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Chapter 52. Airway Management of the Obstetrical Patient with an Anticipated Difficult Airway

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Which of the following is NOT a physiological change of pregnancy that would impact on the airway management of the patient?

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A. increase in oxygen consumption

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B. decrease in FRC

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C. increase risk of aspiration

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D. decrease in alveolar-arterial oxygen gradient

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E. increase in closing volume

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(D) All of the physiological changes of pregnancy listed are correct except the alveolar-arterial oxygen gradient which is increased in pregnancy. This abnormality can persist in the immediate postpartum period.

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All of the following are potential problems of preeclampsia on the parturient airway EXCEPT

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A. severe upper airway edema

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B. friable airway and thus very unforgiving if multiple attempts at intubation are required

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C. pharyngeal narrowing that could contribute to difficulty in blind intubating techniques

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D. bronchoscopic intubation under indirect vision is contraindicated because of the potential airway bleeding

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E. blind nasotracheal intubation will inevitably lead to considerable bleeding

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(D) Friable and easily bleeding airway, upper airway edema, pharyngeal narrowing are potential problems of preeclampsia on the parturient airway. Awake intubation using a flexible bronchoscope is an acceptable technique for preeclamptic parturient with an anticipated difficult airway.

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Which of the following is a reasonable intubating technique for an obese parturient with severe preeclampsia and a history of difficult laryngoscopic intubation?

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A. awake bronchoscopic intubation

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B. laryngoscopic intubation following a rapid sequence induction

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C. awake intubation using a lightwand

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D. awake blind nasal intubation

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E. intubation through an intubating LMA under general anesthesia

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(A) For an obese parturient with severe preeclampsia and a history of difficult laryngoscopic intubation, awake bronchoscopic intubation is the most reasonable technique among these choices.

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