Anesthesia Complications

Question 1

What are some respiratory complications?

Answer 1

Aspiration
Laryngospasm and bronchospasm
Airway and resp obstruction
Hypoventilation
Pulmonary embolism
Pneumothorax
Intercostal muscle spasm
Atelectasis
Pulmonary edema
Pseudocholinesterase deficiency

Question 2

What can happen with aspiration of acidic gastric juices?

Answer 2

Leads to chemical pneumonitis,
Edema,
Alveoli collapse,
Ventilation-perfusion mismatch,
Results in hypoxemia

Question 3

What can happen with aspiration of solid emesis?

Answer 3

Edema, severe hypoxia, resp obstruction

Question 4

Exaplain bronchospasm

Answer 4

Contraction of smooth muscle in walls of bronchi and bronchioles causing narrowing of the lumen

Question 5

Explain laryngospasm

Answer 5

Partial or complete closure of the vocal cords as an involuntary reflex action.

Question 6

What is the most frequent cause of resp difficulty in immediate post op period?

Answer 6

Obstruction

Question 7

How is the airway maintained in obstruction?

Answer 7

Using an oral airway or endnotes heal tube.

Question 8

Where do the majority of thrombi occur that can detach and cause a pulmonary embolism?

Answer 8

Deep veins of legs and pelvis

Question 9

What is a pulmonary embolism?

Answer 9

Obstruction of a pulmonary artery or one of its branches by an embolus (often a blood clot)

Question 10

What is a pneumothorax?

Answer 10

Collection of free air in chest outside lung.

Causes lung to collapse

Question 11

A pneumothorax is rare but can occur when?

Answer 11

During subclavian catheter insertion or needle insertion into thoracic cage

Question 12

What are he symptoms of a pneumothorax?

Answer 12

Pain and sob

Question 13

How is a pneumothorax diagnosed and treated?

Answer 13

X-ray,

Chest tube with underwater seal

Question 14

When does an intercostal muscle spasm occur? How do u fix it?

Answer 14

After lg dose of fentanyl or on emergence fr general anesthetic

May reverse itself or neuromuscular blockers are given.

Question 15

What is atelectasis?

Answer 15

Partial lung collapse

Question 16

What causes atelectasis?

Answer 16

Mucous obstructing bronchus, air in alveoli distal to obstruction is reabsorbed
Segment of lung collapses and consolidates. Retained mucous becomes contaminated by inhaled bacteria

Question 17

Explain pseudocholinesterase deficiency.

Answer 17

Inherited condition where person cannot metabolize succinylcholine because there is no pseudocholinesterase enzyme.

People have prolonged paralysis if resp muscles.

Pt ventilated until breathing function returns

Go to icu

Question 18

What are mildly hypertensive pts prone to with anesthesia and at what phase are they prone to it?

Answer 18

Prone to myocardial ischemia during induction and emergence

Question 19

What is venouspasm caused by?

Answer 19

Cold IV fluid infusion

Slow flow

Question 20

What relieves a venospasm?

Answer 20

Iv procaine

Thrombophlebitis may follow venospasm

Question 21

What are some symptoms for an airembolism?

Answer 21

Cardiac dysrhythmias
Hypotension
Heart murmur audible with stethoscope or Doppler

Question 22

Treatment for an air embolism

Answer 22

Preop placement of cvp catheter allows immediate aspiration of air

With no cvp in place for ventricular obstruction place pt in steep head down position with the right side up

Question 23

What is disseminated intravascular coagulation?

Answer 23

Normal clotting function does not function
Repetitive over active cycle of clot formation
Simultaneous clot breakdown (fibeinolysis) occurs
Leads to consumption of platelets and coagulation factors
Release of fibrin degradation products that act as potent anticoagulants.

Question 24

Treatment for DIC

Answer 24

Control of primary condition
Blood, plasma
Dextran given IV
heparin and clotting factors given early to prevent hemorrhage

Question 25

What is malignant hyperthermia?

Answer 25

Genetic trait that causes severe muscle contractions and a fast rising fever when person gets general anesthesia.

Usually found in older adults and young adults

Question 26

How is a definitive diagnosis made?

Answer 26

Through a muscle biopsy

Question 27

What are some possible clinical signs of malignant hyperthermia?

Answer 27

Tachycardia
Ventricular fibrillation
Unstable BP
Increased RR
Increased co2 production
Increase in end tidal co2 production
Severe contracture of jaw muscles (with succinylcholine )
Not relieved with further doses of succs or non depolarizing muscle relaxant.
Whole body rigidity.
Fever (classic but later symptom).
Lab increase in Cr, co2 p and decreased ph.
Abnormal coagulation studies. 
Mg, Ca, phosphate, K imbalance.
Skin flushed with peripheral mottling.

Question 28

What are the triggering agents of MH?

Answer 28

All volatile inhalation gases
Succinylcholine
Stress, etoh, cocaine in combination.

Question 29

What are safe agents for MH?

Answer 29

Non depolarizing muscle relaxants
Narcotic and opioids
IV anesthetics
Nitrous oxide
Benzodiazepines
Local anesthetics

Question 30

What mnemonic is used for MH treatment? Explain it

Answer 30

Some hot dude better give iced fluids fast…

S- stop triggering agent, surgery ASAP 
H- hyperventilate
D- Dantrium (2.5mg/kg-10mg/kg)
B- (sodium) bicarbonate
G- glucose
I- iced fluids, ice packs
F- furosemide
F- fast