Airway Management

Question 1

T or F: smokers have increased rates of all pulmonary complications, including infection, ICU admission, and prolonged ventilation.

Answer 1

True- the causative factor with the greatest impact on complications appears to be sputum production.

Question 2

T or F: smoking is associated with a higher incidence of periperative airway complications, including reintubation, laryngospasm, bronchospasm, and hypoventilation.

Answer 2

True

Question 3

T or F: the following criteria have been found to be predictive of difficult mask ventilation:

Age > 55
BMI > 26
lack of teeth
presence of beard
history of snoring
Mallampati class III and IV
reduced jaw protrusion

Answer 3

True

Question 4

Anatomic differences between the infant and the adult airway:

Tongue
Larynx position
epiglottis
Cricoid cartilage

Answer 4

1- Infant tongue is larger and will obstruct more easily
2- Larynx sits in a more cephalad position
3- Infant epiglottis is narrower and more difficult to manipulate with a laryngoscope.
4- Infant airway is narrowest at the cricoid cartilage, so you may have successful passage of the ETT through the vocal cords only to be followed by inability to pass beyond the cricoid cartilage.

Question 5

T or F: For CO2 and KTP lasers, use flexible stainless steel, copper-covered red rubber tubes, and Teflon/silicon/aluminum tubes.

Answer 5

True

Question 6

T or F: For Nd-YAG lasers, use spiral-wound metal tubes with thick walls (Norton Tube) or the white rubber tubes with a cuff-within-a-cuff (LaserTube)

Answer 6

True

Question 7

T or F: Laser tube cuffs often contain methylene blue crystals and should always be filled with saline. The methylene blue acts as a marker for cuff rupture or perforation due to laser damage.

Answer 7

True

Question 8

T or F: PEEP can reduce the risk of fire in PVC tubes when CO2 lasers are in use.

Answer 8

True

Question 9

T or F: in laser surgery, nitrogen, air, or helium, should be used to reduce the oxygen concentration to the lowest level possible while still providing adequate oxygenation.

Answer 9

True

Question 10

T or F: bilateral recurrent laryngeal nerve injury results in stridor or complete airway obstruction immediately after extubation.

Answer 10

True

Question 11

T or F: unilateral recurrent laryngeal nerve injury results in one vocal cord in the paramedian position due to unopposed adduction by the ipsilateral cricothyroid muscle. This can cause mild hoarsenss but negligible airway obstruction and minimal aspiration risk.

Answer 11

True

Question 12

T or F: postextubation stridor also tends to present immediately after extubation and rarely presents after a period of normal peech.

Answer 12

True

Question 13

T of F: due to its long length and relatively small diameter, the ETT creates the greatest resistance in the breathing circuit.

Answer 13

True

Question 14

In the setting of impending complete airway obstruction due to angioedema, what is the safest course of action?

Answer 14

Perform an awake fiberoptic intubation after topical anesthesia.

Do NOT observe, as observation of the patient or transfer to another location may lead to total airway obstruction, hypoxemia, and death.

Question 15

What are at least 4 risk factors for tracheal mucosal injury and tracheal stenosis?

Answer 15

Prolonged hypotension
infection
prolonged intubation
cuff pressures exceeding the tracheal capillary blood pressure resulting in tissue ischemia.

The recommended cuff pressure for tracheostomy cuffs is 25-35 mm Hg

Question 16

T or F: with a double lumen tube it is not necessary to know which lung is bleeding.

Answer 16

True

Question 17

T or F: malignancy in the neck can affect recurrent laryngeal nerve function.

Answer 17

True

Question 18

T or F: the left recurrent laryngeal nerve is injured twice as frequently as the right. The recurrent laryngeal nerve carries both abductor and adductor fibers. The abductor fibers are more vulnerable.

Answer 18

True

Question 19

T or F: unilateal recurrent laryngeal nerve injury is usually harmless, but bilateral recurrent laryngeal nerve injury can cause the adductor fibers to draw the cords towards each other, resulting in a very narrow glottic opening and potentially respiratory distress.

Answer 19

True

Question 20

T or F: laryngeal edema is an important cause of postextubation airway obstruction. It is most common in children and infants. It may result from traumatic intubation. It usually develops rapidy but may be delayed for up to 6 hours.

Answer 20

True- steroids may help this condition.

Question 21

Which nerve innervates the cricothyroid muscle?

Answer 21

the external branch of the superior laryngeal nerve provides motor innervation

Question 22

Which nerve provides sensory innervation to the base of the tongue, epiglottis, aryepiglottic folds, and aretynoids?

Answer 22

the internal branch of the superior laryngeal nerve provides sensory innervation

Question 23

Which nerve provides sensory innervation below the level of the vocal cords?

Answer 23

the recurrent laryngeal nerve, which is a branch of the vagus nerve.

Question 24

Which nerve provides sensory innervation to the pharynx?

Answer 24

the glossopharyngeal nerve

Question 25

T or F: the cricothyroid muscle is the only muscle of the larynx not innervated by the recurrent laryngeal nerve.

Answer 25

True- the external branch of the superior laryngeal nerve innervates the cricothyroid muscle.