Anesthesia Flashcards
(35 cards)
RSI 7Ps
7 P’s
Preparation
PreOxygenate (100 o2 NRM. fail CPAP. fail 3-5 VC breaths)
Premedicate - fentanyl to blunt sympathetic reflexes; Lignocaine of tight lungs or tight brains)
Paral & induce - succ vs atrac or rocu
HOPA;
HypO: EK
HTN (isolated closed head injury - ETM
High ICP and hypoV - EK
asthma - EK
position & pressure -HT,CL,JT; BURP
cricoid pressure; align 3 axes oral cav, pharynx trachea
Placement + proof
post intubation mx
Normal Intubation
Prep - SOAEPME
suc, o2, (ETT, lscope, lma, adjunct), position & preO2, monitors, ETCO2)
Post Op complications
Agitation (Pain)
PONV
hypertension/hypotension
Secretions
HAndover in PACU
Patient
Surgery
problems encountered and expected
dsiposition
O2
monitoring of BP, HR, SpO2 kiv airway supp
Reversal of anes agents & monitoring
PAralysis: sugamedex;
neostigmine + atropine/glycopyrolate
pseudocholinesterase/ hoffman elimination (atrac)
Train of 4
anesthetics: gas - exhaled out MAC
% inhaled air
TIVA - BIS (>40-60)
Management of common medical comorbidities
DM:
fast 8h; first case of day;
Stop SGLT2i 2 days before
stop OHGAs and insulin day of
autonomic neiropopathy; aspiration
intubation; hypogly
poor control - postpone - diabetic crisis + wound infection
HTN
ideally normal 130/80
DBP>110 - postpone elective
ischemia, arrhythmia, hypot, HTN post op
meds - hypoK, hypoNa - thiazides
BB - bradycardia, conduction block
omit ACEi and ARB
stabilise BP 20%;
resume med ASAP
pain mx
COPD
- RH failure;
- control of disease
- steroids - adrenal suppression
preop physio, secretion
smoking
arterial line - BP
avoid bronchospams histamine release - morphine & atracurium
avoid
IHD
MRVO
postpone if ACS, BMS, CCF in 1 month ; Drug eluting stent 6-12mths
anti plt - bleeding vs stent thrombosis ;
aspirin clopi - 7 days; ticlo 14 days
warfarin stop 5 days, bridge LMWH or IV heparin
stop ACEi or ARB
intraop - 5LECG; intraarterial BP, CVP
avoid tachycardia; MAP>65
Transfusion threshold - 8-9g/dL
difficult BVM & intubation risk
MOANS mask seal (facial hair, trauma), obesity, age, no teeth, stiff lungs - chronic lung disease
LEMON:
look (face, mouth, neck)
eval (332) incisor, thyromental, thyrohyoid distance
mallampati
obstruction,
neck mobility - sniff the morning air
history taking of anes
previous surgeries - complications - ventilation, intubation, medication (PONV, MH), intraop (BP)
pmhx - cardio, respi (COPD, asthma, smoking, URTI) , HTN, renal, DM,
fmhx - MH, cholinesterase
Difficult lscope intubation
reposition
BURP
SpO2>90%
bougie
crico
blade
aids
maintian O2; mask; LMA (3F, 4M, 5L)
i. pressure <60cmH2O + insert bite block
<90% crico
correct placement
visualize; chest rise; ETCO2; misting; 5 pt ausc,
cuff @ 20-30cmH2O
indications for intubation
- airway not patent (unabel to maintain airway, impending failure; oxygenation by mask
- risk of aspiration
- prolonged vent
contra for LMA
> 14w gestation
maxillofaicial thorax injury
aspiration risk
ASA assessment and invx validity
FBC UECr - 6mths
CXR, ECG - 1 year if no change
difficult airway mx
early
- reposition, BURP, blades,
maintain O2 - BVM, LMA
ventilate the pt
intub
BVM
oral adjucts
LMA (#3 -<60kg, 4>60, #5>80)
airway obst recogn
look - cyanosis, retraction (tracheal, suprasternal) agitation, drooling
listen - stridor, reduced breath
feel chest expansion
physiological considerations
CRASH
consumption of O2
RV failure - pulm htn; lead to cardio collapse
acidosis - metabolic; woth apnea respi acidosis
saturation - preO2 NIV
Hypo - volume resusc
monitoring standards
BP: NIBP; arterial lone, CVP
SpO2
ECG (lead 2, 5)
Capnograph
Inspired Oxygen analyszer
Airway & breathing:
Inspird O2, CO2, gas conc
Monitoring depth
Peripheral nerve Stim - residual nm block
BIS TIVA
MAC
fluid replacement
sedation scale
ramsay
6 levels
1-3 awake 4-6 alseep
indications of IA monitoring
sources of inaccurary
ABGs or frequent labs
beat- beat
frequent BP mon
transducer height;
CVP idnciation
complications
i. hemodynamic instability + sig blood loss
ii. operations with air embo risk
iii. venous access for drugs and TPN
IV volume and RV fx
(lie in intrathoracic vein or RA)
internal jug, subclav, antecubital, fem
Arterial puncture,
PTX, HTX,
peri eff, tamp
embolism
infection
ETCO2 abnorm
CVS collapse
airway obs
hypotnesion
hypovent, rebreathing
CUrare cleft
Clinical and electro depth of anes mon
guedel,(4 stages) (3 is surgical anes0
movement
BP, HR
EEG
LES tone
Regional Anesthesia toxicity & mx
responsiveness ABCs
early: perioral; metal; anxiety
late: tinnitus, arrhythma, eizure; LOC, ECG
lipid emulsuion 20% 1.5ml/kg bolus
CI for central neuroaxial blocks
- coag - hematoma
sepsis
local infection
aortic stenosis (fixed CO)
hypotension
raised ICP
exisitng neuro issues - spinal stenosis
AS
bacteria - sepsis or local
coag
CP
circulation - hypotension
Spinal stenosis
