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pharm exam 1 > Anesthesia Exam 1 Week 2-Diana > Flashcards

Anesthesia Exam 1 Week 2-Diana Flashcards

1
Q

LMA

A
  1. Does not protect against aspiration of gastric contents
  2. Low incidence of aspiration when used in patients at low risk
  3. Ideal for short cases (2-3 hours max)
  4. Designed initially for spontaneous ventilation
  5. Safe use with PPV Limit tidal voluve <8 mo/kg and maintain airway pressure <20cm cmH20
  6. Remove LMA- deeply anesthetized/awak with intact reflexes
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2
Q

LMA contraindication

A
  1. # 1 high risk for gastric content aspiration
  2. Full stomach
  3. Hiatal hernia with significant GERD
  4. Morbid obesity
  5. Intestinal obstruction
  6. Delayed gastric emptying
  7. Airway obstruction at the level of the glottis or below the glottis
  8. Poor airway compliace
  9. High airway resistance
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3
Q

FASTRACH LMA

A
  1. Designed to facilitate tracheal intubation through rigid tube
  2. Stainless tube shaped to follow curvature of the sort/hard palate during insertion
  3. Designed to be used with silicone ETT and introducer
    7.0-8.0 ID (cuffed). Stabilization is necessary to avoid extubation of the trachea.
    SPECIAL FEATURES: methal handle (no MRI), specially designed ETT (uses a high pressure cuff) tube pusher, epiglottic elevating bar
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4
Q

Supraglottic airway- KING LT Cobra

A

Oropharyngeal cuff, single valve and pilot balloon, gastric tube lumen, ventilation holes

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5
Q

Supraglottic airway-AIRQ LMA

A

Air Q disposable airway
Size 4.5 : Large adults males 70-100kg
Size 3.5: small adults females 50-70 kg

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6
Q

Sniffing position

A

Alignment of the oral, pharyngeal and laryngeal axis

  1. Pharyngeal axes: aligned by elevating the patient’s head (8-10 cm)
  2. Head extension at the atlantooccipital joint aligns oral opening with the glottis (oral axis)
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7
Q

LMA ProSeal

A

It is a double lumen LMA with the following features: Gastric drain tube (second lumen) for easy gastric decompression, larger mask, bite block
Do not place suction directly to the drain tube. Instead, you must pass an OGT through the tube to decompress the stomach.
It has a BETTER seal than the LMA classic, max pressure for PPV<30 cmH2O (LMA classic is <20 cmH2O)

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8
Q

LMA Supreme

A

Disposable version of the Pro seal is called LMA supreme

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9
Q

LMA C-trach

A

This is very similar to the Fastrach but includes a camera so you can visualize intubation

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10
Q

LMA flexible

A

This has an airway tube that is flexible, wire reinforced (no MRI) longer that the LMA classic and narrower than the LMA classsic (must use a smaller ETT or bronchoscope)

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11
Q

LMA facts

A
  1. Sits over glottis, nothing inside the trachea to stimulate it during emergence therefore less likely to bronchospasms
  2. LMA is the least stimulating airway device. Hence, less likelihood of increased cathecholamines, tachycardia, HTN, dysrrhythmias, bronchorrea and bronchospasma
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12
Q

Gastric regurgitation with LMA in place

A

1.Leave LMA in place
Place patient in 2.Trendelenburg position and deepen anesthetics if necessary
3. Give 100% O2 via Ambu bag (because gastric contents are in the breathing circuit and you dont want to push them inside the lungs)
4. Use low FGF and low Vt
5. Suction LMA
6. Use a FOB to evaluare the presence of gastric contents in the trachea. If present, then consider intubation and aspiration protocols.

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13
Q

Oral tracheal intubation

A

1.Patient’s mouth is widely open
2.The laryngoscope is inserted to the right side of the mouth
3.Avoid incisors and sweep tongue to the left
4.Handle is raised towards the sealing to lift the mandible
These maneuver should expose vocal cords

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14
Q

Nasotracheal intubation

A
  1. Nostril pre-treated with a vasoconstrictor
  2. A well lubricated ETT inserted through nostril
    3.Cephalad traction of ETT as it advances through the floor of the nasal passages
    Laryngoscopy will expose the pharynx and the vocal cords (Macintosh blade for better visualization)
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15
Q

Confirmation of EET placement

A

1.Persistent detection of CO2 by capnography
2.Auscultation of the chest and epigastrium
3.Visualization of ETT passing through cords
Thoracic movements (rise and fall)
4.Condensation of water vapor in the ETT
5.Palpation of cuff over the sternal notch during compression of pilot balloon

