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Patient Monitoring/Instrumentation & SIM > Anesthesia Circuits > Flashcards

Anesthesia Circuits Flashcards

1
Q

Any portion of the airway that does not participate in gas exchange

A

Dead space

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2
Q

True/false: Dead spaces causes us to rebreathe CO2 with every breath

A

True

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3
Q

Anatomic dead space

A

Pharynx, trachea, bronchi

2ml/kg

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4
Q

Physiologic dead space

A

Alveolar spaces that receive air but no blood flow

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5
Q

Physiology of smokers

A
  1. Alveolar sacs fuse into blebs (bullae)
  2. Excess mucus forms in the bronchioles
  3. Pulmonary capillaries get destroyed
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6
Q

Mechanical dead space

A

Anesthesia airway equipment (circuit tubing, humidifiers, ETT)

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7
Q

Which has less dead space? Masks, LMAs, or ETT?

A

ETTs have less, then LMAs, then masks

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8
Q

True/false: Even though dead space is fixed, when a patient takes a larger breath, a lower percentage of that will be dead space?

A

True

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9
Q

Perfused, but not ventilated

A

Pulmonary shunt

v/Q

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10
Q

Ventilated, not perfused

A

Dead space

V/q

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11
Q

Most common cause of hypoxemia

A

V/Q mismatch most likely due to atelectasis (v/Q, shunt)

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12
Q

v/Q

A

Pulmonary shunt

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13
Q

V/q

A

Dead space

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14
Q

Is a pneumothorax a shunt or dead space?

A

v/Q, pulmonary shunt

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15
Q

Pulmonary embolism: shunt or dead space?

A

V/q, dead space

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16
Q

Pulmonary edema: shunt or dead space?

A

v/Q, pulmonary shunt

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17
Q

Atelectasis: shunt or dead space?

A

v/Q, pulmonary shunt

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18
Q

Increase in pulmonary vascular resistance: shunt or dead space?

A

V/q, dead space

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19
Q

R mainstem intubation: shunt or dead space?

A

v/Q pulmonary shunt

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20
Q

Top lung in lateral decubitus position: shunt or dead space?

A

V/q, dead space

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21
Q

Lower lung in lateral decubitus position: shunt or dead space?

A

v/Q, pulmonary shunt

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22
Q

Emphysema: shunt or dead space?

A

Both (due to bullae and mucus plugs)

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23
Q

Spontaneous ventilation under GA: shunt or dead space?

A

v/Q, pulmonary shunt

24
Q

NTG (inc pulmonary vasculature and blood flow): shunt or dead space?

A

v/Q, pulmonary shunt

25
Q

Drop in cardiac output due to internal hemorrhage: shunt or dead space?

A

V/q, dead space

26
Q

Types of circuits used in anesthesia

A
  1. Open circuits (nasal cannula, insufflation/blow by, open drop anesthesia
  2. Partial re-breathing circuits (anesthesia circuits, oxygen masks)
  3. Non-rebreathing circuits (T-piece, nonrebreather mask)
27
Q

What are open circuits primarily used for?

A

Oxygen delivery

28
Q

Max FiO2 for nasal cannula

A

44% (reached at 6L/min)

29
Q

How to calculate FiO2 with nasal cannula

A

21% + 4% for each L/min

30
Q

Hazards of nasal cannula use

A
  1. Dries out nares at >4L/min flows

2. Can increase risk of fire for facial surgeries/where cautery is used near face

31
Q

When is insufflation (blow by) used?

A

When a patient is claustrophobic, anxious, or won’t tolerate the mask well
During sedation/scope cases
Facial surgeries to prevent CO2 accumulation under the drapes (use air, NOT O2)

32
Q

Types of partial rebreathing circuits

A
  1. Semi-closed partial rebreathing circuits (used on our machines)
  2. Semi-open partial rebreathing circuits (Mapleson)
  3. Partial rebreathing O2 masks (simple face mask, venturi mask, ambu bag, “nonrebreathing” mask on lower flows
33
Q

Advantages and disadvantages to rebreathing circuits

A

Advantage: Conserves heat and humidity
Disadvantage: Slower wake up on emergence and potential for CO2 retention/hypercarbia

34
Q

How can you prevent rebreathing in partial rebreathing circuits?

A

Increase fresh gas flow, or by opening the APL valve if applicable

35
Q

What do you do if you want to use an LMA or ETT outside of the operating room?

A

Transport an anesthesia machine to the room and hook it up to scavenging
Use a mapleson circuit

36
Q

Best mapleson circuit for spontaneous ventilation

A

Mapleson A -APL valve closer to patient, FGF at end of circuit

37
Q

Best mapleson circuit for control ventilation

A

Mapleson D -FGF closer to patient, APL valve at end of circuit

38
Q

Mapleson circuits are primarily used for:

A

Delivering oxygen

39
Q

Advantage of Mapleson Circuits

A

Can hook them up to ETT or LMA for GA (TIVA)

Can deliver positive pressure ventilation

40
Q

Disadvantage of Mapleson Circuits

A

More dead space = more potential to rebreathe CO2

No CO2 absorber and no inspiratory or expiratory valves

41
Q

Purpose of T piece

A

When a patient is breathing on their own but not ready to wake up yet
To limit/decrease rebreathing CO2. Oxygen goes in one side and CO2 comes out the other

42
Q

Disadvantage of T piece

A

Cannot use positive pressure

43
Q

Advantages of a coaxial circuit

A

Conserves heat and humidity

44
Q

Disadvantage to a coaxial circuit

A

Possibility of disconnection or kink in tubing

45
Q

Open during inspiration, closed during expiration

A

Inspiratory valve

46
Q

Open during expiration, closed during inspiration

A

Expiratory valve

47
Q

Purpose of unidirectional valves

A

So the patient does not rebreathe CO2

48
Q

When is a CO2 absorber practically unneccesary?

A

When fresh gas flows over 5L/min are running

49
Q

Desiccated “old school” granules will:

A
  1. Degrade all volatile agents into carbon monoxide (desflurane is the worst)
  2. Accelerate the degradation of sevoflurane into compound A
50
Q

AIAAAH recommends a humidity range of ___ for the OR

A

30-60%

51
Q

FiO2 for a simple face mask

A

40% at 5L/min

60% at 10L/min

52
Q

FiO2 for nonrebreathing mask

A

80s at 10L/min

90s at 15L/min

53
Q

Maximum FiO2 of venturi mask

A

60%

also depends on the adapter

54
Q

Purpose of supplemental oxygen

A

To compensate for:

  1. atelectasis
  2. anesthetic induced hypoventilation
55
Q

Supplemental oxygen is most often given:

A

During MAC
In transport from OR to PACU
In the PACU

56
Q

Airway resistance equation (and what each variable means)

A

R= 8ul/π(r^4)

R: resistance

u: viscosity of air
l: length of circuit
r: radius

57
Q

What does the Hagen Poiseuille equation tell us?

A
  1. Adding dead space (length) to a circuit increases resistance
  2. Resistance can minimized if: the diameter of the equipment is bigger or the length of the equipment is shorter (diameter has a bigger effect than length)

Patient Monitoring/Instrumentation & SIM (12 decks)

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