Head and neck anaesthesia — Viva

Viva Stems

1. How would you assess this airway before induction, and which findings would push you towards an awake technique? Cover mouth opening, neck mobility, stridor and fibre-optic examination; stridor with a distorted irradiated larynx means awake tracheostomy or awake intubation.^[3][1]
2. Describe your tube and oxygenation strategy for the microlaryngoscopy. Small microlaryngoscopy tube, or supraglottic jet via Hunsaker catheter once secured; HFNO as a tubeless adjunct.^[3]
3. How would you manage an airway fire during laser surgery? Stop laser and gases, remove the burning tube with flammable material, flood with saline, re-ventilate avoiding oxidiser enrichment, check fragments, bronchoscope — after preventing with low FiO2, laser tubes and N2O avoidance.^[6][3]
4. In the CICO crisis after failed intubation, describe your eFONA sequence. What technique does DAS 2015 recommend? DAS default is scalpel-bougie-tube with a cuffed 6.0 tube; cannula was faster in one wet-lab simulation but remains backup.^[2][4]
5. What are the specific hazards of nitrous oxide in middle-ear surgery? N2O raises middle-ear pressure, so it is traditionally avoided — though one randomised study found no graft or hearing difference in underlay tympanoplasty.^[8][9]
6. How do you manage a post-tonsillectomy bleed back in theatre? Priorities are haemorrhage control, oxygenation and resuscitation, with dual rigid suction and a plan spanning rapid-sequence induction with suction versus awake front-of-neck access.^[3]