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16
Q

Physiological Responses to intubation

A

1.Vagal stimulation during laryngoscopy
2.Bradycardia
3.SNS stimulation
4.Systemic hypertension
Tachycardia
5.Cardiac dysrhythmias (light anesthesia)
6.Increased intracranial and intraocular pressures

17
Q

Complications of Tracheal Intubation

A 
Cuff perforation
Esophageal intubation
Endobronchial intubation
Cardiac dysrhythmias
Myocardial ischemia
Aspiration of gastric contents
Gastric distention
Airway trauma: tooth damage, lip or tongue lacerations, sore throat
Mucosal lacerations
Dislocated mandible
18
Q

Anesthetic techniques

A
  1. General anesthetic
  2. Monitored Anesthesia Care
  3. Regional Anesthetic
  4. Peripheral Nerve block
19
Q

Surgical considerations for anesthesia

A

Position, Site and Duration

20
Q

General anesthesia

A
  1. Inhibition of sensory, motor and sympathetic nerve transmission at the level of the brain
  2. Reversible unconsciousness and lack of sensation
  3. Immobility and muscle relaxation
  4. Loss of voluntary reflexes
21
Q

What depends on the uptake and removal of inhalation agents from the body?

A

It depends on alveolar concentration of the agent and its uptake from the alveoli by the pulmonary circulation

22
Q

What is pre-oxygenation?

A

The process of replacing nitrogen in the lungs with oxygen.

23
Q

Why is pre-oxygenation so important?

A

Because it gives us a reservoir in patients who will not be masked like RSI

24
Q

Phases of GA?

A

Induction, Maintenance and Recovery

25
Q

Guedels Planes of Anesthesia

A

Stage 1-Reduced sensation of pain
Stage 2-unconsciousness with involuntary movement and excitement
Stage 3-General surgery is performed
Stage 4-characterized by respiratory or medullary paralysis

26
Q

How do we maintain GA?

A

With a combination of drugs to provide analgesia, muscle relaxation, control SNS responses

27
Q

What is RSI?

A

Is a rapid onset of unconsciousness and muscle paralysis followed by rapid instrumentation of the airway
GOAL: gain control of the airway rapidly after the ablation of protective reflexes and decrease the risk of pulmonary aspiration (full stomach, incompete nt LES)

28
Q

How do we do RSI?

A
  1. Pre-oxygenate your patient
  2. Have someone apply proper cricoid pressure at the beginning of IV induction
  3. Induce your patient with your IV anesthetic of choice and DO NOT VENTILATE YOUR PATIENT
  4. Immediately give succinylcholine
  5. Intubate and confirm ETT placement
  6. Once ETT placement has been confirmed release CRICOID PRESSURE
29
Q

RSI indication

A
  1. Patients with full stomach
  2. Patients with bowel obstruction
  3. Poorly controlled GERD
  4. Diabetic gastroparesis
  5. Pregnancy
  6. Unknown NPO status
30
Q

Who its RSI not good for?

A

Patients actively vomiting, cervical spine fractures and patients with laryngeal fractures.

31
Q

What is the acronym for placement of LMA/SGA?

A 
RODS
Restrictive mouth
Obstruction
Disrupted/Distorted
Stiff lungs
32
Q

What is the acronym for surgical airway?

A 
SHORT
Surgery/short neck
Hematoma/laryngeal edema
Obesity
Tumor
33
Q

What are the four types of breathing systems?

A

Open Fresh Gas from atmosphere (chloroform)
Semi open FGF plus an apparatus
Semi-closed (Mapleson A-F)
Closed (Anesthesia machine circuit)

34
Q

Breathing circuit

WHAT WE USE

A

A pathway in shich volatile agents and oxygen is delivered and CO2 is removed two types non circle and circle.

35
Q

Co Axial

A

It is where two coduits for inhaled and exhaled gasses, where one coduit is inside the other

36
Q

Magills circuit

A

a circuit in which has a reservoir bag a corrugated tube and spring loaded expiratory valve, rebreathing prevented by keeping FGF more than the patients respiratory volume

37
Q

Mapleson

A

A circuit in which the FGF is used to removed the exhaled CO2

38
Q

Breathing circuit components

A 
FGF/connection
Tubing (usually corrugated)
Connection to patient
APL valve
Reservoir bag
Waste gas connection
39
Q

Mapleson A or also know as MAGIL ATTACHMENT

A

It is used for spontaneous ventilation

pharm exam 1 (12 decks)

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