460: Laryngoscope, Intubation, Extubation Flashcards Preview

MSA S2015 > 460: Laryngoscope, Intubation, Extubation > Flashcards

Flashcards in 460: Laryngoscope, Intubation, Extubation Deck (24):
1

Criteria for Extubation (9 Considerations)

1. Adequate oxygenation
2. Adequate ventilation
3. Hemodynamically stable
4. Full reversal of muscle relaxation
5. Neurologically intact
6. Appropriate acid-base status
7. Normal metabolic status
8. Normothermic
9. Other considerations

2

Adequate Oxygenation
Criteria for Extubation

SpO2 > 92%
PaO2 > 60mmHg

3

Adequate Ventilation
Criteria for Extubation

VT > 5mL/kg
Spontaneous RR > 5bpm
etCO2

4

Hemodynamically stable
Criteria for Extubation

Proper blood circulation
Within -/+20% of baseline

5

Full Reversal of Muscle Relaxation
Criteria for Extubation

Sustained tetany
TOF ratio > 0.9 (4 twitches)
Sustain 5 second head lift or hand grip

6

Neurologically Intact
Criteria for Extubation

Responds to commands
Intact gag and cough relex

7

Normal Acid-Base Status
Criteria for Extubation

pH > 7.25

8

Normal Metabolic Status
Criteria for Extubation

Normal electrocytes
Normovolemic

9

Normothermic
Criteria for Extubation

temp > 35.5 degrees C

10

Other considerations
Criteria for Extubation

1. Aspiration risk
2. Airway edema
3. Deep (i.e. NOT phase II) or awake extubation

11

Stage 1
Stages of Anesthesia

Sedated
Intact lid reflex
Can follow commands

12

Stage 2
Stages of Anesthesia

Excited/disinhibited
Unconscious
Unable to follow commands/unable to exhibit purposeful movement
Irregular breathing/breath holding
Dilated/disconjugate pupils, conjunctival injection (blood shot eyes)
Increased incidence of laryngospasm, arrhymthia, vomiting

13

Stage 3
Stages of Anesthesia

Surgical anesthesia

14

Stage 4
Stages of Anesthesia

Medullary depression
Cardiovascular/ respiratory collapse

15

Halothane
1 MAC Equivalent

0.75%

16

Isofluorine
1 MAC Equivalent

1.15%

17

Enfluorine
1 MAC Equivalent

1.6%

18

Sevofluorane
1 MAC Equivalent

2.1% (1.8%)

19

Desfluorane
1 MAC Equivalent

6.0%

20

Nitrous Oxide
1 MAC Equivalent

105%

21

ED 95
MAC Effectiveness

Prevents 95% of patients from moving during surgical stimulus
1.2-1.3 MAC

22

MAC-Awake
MAC Effectiveness

0.15-0.5 MAC

23

MAC-Recall
MAC Effectiveness

Patient cannot recall/ amnesia
0.4-0.5 MAC

24

MAC-Bar
MAC Effectiveness

Dangerous!!
1.5 MAC