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Chapter 42. Airway Management of a Patient with History of Difficult Airway Who Refuses to Have Awake Tracheal Intubation

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Patients with rheumatoid arthritis:

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A. may have cervical spine rigidity and upper cervical subluxation

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B. are found with high prevalence of airflow obstruction, especially in men

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C. may report TMJ dysfunction in up to 31% of cases

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D. have the same incidence of lumbar spine involvement as in the general population, thus suitable for spinal block

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E. all of the above

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(E) All the statement are true in patients with rheumatoid arthritis.

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If a patient refuses an indicated procedure as part of anesthesia care

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A. the anesthesia practitioner is not obligated to provide anesthesia care under any circumstances

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B. psychiatric consultation is mandatory to determine the patient's competency

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C. the anesthesia practitioner has to comply with patient's wishes and proceed with the patient's selected type of anesthesia

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D. it must be determined that the patient has a reasonable understanding of the issues being discussed and her/or his judgment is not based on inaccurate information

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E. none of the above

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(D) If a patient refuses an indicated procedure as part of anesthesia care, every effort should be made to determine that the patient has a reasonable understanding of the issues being discussed and her/his judgment is not based on inaccurate information.

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Impossible mask-ventilation:

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A. occurs approximately in 5% of patients presented for general surgery

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B. can be predicted in the presence of neck radiation changes

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C. is rarely associated with difficult intubation

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D. is reported more in women than in men

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E. none of the above

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(B) Impossible BMV has been found to be much less frequent (0.15%), with neck radiation changes as the most significant clinical predictor in addition to male gender, sleep apnea, Mallampati III–IV classification, and presence of a beard.

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