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LANCE > Anesthesia Circuits > Flashcards

Anesthesia Circuits Flashcards

1
Q

dead space

A

any portion of the airway that doesn’t participate in gas exchange

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2
Q

breathing normally do we rebreathe CO2?

A

yes b/c of dead space

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3
Q

if you increase someones dead space do you increase or decrease the amount of CO2 rebreathed?

A

increase

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4
Q

what is the amount of anatomic deadspace in patients in upright position?

A

2mL/kg

~ 1/3 of patients Vt

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5
Q

Physiologic dead space

A

alveolar spaces that receive air but no blood flow

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6
Q

What patients have more physiologic dead space?

A

smokers, elderly

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7
Q

What is special about the physiology of smokers (airway)?

A

1- alveolar sacs fuse into blebs
2- excess mucus in bronchioles
3- pulmonary capillaries destroyed

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8
Q

Mechanical dead space

A

circuit tubing
humidifiers
ETT
etc

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9
Q

normal extrathoracic anatomic deadspace adults

A

70-75mL

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10
Q

ETT dead space

A

12.6mL

~60mL less than a non intubated pt

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11
Q

LMA dead space

A

90mL of dead space

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12
Q

Face mask dead space

A

162mL

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13
Q

Y piece dead space

A

8mL (peds= 4mL)

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14
Q

Is dead space fixed?

A

yes

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15
Q

pulmonary shunt

A

some blood vessels bypass alveoli and doesn’t pick up alveoli

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16
Q

What is the normal healthy person % of shunting?

A

up to 3%

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17
Q

Could we increase pulmonary shunting?

A

yes by ventilating only one

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18
Q

Capital V

A

normal ventilation

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19
Q

Lowercase v

A

less ventilation

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20
Q

Capital Q

A

normal alveolar perfusion

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21
Q

Lowercase q

A

less alveolar perfusion

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22
Q

ventilation

A

alveolar capillary gas exchange

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23
Q

perfusion

A

delivery of blood and oxygen to the organs of the body

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24
Q

V/Q mismatch

A

decreased alveolar capillary exchange and some degree of hypoxia

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25
Q

V/q

A

dead space

ventilation without perfusion

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26
Q

v/Q

A

pulmonary shunt

perfusion without ventilation

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27
Q

lateral decubitus position

A

upper lung= more ventilation

lower lung= more perfusion

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28
Q

3 types of circuits used in anesthesia

A
  1. open circuit
  2. partial rebreathing circuit
  3. “non-rebreathing” circuit
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29
Q

3 examples of open circuit

A

nasal cannula
insufflation “blow by”
open drop anesthesia

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30
Q

example of partial rebreathing circuits

A

semi-open mapleson
semi closed machine
simple face mask
self inflating ambu bag

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31
Q

example non rebreathing circuit

A

t piece

non rebreather

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32
Q

what is the caution of using an open circuit in facial/head/eye surgery?

A

if using cautery then chance for fire

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33
Q

equation to estimate FiO2 with a nasal cannula

A

21% + 4% per 1L/min flow

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34
Q

what is the max FiO2 with nasal cannula?

A

44% with 6L/min

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35
Q

what is the top flow rate you want to use to make the patient comfortable?

A

4L/min

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36
Q

insufflation blow by

A

people who do not want mask around face or children

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37
Q

EGD

A

esophagogastroduodenoscopy

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38
Q

oxygen options for EGD

A

NC and blow by

special mask with hole for the scopes

39
Q

how to manage a MAC case with a bovie and facial drapes

A

turn on air and place it under the drape

40
Q

insufflation via bronchoscope

A

oxygen source hooked up and insufflated for brief apnea

41
Q

what is the advantage for rebreathing circuits?

A

conserves heat and humidity

42
Q

disadvantages to rebreathing

A

slower wake up

CO2 retention and hypercarbia

43
Q

how to prevent rebreathing in partial rebreathing circuit

A

turn up FGF rate

adjust APL valve if has one

44
Q

two common mistakes with oxygen

A

forgetting to turn on when transport or when preoxygenating

45
Q

sedation outside OR

A

IV only medication
spontaneous breathing and oxygen
ambu bag on deck

46
Q

limitation to NC and Facemask

A

not able to provide positive pressure ventilation

47
Q

2 options for general outside the OR

A
  1. bring machine

2. use mapleson circuit

48
Q

if the room had oxygen wall supply but no wall scavenging then could you supply volatile agent?

