Emergency Airway Management Quiz

• Fiberscope procedure involves inserting a laryngeal mask and then a ramie tube through a sound insulated tube for fiberoptic examination.

• Problems with the laryngeal mask in practice and safety features.

  • Does not protect against aspiration of gastric contents.
  • About 10% of patients develop airway obstruction due to epiglottis downfolding.
  • Manufacturers recommend using it for a maximum of 40 times, as the cuff is likely to perish after autoclaving.
  • Rotation of the laryngeal mask may result in complete airway obstruction.
  • Black line present on the tube to assess its orientation when inserted.
  • Cricoid pressure may prevent correct placement of the laryngeal mask.

• The i-gel airway is a single-use extraglottic airway with a mask designed to fit the perilaryngeal and hypopharyngeal structures without an inflatable cuff.

  • Large lumen for ventilation and a proximally placed non-inflatable gel-like cuff with a ridge at the superior anterior edge.
  • Two separate ventilation and gastric channels positioned in the upper esophagus.
  • Wide oval body to prevent rotation and act as an integral bite block.
  • Epiglottic blocking ridge to reduce the risk of epiglottis downfolding.
  • Available in adult, pediatric, and neonatal sizes.
  • Intended for use with fasted patients, both spontaneous and controlled ventilation, and can be used as a conduit for tracheal intubation.
  • Mechanism of action:
    • Soft, gel-like plastic allows it to mold without an inflatable cuff.
    • Gastric channel allows for direct suctioning or passage of a gastric tube.
    • Wide oval body prevents rotation and acts as an integral bite block.
    • Epiglottic blocking ridge reduces the possibility of epiglottic downfolding.

• The Laryngeal Mask (LM) is a commonly used device in anesthesia as an alternative to a face mask or endotracheal tube.

• Components include:

  • A wide internal diameter, transparent tube with a 15mm proximal end connection.
  • An ellipse-shaped cuff with a pilot balloon and self-sealing valve for inflation at the distal end.
  • Low-cost disposable LMs are widely used.
  • A modified design (LMAProSeal) has an additional lateral lumen for blind passage of an orogastric tube and improved seal pressure.
  • A single-use version, LMA Supreme, combines the best features of previous LMA versions and contains an ellipse cuff and anatomically shaped curve for easier insertion and a double seal for improved gas exchange.

• LMs can be used for oropharyngeal sealing, reducing the risk of stoma insufflation during ventilation, and providing a passive conduit for unexpected regurgitation or active suctioning.

• A well-placed LM can act as a conduit for oral intubation in difficult situations such as "can't intubate, can't ventilate."

• LMs provide little or no protection against aspiration and should not be used in patients with full stomas or those prone to reflux.

• The use of LMs is increasing in various settings including routine anesthesia, emergency airway management, and as an aid to intubation.

• Extraglottic airways (LMAs) require the suppression of airway reflexes such as the gag reflex with general or topical anesthesia.

• The use of LMs can lead to increased cardiac stability and improved blood oxygenation during surgery and anesthesia.

• The application of negative pressure or intermittent positive pressure on the LM cuff can improve the seal and prevent air leaks.

• The use of a bite block integrated with LMs can prevent damage to the teeth and improve patient comfort.

• The use of a stylet can facilitate the insertion of a difficult LM and can reduce the risk of trauma to the vocal cords.

Test your knowledge on emergency airway management with this quiz. The quiz covers topics such as using devices for oral tracheal intubation, decision-making in difficult scenarios, and contraindications for certain airway devices.