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

Patients with rheumatoid arthritis:

A. may have cervical spine rigidity and upper cervical subluxation

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

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

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

E. all of the above

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

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

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

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

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

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

E. none of the above

(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.

Impossible mask-ventilation:

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

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

C. is rarely associated with difficult intubation

D. is reported more in women than in men

E. none of the above

(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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