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PRINCIPLES OF ANESTHESIA EXAM 3 > exam 3 part 3 > Flashcards

exam 3 part 3 Flashcards

breathing systems

1
Q

estimated FiO2 achieved with nasal prongs O2 cannula at various flow rates (1L-4L)

A

1L- 24%
2L- 28%
3L - 32%
4L - 36%

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2
Q

during regional anesthesia or sedation it is common that

A

no breathing system is used, but supplemental O2 often administered

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3
Q

nasal cannula is an example of an ________ system

A

open

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4
Q

estimated FiO2 achieved with simple face mask at various O2 flow rates (5L-9L)

A

5-6L - 40%
6-7L - 50%
7-8L - 60%
8-9L - 70%

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5
Q

minimum flow rate on simple mask to avoid rebreathing

A

5L

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6
Q

need to use a reservior on simple mask to get FiO2 > ______, if flow rates are >____L

A

80%
10L

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7
Q

flow out of CGO is ______ whereas flow in trachea is _____

A

consistent
variable

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8
Q

a breath of 500 ml inhaled over 3 seconds requires a flow rate of _______

A

10L/min for that 3 seconds

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9
Q

functions of the anesthesia breathing circuit (2)

A

1- deliver oxygen and/or anesthetic gases without significant increase in airway resistance
2- eliminate CO2 by wash out with FGF or chemical neutralization

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10
Q

elements of the breathing system

A

fresh gas flow
dead space
rebreathing
reservoir
adjustable pressure limiting valve (APL)

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11
Q

most commonly used breathing circuit type

A

semi-closed

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12
Q

open breathing circuit types and components

A

insufflation
open drop
nasal cannula
(NO RESERVOIR BAG NO UNIDIRECTIONAL VALVES)

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13
Q

open breathing circuit elimination of CO2

A

no rebreathing of gas - no chemical elimination needed

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14
Q

semiopen breathing circuits components

A

Mapleson A, B, C, D
Bain
Mapelson E
Mapelson F (Jackson-Rees)

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15
Q

what semiopen breathing system does NOT have a gas reservoir bag or unidirectional valves

A

Mapleson E

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16
Q

majority of semiopen breathing circuits have ______ unidirectional valve

A

1

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17
Q

semiopen breathing circuits have ______ FGF

A

High

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18
Q

semiopen breathing circuits elimination of CO2

A

high fresh gas flow prevents rebreathing - no chemical elimination needed

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19
Q

semiclosed breathing circuit components

A

Circle system
has reservoir bag, partial rebreathing and 3 unidirectional valves

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20
Q

which breathing system has moderate FGF

A

semiclosed

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21
Q

semiclosed breathing circuit elimination of CO2

A

fresh gas flow exceeds consumption while allowing for rebreathing - needs chemical neutralization of CO2

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22
Q

circle system breathing circuit advantages

A

constant inspired concentrations
conserve respiratory heat and humidity
useful for all ages
low resistance
useful for multiple system types
cost reduction- less agent/O2 used
decreases exposure to OR staff of waste gas
decreased pollution and waste of anesthetic gases

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23
Q

closed breathing circuit components

A

Circle system
has gas reservoir bag, total rebreathing, 3 unidirectional valves

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24
Q

which breathing system requires a low FGF

A

closed

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25
Q

closed breathing circuit elimination of CO2

A

indicated gas inflow equals amount consumed by the patient, rebreathing is 100% - so chemical neutralization of CO2 is needed

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26
Q

closed breathing circuit advantages

A

less waste/pollution, heats and humidifies inhaled gas

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27
Q

closed breathing circuit disadvantages

A

difficult to rapidly changes anesthetic concentration, risk of hypoxic concentrations especially if N2O is used
requires careful monitoring of O2, CO and anesthetic agent

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28
Q

mapleson circuits, work of breathing is _____ in all wit no __________ or _________ to create resistance

A

low
unidirectional valves
soda lime granules

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29
Q

there is no separation of inspired and expired gas with _________

A

mapleson circuits

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30
Q

if inspiratory flow exceeds FGF _______ occurs

A

rebreathing

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31
Q

less rebreathing will occur if FGF is _______, tidal volume is _____, and the duration of the expiratory pause is _____

