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Sp: Sim Lab 1 > Session 6: Ventilation Under Anesthesia > Flashcards

Session 6: Ventilation Under Anesthesia Flashcards

(76 cards)

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1
Q

3 types of ventilation

A

bag mask
LMA
ETT

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2
Q

most common situation for mask ventilation

A

mask induction
after IV induction but before intubation
over-sedated pts who go apneaic
failed itubation
any other unexpected apnea

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3
Q

advantage of mask ventilation

A

non-invasive
non-traumatic

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4
Q

disadvantages of mask ventilation

A

hands are not free
airway not protected
difficult on certain pts
limited to 20cmH2O
difficult in field avoidance cases

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5
Q

predictors of difficult mask ventilation

A

Obesity (can cause airway obstruct)
Overbite (prominent)
Facial hair/beard
Facial/neck trauma
Foreign body

Edentulous
Pharyngeal abscess or mass
Airway swelling

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6
Q

types of airway swelling

A

airway trauma
epiglottitis
burn pts
ludwig’s angina
anaphylaxis

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7
Q

Ludwig’s Angina

A

bacterial infection in the mouth that causes airway swelling

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8
Q

causes of ineffective mask ventilation

A
  1. poor mask seal/not enough pressure
  2. soft tissue airway obstruction
  3. too much pressure in circuit
    • APL valve closed too much = hard to inflate lungs
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9
Q

how to improve mask ventilation

A
  1. use oral/nasal airway
  2. doing jaw thrust w/double handed masking technique
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10
Q

difficult mask ventilation protocol step 1

A
  1. properly positioned w/airway aligned
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11
Q

difficult mask ventilation protocol step 2

A
  1. if you cant mask, place oral/nasal airway
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12
Q

difficult mask ventilation protocol step 3

A
  1. perform double handed technique w/oral airway
    • need additional person to squeeze bag
    • if you dont have additional person, use ventilator
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13
Q

difficult mask ventilation protocol step 4

A
  1. if 2 hand mask fail, place LMA
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14
Q

Difficult mask ventilation protocol step 5

A
  1. if LMA doesnt work, 2 options
    • if paralyzed w/Roc, try to intubate while assitant draws up reversing dose of sugammadex (16mg/kg)
    • if not paralyzed, wake them up (let propofol wear off)
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15
Q

Ventilator setup during difficult mask protocol

A

pressure control ventilation
stay under 20cmH2O

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16
Q

Options for potential difficult mask ventilation and intubation

A
  • awake intubation w/bronchoscope
  • CPAP preoxygenation w/RSI
  • emergency tracheotomy
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17
Q

LMA relieves

A

all airway obstruction
creates effective seal in pharynx

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18
Q

LMA vs Mask ventilation

A

LMA more effective and efficient
LMA accomplishes everything a mask can do but anesthetist has free hands

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19
Q

LMA advantages

A
  • more effective ventilation
  • great backup ventilation for difficult pts (rescue device)
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20
Q

LMA disadvantages

A
  • doesnt protect airway
  • limited to 20cmH2O
  • cannot use volume control vent setting
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21
Q

Using ventilator w/LMA risks

A

higher risk for atelectasis
reduce risk by using pressure support ventilation or assist ventilation

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22
Q

LMA vs Intubation

A
  • LMA is less traumatic
  • LMA does not require muscle relaxants
  • LMA lowers risk of laryngospasm
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23
Q

when do you place an LMA

A

for every general anesthetic unless LMA placement is contraindicated

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24
Q

Absolute contraindications for LMA

(FGPLVHDN)

A

Full stomach
GERD/Hiatal Hernia/pregnancy/neonates
Paralysis needed
Laparoscopic Surgery
Ventilator needed (pt not spontaneously breathing)
Higher airway pressure needed
Difficult intubation suspected
Neck/pharyngeal pathology

