Management of Difficult Airway

Question 1

What are the criteria for inability to ventilate a patient?

Answer 1

Anesthetist cannot cause a life-sustaining amount of gas exchange to occur with a jaw thrust, oral or nasal airway

Question 2

What are the criterial for the inability to intubate a patient?

Answer 2

Anesthetist cannot place an ETT through the vocal cords within a life-sustaining period of time

Question 3

What are the causes of inability to ventilate?

Answer 3

LaryngospasmSupraglottic soft tissue relaxationChest wall rigidityPathologic, glottic and subglotticEquipment failure

Question 4

What are the causes of a laryngospasm?

Answer 4

Nerve injury or light anesthesia

Question 5

What are the structures of the supraglottic soft tissues that can cause an obstruction?

Answer 5

Tongue, epiglottis, soft palate and pharyngeal walls

Question 6

What factors can cause chest wall rigidity?

Answer 6

Breath holding and narcotic induced

Question 7

What pathological processes can result in an inability to ventilate?

Answer 7

Foreign body, edema, infection, vocal cord palsy, stenosis and compression

Question 8

According to the ASA closed case reports, what factor contributed to the decline in respiratory claims?

Answer 8

The use of pulse oximeters and CO2 monitoring

Question 9

What major problem were providers more likely to recognize with CO2 monitoring and pulse oximetry?

Answer 9

Identifying esophageal intubation

Question 10

What is the most common adverse respiratory event according to ASA closed claims database?

Answer 10

Failure to ventilate

Question 11

What is another name for the intubating LMA?

Answer 11

Fastrach LMA

Question 12

What are the typical uses for a glidescope?

Answer 12

Known difficult airwayRescueAnterior LarynxPoor neck mobility

Question 13

What are common requirements for a fiberoptic intubation?

Answer 13

Difficult airway or C spine injuryAssessment of double lumen ETTAirway evaluation

Question 14

Rigid laryngoscope that has an anatomically shaped scope with fiberoptic bundle and eye piece

Answer 14

Bullard scope

Question 15

Rigid anatomically shaped blade with separate flexible fiberoptic scope

Answer 15

Wu scope

Question 16

Rigid blade shaped in form of oropharynx will attach eye piece

Answer 16

Upsher scope

Question 17

What is another name for the bougie?

Answer 17

Eschmann introducer

Question 18

When is a bougie useful?

Answer 18

When laryngoscopic view is poor grade III or IV

Question 19

What is the size and shape of a typical bougie?

Answer 19

15fr 60cm long and angled 40 degrees at the tip

Question 20

What is the purpose of the lighted intubating wand?

Answer 20

Transillumination of the neck to guide ETT

Question 21

Which lateral position is easier to intubate?

Answer 21

Left lateral, the tongue is pushed out of the way by gravity

Question 22

Which supraglottic airway has two lumens and will function whether placed in the trachea or esophagus?

Answer 22

Combitube, used in the emergency airway

Question 23

What determines the tidal volume of transtracheal jet ventilation?

Answer 23

Inspiratory timeChest wall and lung complianceCatheter size

Question 24

What catheter sizes and tidal volumes are typically used with transtracheal jet ventilation?

Answer 24

14g 1600mL/s16g 500mL/s

Question 25

What is the most common complication of transtracheal jet ventilation?

Answer 25

Tracheal mucosa damage and thickened secretions blocking the airway, resulting from inadequate humidification of inspired gases

Question 26

How long should TTJV be used?

Answer 26

Short term, should be used as a bridge device

Question 27

What is the technique for retrograde intubation?

Answer 27

Puncture cricothyroid membrane with 18g needle towards the head at 45 degree angleThread a j-wire through the needle and out through the mouthFollow ETT over wire guide into trachea

Question 28

What size needle should be used for a cricothyrotomy?

Answer 28

12-14g needle

Question 29

How can we ventilate once the catheter is in place?

Answer 29

Attach a 3mL syringe with no plunger, attach a 15mm ETT adaptor and connect to breathing circuit