MCQ – 74400

During direct laryngoscopy and endotracheal intubation, which of the following statements is INCORRECT?

Correct Answer » A Explanation

• Direct laryngoscopy is performed to visualize the vocal cords for endotracheal intubation.
• Proper technique is essential to obtain an adequate laryngeal view while minimizing trauma to the airway and teeth.
• Several steps of the procedure are standardized and frequently tested in anesthesia examinations.

• Cricoid pressure (Sellick maneuver) involves applying backward pressure over the cricoid cartilage to compress the esophagus and theoretically reduce the risk of regurgitation and aspiration.
• Traditionally, it was routinely used during rapid sequence induction (RSI).
• However, current evidence does not support its routine use, as it may:
  • Worsen the laryngoscopic view.
  • Make intubation more difficult.
  • Interfere with ventilation.
• Present guidelines recommend its use only in selected patients, and it should be released if it impedes ventilation or intubation.
• Therefore, this statement is not universally true, making it the incorrect statement in the context of standard laryngoscopy technique.

Why Other Options are Correct

B. The laryngoscope is held in the left hand and introduced through the right side of the mouth while displacing the tongue to the left.

• Regardless of whether the operator is right- or left-handed, the laryngoscope is conventionally held in the left hand.
• The blade is introduced from the right side of the mouth, sweeping the tongue to the left to improve visualization of the glottis.
• This is the standard technique for direct laryngoscopy.

C. The neck is flexed with extension at the atlanto-occipital joint to achieve the “sniffing position.”

• The sniffing positionaligns the:
  • Oral axis
  • Pharyngeal axis
  • Laryngeal axis
• This position improves visualization of the vocal cords.
• It consists of:
  • Flexion of the lower cervical spine.
  • Extension at the atlanto-occipital joint.

D. After insertion of the laryngoscope, it is lifted upward and forward along the axis of the handle without using the upper incisors as a fulcrum to visualize the vocal cords.

• The laryngoscope should be lifted upward and away from the patient.
• The handle should never be levered against the upper incisors, as this can cause:
  • Dental trauma
  • Tooth avulsion
  • Damage to the laryngoscope
• The lifting force should be directed along the axis of the handle.