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25
Full stomach pt examples
not NPO gastroparesis (delayed emptying) - narcotics, diabetes, ozempic, intense pain bowel obstruction
26
types of pts w/decreased lower esophageal tone
GERD hiatal hernia pregnant neonates
27
surgery types that require muscle paralysis
inner abdominal laparoscopic hip replacement cardiothoracic
28
when is the ventilator required
Muscle relaxants used Brain surgery Cardiothoracic surgery
29
Clear liquid NPO
2 hrs
30
non-clear liquid NPO
4 hrs
31
breast milk NPO
4 hrs
32
non-human milk NPO
6 hrs
33
baby formula NPO
6 hrsi
34
light meal NPO
6 hrs
35
normal meal NPO
8 hrs
36
chewing tobacco NPO
6 hrs
37
clear liquids
juice tea black coffee water jello italian ice pedialyte jellow
38
non-clear liquid
juice w/pulp milk alcohol coffee w/milk broth w/fat
39
light meal
toast and clear liquids
40
normal meal
fried/fatty foods or meat
41
chewing gum
increases saliva production increases volume of stomach liquids does not impact stomach acidity does not elevate risk of complications treat like clear liquid meal
42
Gastroparesis
delayed gastric emtying
43
causes of gastroparesis
narcotic use trauma diabetes neonates pregnancy/labor liver failure w/ascites
44
obese pts gastric emptying
have faster gastic emptying larger gastric volumes still considered full stomach
45
hiatal hernia
upper portion of stomach herniates through lower esophageal sphincter into esophagus
46
nissen fundoplication
treatment for hiatal hernia and gastric reflux lower esophageal sphincter is strengthened by wrapping portion of stomach around the lower portion of esophagus
47
Relative Contraindications to LMA placement
Long procedures (3+ hrs) Obese pts Non supine positions
48
Long procedures w/LMA risk
atelectasis pressure ischemia due to LMA cuff
49
LMA complications
Laryngospasm/Bronchospasm Aspiration Dislodged LMA Biting tube
50
diagnose laryngospasm from LMA
sudden loss of CO2 (right after incision) too light anesthesia
51
treat LMA laryngospasm
150mg propofol follow w/succinylcholine if propofol doesnt work
52
how to prevent aspiration w/LMA
avoid LMA placement in GERD/full stomach pts avoid excessive PPV (>20cmH2O)
53
how to treat aspiration from LMA
-succinycholine and intubation -bronchoscopy to remove gastric contents in airway -chest xray/pulmonary consult/ICU stay
54
LMA Size 1
5kg
55
LMA size 1.5
5-10kg
56
LMA size 2.0
10-20kg
57
LMA size 2.5
20-30kg
58
LMA size 3.0
30-70kg
59
LMA size 4
70-90kg
60
LMA size 5
>90kg
61
Indications for Intubation
Full stomach pt GERD/hiatal hernia Paralytics needed Laparoscopic Ventilator needed higher airway pressure needed Long procedure
62
intubation disadvantages
more invasive/traumatic sore throat risk for laryngospasm on emergence must paralyze pt higher risk of bronchospasm on emergence
63
ways to avoid coughing on intubated pts
administration of muscle relaxants heavier narcotic dosing deep anesthesis (>1MAC) Local anesthetic (lidocaine)
64
Difficult intubation predictors (11)
Mallampatic class 3 or 4 (M) Hx of difficult intubation Obesity neck trauma foreign body airway swelling long protruding incisors prominent overbite small mouth opening (2 finger brreaths) short thyromental distance (3 finger breaths) limited cervical spine ROM (<21 degree extension) TMJ
65
ETT Murphy Eye
hole on the right side of the endotracheal tube alternative path for ventilation in case of distal tube obstruction
66
ETT bevel
allows ETT to be rotated to slide more easily into airway
67
Oral RAE ETT
can bend at mouth for ENT surgery
68
Nasal RAW ETTs
placement requires nasal intubation popular for jaw/dental surgery
69
Adult female ETT size
7.0-7.5
70
Adult male ETT size
7.5-8.0
71
obese adult ETT size
>=8.0
72
pediatric uncuffed ETT size
Age/4 +4
73
pediatric cuffed ETT size
1/2mm smaller than uncuffed (Age/4 +4) - 0.5mm
74
right mainstem intubation
endotracheal tube more likely to go into right mainstem if inserted too deeply
75
right lung lobes
3l
76
left lung lobes
2

Sp: Sim Lab 1 (23 decks)

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