the indications for Regular Induction?
Elective procedures with NPO confirmation, stable respiratory/airway status.
107
What is the technique for Regular Induction?
Gradual induction with preoxygenation, bag-mask ventilation between agents and intubation.
108
What are the considerations for Regular Induction?
Slower pace allows assessment and adjustment, more versatile but requires readiness for unexpected difficulty.
109
How do you confirm ventilation in an asleep patient?
Confirm chest rise, EtCO₂ waveform, airway pressure (aim <20 cmH₂O). Prepare for supraglottic airway or intubation.
110
What mnemonic is used for difficult ventilation?
BONES: Beard, Obese (BMI >26), No teeth, Elderly (>55), Snores.
111
What are backup strategies for ventilation?
2-handed mask ventilation, oral or nasal airway adjunct, supraglottic device, direct or video laryngoscopy.
112
What are the general features of face masks for ventilation?
Soft, clear, cushioned rim; standard 15mm/22mm connector; pediatric option: Rendell-Baker-Soucek mask.
113
What is the technique for one-handed mask ventilation?
Use non-dominant hand: C-E grip, lift jaw into mask for seal, use other hand to squeeze bag.
114
What is the technique for two-handed mask ventilation?
Provider at head of bed, both hands form C-grip on mask, perform jaw thrust, assistant squeezes bag.
115
What is the measurement for an oropharyngeal airway (OPA)?
Corner of mouth to angle of jaw.
116
What are the indications for using an oropharyngeal airway (OPA)?
Unconscious patients (no gag reflex).
117
What are the contraindications for using an oropharyngeal airway (OPA)?
Conscious or semi-conscious patients (intact gag reflex).
118
What is the measurement for a nasopharyngeal airway (NPA)?
Tip of nose to earlobe.
119
What are the indications for using a nasopharyngeal airway (NPA)?
Conscious or unconscious; intact gag reflex.
120
What are the contraindications for using a nasopharyngeal airway (NPA)?
Basilar skull fracture, nasal trauma, coagulopathy.
121
What are the types of supraglottic airways (SGAs)?
Laryngeal Mask Airway (LMA), i-gel, Laryngeal Tube.
122
What are the indications for using a supraglottic airway (SGA)?
Alternative to endotracheal intubation for general anesthesia with low aspiration risk, emergency airway management, difficult airway situations.
123
What are the advantages of supraglottic airways (SGAs)?
Quicker and easier to insert than ET tubes, less invasive, reduced airway trauma.
124
What are the limitations of supraglottic airways (SGAs)?
Does not protect airway from aspiration, limited use in high positive pressure ventilation needs.
125
What are the absolute contraindications for supraglottic airways (SGAs)?
High aspiration risk, inability to open mouth.
126
What is the mnemonic for difficult SGA placement?
RODS: Restricted mouth opening, Obstruction, Distorted airway, Stiff lungs/neck.
127
What is the placement technique for Laryngeal Mask Airway (LMA)?
Insert with the curve against the hard palate, advance until resistance at hypopharynx.
128
What is the recommended cuff pressure for LMA?
Recommended pressure: 40–60 cmH₂O. Do NOT exceed 60 cmH₂O – monitor with a manometer.
129
What are the risks of overinflation of the LMA cuff?
Overinflation risks: Lingual/hypoglossal/recurrent laryngeal nerve injuries, pharyngeal ischemia → necrosis.
130
How does nitrous oxide affect LMA cuff pressure?
Nitrous oxide may diffuse into cuff, raising pressure – monitor during N₂O use.
131
What are the ventilation parameters for LMA?
Max PPV pressure = 20 cmH₂O. Higher pressures risk gastric insufflation and aspiration.
132
What are the complications associated with LMA use?
Nerve injuries (lingual, hypoglossal, RLN) from high cuff pressure, pharyngeal necrosis, sore throat, aspiration risk, dislodgement during movement or repositioning.
133
What are the indications for using an LMA?
GA cases where intubation not required, shorter, lower-risk surgeries (ENT, extremities, some gynecological cases).
134
What are the contraindications for LMA use?
Full stomach / aspiration risk, known or suspected airway obstruction, procedures requiring high airway pressures.
135
What are the advantages of LMA over ETT?
Faster insertion, less trauma, reduced sore throat and coughing on emergence, useful bridge in failed intubation or difficult airway algorithms.
136
What is the LMA Classic?
Original design, reusable silicone, inflatable cuff; no gastric access port. Best for routine elective surgeries with low aspiration risk.
137
What is the LMA Supreme?
