Medical Conditions and Anesthesia Flashcards
Risk of URI and exacerbating factors
2-10x incr risk of resp complications –> Lspasm, Bspasm, periop hypoxemia
Risk incr with kids <2yrs
Complications can occur up to 6 wks post URI
Exac Factors:
intubation, RAD, parental smoking, airway sx, copious secretions, nasal congestion
What are mediators are released during URI?
Leukotrienes, bradykinin, histamine
Incr vagal activity –> PNS flares
Decr neutral endopeptidase –> results in incr amounts of bronchoconstrictive substances –> promotes shunting/hypoxemia d/t decr diffusing capacity
Complications during Anesthesia
Bspasm, Lspasms, hypoxemia, atelectasis, stridor/subglottic edema
HME = prevents dry secretions
Lido/Opioids = decr AW reflexes
Atropine = decr brady risk, decr secretions
Suction ETT while deep = removes mucus plugs
Cool Mist in PACU = prevent dry secretions
Uncomplicated URI =
Complicated URI =
Seasonal allergies/rhinitis =
1-postpone sx 2 weeks if runny nose/congestion/non-prod cough
2-postpone sx 4-6 weeks if any lower airway involvement, wheeze/croup/poor appetite/febrile/prod cough
3-considered non-infectious, ok for sx
Req sx still? LMA if possible, deep plane for ett and 1/2 size smaller, prevent dry secretions, depress AW reflexes, sxn ett when deep p/ intubation, a/ extubation
RAD, precipitating factors for Bspams
URI, lower airway infection, irritants, cold/dry gases, allergens, emotional stress/fear/anxiety, mechanical manipulation of airway, GERD
RAD pathophys
1-inflamm cells, mast/ephils –> rls subs –> obstruction/hyperreactive tissue
2-bronchoconstriction/mucosal swelling by mediators
3-increased mucus production –> aw obstruction
Overall = wheeze, air trapping, hyperinflation, decr gas exchange, obs sm airways, v/q mismatch, hypoxia/hypercarbia, resp fatigue–>failure
RAD/asthma treatments
bronchD with Beta2 agonists
oral/inh steroids
leukotriene modifiers
anti-Ach, methylxanthines –> adenosine induced bronchial relaxation
Pre-op questions for asthmatics
Typical episode? Precip factors? Most recent attack? Oral steroids this year? Hospitalized? Intubated? Compliant w/ meds? Need pre-op optimization?
Intra-Op Mgmt of RAD
BronchoD p/ induction / ketamine/safe propofol induction
Avoid histamine rx = morphine, atracurium, thiopental (toradol), use IV lidocaine
Use LMA if possible, deep profile for ETT w/ warmed gas
Signs = changed EtCO2 waveform, incr PAP, wheeze+, decr O2 saturation
Avoid: breath stacking, air trapping, hyperinflation by prolonged exp time, lower RR, appropriate NDMR
Laryngospasm Mgmt
Lspasm: 100% FiO2, CPAP/PEEP, jaw thrust/head tilt/OA, sxn OP, deepen anesthetic, apply 10-15 secs of PPV
Rx = succs 2-3mg/kg IV, 4-5mg/kg IM + atropine 0.02mg/kg
Bronchospasm Mgmt
Bspasm: Confirm Dx, 100% FiO2, incr anesth depth, Inh albuterol, IV lido/atropine, IV corticosteroid, modify vent settings no breath stacking
Adjuncts: terbutaline 0.01ml/kg subq (max 0.25ml), IV epi 10 mcg/kg, theophylline 5mg/kg IVP (level 10-20), mag sulf 50-100mg/kg over 30m
Deep Extubation for RAD
Not OK: RSI, full stomach, diff airway, neo & young infants
OK: albuterol, suction while deep, lido1-1.5mg/kg 5 min prior, consider atropine for bronchD and anti brady
Post op give humidified O2
Anemia Pre-op
Normal Values: neo = 15-20, 3mo = 9-11, 6m-2yr = 11-15
Anemia most likely r/t poor diet
No transfusion trigger but 7g/dL is threshold for negative phsyio changes, heart compromised if < 5g/dl
1.5kg prem w/ cardiopulmo disease requires preop Hgb of 12+
Anemia Intra-op
avoid excess sedation (hypercapnia = incr CO/BP = incr O2 use), maintain PaO2, maintain intravasc volume, avoid incr CVP (increase venous oozing), no bucking/coughing, avoid high PEEP, poor positioning. Avoid shivering and L shifts of OxCurve w/ alkalsosis, hypocapnia, hypothermia.
Retinopathy of Prem
Definition: failure of retinal vasc growth. Vasc damage by hyperoxic environment –> free radical damage tissues. Pathophys: hyperoxia>hypoxia –> retinal art vasoC –> capillary endothelial swelling –> peripheral retinal tissue damage. Common pts: born <1.5kg. Post term susceptible as well. Normal PaO2 = 60-80 in neonates.
