Exam 2

Question 1

What are the conditions that necessitate continued intubation?

Answer 1

• Epiglottis
• Localized edema
• RLN damage
• Hemodynamic instability
• Bleeding
• Prolonged obtundation
  
  • Anesthetics
  • Metabolic abnormalities
  • Neurologic injury

Question 2

What is the most frequently encountered serious complication in PACU?

Answer 2

Respiratory problems

Occur in 1.9% of patients

Related to:

• A/w obstruction
• Hypoventilation
• Hypoxemia

Question 3

Causes of airway obstruction

Answer 3

Posterior displacement of tongue

Secretions

Laryngospasm

Glottic edema

Vomitus

Blood in airway

External pressure on the trachea

Question 4

Hypoventilation

Answer 4

• PaCO2 > 45 mmHg
• Common after anesthesia
• Significant > 60 mmHg or pH < 7.25
• Signs:
  
  • Somnolence (drowsiness)
  • a/w obstruction
  • Slow RR
  • Tachypnea w/ shallow breathing
  • Labored breathing
• Respiratory acidosis = HTN, tachypnea, and cardiac irritability = cardiacdepression

Question 5

Etiology of Hypoventilation

Answer 5

• Etiology: most common respiratory problem that occurred in PACU
• Depressant effects of anesthetic agents
• Residual paralysis (from NMBD)
• Splinting due to pain

Question 6

Treatment of Hypoventilation

Answer 6

• Directed at underlying cause
• Controlled ventilation until corrected
• Intubation:
  
  • Obtundation, circulatory depression, and sever acidosis
• Opioid antagonism
  
  • Cons: severe pain, HTN crisis, pulmonary edema, myocardial ischemia / infarction
• Judicious opioid analgesia