Flashcards in Week 8&9 - Dr. White Deck (61)
o what is mandatory for all airway management scenarios:
o the first step in airway management
Bag and mask ventilation (BMV) is
no sign of chest rising, no end-tidal CO2 detected, no mist in the clear mask
these are signs of:
o Difficult mask ventilation is often found in patients with
a life saving temporizing measure in patient with difficult airways (b/c they cannot be ventilated or intubated)
(i-gel LMA is what Dr. White talked about)
Difficult airway - LEMON Trial:
• Facial trauma
• Large incisors
• Large tongue
• Interincisor distance (3 fingers)
• Hyoidmental distance (3 fingers)
• Thyroid to floor of mouth (2 fingers)
Neck Movement – chin to chest
Predictors of Difficult Intubation
o B – Beard
o O– Obesity
o N – No teeth
o E – Elderly
o S – Snores
type of intubation not for an unstable neck:
type of intubation good for an unstable neck:
awake blind nasal intubation
nebulized anesthesia - 4% lidocaine blocks for how long?
15 mins MAX
most important element for a successful awake fiberoptic intubation?
Surgical airway - Invasive technique required when you "can't intubate, can't ventilate".
A few important things to remember:
-16 or 14g IV cannula required to pass through CTM.
-jet ventilation system usually found on the back of vent
-catheter MUST BE SECURE!
-short 1s bursts of Oxygen
-Avoid barotrauma; pt may develop subcutaneous or mediastinal emphysema
**If no jet ventilation; 3ml syringe can attache to catheter with plunger removed. a 7.0mm TT connector can be inserted into the syringe to attach to breathing circuit or an ambu bag.
• Poor functional status has been identified as a risk factor for surgical site
infection and postoperative complications.
• Frailty is a perioperative risk factor for
complications and mortality.
Frailty is classified as primary or secondary.
o Primary frailty occurs as part of the intrinsic process of aging.
o Secondary frailty is related to the end-stage of chronic illnesses and is caused by inflammation and wasting, for example heart failure, COPD, inflammation, and wasting associated with cancer.
• By some estimates, over half of elderly patients also take over-the-counter herbal products.
o The American Society of Anesthesiologists (ASA) recommends that whenever possible, herbal products be discontinued at least
1–2 weeks prior to surgery.
o Garlic extract and ginkgo biloba increase the risk of
• IV anesthetics have more pronounced hemodynamic effects, and smaller doses are required to achieve the same anesthetic depth. Dose of an induction drug and opioids should be decreased by at least
• The strongest predisposing factor for postoperative delirium is
• The basic principles in ethical decision making that apply to the older adult are the same as those that apply to all patients.
o In health care the most common principles are
autonomy ** most important
Patient's right to self-determination. defined:
An obligation or responsibility to help the patient; “to do good”
To not intentionally harm the patient; "do no harm"
To treat the patient fairly
What body part/ organ is especially vulnerable to laser surgery?
all OR personnel should wear laser-specific eye goggles with side protectors to prevent injury.
• The eyes of a patient undergoing laser treatment must be protected by taping them shut, followed by the application of wet gauze pads and a metal shield.
• Minimally invasive robotic surgery is associated with improved patient outcomes including :
decreased length of stay,
faster recovery, reduced perioperative blood loss, and reduced postoperative pain
** Regardless of the procedure the anesthetic plan must take into consideration the following factors:
-prolonged surgical times
-spatial restrictions associated with use of the robot
-inability to alter patient position after docking of the robot
-physiologic changes associated with extreme positioning
-risk of postoperative visual loss (POVL)
-physiologic consequences associated with the creation of pneumoperitoneum
-implementation of Enhanced Recovery after Surgery (ERAS) protocols
type and screen tests for
if indicated b the surgical procedure, in robotic surgery, pt should be typed and cross matched for a minimum of
four units of blood