Single-use, preformed curved airway, includes bite block and gastric access port. Higher seal pressures; better aspiration protection than Classic.
138
What is the LMA Fastrach?
Designed for difficult airway management, rigid, curved tube allows for blind or fiberoptic-guided intubation.
139
What is the LMA C-Trach?
Enhanced version of the Fastrach with integrated camera and monitor for real-time visualization of the glottis.
140
What is the LMA Flexible?
Long, flexible airway tube ideal for procedures involving head/neck movement (ENT, dental, ophthalmic).
141
What is the i-gel Supraglottic Airway?
Non-inflatable cuff made of thermoplastic elastomer, anatomical seal over the larynx — no inflation needed.
142
What are the features of Combitube?
Dual-lumen (tracheal + esophageal), blind insertion, usually enters esophagus.
143
What are the features of King Laryngeal Tube?
Single-lumen with 2 inflatable cuffs, blind insertion designed for esophageal position.
144
What are the indications for Combitube?
Emergency airway when intubation fails or is not possible.
145
What are the indications for King Laryngeal Tube?
Emergency airway, especially prehospital or crash settings.
146
What happens if there is emesis and the patient is not intubated?
Risk of aspiration increases significantly.
147
What is the design of the Macintosh (Mac) Blade?
Curved blade designed to sit in the vallecula, anterior to the epiglottis.
148
What is the mechanism of the Macintosh (Mac) Blade?
Indirectly lifts the epiglottis revealing the vocal cords.
149
What is the primary use of the Macintosh (Mac) Blade?
Standard for adults with normal anatomy; useful for large tongues or limited space.
150
What are the advantages of the Macintosh (Mac) Blade?
Follows the natural curve of the oropharynx, easy to navigate large tongues or small mouths, easier for less experienced providers, provides more space for ETT insertion.
151
What is the design of the Miller Blade?
Straight blade with a flatter profile.
152
What is the mechanism of the Miller Blade?
Directly lifts the epiglottis for glottic exposure.
153
What is the primary use of the Miller Blade?
Ideal for neonates and small children, and in patients with a floppy epiglottis.
154
What are the advantages of the Miller Blade?
Better control of epiglottis, more effective in patients with short necks or anterior airways.
155
What is Direct Laryngoscopy (DL)?
Technique that aligns oral, pharyngeal, and laryngeal axes using Mac or Miller blade for direct line-of-sight.
156
What are the advantages of Direct Laryngoscopy (DL)?
Time-tested method, no need for video equipment.
157
What are the limitations of Direct Laryngoscopy (DL)?
Difficult in anterior airways or obese patients, relies on provider’s skill and positioning.
158
What is the first step in preparation for laryngoscopy?
Equipment Check: Ensure light source works properly and select appropriate blade size and type.
159
What is the recommended patient positioning for laryngoscopy?
Supine position with head in 'sniffing position'; may require pillow under occiput.
160
What is the purpose of preoxygenation?
Deliver 100% oxygen for several minutes to denitrogenate lungs, increase oxygen reserve, and reduce risk of hypoxemia during apnea.
161
How should the laryngoscope be held?
Use left hand to hold laryngoscope and keep right hand free for endotracheal tube placement.
162
What is the technique for inserting the blade?
Open mouth with right hand, insert blade on right side of mouth, sweep tongue to left.
163
How do you visualize the glottis?
Advance blade until glottis is seen; use Macintosh blade in vallecula or Miller blade directly under epiglottis.
164
What is the technique for lifting the blade?
Lift upward and away at a 45° angle toward ceiling; avoid using teeth as a fulcrum.
165
What is the process for endotracheal tube insertion?
With glottis in view, use right hand to guide the ETT through the vocal cords and advance until the cuff just passes the cords.
166
How do you confirm ETT placement?
Inflate the cuff and confirm placement by bilateral chest auscultation, visible chest rise, and capnography.
167
What is the final step after confirming ETT placement?
Secure ETT with tape or commercial tube holder and continuously monitor for displacement or obstruction.
168
What is Video Laryngoscopy (VL)?
Technique that inserts blade midline; view glottis via camera on monitor without full axis alignment.
169
What are the advantages of Video Laryngoscopy (VL)?
Enhanced glottic view, useful for difficult airways, less cervical spine movement required.
170
What are the limitations of Video Laryngoscopy (VL)?
Technology dependent, may require learning curve and is subject to equipment failure.
171
What is the first step in preparation for Video Laryngoscopy?
Equipment Check: Ensure camera and monitor are working properly and choose the correct blade size.
172
What is the recommended patient positioning for Video Laryngoscopy?
