Anaestheticd

Question 1

Effects of obesity on respiratory system for RSI

Answer 1

Increase incidence of hypoxaemia
Increased incidence of hypercarbia
Increased oxygen consumption
Increased airway resistance
Reduced TLC
Reduced VC
Reduced FRC
Decreased expiratory reserve volume
Inefficient respiratory muscles

Question 2

Effects of obesity on RSI on non respiratory organs

Answer 2

Increased intra abdominal pressure
Increased incidence of hiatus hernia
Increase GORD
Increase gastric volume
Higher volume distribution
Increased CO2 production

Question 3

Drugs IBW vs actual and dose
Propofol induction
Sux dose
TV
Midaz infusion for sedation
Vec maintainance

Answer 3

Propofol induction: 1-2mg/kg ideal body weight
Sux dose: 1-2mg/kg actual body weight
TV: 6-8ml/kg ideal body weight
Midaz infusion for sedation: 0.05-0.2mg/kg/hr ideal body right
Vec maintainance: 0.1mg/kg ideal body weight

Question 4

Outline 5 strategies can be implemented to improve safety of intubation

Answer 4

Standardised pre RSI checklist
Standardised difficult airway algorithm
RSI performed by only adequately trained operators
Standardised equipment available including videolargoscopy
Mandated use of nasal progs oxygenation during apneic period
Regular training of staff
Provision of part task training and workshops

Question 5

After successful intubation

Answer 5

New circuit for new patient
Semi recombinant position 35-45 degrees
Subglottic suctioning
Mouth cares
Avoidance of flushing of condensate into lower airways