General Anesthesia Induction Equipment Flashcards
What are the 3 types of induction?
- Inhalation induction (Mask)
- IV induction
- RSI (give the drugs and put the tube in)
- Modified RSI (When you hold cricoid but you give them breaths) - Combination (masking with nitrous oxide to place IV)
Define General Anesthesia
Anesthesia - meant the condition of having sensation (including the feeling of pain) blocked or temporarily taken away
- Total lack of awareness or lack of awareness of a part of the body such as a spinal anesthetic
What is the main sequence of most GA inductions?
- Monitor application
- Pre-oxygenation
- Induction agents given
- Airway support through masking, LMA, or ETT placement
What is the FRC?
Lung volume at the end of normal exhalation
What is the FRC volume?
2.5 liters
What does pre-oxygenation do?
Increases the apnea threshold by filling the FRC with oxygen
What is the residual volume of the lungs?
1.25-2.0 liters
What volume is the tidal volume?
0.5-0.6 Liters
What volume is the vital capacity?
3.5-5.5 liters
What volume is the total lung capacity?
6 liters
What are the indications for mask induction?
- pediatric patients that are NPO where IV placement may be distressing
- Adult patients that are NPO that are difficult IV placement or unable to cooperate with IV placement
Laryngospasm is mediated by what nerve?
Superior Laryngeal Nerve - in response to irritating glottic or supraglottic stimuli such as presence of food, blood, vomit or airway secretions.
*Occurs most frequently with light anesthesia upon induction or emergence
What is a laryngospasm?
False cords and epiglottic body come together firmly and allow no air flow and no vocal sound
What is the treatment for laryngospasm?
- Forward displacement of the jaw and apply positive pressure with 100% oxygen
- Severe spasm may require small doses of succinylcholine and re-intubation (given intramuscularly or sublingual injection)
* *Laryngospasm will eventually cease as hypercarbia and hypoxia develop
What is Rapid Sequence Induction (RSI)?
- Anesthesia induction sequence that aids in securing airway with an ETT as quickly as possible. There is NO masking after induction agent is given.
- Reduces the time at risk for pulmonary aspiration and development of hypoxemia.
What are the indications for Rapid Sequence Induction (RSI)?
- Full stomach
- Severe GERD
- Anticipated possible difficult mask or intubation
What is Modified RSI?
- Patient is masked with gentle pressure while cricoid pressure is maintained
- May be done if you need extra oxygenation or feel the need to see if the patient has a good mask airway
What is Cricoid Pressure (Sellick Maneuver)?
- Hypothetical basis that pressure on the front of the cricoid cartilage is transmitted to its posterior lamina, which occludes the esophagus by compression against the vertebral bodies
- Used to prevent pulmonary aspiration
Where is the cricoid cartilage located?
- Below the thyroid prominence (adam’s apple)
- Pressure is placed with thumb and index finger on lateral edges of the cricoid cartilage
How long should you hold cricoid pressure?
- DO NOT release cricoid pressure until after confirmation of successfl intubation:
- Visualization of ETT through vocal cords
- Fogging of OET
- ETCO2 present
- Bilateral breath sounds present
What are some disadvantages of cricoid pressure?
- increased risk of regurgitation (reduced tone of lower esophageal sphincter)
- Degrades view of larynx
- Fracture of the cricoid cartilage
- rupture of the esophagus from vomiting
If at any time you are unable to intubate a patient and unable to mask a patient, what is the next step?
- Insert an LMA
What is the end option if you can’t intubate, can’t ventilate scenario?
Surgical airway
What is the “Thyromental distance”?
- It is the “anterior” airway
- Area from the chin to the throat - you want 4 finger breaths
