Anesthesia for Airway Disease

Question 1

when are the most critical times in anesthesia for airway obstructive diseases

Answer 1

induction and recovery

Question 2

preop considerations for brachycephalics

Answer 2

• avoid excitement prior to induction
• select SMALL et tubes
• preoxygenate
• rapid induction
• use SHORT ACTING induction agents for rapid recovery

Question 3

surgical considerations for brachycephalics

Answer 3

• tissue swelling may worsen the airway obstruction
• be prepared to manage up to 24 hours post-op

Question 4

postop considerations for brachycephalics

Answer 4

• keep intubated AS LONG AS POSSIBLE to allow control of the pharynx
• if partial airway obstruction after extubation - extend head, open mouth, and pull tongue
• be ready to re-intubate if needed

Question 5

anticipated anesthetic problems for brachycephalics

Answer 5

anesthesia: hypoventilation, hypothermia, hypotension, bradycardia, recovery

procedure: pain, hemorrhage, no access to head for monitoring

disease: anatomy

Question 6

premedication - brachycephalics

Answer 6

sedation & analgesia
1. acepromazine + midazolam
2. opioid +/- anticholinergic

Question 7

induction - brachycephalics

Answer 7

propofol or alfaxalone
+ midazolam

etomidate if concurrent heart disease

Question 8

maintenance - brachycephalics

Answer 8

inhalant or opioid CRI

Question 9

postoperative analgesia - brachycephalics

Answer 9

opioid + NSAID

Question 10

extubation - brachycephalics

Answer 10

as LATE as possible

can use postop opioids to prolong the tolerance of ET tube

wait to extubate until patient is chewing on the tube

keep O2 available

Question 11

preoperative considerations for tracheal collapse

Answer 11

• avoid excitement prior to induction
• select appropriate ET tubes and avoid irritation during intubation
• preoxygenate
• rapid induction
• disconnect tube from circuit when moving patient

Question 12

postoperative considerations - tracheal collapse

Answer 12

• extubate EARLY to avoid irritation and coughing
• sedated with acepromazine if needed to keep calm
• be ready for re-intubation if needed

Question 13

premedication - tracheal collapse

Answer 13

opioid +/- anticholinergic
acepromazine (low dose) + midazolam

or midazolam alone

Question 14

induction - tracheal collapse

Answer 14

propofol + midazolam

Question 15

postoperative analgesia - tracheal collapse

Answer 15

opioids, NSAID, regional blocks if needed

Question 16

extubation - tracheal collapse

Answer 16

as EARLY as possible

as soon as patient swallows - extubate to prevent coughing

Question 17

what causes tracheal rupture following intubation

Answer 17

cuff overinflation

most commonly occurs in cats