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RUSVM Anesthesiology > Breathing Systems, ET Tubes, and Scavenging > Flashcards

Breathing Systems, ET Tubes, and Scavenging Flashcards

1
Q

what are the 2 types of patient breathing systems

A

re-breathing and non-rebreathing

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2
Q

what are the types or rebreathing systems

A

circle

universal F

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3
Q

what are the types of non-rebreathing systems

A

mapleson A-F

Most common - modified mapleson D, mapleson F

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4
Q

what is anatomic dead space

A

airway structures that do not participate in gas exchange

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5
Q

what is mechanical dead space

A

portion of the anesthesia circuit where bidirectional flow is occuring (rebreathing of exhaled gases)

if excessive may cause an unsafe increase in inspired CO2

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6
Q

sources of mechanical dead space

A

face mask

ET tube extending past patient’s incisors

capnograph or other adapters

y-piece

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7
Q

T/F breathing tubes in a circle system do not constitute dead space becuase they flow is unidirectional (no rebreathing)

A

True

why breathing tubes may be long - ex. anesthesia machine palced outside MRI room

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8
Q

T/F dead space in a non-rebreathing system consists of the space between the fresh gas flow inlet and the patient

A

True

differs depending on mapleson type

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9
Q

components of re-breathing system

A

fresh gas input and O2 flush

unidirectional valves (inspiratory and expiratory)

breathing hoses

CO2 absorber

adjustable pressure limiting valvue (pop-off)

reservoir bag

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10
Q

T/F patient rebreathes gases via the inspiratory valve

A

True

composed of exhaled gases adter CO2 removal and fresh gas flow

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11
Q

advantages of re-breathing system

A

lower fresh gas flow rate required

patient breaths warm, humidifed gases

saves money

decreases environmental pollution

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12
Q

disadvantages of re-breathing system

A

higher resistnace to breathing due to valves

changes in anesthetic gas concentration occur slowly (lower fresh gas flow)

more components → morepotential for leaks

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13
Q

what is the shared connection between re-breathing and non-rebreathing systems

A

fresh gas inlet

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14
Q

Adjustable pressure-limiting (APL) valve or pop-off

A

limits pressure build-up in breathing system

should “pop-off” at 3-5 cmH20

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15
Q

when should pop-off be closed

A

checking the machine for leaks

administering positive pressure ventilation (manual or mechanical)

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16
Q

what can happen if the pop-off valve is cloed

A

increased pressure in breathing system (fresh gas flow continues with no exhaust) → cardiorespiratory arrest and death

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17
Q

breathing circuit pressure gauge

A

should be 0 +/- 1 with spontaneous patient breathing

exception - leak check, positive pressure ventilation

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18
Q

what color does the carbon dioxide absorber (soda lime) change when exhausted

A

white → purple

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19
Q

T/F color change in the absorbant can be seen when active and does not mean it is exhausted

A

True

20
Q

what are signs of CO2 absorbant exhaustion

A

inspired CO2 is > 1-2 mmHg on capnograph (= rebreathing)

increased PaCO2 on blood gas

21
Q

patient signs with CO2 absorbant exhaustion

A

increased RR (compensation)

increased HR ad BP (CO2 → sympathetic stimulation)

red mucous membranes (CO2 induced vasodilation)

22
Q

function of reservoir bag

A

inspiratory reserve for patient

administering positive pressure ventilation

allows anesthetist to monitor ventilation

23
Q

how do you calculate bag size for small animals

A

15 mL/kg x 6

short cut: (BW in kg) x 90

24
Q

oxygen flow rate

A

many different rates can be used

all are safe for patients as long as greater than metabolic O2 requirement (5-10 mL/kg/min)

25
Q

typical O2 flow rate for small animals (<50 kg) includes sheep under 50 kg

A

induction and recovery 50-100 mL/kg/min

maintenance 20-50 mL/kg/min

26
Q

typical O2 rate for larger animals

A

induction and recovery: 20-50 mL/kg/min

maintenance: 10-20 mL/kg/min

27
Q

advantages of non-rebreathing systems

A

light, minimal dead space, minimal resistance to ventilation (use for small patients <3 kg)

concentration of anestheitc gas changes rapidly due to high fresh gas flow

few components = fewer potential for leaks

28
Q

disadvantages of non-rebreathing system

A

requires high gas flow rates

patient breaths cold and dry gas

more expensive

increases environmental pollution

29
Q

oxygen flow rates for non-rebreathing system

A

should be 2-3x tidal volume

300mL/kg/min

30
Q

which monitor would help determine if the O2 flow rate was too low and patient was rebreathing CO2

A

capnograph

31
Q

indications for ET tube and intubation

A

maintain patent airway

administer O2, deliver inhalant anesthetics

provide positive pressure ventilation

protect airway from foreign material

apply tracheal and bronchial suction (transtracheal wash)

decreases environmental contamination if cuff is properly inflated

32
Q

types of ETT

A

murphy

cole

wire-reinforced

33
Q

routes of intubation

A

oral (most common)

nasal

tracheal (tracheostomy)

pharyngotomy

34
Q

characterisitcs of murphy

A

cuffed or uncuffed

has “murphy eye” that allows gas flow if end of tube is obstructed

most common

35
Q

T/F tubes with larger radius and shorted length will have less resistance to gas flow

A

True

radius has the largest effect

36
Q

T/F side of the tube is measured in mm and indicates an internal diameter

A

True

37
Q

laryngoscope

A

make intubation safer and easier

allows visualization of airway

apply light pressure to base of tongue, rostral to epiglotis

DO NOT place the blade of the laryngoscope on the epiglottis

38
Q

T/F inflate cuff a little first and then check to see if there is a leak

A

False

exception: ruminants-air should be added before any movement, high risk of regurgitation

39
Q

what can cause tracheal damage

A

over-inflated cuff

moving or twisting patient with inflated cuff

40
Q

complication of intubation

A

ETT obstruction

endobronchial intubation

ETT inhalation or ingestion

41
Q

types of scavenging systems

A

active

passive

42
Q

how can you minimize waste gas exposure

A

scavenge all the time

ensure that the machine has no leaks

use ETT with properly inflated cuff

avoid mask of chamber induction

check for tight fitting

use low O2 flows

maintain appropriate room ventilaion

use keyed systems for filling vaporizers

43
Q

passive scavenging systems

A

no vacuum

exhaust directly to atmosphere

F-air canister

44
Q

Advantages of F air canister

A

absorbs anesthetic vapors

does not release to atmosphere

portable

45
Q

disadvantages to F air canister

A

does not absorb N2O

flow-limited

added resistance

must be discarded when canister has gained 50g (weight before starting and PRN)

46
Q

other sourses of waste gas pollution

A

capnograph

face mask and chamber induction

recovery areas (large animals)

volitile agent spills

RUSVM Anesthesiology (39 decks)

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