Fellowship - airway Flashcards
A 50-year-old man with a base of tongue cancer is scheduled for elective tracheostomy immediately followed by tumour resection. Discuss the issues involved with his airway management.
List the essential equipment currently recommended to manage a difficult airway in an adult patient. (50%) Justify supplementary items you would recommend. (50%)
“Describe the physiological principles underlying preoxygenation prior to the induction of anaesthesia. (50%) Discuss the advantages and disadvantages of using a high inspired oxygen concentration (>80%) during maintenance of anaesthesia.
(50%) “
“A 40 year-old male is scheduled for elective bariatric surgery.For this patient: List the important features of history and examination that may identify a potentially difficult airway. (30%) How could you modify your anaesthetic technique to
minimise hypoxia at induction. (70%)”
a. How is the need for manual in-line stabilisation of the neck determined? (50%) b. What are the implications of inline stabilisation for endotracheal intubation of the airway (50%).
a. Describe the sensory innervation of the respiratory passage from the nostrils to, and including, the vocal cords (50%). b. List the indications and contraindications for nasal intubation (50%).
A 68-year-old man in hospital awaiting definitive surgery for a supraglottic squamous cell carcinoma of the larynx has worsening stridor at rest. (a) How might his symptoms be improved in the preoperative period? (30%) (b) Describe your evaluation of his airway and how this will influence your intraoperative airway management plan. (70%)
An adult patient who was intubated for tonsillectomy is noted to have an upper central incisor tooth missing in the Recovery Room after extubation. (a) List the predisposing factors for perioperative dental damage. (50%) (b) What is your management of this situation? (50%)
2010.1.15 a. What is the physiological basis of preoxygenation? (50%) b. Describe your method of preoxygenation including how you assess its adequacy. (50%)
A 60-year-old man is anaesthetised for a rigid cystoscopy. You notice bile stained fluid in his classic laryngeal mask airway (LMA) during the procedure. Describe your management.
An adult patient from the intensive care unit with severe adult respiratory distress syndrome (ARDS) requires a laparotomy for an acute abdomen.a. What are the features of ARDS? (30%)b. Explain your perioperative ventilation strategy (70%)
You are called to anaesthetise a 70-year-old man with a perforated bowel for laparotomy, three days after colonoscopy.Outline the measures you will take to reduce the likelihood of this patient developing acute lung injury.
(a) Describe the anatomy, including surface landmarks, relevant to performing cricothyroidotomy. (50%) (b) What are the complications of this procedure? (50%)
Describe a technique for front of neck access to the airway in a ‘Can’t intubate, Can’t Oxygenation’ situation (50%). Outline the potential complications and limitations of this technique (50%).
Evaluate the equipment available for the delivery of oxygen to postoperative patients on a general surgical ward.
Compare and contrast first-generation and second-generation laryngeal mask airways.
Describe the physiological effects of a high-flow nasal cannula device (HFNC) e.g. OptiflowTM or AirvoTM. (50%) Justify its use in an adult endoscopy suite. (50%)
Considering the indications and limitations, compare the rationale for the use of: —Hudson masks —Non-rebreathing masks —Nasal prongs
“A patient is undergoing revision parathyroidectomy. At the surgeon’s request, you have placed a Nerve Integrity Monitor (NIM) tube for monitoring recurrent laryngeal nerve function. The surgeon is unable to elicit a response from the monitor
when stimulating the recurrent laryngeal nerve. a. Explain how the NIM tube monitors nerve function? (30%) b. Outline the possible causes of being unable to elicit a response and how you would manage them? (70%) “
With regard to oxygen therapy for patients in a general postoperative ward a. Describe the options available (30%) b. What are the justifications for your choice for a particular patient? (70%)
Compare and contrast oxygen delivery by nasal prongs, simple facemask and Venturi mask.
A patient has undergone an eight-hour elective cervical spine fusion involving both anterior and posterior approaches. Outline your approach to extubation of this patient.
Outline extubation strategies for anticipated difficult extubation of an adult.
