Chapter 21 Anesthesia Principles and Monitoring Flashcards by Ericka Jaramillo

Oxygen: Cylinder type, color, pressure and volume

Oxygen: green
E - 1900 PSI and 660 L
H - 2200 PSI and 6900 L

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Medical Air: Cylinder type, color, pressure and volume

Medical air : Yellow
E - 2200 PSI and 6550 L

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Nitrous oxide: Cylinder type, color, pressure and volume

Nitrous Oxide: Blue
E - 745 PSI and 1590 L

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Carbon Dioxide: Cylinder type, color, pressure and volume

Carbon dioxide: grey
E - 838 PSI and 1590 L

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Nitrogen: Cylinder type, color, pressure and volume

Nitrogen: Black
H - 2200 PSI and 6400L

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What are three indications for IPPV

Hypoventilation
Manipulate alveolar ventilation in hypoxemic patients
Limit atelectasis

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When is positive pressure maintained during IPPV

Positive pressure is maintained only during inspiration

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Tidal volume in dogs

Tobias: 15ml/kg
Lumb and Jones: 10 - 20ml/kg

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Label the inspiratory, expiratory, and APL valves

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Why should a patient ≥ 5kg use a rebreathing system

Dead space exits the rebreathing system where the inspiratory and expiratory breathing tubes meet at the patient (the Y piece). This is enough to cause rebreathing of CO2 in small patients

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How much is the fresh gas flow rate in a non-rebreathing system in relation to the patients respiratory minute volume

At least 3x the patients respiratory minute volume

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Non-rebreathing requires a high flow rate to prevent rebreathing. What is the recommended flow rate

200-500 ml/kg to prevent rebreathing

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What is the flow rate of the oxygen flush valve

30-50L/min which can cause significant barotrauma and should not be used in non-rebreathers

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What does the one-way valve system on the rebreathing circuit do

The circle (aka rebreathing) system incorporates one-way valves to prevent immediate rebreathing of exhaled gas

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Pressure regulator function

An internal pressure regulator reduces the carrier gas pressure from that in the tank or wall outlet to 50 PSI

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What are the ingredients in soda lime

Sodium hydroxide, potassium hydroxide, water, and calcium hydroxide

Soda lime MOA

CO2 reacts with water to form carbonic acid which then dissociates to free protons and carbonate

How could a dual flow meter aid in preventing alveolar collapse

Dual flow meter is used to mix two gases. To prevent alveolar collapse mix 100% oxygen with medical air or nitrogen. Nitrogen will provide a scaffold for alveoli once all O2 is removed by pulmonary blood flow

How does a higher fresh gas flow affect soda lime

The absorbent may lose water to evaporation and become less effective

What is PEEP and IPPV effect on cardiac output

PEEP benefits oxygenation without negatively impacting cardiac output and prevents alveolar collapse
IPPV depresses CO

What causes a progressive increase in ETCO2 plateau

Hypoventilation

What causes a progressive decrease in ETCO2 plateau

Hyperventilation

Causes of hypoventilation

Neuromuscular disorders
Diaphragmatic hernia
Pleural space disease
Flail chest
Airway obstruction
CNS disorders
CO2 in tissues is increased and the lungs are incapable of expelling the excess - Malignant hyperthermia and heatstroke

Purpose of adding helium to oxygen

Helium may be combined with oxygen in a 70:30 ratio to protect against fires caused by laser ignition of anesthetic carrier gas.

Cause of absorption atelectasis

Oxygen is rapidly absorbed from the alveoli. An alveolus filled with 100% oxygen will gradually collapse as that oxygen is removed by the pulmonary blood flow.

How to prevent absorption atelectasis

Mix with other gas such as nitrogen which provides structural support to the alveolus or PEEP at 5cm H2O.

Is the inhalant vaporizer knob indicative of the concentration of inhalant in the rebreathing circuit? Explain

No, the circuit concentration of the inhalant to start is 0%. Incoming inhalant increases the concentration but there’s some already in the circuit so it’s diluted and doesn’t match what’s set on the vaporizer.

Is the inhalant vaporizer knob indicative of the concentration of inhalant in the non-rebreathing circuit? Explain

Yes - common gas outlet enters near the patient, the gas from the common gas outlet is delivered directly to the patient. - no dilution occurs as does with rebreathing system

If rebreathing of CO2 is seen on capnograph but absorbent is not discolored, does the absorbent need to be changed

Yes

T/F: If flow rate is high then the condensation results in an increased weight of CO2 obsorbent

False, At higher fresh gas flows, the absorbent may lose water to evaporation and become less effective

Label each

A. Normal B. Hypoventilation C. Rebreathing CO2 D. Leak E. Hyperventilation F. Cardiac arrest

How do one way valves affect gas flow

During inspiration, the inspiratory one way valve opens, allowing gas to move from the fresh gas inlet and reservoir bag to the valve into the inspiratory limb of the breathing circuit During expiration, the inspiratory valve is closed , preventing exhaled gas from entering the inspiratory limb of the breathing circuit, forcing it into the expiratory limb of the breathing circuit The inspiratory valve helps direct gas into the expiratory limb of the breathing system

How to calculate reservoir bag

[BWkg x TV (10-20 ml/kg)] x 5-10 5-10 x the patients normal tidal volume

How are vaporizers classified (5 classes)

Regulation of vapor output Method of vaporization Vaporizer location in the anesthetic circuit Temperature compensation Agent specificity

MOA of beta-blockers when given under anesthesia to decrease blood pressure

Control blood pressure through reduction in HR and CO Also inhibit RAS due to blockade of B1-adrenergic receptors at the juxtaglomerular apparatus

What is the order of MAC in dogs and cats for isoflurane, sevoflurane, and desflurane

Dogs have a lower MAC Isoflurane 1.3% Sevoflurane 2.1% Desflurane 7.2% Cats have a higher MAC Isoflurane 1.7% Sevoflurane 3.1% Desflurane 10.3%

What are the cardiovascular effects of IPPV

Alters CV function by changing the intrathoracic pressure and lung volume. This effects CV directly by altering preload, after load, and/or HR. Intrapleural pressure increases during inspiration, leading to a decrease in venous return and right ventricular output IPPV increases vagal tone and reduces sympathetic input therefore decreasing heart rate - which decreases cardiac output.

What are the physicals signs of anesthetic depth within stage III

Plane 1 - light - central eyeball position, positive palpebral, medium to large pupil size, positive PLR, Moist cornea, lots of eyelid muscle tone, lots of mandibular muscle tone, reflex movement to nociception - maybe, physiologic response to nociception present Plane 2 - Light-medium - rotated or med/vent eye ball, absent palpebral, small to medium pupil size, positive PLR, moist cornea, some eyelid muscle tone, some mandibular muscle tone, no reflex movement to nociception, maybe physiologic response to nociception Plane 3 - Deep-medium - rotated or med/vent eyeball, medium to large pupil size, absent PLR, intermediate corneal moistness, little eyelid and mandibular muscle tone, absent physiologic response to nociception. Plane 4 - Deep - Central eyeball, large pupil size, dry cornea, absent eyelid and mandibular muscle tone

Define hyperalgesia

An exaggerated and prolonged response to a noxious stimulus