day 4 - Anaesthesia in the 21rst century

Question 1

Aims of Pre-assessment

Answer 1

Screen for unknown conditions
Assess and optimise known medical problems
Assess risk
Anticipate complications
Reduce risks of anaesthetic and surgery to a minimum

Question 2

Mallampati score

Answer 2

In anesthesia, the Mallampati score, also Mallampati classification, is used to predict the ease of intubation.[1] A high Mallampati score (class 3 or 4) is associated with more difficult intubation as well as a higher incidence of sleep apnea.[2] In many ways it assesses the height of the mouth; the distance from the tongue base to the roof of the mouth, and therefore the amount of space in which there is to work. It is an indirect way of assessing how difficult an intubation will be; this is more formally scored using the Cormack-Lehane classification system, which describes what you actually see on direct laryngoscopy.

The Mallampati score is assessed by asking the patient (in a sitting posture) to open his/her mouth and protrude the tongue as much as possible.[1] The anatomy of the oral cavity is visualized; specifically, whether the base of the uvula, faucial pillars (the arches in front of and behind the tonsils) and soft palate are visible. Scoring may be done with or without phonation. Depending on whether the tongue is maximally protruded and/or the patient asked to phonate, the scoring may vary.

Modified Mallampati Scoring:[3]

Class I: Soft palate, uvula, fauces, pillars visible.
Class II: Soft palate, uvula, fauces visible.
Class III: Soft palate, base of uvula visible.
Class IV: Only hard palate visible

Question 3

normal Hb range

Answer 3

Haemoglobin (male) 13.0 – 17.0 g/dL

(female) 11.5 – 15.5 g/dL

Question 4

ASA status

American Society of Anesthesiologists

Answer 4

1. Normal healthy patient
2. Mild to mod. systemic disease. No functional limitation
3. Severe systemic disease with limitation of normal function
4. Severe systemic disease that is a constant threat to life
5. Moribund patient unlikely to survive 24 hours with or without operation

Question 5

Laryngeal Mask Airway

Answer 5

It has an airway tube that connects to an elliptical mask with a cuff. The cuff can either be of the inflating type (achieved after insertion using a syringe of air), or self sealing. Once inserted correctly (and the cuff inflated where relevant) the mask conforms to the anatomy with the bowl of the mask facing the space between the vocal cords. After correct insertion, the tip of the laryngeal mask sits in the throat against the muscular valve that is located at the upper portion of the oesophagus.[2]

A laryngeal mask is composed of a airway tube that connects to an elliptical mask with a cuff which is inserted through the patient’s mouth, down the windpipe, and once deployed forms an airtight seal on top the glottis (unlike tracheal tubes which pass through the glottis) allowing a secure airway to be managed by a health care provider.