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2025 Anesthesia > Exam 1: Lecture 4: Breathing system, Scavenging, and intubation supplies > Flashcards

Exam 1: Lecture 4: Breathing system, Scavenging, and intubation supplies Flashcards

1
Q
A
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2
Q

Where are common areas to find a leak in the breathing system

A
  • Neck of the reservoir bag
  • breathing circuits hoses
  • Any hose connection
  • Inlet/outlet to vaporizer
  • One-way valve
  • CO2 absorbing canister
  • Flow meter
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3
Q

What should you always do before you use a breathing system

A

Pressure check (leak test)

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4
Q

What is the purpose of breathing systems

A
  • deliver O2 +/- anestheic gases
  • eliminate CO2
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5
Q

What are the two types of breathing systems

A

rebreathing and non-rebreathing

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6
Q

What type of breathing system is this?

A

Rebreathing system
AKA: circle system

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7
Q

What are the components of a rebreathing system

A

fresh gas source
unidirectional valves
breathing hoses
breathing system pressure gauge
CO2 absorber
APL valve
resivor valve

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8
Q

Define in simple terms how a rebreathing system works

A

gases flow in one-way circulation - into a patient via inspiratory hose - out of the patient through the expiratory hose

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9
Q

What are two advantages of using a rebreathing system

A
  • can use lower O2 flow rates
  • Easy to set up and use
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10
Q

What are two disadvantages of using a rebreathing system

A
  • increased resistance for smaller patients
  • more components to work with
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11
Q

What type of rebreathing system is defined?

  • 4 - 11 mL/kg/min
  • oxygen flow approximates patient oxygen consumption, which varies with metabolic rate
A

closed circle system

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12
Q

What type of rebreathing system is defined?

  • 10 - 22 mL/kg/min
  • Oxygen flow rate is greater than the patients oxygen consumption
A

Low flow circle system

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13
Q

What type of rebreathing system is defined?

  • 22-44 mL/kg/min
  • Fresh gas inflow exceeds the uptake of oxygen by patient
A

semi closed circle system

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14
Q

What type of rebreathing system is defined?

Advantages
- more economical
- retain more heat and humidity
- less likely to cause OR pollution
Disadvantages
- Vaporizer accuracy compromised
- N2O can not be used
- CO2 absorption completely dependent on chemical absorbant

A

Closed circle system

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15
Q

What type of rebreathing system is defined?

Advantages
- economical
- some heat and humidity retained
- reduced waste gas
Disadvantages
- inadequate delivery of anesthetic from a modern vaporizer

A

low-flow circle system

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16
Q

What type of rebreathing system is defined?

Advantages
- N2 accumulation insignificant
- N2O used safely
- rapid changes in inspired anesthetic concentration
- CO2 partially eliminated via pop-off valve
Disadvantages
- less economical
- more heat and humidity lost

A

semi-closed circle system

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17
Q

Calculate the maintenance oxygen flow rate for a 25 kg dog for a rebreathing system

A

25 kg x 22 ml/kg/min = 550 ml/min

set O2 flow meter to 600 ml/min or 0.6 L/min

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18
Q

calculate the oxygen flow rate for a 10 kg dog immediately after induction of anesthesia

A

10 kg x 44 ml/kg/min = 440 ml/min

The O2 flow meter should not be set below 0.5 L/min so even though you calculated 440 ml/min you would set it at 500 ml/min

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19
Q

What value should the breathing system pressure gauge be set at unless you are giving manual or mechanical ventilation

A

0

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20
Q

What value should the breathing system pressure gauge be set at when performing a leak test on the machine

A

0

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21
Q

What is the purpose of a CO2 absorption canister?

A

chemical reaction that removes CO2 from the rebreathing system

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22
Q

What happens to the patient if the CO2 absorption canister is out/exhausted

A

CO2 will accumulate in the circuit = rebreathing of CO2 = respiratory acidosis

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23
Q

What is this?

A

CO2 absorption cansiter

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24
Q

What are the components of a non-rebreathing system

A

fresh gas source
expiratory limb or coaxial breathing hose
open / close valve
reservoir bag

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25
Q

What is the typical flow rate of a non-rebreathing system

A

200 - 300 ml/kg/min

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26
Q

Which patients should use a non-rebreathing system

A

less than 3 kg = always use

3 to 7 kg = grey zone (anesthetist dependent)

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27
Q

What are three advantages of using a non-rebreathing system

A
  • less resistance for a breathing patient
  • little to no dead space
  • fewer components that can leak or malfunction
28
Q

What is a disadvantage of using a non-rebreathing system

A
  • higher O2 flow rates required to get rid of CO2
  • pollution to the environment and can contribute to hypothermia
29
Q

What non-rebreathing systems are most commonly used in vet med

A

Mapleson D
- bain circuit: modified mapleson D

Mapleson F
- modified Jackson trees circuit

30
Q

Why is waste air gas (WAG) so important?

A

sickness, pregnancy, and environmental

31
Q

What pressure does the National institute for Occupational Safety and Health published recommendation that exposure to halogenated anesthetics be kept below?

