EDAIC Airway Management 5 — Questions and Answers
Question 1: In a patient with a known difficult airway presenting for elective surgery, which strategy is most appropriate according to ASA guidelines?
- Proceed with RSI and have rescue devices available
- Perform awake intubation before induction of general anaesthesia (Correct answer)
- Use a supraglottic airway as the primary airway device
- Induce general anaesthesia and perform direct laryngoscopy first
Correct answer: Perform awake intubation before induction of general anaesthesia
Awake intubation preserves spontaneous ventilation and airway reflexes, making it the safest primary strategy for a patient with a known difficult airway.
Question 2: Which feature of the Cormack–Lehane grade IV laryngoscopic view differentiates it from grade III?
- Only the epiglottis tip is visible
- No laryngeal structures are visible at all (Correct answer)
- Only the posterior commissure is visible
- The entire glottis is obscured by secretions
Correct answer: No laryngeal structures are visible at all
Cormack–Lehane grade IV indicates that neither the epiglottis nor any glottic structures are visible, whereas grade III shows only the epiglottis.
Question 3: A second-generation supraglottic airway (e.g., LMA Supreme) differs from a first-generation device primarily because it:
- Allows higher airway sealing pressures only
- Incorporates a gastric drainage channel to reduce aspiration risk (Correct answer)
- Requires neuromuscular blockade for insertion
- Is contraindicated in patients with full stomachs
Correct answer: Incorporates a gastric drainage channel to reduce aspiration risk
Second-generation SGAs include a separate gastric drainage channel that allows venting of gastric contents, substantially reducing the risk of pulmonary aspiration.
Question 4: What maximum total dose of topical lidocaine is generally considered safe for awake airway anaesthesia to avoid systemic toxicity?
- 2 mg/kg
- 4 mg/kg (Correct answer)
- 9 mg/kg
- 12 mg/kg
Correct answer: 4 mg/kg
The standard safe upper limit for topical (not infiltrated) lidocaine for airway anaesthesia is approximately 4 mg/kg, though some protocols extend this slightly.
Question 5: In paediatric airway management, uncuffed versus cuffed endotracheal tubes: which statement is most accurate for current practice?
- Uncuffed tubes are always preferred in children under 8 years
- Cuffed tubes with careful cuff pressure monitoring are acceptable and preferred in most paediatric ICU settings (Correct answer)
- Cuffed tubes are contraindicated below 2 years of age
- Uncuffed tubes provide better protection against aspiration than cuffed tubes
Correct answer: Cuffed tubes with careful cuff pressure monitoring are acceptable and preferred in most paediatric ICU settings
Current evidence supports the use of cuffed tracheal tubes in children including infants, provided cuff pressure is kept below 20–25 cmH₂O to prevent mucosal ischaemia.
Question 6: Which physiological change during pregnancy most significantly increases the risk of failed intubation and difficult airway management?
- Increased functional residual capacity reducing apnoea tolerance
- Airway oedema, increased vascularity, and weight gain reducing Mallampati score (Correct answer)
- Elevated progesterone increasing bronchomotor tone
- Decreased plasma cholinesterase prolonging succinylcholine action
Correct answer: Airway oedema, increased vascularity, and weight gain reducing Mallampati score
Pregnancy causes progressive airway oedema, mucosal vascularity, and soft tissue enlargement that worsen the Mallampati class and increase the rate of failed intubation.
Question 7: When using a fibreoptic bronchoscope to perform nasotracheal intubation, which technique best prevents the tube from hanging up at the arytenoids during railroading?
- Advance the tube rapidly to overcome resistance
- Rotate the tube 90° counterclockwise while advancing (Correct answer)
- Apply firm backward pressure on the tube
- Withdraw the bronchoscope before advancing the tube
Correct answer: Rotate the tube 90° counterclockwise while advancing
Rotating the endotracheal tube 90° counterclockwise reorients its bevel away from the arytenoid cartilages, allowing it to advance smoothly into the trachea.
EDAIC Airway Management 5
In a patient with a known difficult airway presenting for elective surgery, which strategy is most appropriate according to ASA guidelines?