FANZCA Airway Management and Techniques 2 — Questions and Answers
Question 1: Which of the following is the MOST important pre-operative assessment finding that predicts a difficult bag-mask ventilation?
- Mallampati Class III
- Limited mouth opening less than 3 cm
- Presence of a beard (Correct answer)
- Body mass index greater than 35 kg/m²
Correct answer: Presence of a beard
A beard is one of the MOANS predictors (Mask seal, Obesity/Obstruction, Age, No teeth, Snores/Stiff) and significantly impairs the ability to achieve a seal for bag-mask ventilation, though all listed factors contribute.
Question 2: The intubating laryngeal mask airway (ILMA/Fastrach) is designed to facilitate blind intubation. What is the recommended maximum number of intubation attempts through the ILMA?
- 1 attempt
- 2 attempts
- 3 attempts (Correct answer)
- 4 attempts
Correct answer: 3 attempts
A maximum of 3 intubation attempts through the ILMA is recommended; if unsuccessful, another strategy should be employed to avoid airway trauma and deteriorating conditions.
Question 3: During nasotracheal intubation, at which turbinate level should the tube be directed to minimise the risk of bleeding?
- Superior turbinate
- Middle turbinate
- Along the floor of the nasal cavity below the inferior turbinate (Correct answer)
- Through the middle meatus
Correct answer: Along the floor of the nasal cavity below the inferior turbinate
The nasotracheal tube should be directed along the floor of the nasal cavity, inferior to the inferior turbinate, as this path has the lowest vascular density and minimises the risk of haemorrhage.
Question 4: When using a supraglottic airway device (SAD) such as the ProSeal LMA, what is the maximum recommended airway leak pressure (oropharyngeal leak pressure) that indicates adequate positioning?
- 10 cmH2O
- 20 cmH2O
- 25 cmH2O (Correct answer)
- 30 cmH2O
Correct answer: 25 cmH2O
An oropharyngeal leak pressure of 25 cmH2O or greater with the ProSeal LMA indicates an adequate seal for positive pressure ventilation; lower pressures may indicate malposition or inadequate cuff inflation.
Question 5: Awake fibreoptic intubation (AFOI) is considered the technique of choice in which of the following clinical scenarios?
- Paediatric patient with a foreign body airway obstruction
- Adult patient with known difficult airway and full stomach (Correct answer)
- Pregnant patient at 28 weeks for elective Caesarean section
- Patient with anaphylaxis and angioedema
Correct answer: Adult patient with known difficult airway and full stomach
AFOI is the preferred technique for the adult patient with a known difficult airway and full stomach as it maintains protective airway reflexes, allows confirmation of tube placement before induction, and avoids the risks of RSI in a difficult airway.
Question 6: The 'cannot intubate, can oxygenate' scenario is best managed initially by which of the following?
- Immediate front-of-neck access
- Waking the patient up and rescheduling surgery
- Insertion of a supraglottic airway device and considering surgical options (Correct answer)
- Repeated direct laryngoscopy attempts with different blades
Correct answer: Insertion of a supraglottic airway device and considering surgical options
When a patient can be oxygenated but cannot be intubated, maintaining oxygenation via a supraglottic airway is the immediate priority, followed by a calm assessment of options including waking the patient or proceeding cautiously with airway adjuncts.
Question 7: What is the purpose of applying back, upward, right-sided pressure (BURP) during direct laryngoscopy?
- To reduce the risk of oesophageal intubation
- To improve the laryngoscopic view by repositioning the larynx (Correct answer)
- To prevent passive regurgitation during intubation
- To facilitate passage of the tube past the arytenoids
Correct answer: To improve the laryngoscopic view by repositioning the larynx
BURP manoeuvre — applying backward, upward, and rightward pressure on the thyroid cartilage — repositions the larynx to improve the laryngoscopic grade of view, particularly for Grade II and III views.
FANZCA Airway Management and Techniques 2
Which of the following is the MOST important pre-operative assessment finding that predicts a difficult bag-mask ventilation?