Assignment 12

I.

II.

III.

1.
2.
3.
4.
5.

Thyromental distance
Central incisor examination
Cervical spine mobility
Temporomandibular mobility
Examination to identify diseased or artificial teeth

1.
2.
3.
4.

Class
Class
Class
Class

1.
2.
3.
4.

Grade
Grade
Grade
Grade

IV.

I: The soft palate, fauces, uvula, and tonsillar pillars are visible
II: The soft palate, fauces and uvula are visible
III: The soft palate and base of the uvula are visible
IV: The soft palate is not visible
I: visualization of the entire laryngeal aperture
II: visualization of the posterior portion of the laryngeal aperture
III: visualization of only the epiglottis
IV: visualization of just the soft palate

Extension of head (atlanto-occipital joint) and flexion of neck (lower cervical spine)
which brings all three axes (OA, LA, and PA) into alignment.

V.

It should be 6-7cm.

VI.

Oral axis, pharyngeal axis, laryngeal axis

VII.
1.

Interincisor gap (measure of distance between incisors when the mouth is open
maximally)
2. Size and position of maxillary and mandibular teeth
3. Evaluating for loose teeth and artificial teeth
VIII.

IX.

1.
2.
3.
4.
5.

All patients receiving general anesthesia

cardiac or respiratory arrest
failure to protect the airway from aspiration,
inadequate oxygenation or ventilation
impending or existing airway obstruction
Applying pressure to the cricoid cartilage to compress the esophagus. This is
done to prevent spillage of gastric contents into the pharynx during the period of
induction of anesthesia. There should be 5kg of pressure applied. The pressure

X.

should be released after induction of anesthesia.

Pre-oxygenation followed by administration of non-depolarizing and depolarizing

neuromuscular blocking drugs. This is done to minimize the risk of aspiration in
patients who are high risk.

XI.
1.

For the curved (MacIntosh) blade the tip is advanced between the base of the
tongue and the pharyngeal surface of the epiglottis. Forward and upward movement
of the blade exerted along the axis of the laryngoscope will expose the glottic
opening. Advantages include fewer traumas to the teeth and less bruising of the

epiglottis.The curved MacIntosh blade works best in adults, especially in those with
obesity.
2. The straight (Miller) blade is passed beneath the laryngeal surface of the epiglottis.
Forward and upward movement is exerted to expose the glottic opening. The
advantage of this blade is better exposure of the glottis opening.
3. The straight Miller blade is useful for children and in situations where the patient
has a large epiglottis.

XII.

6.0-7.0mm tube

XIII.
1.

XIV.

The tube size can be based on age and body weight or the following formula can be
used: (Age/4+4)
2. Position is confirmed by lung auscultation or by rise and fall of chest on ventilation
1.
2.
3.
4.

XV.

XVI.

Laryngeal mask airway

Nasotracheal intubation
Glottis aperture airway
Pharyngeal airway

1. Assess the likelihood and clinical impact of basic management problems.

2. Actively pursue opportunities to deliver supplemental oxygen throughout the process
of difficult airway management.
3. Consider the relative merits and feasibility of basic management choices.
4. Develop primary and alternative strategies.
1.

Tracheal intubation complications: Dental trauma, systemic hypertension and

tachycardia, cardiac dysrhythmias, myocardial ischemia, aspiration of gastric

contents, tracheal mucosa ischemia, esophageal intubation, cuff leak.
2. Extubation complications: laryngospasm, aspiration, pharyngitis, tracheitis, tracheal
stenosis, vocal cord paralysis.
XVII.

Laryngospasm is involuntary spasm of the vocal cords that impede breathing and
speech. It can be caused by manipulation of the larynx or presence of blood or a
foreign body. This leads to prolonged response of the protective glottis closure
reflex mediated by the superior laryngeal nerve. Oxygen delivered with positive

pressure through a facemask and forward displacement of the mandible is indicated.

Succinylcholine can also be indicated if laryngospasm persists.