ABA Airway Management 2 — Questions and Answers
Question 1: What is the primary advantage of video laryngoscopy compared to direct laryngoscopy?
- Consistently faster time to intubation
- No need for cervical spine precautions in trauma
- Improved glottic visualization without requiring direct line-of-sight alignment (Correct answer)
- Eliminates the need for neuromuscular blockade
Correct answer: Improved glottic visualization without requiring direct line-of-sight alignment
Video laryngoscopy uses a camera at the blade tip to display the glottis on a screen, allowing visualization without requiring the oral-pharyngeal-laryngeal axes to be aligned.
Question 2: The intubating laryngeal mask airway (ILMA/LMA Fastrach) is primarily designed to:
- Serve as a definitive surgical airway in CICO scenarios
- Facilitate blind or fiberoptic-assisted tracheal intubation through the device (Correct answer)
- Provide higher oropharyngeal seal pressures than a standard LMA
- Continuously monitor end-tidal CO2 levels
Correct answer: Facilitate blind or fiberoptic-assisted tracheal intubation through the device
The ILMA has a metal handle, modified airway tube, and elevated epiglottic elevating bar to align a tracheal tube with the glottis, enabling blind or guided intubation through it.
Question 3: During awake fiberoptic intubation, which topical anesthetic agent is most commonly used to anesthetize the airway mucosa?
- Bupivacaine 0.5%
- Lidocaine 4% (Correct answer)
- Tetracaine 2%
- Ropivacaine 0.75%
Correct answer: Lidocaine 4%
Lidocaine 4% (or 2%) is the most widely used agent for topical airway anesthesia due to its rapid onset, adequate duration, and favorable safety profile when used in appropriate doses.
Question 4: The cricothyroid membrane is the preferred site for emergency surgical airway access for which of the following reasons?
- It is the widest portion of the trachea
- It is relatively avascular and lies just below the skin surface (Correct answer)
- It contains no cartilage
- It is visible on standard chest radiography
Correct answer: It is relatively avascular and lies just below the skin surface
The cricothyroid membrane is preferred because it is superficial, relatively avascular, and easily identifiable between the thyroid and cricoid cartilages.
Question 5: Which of the following best describes the technique of retrograde intubation?
- Advancing a guide wire cephalad through the cricothyroid membrane and out the mouth to railroad an endotracheal tube (Correct answer)
- Advancing an endotracheal tube blindly through the nasopharynx
- Using a bronchoscope inserted from a tracheostomy stoma to visualize cords from below
- Directing an endotracheal tube with the bevel facing posteriorly
Correct answer: Advancing a guide wire cephalad through the cricothyroid membrane and out the mouth to railroad an endotracheal tube
Retrograde intubation involves puncturing the cricothyroid membrane, advancing a guide wire upward through the cords and out the mouth or nose, then railroading the endotracheal tube over the wire.
Question 6: External laryngeal manipulation using the BURP maneuver involves applying pressure in which direction on which structure?
- Backward, Upward, and Rightward pressure on the thyroid cartilage (Correct answer)
- Backward, Upward, and Rightward pressure on the cricoid cartilage
- Downward and Leftward pressure on the thyroid cartilage
- Upward and forward pressure on the hyoid bone
Correct answer: Backward, Upward, and Rightward pressure on the thyroid cartilage
BURP (Backward, Upward, Rightward Pressure) is applied to the thyroid cartilage by an assistant to shift the larynx into a better position for the intubating laryngoscopist.
Question 7: During awake fiberoptic intubation, superior laryngeal nerve blocks are performed to anesthetize which airway structures?
- Tracheal mucosa below the cords
- Supraglottic structures including the epiglottis and piriform fossae (Correct answer)
- Nasal mucosa and nasopharynx
- The vocal cords and subglottic mucosa
Correct answer: Supraglottic structures including the epiglottis and piriform fossae
The internal branch of the superior laryngeal nerve carries sensation from the epiglottis, aryepiglottic folds, and supraglottic mucosa, which are blocked during this technique.
ABA Airway Management 2
What is the primary advantage of video laryngoscopy compared to direct laryngoscopy?