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Anesthesia > Common Intraop Problems > Flashcards

Common Intraop Problems Flashcards

1
Q

Hypoxemia

A

PaO2

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2
Q

V/Q mismatch - hypoxemia

A

most common pathophysiologic cause of hypoxemia
results from decreased alveolar ventilation in respect to perfusion
ex) shunts, pneumonia, PE, pulmonary edema

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3
Q

Improper placement of tube - hypoxemia

A

endobronchial, esophageal, oropharyngeal

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4
Q

oxygen supply - hypoxemia

A

equipment failure or high altitude

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5
Q

alveolar hypoventilation - hypoxemia

A 
COPD, asthma, bronchitis
drug overdose
neuromuscular abnormality (MG, Guillan Barre)
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6
Q

Intrapulmonary shunting - hypoxemia

A
  • decreased ventilation in perfused lung regions -> shunting of venous blood without being oxygenated
  • O2 therapy unable to improve PaO2
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7
Q

Diffusion Abnormality - hypoxemia

A

impaired transfer of O2
- sarcoidosis, ILD
decreased O2 carrying capacity

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8
Q

Bronchospasm

A

Causes:

  • preexisting reactive airway disease
  • manipulation of airway
  • ETT with inadequate anesthesia
  • ETT with bronchial stimulation
  • histamine release, anaphylaxis, pulmonary edema
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9
Q

Investigations of bronchospasm

A 
examine ETT, check positioning
- look for wheezing
- capnograph
- high peak pressure
RULE OUT: PTX, PE, pulmonary edema
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10
Q

Management of Bronchospasm

A 
increase FiO2
increase anesthetic depth
increase expiratory time and decrease RR
give albuterol, epi for anaphylaxis
hydrocortisonefor long term
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11
Q

Hypotension

A

MAP

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12
Q

Decreased preload - hypotension

A

low blood volume (hemorrhage, fluid loss)
decreased venous return -> position
Tamponade, PTX, compression by surgeon, excessive PEEP

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13
Q

Decreased afterload - hypotension

A

sepsis, vasodilating drugs (anesthetics)

anaphylaxis reaction, neuro injury

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14
Q

Decreased contractility - hypotension

A

MI, arrhythmias, CHF, anesthetic effect, electrolyte abnormalities

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15
Q

Hypertension

A 
BP > 140/90 or MAP >20-25% from baseline
- examine BP cuff, artline, IV
- review events thus far
- check for hypoxia and hypercarbia
- check anesthetic level
Tx: anti-hypertensives (beta-blockers, vasodilators)
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16
Q

Primary HTN

A

No known cause (70-95%)

17
Q

Secondary HTN

A
  • pain/surgical stimuli (inadequate anesthesia), ETT stimulation
  • hypercarbia, hypoxia, hypervolemia, hyperthermia
  • intracranial pathology
  • endocrine problems
  • alcohol withdrawal
  • malignant hyperthermia
18
Q

Timing of HTN

A

prior to induction -> withdrawal from medications
post-induction -> laryngoscopy, ETT stim, improper placement, pain
during case -> pain control, hypercarbia, pneumoperitoneum, fluid overload, bladder distention, drugs

19
Q

Hypercarbia

A

increased CO2 levels (blood gas or ETCO2)

  • examine pulse ox
  • vent settings and CO2 absorber
  • consider ABG
  • assist breathing or increase minute ventilation
20
Q

Increased CO2 production - hypercarbia

A

malignant hyperthermia
sepsis
fever/shivering
thyrotoxicosis

21
Q

Decreased CO2 elimination - hypercarbia

A

reduced minute ventilation
increased dead space
drug effects

22
Q

Timing of hypercarbia

A

Start of case -> ETT placement, vent settings, oversedation
Post-induction -> malignant hyperthermia, vent settings, thyrotoxicosis, CO2 absorber
During Emergence -> inadequate reversal, residual narcotics, hypoglycemia, electrolyte disturbances

23
Q

Hypocarbia

A

decreased CO2 levels (ABG, ETCO2)
check circuit, check BP, HR, SpO2
check vent settings
Tx underlying cause

24
Q

Causes - hypocarbia

A

Hyperventilation - decreased metabolic rate

PE, Air embolus, cardiac arrest, ETT problems

25
Q

High peak airway pressures

A

circuit probelms, ETT problem, drug induced, decreased pulmonary compliance
Tx: check tubes, hand ventilate, FiO2 of 100%, auscultate, suction, consider paralysis

26
Q

Oliguria

A

urine production

27
Q

DDx for oliguria

A

Prerenal - intravascular fluid depletion
Renal - lack of perfusion, renal damage
Postrenal - obstruction

28
Q

MI

A

damage to heart muscle from imbalance of myocardial O2 supply and demand
- atherosclerosis, aneurysm, artery spasm, aortic stenosis, blood viscosity, embolus

29
Q

Investigations for MI

A 
Lead II - most sensitive for arrhythmia
Lead V5 - most sensitive for ischemia detection
- together, detect 90% of events
ST-depression -> subendocardial
ST-elevation -> transmural
T-wave inversion and Q-waves
check TEE and cardiac enzymes
30
Q

Tx for MI intraop

A

Goal: maintain acceptable balance of O2 supply and demand

  • maintain BP and 100% FiO2
  • confirm placement of leads
  • notify surgeon
  • consider reducing anesthetic, beta-blockers
  • consider fluid therapy, anticoagulation, inotropic agents to support contractility
31
Q

Bradycardia

A

heart rate anticholinergics
unstable -> FiO2 of 100%, abort anesthetic, CPR or pacing
Tx: underlying cause

32
Q

DDx of Bradycardia

A 
altered pulse formation (vagal tone)
drugs (beta-blockers, Ca-blockers, cholinergics, narcotics)
pathology (thyroid, sick sinus syndrome)
MI
surgical/anesthesia stimuli
reflex bradycardia
33
Q

Tachycardia

A 
heart rate > 100 bpm
ensure adequate oxygenation and ventilation
verify ECG placements
assess BP or artline
volume status, depth of anesthesia
Tx: underlying cause
34
Q

Tachycardia and hypertension

A 
pain/light anesthesia
hypovolemia, hypercapnia, hypoxia
Drugs
Electrolyte abnormalities
MI
Endorcrine abnormalities
Bladder distention
35
Q

Tachycardia and hypotension

A

anemia, CHF, valvular heart disease
PTX, immune stuff
MI, sepsis, PE

36
Q

Delayed Emergence

A 
check for residual neuromuscular blockade
check for hypoxia or hypercarbia
check glucose/electrolytes
consider narcotic reversal (naloxone)
consider benzo reversal (flumazenil)
check body temp and neuro status
37
Q

DDx for delayed emergence

A 
residual drug effects
Neuro complications
metabolic complications
Respiratory failure
CV collapse
hypothermia
sepsis

Anesthesia (20 decks)

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