A

high
low
long

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32
Q

with mapleson circuits inspiratory flow can reach

A

60L/min or 1L/sec

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33
Q

FGF 2-3X ____ is recommended

A

minute ventilation

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34
Q

Mapleson A spontaneous respiration process

A
  1. Inhalation:
    When the patient inhales, fresh gas flows from the reservoir bag through the tubing towards the patient, as the expiratory valve remains closed.
  2. Exhalation:
    During exhalation, the expired gas travels through the tubing and fills the reservoir bag, causing pressure to build up and open the expiratory valve, venting the expired gas to the atmosphere
    (dead space can be a concern with increasing tubing length)
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35
Q

Mapleson D spontaneous respiration process

A

Inspiration: The patient inhales fresh gas from the reservoir bag and the machine.

Expiration: The patient exhales, and the expired gas collects in the reservoir bag and tubing.

APL valve: The APL valve is fully open, allowing the expired gas to exit the system

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36
Q

Mapleson A vs Mapleson D which is better for spontaneous respiration

A

Mapleson A:

Most efficient for spontaneous breathing.

Requires a fresh gas flow close to the patient’s minute ventilation to prevent rebreathing.

Considered the “ideal” circuit for spontaneous ventilation.

Mapleson D:

Less efficient for spontaneous breathing.

Expired gas can accumulate in the tubing and reservoir bag before enough pressure builds to open the APL valve during spontaneous breaths.

Best suited for controlled ventilation where fresh gas flow can effectively push expired gas away from the patient

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37
Q

during controlled ventilation you have to close the ___________ so inspiration pressure can be generated

A

APL valve

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38
Q

the APL valve is open during ________

A

spontaneous respiration

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39
Q

which mapleson circuits are poor for controlled ventilation due to placement of APL valve

A

A B C

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40
Q

which mapleson circuits use a T piece at the patient connections

A

D E F

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41
Q

which circuits are modified mapleson D circuits

A

F (jackson-rees) and Bain

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42
Q

this mapleson circuit is good for

spontaneous respiration in pediatric patients due to reduced resistance

A

MAGILL - mapleson A

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43
Q

For Mapleson A- Magill circuit, FGF is recommended to be at _______ or ________ to avoid rebreathing, or FGF of _________ of minute volume only for spontaneous respiration

A

5L/min or 85ml/kg/min
42%-88%

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44
Q

during controlled ventilation, rebreathing occurs due to the placement of the

A

FGF inlet and APL valve

45
Q

for the Bain circuit the FGF needs to be at ____________ or _________.

A

100-300ml/kg/min
1.5-3x minute volume

46
Q

what makes the Bain circuit a modified mapleson D

A

the FGF tube runs through the corrugated expiratory limb
whereas the FGF and the expired gas mixes in the regular mapleson D

47
Q

Bain circuit FGF tube can kink or disconnect, how do you test for this

A

The Pethick Test

48
Q

4 steps of the Pethick Test

A

1- occlude the patient’s end of the circuit
2- close the APL valve
3- fill the circuit, using the oxygen flush valve
4- release the occlusion at the elbow and flush

49
Q

result of pethick test if there is NO leak

A

the reservoir bag would fill while occluding and then flatten without you occluding it

50
Q

name this mapleson circuit:
- used for spontaneous breathing
- lack of scavenging
- can occlude tubing to deliver positive pressure but difficult to control
- no bag expiratory limb is the only reservoir

A

mapleson E

51
Q

circuit used for low resistance for pediatric patients

A

mapleson F - Jackson-Rees (FGF requirements same as Bain)

52
Q

the circle system can be 3 different types of breathing system

A

1 - semiclosed: some rebreathing
2 - closed total: rebreathing
3- semiopen: no rebreathing with high FGF

53
Q

circle systems remove _____ from exhalations chemically which allows for _____ of all other exhaled gases

A

carbon dioxide
rebreathing

54
Q

Poiseuille’s law for resistance

A

resistance of a fluid to flow is equal to (8ln/pi X r^{4}), where:
n: The viscosity of the fluid
l: The length of the tube
r^4: The radius of the tube

