FANZCA Airway Management and Techniques 1 — Questions and Answers
Question 1: Which laryngoscope blade design provides the best view when the epiglottis is long and floppy and cannot be lifted indirectly?
- Macintosh blade
- Miller blade (Correct answer)
- McCoy blade
- Bullard blade
Correct answer: Miller blade
The Miller (straight) blade directly lifts the epiglottis, making it superior when the epiglottis is long, floppy, or omega-shaped and cannot be lifted indirectly via the vallecula as with a Macintosh blade.
Question 2: According to the Difficult Airway Society (DAS) guidelines adopted in Australian and New Zealand anaesthetic practice, what is the maximum number of intubation attempts recommended before declaring a failed intubation?
- 2 attempts
- 3 attempts (Correct answer)
- 4 attempts
- 5 attempts
Correct answer: 3 attempts
DAS guidelines recommend no more than 3 laryngoscopy attempts (including one by a senior anaesthetist) before declaring failed intubation and moving to the next step in the algorithm.
Question 3: When performing a rapid sequence induction (RSI), cricoid pressure (Sellick's maneuver) is applied. What is the recommended force to apply once the patient loses consciousness?
- 10 Newtons
- 20 Newtons
- 30 Newtons (Correct answer)
- 40 Newtons
Correct answer: 30 Newtons
The recommended force for cricoid pressure once the patient loses consciousness is 30 Newtons (approximately 3 kg), which provides adequate compression of the oesophagus without distorting the airway.
Question 4: A patient with a Cormack-Lehane Grade III laryngoscopic view is best described as having which of the following?
- Full view of the vocal cords
- Partial view of the vocal cords
- Only the epiglottis visible (Correct answer)
- Neither epiglottis nor cords visible
Correct answer: Only the epiglottis visible
A Cormack-Lehane Grade III view shows only the epiglottis with no part of the glottis visible, making intubation significantly more difficult and often requiring adjuncts such as a bougie.
Question 5: Which of the following is the MOST reliable method for confirming correct endotracheal tube placement in the FANZCA and ANZCA framework?
- Chest auscultation bilaterally
- Visualisation of tube passing through cords
- Continuous waveform capnography (Correct answer)
- Chest rise observed during ventilation
Correct answer: Continuous waveform capnography
Continuous waveform capnography with sustained end-tidal CO2 over multiple breaths is the gold standard and most reliable method for confirming endotracheal tube placement, as recommended by ANZCA guidelines.
Question 6: In the 'can't intubate, can't oxygenate' (CICO) scenario, what is the preferred surgical airway technique in current ANZCA-endorsed guidelines?
- Percutaneous tracheostomy
- Surgical tracheostomy
- Needle cricothyroidotomy with jet ventilation
- Scalpel-finger-bougie cricothyroidotomy (Correct answer)
Correct answer: Scalpel-finger-bougie cricothyroidotomy
The scalpel-finger-bougie (or scalpel-bougie) technique for front-of-neck access is currently the recommended approach in CICO emergencies as it is faster, more reliable, and less prone to failure than needle techniques in adults.
Question 7: What is the primary advantage of a video laryngoscope compared to a direct laryngoscope in the management of an anticipated difficult airway?
- Eliminates the need for neuromuscular blockade
- Provides an improved glottic view without requiring direct line of sight (Correct answer)
- Allows blind nasal intubation
- Removes the risk of dental trauma entirely
Correct answer: Provides an improved glottic view without requiring direct line of sight
Video laryngoscopes use an angled camera blade to visualise the glottis indirectly, significantly improving the view in patients where mouth opening, neck mobility, or anatomy prevents a direct line of sight.
FANZCA Airway Management and Techniques 1
Which laryngoscope blade design provides the best view when the epiglottis is long and floppy and cannot be lifted indirectly?