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Sim Lab > Session 6: Ventilation Under Anesthesia > Flashcards

Session 6: Ventilation Under Anesthesia Flashcards

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
Q

Full stomach pt examples

A

not NPO
gastroparesis (delayed emptying)
- narcotics, diabetes, ozempic, intense pain
bowel obstruction

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26
Q

types of pts w/decreased lower esophageal tone

A

GERD
hiatal hernia
pregnant
neonates

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27
Q

surgery types that require muscle paralysis

A

inner abdominal
laparoscopic
hip replacement
cardiothoracic

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28
Q

when is the ventilator required

A

Muscle relaxants used
Brain surgery
Cardiothoracic surgery

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29
Q

Clear liquid NPO

A

2 hrs

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30
Q

non-clear liquid NPO

A

4 hrs

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31
Q

breast milk NPO

A

4 hrs

32
Q

non-human milk NPO

A

6 hrs

33
Q

baby formula NPO

A

6 hrsi

34
Q

light meal NPO

A

6 hrs

35
Q

normal meal NPO

A

8 hrs

36
Q

chewing tobacco NPO

A

6 hrs

37
Q

clear liquids

A

juice
tea
black coffee
water
jello
italian ice
pedialyte
jellow

38
Q

non-clear liquid

A

juice w/pulp
milk
alcohol
coffee w/milk
broth w/fat

39
Q

light meal

A

toast and clear liquids

40
Q

normal meal

A

fried/fatty foods or meat

41
Q

chewing gum

A

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
Q

Gastroparesis

A

delayed gastric emtying

43
Q

causes of gastroparesis

A

narcotic use
trauma
diabetes
neonates
pregnancy/labor
liver failure w/ascites

44
Q

obese pts gastric emptying

A

have faster gastic emptying
larger gastric volumes

still considered full stomach

45
Q

hiatal hernia

A

upper portion of stomach herniates through lower esophageal sphincter into esophagus

46
Q

nissen fundoplication

A

treatment for hiatal hernia and gastric reflux

lower esophageal sphincter is strengthened by wrapping portion of stomach around the lower portion of esophagus

47
Q

Relative Contraindications to LMA placement

A

Long procedures (3+ hrs)
Obese pts
Non supine positions

48
Q

Long procedures w/LMA risk

A

atelectasis
pressure ischemia due to LMA cuff

49
Q

LMA complications

A

Laryngospasm/Bronchospasm
Aspiration
Dislodged LMA
Biting tube

50
Q

diagnose laryngospasm from LMA

A

sudden loss of CO2 (right after incision)
too light anesthesia

51
Q

treat LMA laryngospasm

A

150mg propofol

follow w/succinylcholine if propofol doesnt work

52
Q

how to prevent aspiration w/LMA

A

avoid LMA placement in GERD/full stomach pts
avoid excessive PPV (>20cmH2O)

53
Q

how to treat aspiration from LMA

A

-succinycholine and intubation
-bronchoscopy to remove gastric contents in airway
-chest xray/pulmonary consult/ICU stay

54
Q

LMA Size 1

A

5kg

55
Q

LMA size 1.5

A

5-10kg

56
Q

LMA size 2.0

A

10-20kg

57
Q

LMA size 2.5

A

20-30kg

58
Q

LMA size 3.0

A

30-70kg

59
Q

LMA size 4

A

70-90kg

60
Q

LMA size 5

A

> 90kg

61
Q

Indications for Intubation

A

Full stomach pt
GERD/hiatal hernia
Paralytics needed
Laparoscopic
Ventilator needed
higher airway pressure needed
Long procedure

62
Q

intubation disadvantages

A

more invasive/traumatic
sore throat
risk for laryngospasm on emergence
must paralyze pt
higher risk of bronchospasm on emergence

63
Q

ways to avoid coughing on intubated pts

A

administration of muscle relaxants
heavier narcotic dosing
deep anesthesis (>1MAC)
Local anesthetic (lidocaine)

64
Q

Difficult intubation predictors (11)

A

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
Q

ETT Murphy Eye

A

hole on the right side of the endotracheal tube
alternative path for ventilation in case of distal tube obstruction

66
Q

ETT bevel

A

allows ETT to be rotated to slide more easily into airway

67
Q

Oral RAE ETT

A

can bend at mouth for ENT surgery

68
Q

Nasal RAW ETTs

A

placement requires nasal intubation
popular for jaw/dental surgery

69
Q

Adult female ETT size

A

7.0-7.5

70
Q

Adult male ETT size

A

7.5-8.0

71
Q

obese adult ETT size

A

> =8.0

72
Q

pediatric uncuffed ETT size

A

Age/4 +4

73
Q

pediatric cuffed ETT size

A

1/2mm smaller than uncuffed

(Age/4 +4) - 0.5mm

74
Q

right mainstem intubation

A

endotracheal tube more likely to go into right mainstem if inserted too deeply

75
Q

right lung lobes

A

3l

76
Q

left lung lobes

A

2

Sim Lab (23 decks)

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