EDAIC Airway Management 2 — Questions and Answers
Question 1: According to NAP4 and standard anesthetic guidelines, a 'difficult airway' is best defined as:
- Tracheal intubation requiring more than two attempts by an experienced anesthesiologist
- A situation where a trained anesthesiologist experiences difficulty with mask ventilation, laryngoscopy, or intubation (Correct answer)
- Any patient with a Mallampati score of Class III or IV
- A patient with documented previous difficult intubation
Correct 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.
Question 2: The primary indication for awake fiberoptic intubation (AFOI) is:
- An anticipated difficult airway where loss of consciousness risks loss of the airway (Correct answer)
- All patients with a Mallampati Class II score
- Patients requiring emergency rapid sequence induction
- Any patient with a BMI greater than 35 kg/m²
Correct 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.
Question 3: A second-generation supraglottic airway device (e.g., LMA Supreme, i-gel) differs from a first-generation device primarily by:
- Providing a higher oropharyngeal seal pressure exceeding 40 cmH₂O
- Incorporating a gastric drainage channel and improved oropharyngeal seal (Correct answer)
- Being designed exclusively for pediatric use
- Allowing unobstructed passage of a standard endotracheal tube
Correct 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.
Question 4: Video laryngoscopy compared to direct laryngoscopy for anticipated difficult airways:
- Always provides a superior glottic view and always improves intubation success equally
- Improves glottic visualization but tube delivery can still be challenging (Correct answer)
- Is contraindicated when blood or secretions are present in the airway
- Consistently results in faster intubation times across all operators
Correct 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.
Question 5: In a 'cannot intubate, cannot oxygenate' (CICO) emergency, after all supraglottic rescue attempts have failed, the correct next step is:
- Administer sugammadex and allow the patient to wake up
- Repeat laryngoscopy with a different blade
- Emergency front-of-neck airway (eFONA) via scalpel-bougie-tube technique (Correct answer)
- Call for senior help and defer the decision
Correct 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.
Question 6: The recommended pre-oxygenation target before RSI to maximize safe apnea duration is:
- SpO₂ > 95% with standard-flow oxygen for 1 minute
- End-tidal oxygen (EtO₂) > 90% or SpO₂ > 98% maintained for at least 3 minutes (Correct answer)
- SpO₂ > 99% achieved in 30 seconds only
- PaO₂ > 80 mmHg confirmed on arterial blood gas
Correct 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.
Question 7: Succinylcholine is the traditional agent of choice for RSI because:
- It has no contraindications and is safe in all patient populations
- It provides the fastest onset (~60 seconds) and shortest duration (~10 minutes) of neuromuscular blockade (Correct answer)
- It can be fully reversed with sugammadex at any time
- It does not cause fasciculations or increase intraocular pressure
Correct 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.
EDAIC Airway Management 2
According to NAP4 and standard anesthetic guidelines, a 'difficult airway' is best defined as: