Mod V: Anesthesia Machine

Question 1

_{Anesthesia Machine}

T/F: Peds can be effectively anesthetized with a standard adult anesthesia machine and a standard ventilator

Answer 1

True

Question 2

_{Anesthesia Machine}

Which adjustments can/must be made to the standard anesthesia machine to compensate for smaller airway and smaller lung volumes?

Answer 2

Peds Breathing circuit

Pt’s Ventilation

Question 3

_{Anesthesia Machine}

Breathing circuit adjustment in peds:

Answer 3

Non-rebreathing circuit system

^{Mapleson and Bain}

Circle breathing system

^{Semiclosed and closed}

^{Change tubing and reservoir bag}

Anesthesia Gas Machine- Breathing circuits

Question 4

_{Anesthesia Machine}

Ventilation adjustment in peds:

Answer 4

Spontaneous vs. controlled

Volume control vs. Pressure control ventilation

Question 5

_{Anesthesia Machine}

Must be able to deliver air to control FiO2, why

Answer 5

Retinopathy of prematurity

Question 6

_{Anesthesia Machine}

Abnormal proliferation of fibrous tissue immediately behind the lens of the eye, leading to blindness. It affected many premature babies in the 1950s, owing to the excessive administration of oxygen.

Answer 6

Retinopathy of prematurity (ROP)

Formaly knowns as retrolental fibroplasia

The risk of Retinopathy of prematurity (ROP) is inversely proportional to birth weight and is a/w neonate oxygen exposure, apnea, blood transfusion, sepsis and fluctuating levels of CO2

Question 7

_{Anesthesia Machine}

Why do you need to review your Air/O2 blending ratios

Answer 7

So you could dial in the amount of oxygen you want to deeiver and

Prevent complications such as Retinopathy of prematurity (ROP)

Question 8

_{Anesthesia Machine}

What’s the formula for calculating the ratio of Air/O2 flows when desired FiO2 to deliver is known?

Answer 8

Calculate Air flow = 100 - (desired % 02) = Air (L/min)

Calculate O2 flow = (Desired % 02) – 20 = O2 (L/min)

Ratio of Air/O2 flows = Air (L/min) ÷ 02 (L/min)

Question 9

_{Anesthesia Machine}

Calculate the flows of both O2 and air if you want to deliver an FiO2 of 28%, aka what’s the Air/O2 blending ratio to deliver 28% FiO2?

Answer 9

100-28 = 72 L/min of Air

28-20 = 8 L/min of O2

72:8 = 9

Air/O2 blending ratio to deliver 28% FiO2 is 9:1

Question 10

_{Anesthesia Machine}

The Air/O2 blending ratio to deliver 28% FiO2 is 9:1. How can you deliver this ration with less flow (you don’t really want o deliver 9L/min of Air)?

Answer 10

Maintain the same ratio at lower flow rates

Question 11

_{Pediatric Breathing Circuits}

What are the desired features of the ideal Pediatric Breathing Circuit?

Answer 11

Low dead space

Low resistance

Lightweight/compact

Low compression volume

Easily humidified

Easily scavenged

Economy of low FGF

Suitable for controlled or mechanical ventilation

Question 12

_{Pediatric Breathing Circuits}

Which Breathing Circuits are actually used in peds?

Answer 12

Standard adult breathing circuit

Pediatric circuit that are lighter and smaller in circumference in order to decrease deadspace

Question 13

_{Anesthesia Ventilator}

Any adult ventilator may be used in peds with appropriate adjustments made to which ventilation variables?

Answer 13

RR - FGF - VT

I:E ratio

Question 14

_{Anesthesia Ventilator}

Meticulous attention to settings PRIOR TO initiation of ventilation is essential in order to prevent:

Answer 14

Barotrauma

Question 15

_{Anesthesia Ventilator - Pressure vs. Volume Control}

What’s the major advantage of Pressure control ventilation?

