General Anaesthesia Principles

Question 1

Predictors of difficult BVM

Answer 1

Poor seal: Large beard, facial dysmorphia
Age >55
No teeth
Obesity
Stiff chest- Asthma, COPD
Short thyromental distance

Question 2

Predictors of difficult Intubation

Answer 2

Predisposing Factors: Age - elderly, Obesity, C spine immobilisation
Anatomical - Large beard, Short neck, limited neck movement, neck injury/surgery
Acquired - Trismus, Mandible #, Ank Spond

Question 3

Process of RSI - 9 P’s

Answer 3

Plan
Preparation - drugs, equipment, people, place
Protection - C spine (if needed)
Positioning
Pre O2
Pre-treatment
Paralysis & induction
Placement - with proof - EtCO2, Auscultate, Chest movement, CXR
Post intubation management

Question 4

Preparation for RSI - SOAPME

Answer 4

S - Suction
O - Oxygen - NRB& BVM to 15L O2, Apnoeic O2 with NP 15L
A - Airways - ETT, bougie, CMAC
P - Pre-Oxygenate 15L NRB
M - Medications/ Monitoring
E - End tidal CO2

Question 5

Laryngospasm - Risk Fx/ Triggers

Answer 5

Insufficient dept of anaesthesia
Airway manipulation - suctioning/laryngscopy
Young Age
Rapid Ketamine administration
Active asthma/concurrent URTI
Smoking
OSA + obesity

Question 6

Laryngospasm - Mx

Answer 6

1. Stop procedure
2. 100% O2 & +ve Pressure Ventilate
3. Suction airway + clear secretion
4. Apply P at Larsons Notch - behind lobule of Pinna
5. Deepen sedation - Propofol
6. Prepare for RSI - Suxamethonium
   - anticipate hypoxia & bradycardia - atropine 20 mcg/kg

Question 7

Paediatric Airway ; Physiological Differences

Answer 7

1. Increased basal metabolic rate: increase O2 consumption, rapid desats.
2. Decreased functional residual capacity. (worsen w gastric distension).
3. Increase ECF compartment = decrease DOA of drugs/faster onset

Question 8

Paediatric Airway ; Anatomical Differences

Answer 8

1. Large Head/occiput
2. Large tongue
3. Superior & anterior larynx
4. Floppy epiglottis & U shaped
5. Short trachea -> R main bronchus intubation
6. Anatomical dead space = 2ml/kg

Question 9

Complication of Intubation

Answer 9

1. Oesophageal intubation
2. R Main bronchus intubation
3. Aspiration/vomitting
4. Tube displacement
5. Cuff leak
6. Perforation
7. Hypotension

Question 10

Hypotension post Intubation

Answer 10

Hypovolemia
Distributive - Anaphylaxis, Induction drugs, Acidosis
Obstructive - Tension PTx, Breath Stacking
Cardiogenic - MI, Arrythmia

Question 11

Ventilator Crisis : DOPES
also applicable post intubation Hypoxia

Answer 11

Displacement
Obstruction - mucus plug, biting, suction catheter
Patient - Pneumothorax, CXR, Decompress, PE, APO
Stacking Breaths - bag slowly, decompress chest
Sedation & paralysis - inadequate