55
Q

Airway resistance

A

The resistance to laminar air flow is directly proportional to the length of the airway and inversely proportional to the fourth power of the airway radius

56
Q

unnecessary valves and sharp bends cause _______ flow

A

turbulent

57
Q

deadspace ends where

A

inspiratory and expiratory gas streams converge

58
Q

Dead space in the anesthetic system can include:

A

The mask

The portion of the endotracheal tube that extends outside the patient’s mouth

The elbow on the endotracheal tube that connects it to the ventilation bag

Any connectors between the end of the tube and the breathing circuit, such as CO2 adapters or apnea alarm adapters

The Y piece at the end of a circuit

59
Q

Anatomical dead space

A

The volume of air in the conducting zone of the respiratory system, which includes the nose, trachea, and bronchi. This volume is about 30% of the normal tidal volume, or 150 mL

60
Q

Alveolar dead space

A

The volume of air in the alveoli that is ventilated but not perfused with blood. In a healthy adult, alveolar dead space is negligible

61
Q

Physiologic dead space

A

The sum of anatomical and alveolar dead space. In healthy people, anatomic and physiologic dead space are roughly equal. However, in people with lung disease or heart failure, physiologic dead space is much larger than anatomic dead space

62
Q

increasing deadspace = _______ rebreathing of CO2
how to combat this ______

A

increases
increase minute ventilation

63
Q

minute ventilation

A

the amount of air that moves into or out of the lungs in one minute. It’s calculated by multiplying the tidal volume (the amount of air inhaled in a single breath) by the breathing rate.

64
Q

increased dead space = __________ compliance

A

decreased

65
Q

dead space will increase with any

A

breathing system

66
Q

length of circuit _______ _______ circuit compliance

A

DOES AFFECT

67
Q

circle system components

A

FG inlet
unidirectional valves
inspiratory and expiratory limb
Y connector or elbow
APL valve
Reservoir
CO2 absorbent

68
Q

_____ size is important in the process of CO2 neutralization

A

granule

69
Q

chemical makeup of soda lime
how is CO2 neutralized

A

Ca(OH)2
H2O
NaOH
3 step rxn
neutralization occurs in 1st and 3rd step with carbonic acid and CaCO3 respectively

70
Q

soda lime mesh size

A

4-8

71
Q

soda lime activator

A

NaOH

72
Q

chemical makeup of Amsorb
how is CO2 neutralized

A

Ca(OH)2
CaCl2
H2O

73
Q

amsorb mesh size

A

4-8

74
Q

chemical makeup of litholyme
how is CO2 neutralized

A

Ca(OH)2
LiCl

75
Q

litholyme mesh size

A

4-10

76
Q

chemical makeup of lithium hydroxide
how is CO2 neutralized

A

(LiOH) neutralizes carbon dioxide (CO2) by reacting with it to form lithium carbonate (Li2CO3) and water (H2O)

77
Q

advantages of amsorb

A

removal of strong alkali significantly reduces degradation of inhalation agents so much less compound A and CO

78
Q

advantages of litholyme

A

efficient CO2 absorption capabilities, longer lifespan compared to other absorbents, no production of harmful compounds like Compound A, lack of strong bases like NaOH and KOH, and a visible color change indicating when it needs to be replaced, generates less heat

79
Q

advantages of lithium hydroxide

A

high absorption capacity, relatively low reactivity with other gases, a high reaction rate with CO2, and potential for regeneration

80
Q

disadvantages of amsorb

A

trace color indicator will turn purple but still need to pay attention to inspired CO2 make sure it is still going back down to 0

81
Q

soda lime will turn purple during case but after case ____

A

even though it is exhausted it will change back to white

82
Q

disadvantages of litholyme

A

only thing is that it costs about $5/bag more than sodalime.

