Anesthesia Flashcards
Factors that lead to difficult mask ventilation
age >55
obese
sleep apnea/snores
facial hair
mallampati III/IV
Facial deformity
no teeth
LEMON evaluation of difficult airway
L: look: obesity, poor dentition, facial abnormalities, beard
E: 3-3-2 rule
M: mallampati
O: obstruction: stridor, foreign body, masses
N: neck mobility
What is the 332 rule
3- patients own fingers can be placed between incisors
3- fingers along the floor of the mandible between the mentum and hyoid bone.
3- 2 fingers in the superior laryngeal notch (thyroid mouth distnce)
a thyromental distance (distance of lower manidble in the midline from the mentum to the thyroid notch) that is under ___ cm is associated with difficult intubation
<6 cm.
Cormack-Lehane score
1: all the laryngeal structures seen (entire cords)
2: only the posterior cords and artenoids
3: larynx is concealed, only the epiglottis
4: neither glottis nor epiglottis.
ASA classification
ASA1: healthy, fit patient
ASA 2: a patient with mild systemic disease (ex/ Controlled T2DM)
ASA3: a patient with severe systemic disease that limits activity (ex/ stable CAD, COPD)
ASA4: a patient with incapacitating disease that is a constant threat to life (unstable CAD, renal failure)
ASA5: a moribund patient not expected to survive 24hours without surgery (ruptured AAA)
ASA6: declared brain dead, a patient whose organs are being removed for donation purses
E* for emergency operations to any ASA class.
TF you should take your diabetic meds the day of your surgery
false. Do not take anti-hyperglycemic agents on the morning of the surgery, especially since you likely would have fasted. Can consider adjusting insulin.
Meds to stop the day of surgery
- antihyperglycemics
- ACE and ARBs
- warfarin (consider bridging with heparin), anti-platelet agents (clopidogrel)
Beta 1 vs Beta 2 location and function
Beta 1: mainly in the heart and kidneys. Targeted activation of the beta-1 receptor increases heart rate, renin release, and lipolysis.
Beta 2: located in the smooth muscle (bronchi) to DILATE them.
Non-selective beta blockers like carvedilol or labetalol may be dangerous in people with respiratory conditions– they will be unresponsive to beta 2 agonists such as salbutamol if they are on a a non-selective beta blocker to regulate blood pressure.
STOPBANG criteria for OSA
Snores
Tired
Observed Apnea
Pressure (high)
BMI
Age >50
Neck circumference
Gender: male
If you put the ET tube too far down, it can cause a ___-sided endobronchial intubation, which is associated with Left sided ___ and right sided___ ___.
If you put the ET tube too far down, it can cause a RIGHT-sided endobronchial intubation, which is associated with Left sided ATELECTASIS and right sided TENSION PNEUMOTHORAX.
gold standard for making sure the ET tube is in the airway
capnography assessment.
reversible causes of PEA arrest (5Hs and 5Ts)
H; hypothermia, hypovolemia, hypokalemia, hypoxia, hydrogen ions (acidosis)
T: tamponade, thrombosis pulmonary, thrombosis coronary, tension pneumo, toxins (overdose/poisonings)
Maintenance fluid requirements
4-3-2 rule: 4 for first 10, 2 for next 10, and 1 for every kg after to calculate fluid requirement ml/H
OR
May add 40 to adults who weigh above 20 kg for ml/Hr dosing: ex// adult weighs 50kg– 90ml/hr is her maintenance.
Calculating acceptable blood loss; how much blood volume (ml) can they lose before you need to transfuse? Consider transfusion threshold to be when Hb is 70.
the man is 70kg, his Hb is 150.
adult male= 70ml/kg
female= 60ml/kg
child=80ml/kg blood vol.
This guy is 70kg. –> 70kg x 70ml/kg = 4900 ml of blood.
[(Hbi- Hbf)- EBV]/Hbi
= [(150-70)-4900]/150
= 2613. Therefore, you need to start transfusing at around 2.6L of blood loss.