Supine position; 'Sniffing' position is common but less neck extension may be sufficient.
173
What is the purpose of preoxygenation in Video Laryngoscopy?
Administer 100% oxygen for several minutes to maximize oxygen reserves and delay hypoxemia.
174
How should the blade be inserted in Video Laryngoscopy?
Open the mouth and insert the blade along the midline of the tongue; approach may vary based on the specific VL device.
175
How do you visualize the airway in Video Laryngoscopy?
Gently advance until glottic structures appear on the screen; no need to align axes.
176
What adjustments may be needed during Video Laryngoscopy?
Use fine manipulations to optimize the view of the vocal cords on the monitor.
177
What is the process for endotracheal tube insertion in Video Laryngoscopy?
Advance ETT under visual guidance, watching the monitor as the tube approaches the vocal cords.
178
How do you confirm ETT placement in Video Laryngoscopy?
Inflate the cuff and confirm correct placement with bilateral breath sounds, visible chest rise, and capnography.
179
What is the final step after confirming ETT placement in Video Laryngoscopy?
Secure the endotracheal tube to prevent displacement and continuously monitor vital signs, oxygenation, and ventilation.
180
What is the connector of an Endotracheal Tube (ETT)?
15 mm universal connection to circuit.
181
What does the pilot balloon of an ETT do?
Monitors cuff inflation status.
182
What is the purpose of the cuff in an ETT?
Inflated to seal trachea (target pressure < 25 cmH₂O).
183
What is the Murphy Eye in an ETT?
Safety opening to prevent complete obstruction.
184
What is the function of the beveled tip of an ETT?
Aids in atraumatic passage through vocal cords.
185
What are the two standard styles of ETTs?
Cuffed and Uncuffed.
186
What is the cuffed ETT used for?
Most common in adults; helps seal the trachea to prevent aspiration.
187
What is the uncuffed ETT typically used for?
Typically used in pediatric patients due to their narrower airways.
188
What is a reinforced (armored) ETT?
Flexible, kink-resistant tubes for head, neck, or prone surgeries.
189
What is the purpose of double-lumen tubes (DLT)?
Used in thoracic surgeries for lung isolation.
190
What are preformed tubes (RAE) designed for?
Curved tubes designed for oral or nasal placement in head/neck surgeries.
191
What is the indication for using ETTs?
General anesthesia requiring definitive airway control.
192
What is one advantage of using ETTs?
Provides a secure and reliable airway.
193
What is a limitation of ETTs?
More invasive than supraglottic airways.
194
What is a contraindication for ETT placement?
Severe maxillofacial trauma where oral access is compromised.
195
What are some complications associated with ETTs?
Insertion-related injuries: dental trauma, vocal cord damage, tracheal injury.
196
What is the design of an Oral RAE Tube?
Preformed with a curve that directs the distal end anteriorly (toward the chin).
197
What is the purpose of a Nasal RAE Tube?
Used for nasal intubation in head and neck surgeries where oral access must remain clear.
198
What is the design of a reinforced (armored) tube?
Spiral wire reinforcement inside the tube wall, giving kink resistance.
199
What is the purpose of double-lumen endobronchial tubes (DLT)?
Used in thoracic surgery for one-lung ventilation.
200
What is the difference between cuffed and uncuffed tubes?
Cuffed tubes have an inflatable balloon to seal the trachea; uncuffed tubes rely on natural airway seal.
201
What is the design of laser-resistant tubes?
Made from laser-resistant materials (e.g., silicone with metallic wrapping).
202
What is a Low Volume High Pressure (LVHP) cuff?
Small internal volume; requires higher pressure to seal the trachea.
203
What are the disadvantages of LVHP cuffs?
Increased risk of tracheal ischemia and injury.
204
What is a High Volume Low Pressure (HVLP) cuff?
Large internal volume; requires lower pressure to seal.
205
What is an advantage of HVLP cuffs?
Lower risk of mucosal injury.
206
What is the material of the Eschmann Introducer?
Made of semi-rigid plastic or rubber for flexibility and stability.
207
What shape does the Eschmann Introducer have?
Long and thin with a Coude tip (angled) for directional control.
208
What markings are present on the Eschmann Introducer?
Depth markers help monitor insertion length.
209
What is a common nickname for the Eschmann Introducer?
Also known as a 'bougie'—a classic difficult airway adjunct.
210
What are the indications for using the Eschmann Introducer?
Difficult airway and failed intubation.
211
What constitutes a difficult airway?
Poor glottic view due to obesity, swelling, trauma, or limited mouth opening; Cormack-Lehane Grade III or IV laryngoscopy.
