SURGERY III-ANESTHESIOLOGY

INTUBATION

INTUBATION
1) This anatomy structure divides y our airway to upper and
lower is
a) Pharynx
b) Larynx
c) Trachea
d) None of the above

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2) As part of pre-operative evaluation, airway examination is

done to assess if any restriction of mobility with
a) Temporomandibular joint
b) Temporomaxillary joint
c) Atlanto-occipital joint
d) Any of the above

3) When you ask patients to open their mouth, your

finger(s) should be at LEAST admit between teeth to
assess any possible airway difficulty is
a) 1-2 fingers
b) 2-3 fingers
c) 3-4 fingers
d) 4-5 fingers

SURGERY III-ANESTHESIOLOGY
4) When patients maximally protrude their tongue, the
structures should include the pharyngeal arches, uvula,
soft palate, hard palate, tonsillar beds, and posterior
pharyngeal wall. Which of the following classification has
the LEAST prediction of difficult airway?
a) Class 1
b) Class 2
c) Class 3
d) Class 4

INTUBATION
AXIS OF THE AIRWAY

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THE TECHNIQUE OF TRACHEAL INTUBATION
INVOLVES FIVE STEPS
I: Positioning the patient
II: Opening the patients mouth
III: Performing laryngoscopy
IV: Insertion of the ET tube through the vocal cords and
removing the laryngoscope
V: Confirmation of correct placement, and securing the ET
tube
OPENING OF THE MOUTH

5) In Cormack-Lehane classification, which of the following

is the MOST predictor of difficult airway?
a) Class I
b) Class II
c) Class III
d) Class IV
Scissors technique

Modifled scissors technique

DIRECT LARYNGOSCOPY

6) Head positioning of patients is preferred in sniffing

position prior to intubation. Which of the following axis
aligned in sniffing position?
a) Axis of the mouth
b) Axis of the pharynx
c) Axis of the larynx
d) Any of the above

7) This anatomic structure should be visualized during direct

laryngoscopy prior insertion of endotracheal tube is
a) Epiglottis
b) Vestibular fold
c) True vocal fold

SURGERY III-ANESTHESIOLOGY

INTUBATION

d) Vallecula

epiglottis tends to fall downward, also increasing upper

airway obstruction.

OVERCOME UPPER AIRWAY OBSTRUCTION

(EXCLUDING INTUBATION)
1) Clearing the airway of any foreign material
2) Using a chin lift maneuver
3) Using a jaw thrust maneuver
4) 4 Inserting an oral and/or nasal airway
5) Positioning the patient on their side in the semi-prone
recovery position
INTUBATION DECISION
ET TUBE INSERTION
Refer to Video
CONFIRMATION OF CORRECT
ETT PLACEMENT
Immediate absolute proof that the ET tube is in the
tracheal lumen
Indirect confirmation that the trachea is intubated with a
tracheal tube includes:
Observing the chest to rise and fall with positive
pressure ventilation
Listening over the epigastrium for the absence of
breath sounds with ventilation
Listening to the apex of each lung field for breath
sounds with ventilation
"distant breath sounds" in each lung field
!incorrectly placed in the esophagus
Decreased air entry to one lung field may indicate
that the ETT is in a mainstem bronchus usually
the right mainstem bronchus
"IF IN DOUBT TAKE IT OUT
Remove the ET, resuming mask ventilation with 100%
oxygen,stabilizing the patient
Calling for help
"IF IN DOUBT LEAVE IT IN
concerns as to whether the patient can be safely extubated
Safe to delay extubation, continue to support ventilation,
ensuring hemodynamic stability, analgesia, and
oxygenation.
8) Most common cause of upper airway obstruction in
anesthesized patient is
a) Fall back of tongue
b) Pharyngeal secretions
c) False dentures
d) Airway edema
UPPER AIRWAY OBSTRUCTION
Tongue falling back into the hypopharynx most
common cause
decrease in the tone of muscles attaching the tongue to
the mandible, hyoid bone and epiglottis
respiratory efforts of the unconscious patient tend to pull
the tongue

LMA
WHAT IS THE DIFFERENCE BETWEEN A LMA
AND ENDOTRACHEAL TUBE??

LMA:
Supraglottic devices
Direct laryngoscopy not required
Muscle relaxants may or may not
use during insertion
Use when difficult airway
encountered to maintain
ventilation

ETT:
Intraglottic device
Requires laryngoscope to
visualize glottis opening
Requires muscle relaxants to
facilitate intubatation

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SURGERY III-ANESTHESIOLOGY

INTUBATION

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RAPID SEQUENCE INDUCTION

3 components:
1) pre-oxygenation
2) application of cricoid pressure
3) tracheal intubation with a cuffed ETT