brachycephalic patient

Question 1

anatomy and physiology

Answer 1

BOAS
anatomical abnormalities
stenotic nares
elongated soft palate
hypoplastic trachea
laryngeal collapse
shallow eye orbit
higher resting vagal tone
lower oesophageal pH

Question 2

anaesthetic concerns

Answer 2

ventilation risk, airway managment
hypoventilation, hypoxia prior to GA
difficult intubation
airway obstruction, laryngeal collapse
bradycardia
suseptable to vomiting and regurgitation

Question 3

pre anaesthetic exam

Answer 3

assess for
upper airway sounds with respiration
respiratory distress
MM
degree of soft palate obstruction

Question 3

premed

Answer 3

lower dose, avoid heavy sedation
avoid drugs with no reversal
atropine to minimise salivation

Question 4

antiemetics

Answer 4

pre op - omeprazole, metaclopramide
avoid morphine - emetics

Question 5

induction

Answer 5

alfaxalone - minimal respiratory depression and short duration
iv
ready to intubate

Question 6

recovery

Answer 6

ensure optimal analgesia to avoid restlessness and tachypnoea

Question 7

iv access

Answer 7

important as we may need to re induce and re intubate

Question 8

pre O2

Answer 8

5-10 mins pre induction

Question 9

intubation

Answer 9

3 ET sizes

Question 10

monitoring

Answer 10

maintanance is lowest risk phase
respiratory and thermoregulatory systems

Question 11

analgesia

Answer 11

intra operative pain meds to ensure calm recovery and avoid panting

Question 12

recovery

Answer 12

post op O2 5-10mins
delay extubation until fully concious
leave ivc in and re intubation equiptment ready

Question 13

recovery temp support

Answer 13

too cold - shivvering
too hot - panting
increase O2 demand
may be kept in mild hypothermia to reduce O2 demand