212
How is the Eschmann Introducer used for insertion?
Insert under direct or video laryngoscopy when cords are not clearly visualized.
213
What is the purpose of the COOK Exchange Catheter?
Allows oxygen insufflation or jet ventilation.
214
What are the sizes of the COOK Exchange Catheter?
External diameters: 2.7 mm, 3.7 mm, 4.7 mm, 6.33 mm; Lengths: 2.7 mm = 45 cm; 3.7–6.33 mm = 83 cm.
215
What is the distal tip of the COOK Exchange Catheter designed to do?
Soft, rounded, and atraumatic to reduce mucosal trauma.
216
What are the applications of the COOK Exchange Catheter?
Available for both adult and pediatric populations.
217
What are the precautions associated with the COOK Exchange Catheter?
Barotrauma, dislodgement, and soft tissue injury.
218
What is the purpose of Bronchial Blockers?
Achieves lung isolation during one-lung ventilation (OLV).
219
What are the types of Bronchial Blockers?
Arndt Endobronchial Blocker, Cohen Flex-Tip Blocker, EZ-Blocker, Univent Tube.
220
What are the advantages of using Bronchial Blockers?
Maintains standard ETT use, ideal for difficult airway cases, offers suction/oxygenation.
221
What are the limitations of Bronchial Blockers?
Displacement risk, difficult placement, bulky design, incomplete lung collapse, increased resistance.
222
What is required for Flexible Fiberoptic Bronchoscopy for Intubation?
Adequate topical anesthesia and skilled operator.
223
What are the indications for Flexible Fiberoptic Bronchoscopy?
Anticipated difficult airway, history of difficult intubation, need for awake intubation.
224
What are the absolute contraindications for Flexible Fiberoptic Bronchoscopy?
Severe oropharyngeal/nasopharyngeal obstruction, uncooperative patient.
225
What are the key considerations for Awake Fiberoptic Intubation?
Patient safety, operator proficiency, communication, and backup plans.
226
What is the first step in Awake Fiberoptic Intubation?
Pre-Intubation Preparation: Assessment, consent, equipment setup, patient positioning.
227
What agents are used for topical anesthesia in Awake Fiberoptic Intubation?
Lidocaine sprays/gels, nebulized lidocaine, viscous rinse.
228
What is the purpose of sedation in Awake Fiberoptic Intubation?
Light sedation to ensure patient comfort while monitoring vital signs.
229
What is the final step in Awake Fiberoptic Intubation?
Secure the ETT and continue monitoring oxygenation and ventilation.
230
What is Retrograde Intubation?
A technique for intubating the trachea by accessing it through the cricothyroid membrane.
231
What are the steps of Retrograde Intubation?
1. Tracheal Access: Puncture the cricothyroid membrane with a needle and confirm tracheal entry.
2. Guidewire Insertion: Pass a guidewire through the needle and advance it until it exits the mouth or nose.
3. ETT Placement: Thread the endotracheal tube (ETT) over the wire and advance it into the trachea. Remove the guidewire once ETT is placed.
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What are the indications for Retrograde Intubation?
Anatomic difficulty, facial trauma, limited mouth opening, cervical spine immobility, fiberoptic failure or unavailability.
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What are the advantages of Retrograde Intubation?
Alternative intubation route in difficult scenarios and preserves neck stability.
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What considerations should be taken into account for Retrograde Intubation?
Requires training, risks of bleeding, infection, airway injury, and rarely used due to fiberoptic advances.
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What is a Bullard Laryngoscope?
A laryngoscope with a curved blade that enables glottic view without neck extension.
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What are the features of the Bullard Laryngoscope?
Curved blade for glottic view, fiberoptic channel for visualization, integrated tube channel for ETT placement, ergonomic handle.
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What are the indications for using a Bullard Laryngoscope?
Difficult airways: limited mobility, obesity, or anatomic abnormalities, and failed direct laryngoscopy.
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What are the advantages of the Bullard Laryngoscope?
Excellent glottic visualization with minimal cervical movement, useful in trauma and spinal injury patients.
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What considerations should be taken into account for the Bullard Laryngoscope?
Requires experience and has limited availability in some settings.
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What is a Lighted Stylet (Lightwand)?
A malleable stylet with a light at the distal tip, inserted inside an ETT to facilitate blind intubation.
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What is the usage procedure for a Lighted Stylet?
1. Insert stylet into ETT and place device into the patient's mouth.
2. Look for bright transillumination at the anterior neck.
3. Advance ETT into the trachea off the stylet.
4. Remove the stylet once the tube is placed.
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What are the indications for using a Lighted Stylet?
