Airway Skills

Question 1

Indication for ETT

Answer 1

common with GA but not requirement

pts with full stomach/gerd
spine surgeries/ prone
high risk of aspiration of blood (head and neck trauma)
predicted difficult airway
ineffective oxygenation or ventilation with supra-laryngeal airway

Question 2

Surgical Indications for ETT

Answer 2

head-neck surgery
paralysis required (abd surgery)
surgery affecting ventilation/perfusion (CTS)
prolonged surgery

Question 3

Medical Indications for ETT

Answer 3

inadequate airway protection (GCS <10)
ineffective oxygenation/ventilation
critical illness
controlled management of CO2 (ICP)

Question 4

Preparation for Direct Laryngoscopy

Answer 4

checking equipment/positioning
test tubes cuff
stylet bent like hockey stick to facilitate anterior larynx intubation
bulb function tested
extra handle, ett, stylet, bougie available
suction
bed at waist level

Question 5

Unsuccessful Intubation

Answer 5

Evaluate why the intubation attempt was unsuccessful and make an adjustment
Examples include: repositioning the patient, selecting a different blade, using an indirect laryngoscope and/or requesting the assistance of another anesthesia provider

Question 6

Plan A DAS

Answer 6

Maximize success of TI on the first attempt (e.g. preparation, preoxygenation, positioning).

*Limit attempts to no more than three total

Question 7

Plan B DAS

Answer 7

Emphasis is maintenance of oxygenation using a SAD.
Video- or fiberoptic-guided TI is recommended instead of blind techniques using bougie or SAD
* blind techniques may cause significant trauma*
* Maximum of three attempts*

Question 8

Plan C DAS

Answer 8

Attempt to oxygenate using a facemask. If facemask ventilation is possible, awaken the patient.

Provide complete paralysis if needed

Question 9

Plan D DAS

Answer 9

Declare cannot intubate and cannot ventilate/oxygenate
proceed with cricothyrotomy.
Attempts to oxygenate the patient should continue (e.g. facemask, SAD, and nasal cannula).
Surgical cricothyrotomy using a scalpel for access is the preferred rescue technique.

Question 10

Nasal Tracheal Intubation

Answer 10

• may be indicated for ENT procedures and/or difficult airways
• nares are prepared with phenylephrine
• nasal tubes are selected based on the patient’s height
• placed in warm sterile water to make more malleable during placement
• nares can be dilated with nasal trumpets
• can be facilitated with a FOS scope or with McGill forceps

The cuff of nasal tubes can get torn on nasal turbninates during placement

Question 11

Complication of tracheal intubation

Answer 11

damage to airway
hypoxia
aspiration
esophageal intubation
laryngospasm

Question 12

Extubation Criteria

Answer 12

Hemodynamically stable
Normothermia
Maintain patent airway
Muscular strength
Metabolic stable
Hematological stable
Adequate analgesia

Question 13

Adequate Respiratory Mechanics: Extubation

Answer 13

1. Vital capacity > 15 mL/kg
2. Maximal negative inspiratory force greater than −20 cm H2O
3. Tidal volume of at least 4–5 mL/kg

Question 14

Adequate oxygenation: extubation

Answer 14

(with Fio2 less than 50%)

1. SpO2 greater than 90%
2. PaO2 greater than 60 mm Hg

Question 15

Adequate alveolar ventiliation: extubation

Answer 15

Paco2 <50mmhg

Question 16

Treatment of Laryngospasm

Answer 16

1. Remove stimulus (e.g., suction the pharyngeal space)
2. Administration of 100% oxygen
3. Provide an open and clear airway (e.g., placement of an oral airway)
4. Perform a jaw thrust (e.g., Larson maneuver or pressure on the laryngospasm notch)
5. Apply positive-pressure ventilation (e.g., 10–30 cm H2O pressure–beware of gastric insufflation)
6. Consider deepening the anesthesia with propofol (e.g., 0.5 mg/kg IV)
7. Administer succinylcholine (e.g., 0.2–2 mg/kg IV or 4–5 mg/kg IM)