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Chapter 7. Context-Sensitive Airway Management

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A stridorous, mentally challenged patient was brought to the operating room for an urgent neck exploration because of a neck hematoma following a neck dissection 2 days prior. In the presence of hypoxemia with SaO2 less than 80%, which of the following is a reasonable airway management option?

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A. bag-mask-ventilation

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B. the use of an extraglottic device

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C. tracheal intubation using a Macintosh laryngoscope

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D. surgical airway

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E. all of the above

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(E) Bag-mask-ventilation, the use of an extraglottic device, tracheal intubation using a Macintosh laryngoscope, and surgical airway are basic techniques in airway management. They all can be used to provide ventilation and oxygenation for this patient.

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For the same patient, and in the absence of hypoxemia (with SaO2 >95%), which of the following is a reasonable intubating technique?

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A. direct laryngoscopy using a Macintosh blade

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B. tracheal intubation using the intubating LMA (Fastrach)

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C. retrograde intubation

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D. intubation using a lightwand (Trachlight)

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E. digital intubation

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(A) In a nonemergency situation, such as in the absence of hypoxemia, a visual technique (direct laryngoscopy) to secure the airway is desirable for this patient as the upper airway anatomy may have been altered. All the other nonvisual or blind techniques should be avoided.

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For the same patient, in the presence of severe hypoxemia with SaO2 less than 70%, while setting up for a cricothyrotomy, which of the following is a reasonable intubating technique?

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A. direct laryngoscopy using a Macintosh blade

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B. tracheal intubation using the intubating LMA (Fastrach)

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C. intubation using a lightwand (Trachlight)

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D. intubation using a Glidescope®

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E. all of the above

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(E) In an emergency situation, such as in the presence of severe hypoxemia, all airway techniques (both visual and nonvisual or blind techniques) may be considered to rescue the airway while concurrently preparing for a cricothyrotomy.

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