Anesthetics Conduct Flashcards
Define 1 “arm-brain” circulation?
The time it takes for an IV GA injected into the arm to reach the brain. About 20 seconds
What are 4 Planes (stages) of anaesthesia?
1) Sedation 2) Excitation 3) Anaesthesia (Light->Deep) 4) Overdose IV goes so fast you don’t notice them. Inhalational, the patient visibly passes through these planes. i.e. sleepy, excited, anaesthetised … etc.
What do we use to monitor a patient’s conscious level during Induction?
Verbal contact Movement Resp Pattern EEG “Planes”
What are the 7 stages for an anaesthetist during surgery?
Pre-op assessment Prep Induction Maintenance Emergence Recovery Post-op care
In order of “seriousness”, what are the 4 types of airway maintenance?
1) Triple airway manoeuvre 2) Face mask 3) Oropharyngeal (Guedel) airway 4) Laryngeal mask airway
What’s involved in the Triple Airway Manoeuvre?
Head Tilt
Chin lift
Jaw Thrust
What are the 3 main apparatus for airway maintenance in anaesthesia?
Face mask
Oropharyngeal (Guedel) Airway
Nasopharangeal Airway
What is a Laryngeal mask airway?
A cuffed tube with a mask that sits over the glottis
What complications could occur during induction of anesthesia?
Obstruction Aspiration
What could cause airway obstruction under anesthesia?
Ineffective Triple Airway Maneouvre Airway device malposition/kinking Laryngospasm
Why might patient’s aspirate under anesthesia?
They lose protective airway reflexes like gag, swallow and cough Plus lots of foreign material like gastric contents, blood and surgical debris
Define airway Maintenance and airway Protection?
A Maintained airway is open & unobstructed A protected airway is protected from contamination. Only endotracheal intubation will do this
What is endotracheal intubation?
A cuffed tube is placed in the trachea via the oral route using a laryngoscope, muscle relaxant and “sniffing the air” position
Why do we need muscle relaxant in endotracheal intubation?
To abolish the laryngeal reflexes
Why would you choose to intubate a patient?
1) Protects from gastric contents in unfasted (emergency) patients
2) For ventilation when using muscle relaxants 3) If there’s risk of blood contamination e.g. tonsilectomy
4) When needing to tightly control blood gasses e.g. neurosurgery
5) When there will be restricted airway access e.g. Maxfax
What parameters can we measure to monitor a patient under anaesthesia?
Basic - SpO2, ECG, NIBP, FiO2 & ETCO2
Respiratory parameters
Agent Monitoring
Temperature
Urine Output and NMJ
Invasive venous/arterial monitoring
Processed EEG
Ventilator Disconnect
What common problems occur during recovery?
A,B & C problems Pain N&V Hence it’s done in a dedicated area with trained staff
What are the major risks to a patient during anesthesia?
Airway problems
Temperature (too cold or too hot)
Loss of other protective reflexes e.g. corneal can cause injury
VTE
Consent/ID Pressure areas
What are the major types of LA blocks?
Spinal
Epidural
Plexus block
Nerve block
What two drugs are mentioned in the lecture for IV induction?
Propofol Thiopentone
What are complications that an anaesthetist must consider?
Airway
Breathing
Circulation
Position / Technique related
Awareness of Patient
Why is “landing as hazardous as takeoff”?
I.e. what problems can occur in emergence?
Muscle relaxation is reversed
Anaesthetic agents off
Resupmtion if spontaneous respiration
Return of airway reflexes / control
Extubation
(all of the above can be very quick or very slow)