“a. What is the physiological basis of preoxygenation? (50%)
b. Describe your method of preoxygenation including how you assess its adequacy. (50%)”
How do you assess an otherwise well patient with regard to difficulty of intubation at the bedside? How accurate is such an assessment?
Draw flow volume loops associated with a) Fixed upper airway obstruction b) Variable extrathoracic airway obstruction c) Variable intrathoracic airway obstruction. Explain briefly the physiological reasons for the shape of these loops
Discuss the risks and benefits associated with intermittent positive pressure ventilation through proseal ® laryngeal mask airway for a patient undergoing laparoscopic cholecystectomy.
What is the physiological basis of preoxygenation? Describe your method of preoxygenation including how you assess its adequacy.
What is the role of a laryngeal mask airway in a failed intubation for laparotomy? Also 2002b15/1995b4
Justify the use of a laryngeal mask airway in a 25 yo, 80kg man having general anaesthesia for removal of 4 molar teeth.
Describe the technique of applying cricoid pressure to prevent regurgitation of gastric contents.
Discuss the presence of morbid obesity as a predictor of difficult intubation.
Discuss the role of the LMA in the management of a difficult intubation
A morbidly obese patient (160kg, 165cm) with sleep apnoea requiring the use of CPAP mask develops acute cholecystitis. He is febrile and sweaty, with warm peripheries. Blood pressure is 110/70. Heart rate is 110/min. He is scheduled for urgent cholecystectomy. His saturation on arrival in the operating theatre is 93% on O2 (nasal prongs 2l/min). Discuss the advantages and disadvantages of an awake intubation in this patient.
A 17 year-old trail bike rider was struck on the neck by a low branch and thrown from his bike. He presents to your casualty with a hoarse voice, stridor and subcutaneous emphysema of the neck. Discuss your plan to secure this patient’s airway.
What are the arguments for and against leaving a laryngeal mask airway in place for unsupervised removal by recovery room nurses?
List the anatomical differences between the neonatal and adult airway. Include the significance of each difference.
A healthy 25 yo, 80kg man had general anaesthesia for the elective removal of 4 molar teeth. The anaesthetist uses a laryngeal mask airway (LMA). Justify the use of a LMA for this procedure. Halfway through surgery, the capnograph trace becomes flat. Describe your management. Discuss methods of postoperative analgesia for this surgery.
“A 50 yo man with gastro-oesophageal reflux and occasional nocturnal pharyngeal reflux is to have knee arthroscopy under general anaesthesia. What are the methods which could be used to minimise the risk of aspiration of gastric contents?
What are the adverse effects of the pharmacological agents which could be used for this purpose (to minimise the risks of aspiration of gastric contents)? Exclude any considerations of anaesthetic agents or muscle relaxants.
Despite your best management the patient does regurgitate and aspirate at induction. How would you manage this?”
What are the arguments for and against the use of a laryngeal mask airway for general anaesthesia for laparoscopic tubal ligation?
Explain your bedside assessment of the airway in an adult who has a history of a difficult tracheal intubation.
List the limitations of awake fibreoptic intubation. (30%)Discuss the options for securing the airway following unsuccessful awake fibreoptic intubation for an adult presenting with acute epiglottitis. (70%
Outline the role of a laryngeal mask airway in managing an unanticipated failed tracheal intubation in a patient who was having an elective laparotomy?
A colleague has asked for your assistance in managing the airway of a patient who is about to have lumbar spine surgery.
After being unable to intubate the patient, your colleague has inserted a size 4 classic (1st generation) laryngeal mask. Ventilation is acceptable with this device and the patient is stable.
How should you and your colleague proceed?
Outline the limitations and possible complications of the use of supraglottic airway devices. (70%)Describe a structured approach to the assessment of a patient with dysphonia after the use of a supraglottic airway. (30%)
Discuss the potential benefits and risks of supranormal oxygen levels in the perioperative setting
You are called to the emergency department to assist with a patient who has presumed epiglottitis. He is 35 years old, otherwise well and has a lateral X-ray of the neck showing a classic ‘thumbprint’ sign. He has been in the ED for 3 hours and nos is stridulous, unable to speak and becoming increasingly distressed. Describe your management of this situation
