Cagayan Valley Medical Center

Department of Anesthesiology

Airway Management for Interns

Assumption: you already have read chapter airway management chapter and preoperative
evaluation chapter in your barash book during your medschool and clerkship…😂 😂 😂

Instructions: For our interns hour, you will be arranged in groups. All groups will answer and
create a ppt presentation. The cases will be given day before the presentation. A random group
will be called to present for every scenario. The audience is encouraged to ask questions to the
presenter. This is a free space for intellectual discussion.

Scenario 1: You were tasked to do preoperative evaluation of a 40 year old female who came
in due to an anterior neck mass diagnosed to have Multinodular Nontoxic goiter indicated for
Total Thyroidectomy.

1. Di erentiate adult and pediatric airway anatomy. What is the best blade to use in pediatric
patients? What are special considerations that we would apply to the technique of
laryngoscopy and intubation in the infant and child?
2. What important physical examination features would implicate di culty with airway
management/intubation?
3. What is Mallampati classi cation? Is it enough to predict di culty intubation? Why or why
not?
4. During your preoperative visit, you assessed the patient to have OBESITY CLASS 1. What
is the best predictor/assessment nding in obese patients that would indicate di cult
airway management? How will you intubate this patient knowing the patient is obese?
5. What is a supraglottic airway device? What are its advantages and its contraindications?

Scenario 2: You were called by the PACU nurse because a 35 year old patient s/p total
thyroidectomy was noted to have inspiratory stridor and desaturation as low as 88%.

1. What will you do initially to address the patient’s symptoms?

2. What do you think is the cause of the patient’ s symptoms? Give 3 di erentials

After mask ventilation and head-tilt-chin-lift maneuver, the patient is still having desaturation
episodes. You decide to reintubate the patient.

3. What is another term for preoxygenation? How is it done? What is the importance of
preoxygention?
4. What are the time sparing methods of preoxygenation?
5. How will u verify tracheal intubation? What is the gold standard to verify tracheal
intubation?
6. What is the importance of end tidal co2 monitoring?
7. What is the formula to compute for appropriate tube sizes and depth.

Scenario 3: A 25 year old G2P1 (1001) was indicated for primary LSCS for nonreassuring fetal
status: fetal bradycardia. The patient is classi ed as ASA 2E for pregnancy. Patients last meal
was 1 hours ago. You are the intern assisting the anesthesiology resident and his plan was to
do GA-ET Rapid sequence intubation.
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1. What is rapid sequence intubation? When is it indicted? ( Side question why are pregnant
patients prone to aspiration?)
2. Enumerate methods to reduce pulmonary aspiration risk?
3. What are the ASA fasting recommendations?
4. What are essential preoperative medications will u give prior to intubation in this scenario?
5. What is Sellick’s maneuver and how is it performed? Are current literature still advocating
it’s use? Why or why not?

Thank you!