Answer 15

Prevents overinflation/barotrauma

Pressure limited breath delivered at a set rate

VT determined by preset pressure limit

Pressure control is more forgiving!!!

Question 16

_{Anesthesia Ventilator - Pressure vs. Volume Control}

What is a potentially negative outcome of ↑ airway pressure with inspiration during Volume control ventilation?

Answer 16

LUNG BAROTRAUMA

Ventilation delivered with constant inspiratory flow to preset VT

VT delivered constant

Question 17

_{Anesthesia Ventilator - Ventilator Settings}

Which two variables are “limiting variables” during mechanical ventilation?

Answer 17

Pressure Limit vs. Volume Limit Setting

Question 18

_{Anesthesia Ventilator - Ventilator Settings}

What are adequate initial I:E settings for most children with normal lung compliance?

Answer 18

1:2

Question 19

_{Anesthesia Ventilator - Ventilator Settings}

What are adequate I:E settings for less compliant lungs?

Answer 19

1:1 or 2:1

Question 20

_{Anesthesia Ventilator - Ventilator Settings}

What’s the initial RR for newborns?

Answer 20

Rate for newborns

RR: 25 – 30

Question 21

_{Anesthesia Ventilator - Ventilator Settings}

What’s the initial RR for Children 1-8 years old?

Answer 21

Rate for Children 1-8 years old

RR: 12 – 15

Question 22

_{Anesthesia Ventilator - Ventilator Settings}

What’s the initial RR for Children older than 8?

Answer 22

Rate for Children older than 8

RR: 8 – 10

Question 23

_{Anesthesia Ventilator - Ventilator Settings}

What should your initial VT, to PIP be?

Answer 23

VT 10-15 ml/kg/breath, to PIP 20-25 cm H2O

Question 24

_{IV Equipment/Set Up}

It is safer to establish IV in all anesthetized pediatric pts. What are exceptions to this?

Answer 24

Very short, noninvasive procedures

^{(However, have set up & ready)}

Question 25

_{IV Equipment/Set Up} What the recommended IV catheter size for **neonates**?

Answer 25

**24 ga**

Question 26

_{IV Equipment/Set Up} What the recommended IV catheter size for **1-5 y/o**?

Answer 26

**22 ga**

Question 27

_{IV Equipment/Set Up} What the recommended IV catheter size for **\>5 y/o**?

Answer 27

**20 ga**

Question 28

_{IV Equipment/Set Up} What's a benefit of using Micro drip infusion set (60gtt/ml) with volume limiting device (burette)?

Answer 28

May be **pre-filled** with desired volume to be administered This _prevents_ **accidental overhydration** of pt, especially very small infants

Question 29

_{IV Equipment/Set Up} What air safety devices would you use in those with known congenital heart defects?

Answer 29

All air bubbles purged **Air filters**

Question 30

_{IV Equipment/Set Up} Why is important to terminate IV lines with T-connector especially in \< 1y/o?

Answer 30

Allows _direct injection of drug_ with **minimal deadspace** Allows to give medication at the closet port possible that prevents unecessarily administration of additional IV fluid This matters a lot in a neonate that could only tolerate a 25 mL infusion for the whole case for example

Question 31

_{IV Equipment/Set Up} What's a benefit of uing 3-way multiple-stopcock manifolds in procedures where blood or colloid may be necessary?

Answer 31

Allows _mainline to continue infusing maintenance_, except during administration of blood or colloids

Question 32

_{Warming Devices} Warming Devices are important because Hypothermia is common and could lead to:

Answer 32

**Acidosis** _Myocardial irritability_ **Bradycardia** _Apnea_ **Prolonged Drug Effects** (NMBD)

Question 33

_{Warming Devices} What are the different mechanisms of heat loss?

Answer 33

Radiant Conductive Convective Evaporative

Question 34

_{Warming Devices} The type of heat loss whereby heat is transferred from one object to another that are not in contact with the body is also known as:

Answer 34

**Radiant** heat loss

Question 35

_{Warming Devices} What's the major determinant of the rate of radiant heat loss?