A

no, TIVA only

49
Q

mapleson A

A

best for spontaneous

worst for control ventilation

50
Q

mapleson d

A

best for cv

worst for sv

51
Q

mapleson E

A

ayre’s T piece

52
Q

mapleson F

A

jackson rees modification

53
Q

advantage to mapleson circuit

A

ability to hook to ETT

provide positive pressure ventilation

54
Q

disadvantage of mapleson circuit

A
  1. 1 tube for inhale exhale so increase deadspace
  2. no CO2 absorber
  3. no inspir. and expir. valves
55
Q

how to minimize rebreathing in mapleson circuit

A

higher FGF (greater than minute ventilation)

  1. open APL
  2. shorten circuit volume
56
Q

which maplesons are commonly used?

A

D,E,F

57
Q

bain circuit

A 
modification of mapleson D
co-axial design
inspired gas (inner)
expired gas (outer)
58
Q

ayre’s t piece

A

mapleson E
spontaneous only
close to 0 added rebreathing

59
Q

advantage of t piece

A

no rebreathing

60
Q

disadvantage of t piece

A

no positive pressure ventilation

61
Q

when do we clinically use t piece?

A

when the pt is SV but not responding to commands to transport to PACU

62
Q

jackson rees’ modification

A

mapleson F
t piece that allows PPV
popular in peds transport

63
Q

what are the components of the semi closed circuit

A 
circuit tubing
elbow adapter
inspir. and expir. unidirectional valves
co2 absorber
breathing bag
humidifier
64
Q

proximal to y piece

A

separate inspir and expir tubes

65
Q

distal to y piece

A

inspir and expir share tubing

66
Q

2 options for circuit tubing

A

inhalation and exhalation tubing

coaxial circuit

67
Q

advantage of coaxial circuit

A

conserves heat and humidity

68
Q

disadvantage of coaxial circuit

A

disconnection or breaking/kinking of inner tube lead to rebreathing/hypercarbia/hypoxia

69
Q

elbow adapter

A

attaches y piece to ett

70
Q

when is the inspiration valve open?

A

during inspiration

71
Q

when is the expiratory valve open?

A

during expiration

72
Q

what does the CO2 absorber convert CO2 into?

A

water and heat

73
Q

what color is an old(non usable) CO2 absorber?

A

purple

change when 50-70% changed color

74
Q

what are the CO2 absorber granules made of?

A

soda lime

silica added

75
Q

large grannules

A

lower resistance

less absorptive capacity

76
Q

small grannules

A

increases resistance

better absorptive capacity

77
Q

what are the two things that dried out CO2 grannules will do?

A

degrade volatile agents to carbon monoxide (Des is most)

accelerate sevo into compound A

78
Q

is the CO2 absorber a double or single canister?

A

double canister to decrease circuit resistance

79
Q

when is the CO2 absorber unnecessary?

A

when FGF > 5L/min

80
Q

which is more compliant lungs or breathing bag?

A

breathing bag

81
Q

what is the humidity in the OR?

A

30-60%

82
Q

humidifier

A

humidifies gases
filter to trap bacteria
adds 10mL-60mL deadspace

83
Q

what is the lower weight limit for humidifiers?

A

2.5kg

84
Q

what is the lower weight limit for filters?

A

3kg

85
Q

what are the locations for the humidifier?

A

distal to elbow piece

expiratory limb

86
Q

simple face mask FiO2 at 5L/min

A

40%

87
Q

simple face mask fiO2 at 10L/min

A

60%

88
Q

venturi/venti mask

A

range 24-60% fiO2

choose color for specific one

89
Q

nonrebreathing mask at 10L/min and 15L/min

A

80% fiO2

90%

90
Q

what are the two main reasons for supplemental oxygen?

A

compensate for:
hypoventilation
atelectasis

91
Q

When are the supplemental devices usually used?

A

sedation
transport
pacu

92
Q

two clinical uses of ambu bag?

A

emergency to ventilate

transport patient that is not going to be extubated

93
Q

what are the four steps to take when transporting with ambu bag?

A

call resp therapy to get ventilator in pacu
ventilate during transport
place patient on ventilator
administer a propofol drip if paralyzed

94
Q

airway resistance

A

you can decrease resistance by a larger diameter and shorter length equipment

LANCE (17 decks)

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