83
Q

disadvantages of lithium hydroxide

A

can severely irritate and burn the skin and eyes, and can cause eye damage. Inhaling lithium hydroxide can irritate the nose, throat, and lungs, and can lead to coughing, shortness of breath, and pulmonary edema

Fire hazards

Environmental impacts

84
Q

what causes the color change of exhausted CO2 absorbent

A

carbonic acid accumulates causes more acidic pH

85
Q

which CO2 absorbents turn purple and stay purple

A

amsorb plus and litholyme

86
Q

hazards of granules

A

dust- so open APL valve to release pressure at completion of high pressure check
channeling - so shake the canister before removing plastic
packing - this is why it is important to have different size granules

87
Q

soda lime can absorb up to _____- of CO2 per 100g of absorbent

A

23-23L

88
Q

amsorb has a _____ capacity compared to sodalime

A

lower

89
Q

you don’t change absorb based on color you change it based on _____ not returning to _______

A

EtCO2
Baseline

90
Q

degradation of Des, Iso and Enflurane by dry soda lime produces _____ and sevo produces _____

A

CO
compound A

91
Q

what will dry out sodalime canisters

A

1-2days of 10L/min FGF

92
Q

how to prevent CO (5 things)

A

1- turn oxygen off at end of case
2- change sodalime regularly
3- change if FGF left on over the weekend or overnight
4- use low flows to keep granules moist
5 - just don’t use soda lime

93
Q

what absorbent has the highest capacity for CO2 neutralization

A

lithium hydroxide

94
Q

factors that increase compound A with sodalime

A

high sevo concentrations
high temperatures
low moisture
low FGF rates

95
Q

scavenging happens when

A

FGF is greater than the amount of gas taken up by the lung

96
Q

what happens when FGF is greater than the amount of gas taken up by the lung but there is no scavenging

A

positive pressure builds up in the circuit

97
Q

in the manual ventilation mode the gas is vented through the

A

APL valve

98
Q

in the mechanical ventilation mode the gas is vented through the

A

ventilator pressure relief valve

99
Q

how is excess gas removed from the OR to prevent exposure and pollution

A

scavenging system connected to suction

100
Q

the apparatus of the scavenging bag includes two types of valves, what are they

A

positive pressure relief valve and negative pressure relief valve

101
Q

scavenging system negative pressure relief

A

suction exceeds inflow of gas into scavenging system, so negative pressure relief valve opens to allow room air to enter and be suctioned

102
Q

scavenging system positive pressure relief

A

if suction does NOT remove all the inflow gas into system, this valve opens at 10 cm H2O pressure and vents gas to room

103
Q

potential sources of anesthetic agent leaks into the OR and PACU

A

leaks at connections within the anesthesia machine
faulty breathing circuit components like tubing or valves
poorly fitted masks or endotracheal tube cuffs
improper patient positioning, damaged equipment
inadequate ventilation
malfunctioning gas scavenging systems
improper handling of anesthetic gas cylinders
poor practices like leaving gas flow control valves open after use or not properly purging the system at the end of a procedure

104
Q

recommended techniques to minimize the level of anesthetic agents in the clinical environment

A

Ventilation and scavenging systems: Use a well-designed ventilation system to reduce waste anesthetic gas concentrations. A scavenging system can capture excess anesthetic gases and deliver them to a gas disposal assembly.

Monitor waste gases: Regularly monitor airborne concentrations of waste gases to ensure they remain below recommended limits (insufficient evidence to support needing to do this)

Use low-flow anesthesia: Use low-flow anesthesia (e.g., <1 l. min‐1) in oxygen/air mixtures.

Avoid desflurane and N2O if possible

Use total intravenous anesthesia (TIVA)

Encourage environmental sustainability

105
Q

components of waste gas

A

nitrous oxide and halogenated anesthetic agents like isoflurane, sevoflurane, desflurane, and enflurane, which are released into the environment during an anesthetic procedure

106
Q

OR ventilation is effective at minimizing agents levels because air is exchanged ____ per hour

A

15 times

107
Q

OSHA numbers for nitrous and volatiles

A

N2O - <25ppm
volatiles - <2ppm

108
Q

bacterial filters added into expiratory limb of circuit to prevent …

A

microorganism retention in the circle system leading to respiratory infections form patient to patient

PRINCIPLES OF ANESTHESIA EXAM 3 (3 decks)

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