Airway Management Flashcards

According to NAP4 and standard anesthetic guidelines, a 'difficult airway' is best defined as:

Answer: A situation where a trained anesthesiologist experiences difficulty with mask ventilation, laryngoscopy, or intubation

A difficult airway is broadly defined as any situation where a trained anesthesiologist encounters difficulty with face mask ventilation, direct laryngoscopy, or tracheal intubation, or a combination of these.

The primary indication for awake fiberoptic intubation (AFOI) is:

Answer: An anticipated difficult airway where loss of consciousness risks loss of the airway

AFOI is indicated when an anticipated difficult airway makes loss of consciousness hazardous, allowing intubation under topical anesthesia while the patient maintains their own airway reflexes and spontaneous ventilation.

A second-generation supraglottic airway device (e.g., LMA Supreme, i-gel) differs from a first-generation device primarily by:

Answer: Incorporating a gastric drainage channel and improved oropharyngeal seal

Second-generation supraglottic airways feature a dedicated gastric access/drainage channel and an improved oropharyngeal seal, substantially reducing aspiration risk compared to first-generation devices.

Video laryngoscopy compared to direct laryngoscopy for anticipated difficult airways:

Answer: Improves glottic visualization but tube delivery can still be challenging

Video laryngoscopy reliably improves glottic visualization, but this does not automatically translate to easier tube delivery — particularly with hyperangulated blades where directing the tube into the trachea requires additional technique.

In a 'cannot intubate, cannot oxygenate' (CICO) emergency, after all supraglottic rescue attempts have failed, the correct next step is:

Answer: Emergency front-of-neck airway (eFONA) via scalpel-bougie-tube technique

Emergency front-of-neck airway (eFONA), most reliably performed via a scalpel-bougie-tube technique through the cricothyroid membrane, is the definitive life-saving intervention in a confirmed CICO scenario.

The recommended pre-oxygenation target before RSI to maximize safe apnea duration is:

Answer: End-tidal oxygen (EtO₂) > 90% or SpO₂ > 98% maintained for at least 3 minutes

Effective pre-oxygenation targets EtO₂ > 90% (indicating near-complete nitrogen washout), achieved with 3–5 minutes of tidal breathing of 100% O₂, maximizing the oxygen reservoir within the functional residual capacity.

Succinylcholine is the traditional agent of choice for RSI because:

Answer: It provides the fastest onset (~60 seconds) and shortest duration (~10 minutes) of neuromuscular blockade

Succinylcholine (1–1.5 mg/kg) achieves profound neuromuscular blockade within 60 seconds with spontaneous offset in approximately 10 minutes, making it uniquely suited for RSI; high-dose rocuronium (1.2 mg/kg) is an alternative when succinylcholine is contraindicated.