Difficult airway, failed visualization, situations with limited neck mobility or when conventional techniques are not possible.
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What are the advantages of the Lighted Stylet?
Portable, minimally invasive, and effective in dimly lit or field environments.
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What considerations should be taken into account for the Lighted Stylet?
Must avoid excessive force to prevent soft tissue damage, requires training for accurate placement, less effective in obese patients.
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What is the overview of Tracheal Intubation (TI)?
Central to airway management with techniques including Direct laryngoscopy (DL), flexible scope, intubating LMA, videolaryngoscopy (VL).
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What are the considerations for Tracheal Intubation?
Patient history, physical airway assessment, previous anesthetic issues, risk factors.
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What is the Sniffing Position for intubation?
Aligns oral, pharyngeal, and tracheal axes.
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What is Ramping in patient positioning for intubation?
Aligns tragus with sternum—ideal for obese or difficult airway patients.
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What should be considered with cervical caution during intubation?
Be careful with trauma or spine disease.
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What is the goal of Preoxygenation?
Delay desaturation during apnea.
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What is the standard for Preoxygenation?
100% O₂ for 3–5 min with ≥5 L/min flow.
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What are the monitors used during Preoxygenation?
Bag movement, ETCO₂ waveform, F_EO₂ ≥90%.
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What are alternatives to standard Preoxygenation?
8 vital capacity breaths in 60 sec, apneic oxygenation via nasal cannula (up to 15 L/min).
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What are the techniques for Laryngoscopy?
Displace tongue R → L, avoid levering teeth. Curved Blade (Macintosh) lifts epiglottis indirectly; Straight Blade (Miller) lifts epiglottis directly.
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What is the BURP Maneuver?
A technique that improves glottic view during laryngoscopy.
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What is the priority during Difficult or Failed Intubation?
Oxygenation and ventilation.
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What adjuncts can be used for Difficult or Failed Intubation?
Fiberoptic scope, intubating LMA, VL, rescue tools.
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What guidelines should be followed when direct laryngoscopy fails?
Use ASA Difficult Airway Algorithm.
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What is the management of a Difficult/Failed Airway?
Anticipated: Plan based on patient-specific risks. Unanticipated: Act immediately using failed airway protocols.
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How is a Difficult Airway defined?
Difficulty with facemask ventilation, supraglottic airway placement, endotracheal intubation, invasive airway access.
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What are signs of a Difficult Airway?
Poor facemask ventilation, Cormack-Lehane III/IV, low tidal volumes with SGA use, difficulty with invasive airway.
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What is the Airway Approach Algorithm?
1. Is airway management required? 2. Is TI expected to be difficult? 3. Can supralaryngeal ventilation be used? 4. Is aspiration risk acceptable? 5. Is rapid desaturation likely?
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What should be done if all answers in the Airway Approach Algorithm are yes?
Proceed with induction and muscle relaxant.
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What should be considered if any answer in the Airway Approach Algorithm is no?
Consider awake intubation or alternatives.
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What are the key takeaways for airway management?
Assessment & Strategy, Optimal Positioning, Preoxygenation, Algorithms, Adaptability.
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What is Awake Intubation?
Indicated when difficulty is anticipated and spontaneous ventilation is essential.
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What are the advantages of Awake Intubation?
Maintains ventilation and muscle tone, reduces aspiration risk.
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What sedation should be used for Awake Intubation?
Use minimal sedatives to avoid risk of apnea.
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What techniques can be used for Awake Intubation?
Awake standard or video laryngoscopy, flexible intubating endoscope.
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What preparation is needed for Awake Intubation?
Explain and consent, glycopyrrolate for secretions, aspiration prophylaxis, nasal vasoconstrictors, calculate local anesthetic doses.
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What are the methods for Topical Anesthesia?
Nebulization, atomization, sprays, lidocaine lollipop, direct cord topicalization.
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What is the Glossopharyngeal Nerve Block procedure?
Displace tongue, inject 1–2 mL of 2% lidocaine at palatoglossal arch bilaterally.
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What is the Superior Laryngeal Nerve Block procedure?
Palpate and displace hyoid, inject 1 mL above thyrohyoid membrane, advance and inject 2 mL more.
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What is the Transtracheal Block procedure?
Identify cricothyroid membrane, inject 3–5 mL of 2% lidocaine after air aspiration.
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What are practical tips for airway management?
Time and cooperation are essential, avoid oversedation, confirm safe local anesthetic dosing, always have backup plans.
