Anesthetic Techniques and Airway Management
What the exam tests
Technique questions ask you to select and sequence: general anesthesia, supraglottic airway, intubation, spinal or epidural, peripheral block, or MAC, and to rescue a failed airway.
Core rules
- Preoxygenate before apnea; oxygenate throughout. The difficult-airway algorithm prioritizes oxygenation over immediate intubation.
- Confirm tracheal placement with continuous capnography, not auscultation alone.
- Rapid-sequence induction uses a rapidly acting induction agent and suxamethonium or high-dose rocuronium; cricoid pressure is not routine.
- Spinal anesthesia: hyperbaric bupivacaine for cesarean, target T4 sensory level, left uterine displacement, vasopressor for hypotension.
- Epidural test dose with lidocaine 1.5% 3 mL plus epinephrine detects intravascular or intrathecal placement, but is imperfect.
- MAC requires titratable sedation, monitoring, and readiness to convert.
Worked example
A 30-year-old at 39 weeks needs cesarean delivery under spinal. Give 10-12 mg hyperbaric bupivacaine 0.5%, 10-15 µg fentanyl, position with left uterine displacement, preload or co-load, and phenylephrine infusion. Reasoning: block height must reach T4 for visceral traction; hypotension is predictable, so treat prophylactically. If block fails, do not repeat a large spinal dose blindly; convert to general anesthesia with aspiration prophylaxis.
Traps
Assuming a supraglottic airway protects against aspiration; using auscultation to exclude esophageal intubation; giving a spinal in hypovolemia; ignoring LAST after peripheral block; sedating a patient with an unsecured airway.