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