A

2 ppm

32
Q

What are some ways you can prevent exposure to WAG (6)

A
  • engage scavenging system
  • leak test
  • used cuffed and correct-size endotracheal tubes
  • Use low flow circle system is possible
  • avoid mask and chamber induction
  • disconnect patient before turning them
  • machine maintenance
  • Adequate ventilation of areas where anesthesia exposure occurs
33
Q

Give an example of tips that can be used when filling or emptying vaporizers

A
  • ideally, wear a charcoal mask
  • announce what you are doing so others can leave if they desire/need to
  • Select a time late in the day to avoid unnecessary exposure
  • replace cap on bottle when doing filling the anesthesia
  • switch to key fill vaporizers if possible
  • always turn vaporizer dial off before filling
34
Q

What are the two types of scavenging systems

A

passive and active

35
Q

Describe passing scavenging systems

A

charcoal absorption to outside wall or window

36
Q

Describe active scavenging systems

A

central vacuum collection

37
Q

What type of gasses to charcoal absorb and not absorb

A

absorb
- halogenated anesthetic gases
- sevo , des, iso

non-absorbable
- CO2
- N2O

38
Q

What are the advantages to charcoal absorption

A

mobile
initial cost is low
easy to set up

39
Q

What are some disadvantages to charcoal absorption

A
  • must be replaced after gaining 50 grams in weight
  • use limited to lower oxygen flow rates
  • adds resistance
  • environmental impact
40
Q

What type of interface protects the breathing circuit and patient from excessive positive or negative pressures

A

active scavenging

41
Q

Where is the active scavenging located on the machine

A

between the pop-off valve and disposal system

42
Q

Clinical Case:

You are approached by a co-worker who is concerned about exposure to anesthetic waste gas because they reveal they are pregnant. What advice could you offer this person?

A

Tell them they need to meet with their primary care provider

  • Once that is done you can talk about ways to prevent exposure in the future
43
Q

How can you determine what size endotracheal tube is needed for a patient and what are the boundaries

A
  • you want to use the largest size of ETT that will fit without causing trauma to the trachea
  • palpate the trachea to estimate size needed. Length should not extend distally beyond the thoracic inlet or rostrally beyond incisors
44
Q

What are some types of ETT and what might they be made out of?

A

types
- murphy (most common)
- magill
- cole
- guarded

material
- PVC
- silicone
- rubber

45
Q

Define dead space related to ETT

A

Portions of the breathing passage that contains air, but there is no gas exchange

46
Q

Give examples of dead space

A
  • mouth
  • nasal passage
  • pharynx
  • trachea
  • end of ET tube / Y piece
47
Q

What type of endotracheal tube is described below?

  • an oval hole positioned on the bevel facing the opening of the tube
  • if the distal end of the tube becomes occluded, there is still airflow
  • Magill tube is the same design, except no “eye”
A

Murphy type

  • they have the Murphys eye that still allows for breathing
48
Q

What type of ETT is this?

  • this has an “eye”
A

Murphys type

49
Q

What type of ETT tube is this?

  • this does not have an “eye”
A

Magill tube

50
Q

What type of endotracheal tube is described below?

  • uncuffed
  • characterized by a shoulder
  • designed to create a seal by using a smaller end to fit in the arytenoid cartilages
  • smaller portion goes in the trachea
A

Cole tube

51
Q

What type of ETT tube is this?

A

Cole tubes

52
Q

What type of endotracheal tube is described below?

  • much larger, usually available in 16-30 mm
A

large animal ETT

53
Q

What type of endotracheal tube is described below?

  • made of silicone rubber
  • have steel wire or nylon coil embedded in the wall
  • resists kinking (good for optho cases of CSF taps
  • more expensive
A

guarded or armored tubes

54
Q

What type of tube is this?

A

guarded or armored tubes

55
Q

What is a laryngeal scope used for

A
  • allows for visualization
  • light source
  • easier to accessibility to airway
56
Q

How do you place a laryngoscope for best visibility?

A
  • apply light pressure to base of tongue
    (underneath the epiglottis)
  • tilts larynx ventrally and opens glottis (frees up the epiglottis if still tucked underneath soft palate)
57
Q

What are the steps for intubation?

A
58
Q

What are some methods used to confirm ETT placement

A
59
Q

Describe the cuff inflation technique
- aka: minimal occlusion volume technique

A
  • can utilize an esophageal stethescope to accomplish the desired effect
  • there should be no escape of gas from around the endotraheal tube when delivering a positive pressure ventilation and the bag is squeezed
60
Q

How much air should be able to escape around the tube, if not some air should be removed from pilot ballon to prevent over-inflation of the cuff ?

A

20 to 30 cm

around 22 cm H2O air

61
Q

What is this device?

A

cuff pressure manometer

62
Q

What is this device?

A

Supraglottic airway device

63
Q

What is this device?

A

Ambu bag

64
Q

What is this device?

  • used in LA medicine
A

demand valve

65
Q

NAVLE Questions:

What might happen if you push the oxygen flush button on an anesthetic machine?
- flow rate increases
- the patient may start to wake up
- oxygen is flushed out of the system
- the patient will go to a deeper anesthetic plane
- anesthetic gas concentration goes up in the breathing machine

A

Flow rate increases

66
Q

What fresh gas flow rate is typical of a non-breathing anesthetic machine?

50 - 150 ml/kg/min
200 - 300 ml/kg/min
30 - 50 ml/kg/min
150 - 200 ml/kg/min

A

200 - 300 ml/kg/min

2025 Anesthesia (6 decks)

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