Answer 35

**Temperature gradient** btw child & near objects

Question 36

_{Warming Devices} Heat loss through contact is also known as:

Answer 36

**Conductive heat loss** ^{Occurs through Bed, scales}

Question 37

_{Warming Devices} Heat loss from body to cooler air is also known as:

Answer 37

**Convective** heat loss

Question 38

_{Warming Devices} Heat loss through vaporization of liquid from the body cavities & respiratory tract is also known as:

Answer 38

**Evaporative heat loss** Could be Sensible(sweat) or Insensible (water thru skin)

Question 39

_{Warming Devices} Which techniques or devices can be used in the OR to prevent hypothermia?

Answer 39

**OR temp** ^{Warm to 80-90˚ F before child arrives in OR} **Radiant Warmers** ^{During prep, induction, after drapes removed Servomechanism temperature control (avoid skin burn) Monitor skin (not core temp) Max skin temp: 39˚ C 3 feet away} **Warming Blankets (circulating water mattress)** ^{Effective if < 10 kg Fluid temp should not exceed 39˚ Avoid direct contact skin with mattress} **Forced air warmers** ^{Most effective Combination of convection with warm air + plastic that reduces evaporative loss Costly} **Heat-moisture exchangers (HME)** ^{Increase resistance to breathing Clog with humidity over time} **Heated humidifiers** ^{May overheat} **Wrapping** ^{Reduces radiant and convective heat loss “Space” blankets with reflective aluminized Mylar layers very effective Covering head ↓ heat loss by 70%}

Question 40

_{Warming Devices} What should the OR temp be before the child arrives in OR?

Answer 40

Warmed to **80-90˚ F**

Question 41

_{Warming Devices} When and how should Radiant Warmers be used?

Answer 41

During prep, induction, after drapes removed Servomechanism temperature control (avoid skin burn) ^{Monitor skin (not core temp)} Max skin temp: 39˚ C Keep 3 feet away!!!

Question 42

_{Warming Devices} Which temp should be monitored with radiant warmers use?

Answer 42

**Skin temp** (not core)

Question 43

_{Warming Devices} What feature of Radiant warmers avoids skin burn?

Answer 43

**Servomechanism** temperature control

Question 44

_{Warming Devices} What's the maximun skin temp acceptable when using radiant warmers?

Answer 44

**39˚ C**

Question 45

_{Warming Devices} At what distance should radiant warmers be placed away from the pt?

Answer 45

**3 feet away**

Question 46

_{Warming Devices} Warming Blankets (circulating water mattress) are _effective_ for pts weighing how much?

Answer 46

**\< 10 kg**

Question 47

_{Warming Devices} Warming Blankets (circulating water mattress), fluid temp should not exceed which temperature?

Answer 47

**39˚ C**

Question 48

_{Warming Devices} T/F: When using warming Blankets (circulating water mattress), direct contact of skin with mattress must be avoided

Answer 48

**True**

Question 49

_{Warming Devices} Which warming device utilizes a combination of convection with warm air + plastic that reduces evaporative loss, is considered the most effective warming device, and is however costly?

Answer 49

**Forced air warmers**

Question 50

_{Warming Devices} Most effectie warming device:

Answer 50

**Forced air warmers**

Question 51

_{Warming Devices} Disadvantages of Heat-moisture exchangers (HME)

Answer 51

Increase **resistance to breathing** **Clog** with humidity over time

Question 52

_{Warming Devices} Disadvantage of Heated humidifiers:

Answer 52

May **overheat**

Question 53

_{Warming Devices} The warming technique that uses “Space” blankets with reflective aluminized Mylar layers an is very effective at reducing radiant and convective heat loss is also known as:

Answer 53

**Wrapping**

Question 54

_{Warming Devices} Covering head with wrapping ↓ heat loss by what percentage?

Answer 54

**70%**