CRNA CRNA Airway Management 3 — Questions and Answers
Question 1: What is the primary purpose of applying cricoid pressure (Sellick maneuver) during RSI?
- To compress the esophagus against the cervical vertebra to prevent passive regurgitation (Correct answer)
- To facilitate visualization of the vocal cords during laryngoscopy
- To prevent laryngospasm during induction
- To reduce the dose of induction agent needed
Correct answer: To compress the esophagus against the cervical vertebra to prevent passive regurgitation
Cricoid pressure occludes the esophageal lumen by pressing the cricoid cartilage posteriorly against the cervical vertebra, reducing passive regurgitation risk during induction.
Question 2: What is the appropriate ETT cuff inflation pressure to prevent both mucosal ischemia and aspiration?
- 20–30 cmH2O (Correct answer)
- 5–10 cmH2O
- 40–50 cmH2O
- >60 cmH2O
Correct answer: 20–30 cmH2O
Cuff pressures of 20–30 cmH2O provide an adequate seal against aspiration while staying below the tracheal mucosal perfusion pressure (~30 cmH2O) to prevent ischemic injury.
Question 3: A patient develops stridor immediately after extubation. What is the most likely cause in an adult?
- Laryngospasm (Correct answer)
- Vocal cord paralysis
- Tracheomalacia
- Subglottic stenosis
Correct answer: Laryngospasm
Immediate post-extubation stridor in adults is most commonly caused by laryngospasm, a reflex glottic closure triggered by secretions or airway stimulation.
Question 4: Which maneuver is used to open the airway in a patient with suspected cervical spine injury?
- Jaw thrust without head tilt (Correct answer)
- Head-tilt chin-lift
- Neck extension with chin lift
- Sniffing position
Correct answer: Jaw thrust without head tilt
The jaw thrust without head tilt opens the airway by displacing the mandible anteriorly without extending the cervical spine, maintaining spinal precautions.
Question 5: What is the role of the bougie (endotracheal tube introducer) during difficult laryngoscopy?
- It guides the ETT into the trachea when only the epiglottis or posterior structures are visible (Correct answer)
- It replaces the need for a stylet in all intubations
- It verifies tracheal placement via CO2 detection
- It dilates subglottic stenosis before tube passage
Correct answer: It guides the ETT into the trachea when only the epiglottis or posterior structures are visible
The bougie's angled tip can be blindly or partially directed through a limited glottic view, then the ETT is railroaded over it into the trachea.
Question 6: What is the appropriate response if laryngospasm does not break with positive pressure ventilation and jaw thrust?
- Administer succinylcholine 0.1–0.5 mg/kg IV to relax the vocal cords (Correct answer)
- Immediately perform surgical cricothyrotomy
- Deepen anesthesia with propofol bolus alone
- Apply cricoid pressure and wait for spontaneous resolution
Correct answer: Administer succinylcholine 0.1–0.5 mg/kg IV to relax the vocal cords
A small ('laryngospasm') dose of succinylcholine (0.1–0.5 mg/kg IV or 4 mg/kg IM) relieves complete laryngospasm by briefly paralyzing the adductor muscles.
CRNA CRNA Airway Management 3
What is the primary purpose of applying cricoid pressure (Sellick maneuver) during RSI?