Induction & Intubation

Question 1

What is the main goal to an anesthetic induction?

Answer 1

Is to have atraumatic intubation of the trachea using a minimum effective dose of anesthetics.

Question 2

Is there a perfect induction technique?

Answer 2

No - dosing and administration are based on each patient.

Question 3

What do endotracheal tubes accomplish?

Answer 3

Creates a patent airway
Allows efficient delivery of oxygen, inhalation anesthetics and medications.
Helps prevent waste gas exposure
Allow for control of ventilation
Prevents aspiration of vomit, blood, saliva
Reduces dead space

Question 4

Endotracheal tube risks

Answer 4

Can stimulate the vagus nerve
Brochi insertion
Cuff over-inflation
Tube obstruction-mucus plugs

Question 5

What are the two different types of tubes

Answer 5

Low volume high pressure tubes

High volume low pressure tubes

Question 6

What is the most common ET name?

Answer 6

Murphy (cuffed, eye at the end)

Question 7

What is a definition of the Cole ET?

Answer 7

No inflatable cuff, shaped with a “shoulder”, shorter than Murphy.

Question 8

How to chose an ET

Answer 8

Length - incisors to thoracic inlet

Diameter - use chart

Question 9

What does the number on the tube reflect?

Answer 9

Inner diameter

Question 10

What does giving “to affect” mean?

Answer 10

Just enough / to desired affect

Question 11

What is the anesthetic affect we are looking for?

Answer 11

Jaw tone

Question 12

How is cuff inflation handled?

Answer 12

Little at a time, wait for push back then stop.

Remember how much so you know to remove.

Question 13

What is the equipment needed for intubation?

Answer 13

Laryngoscope
1-10ml syringe for cuff inflation
lube or water
Rolled gauze
\+/- 2% lidocaine for cats (0.1 ml)

Question 14

A complete chart includes

Answer 14

Surgical release form / estimate of cost
Exam results / patient history
lab results, radiographs
current status of animal and risk factors
DVM pre-surgical orders (i.e., drug requests.

Question 15

What are some pre-surgical supplies needed?

Answer 15

Pre-surgical physical exam form and anesthesia monitoring form
Calculate dose required
Get drugs, needles, syringes, fluids, IV catheter ready
ET intubation supplies
Prepare the Ax machine

Question 16

What is patient position for a 2 person intubation?

Answer 16

lateral and sternal recumbancy

Question 17

What is the patient position for a single person intubation?

Answer 17

Dorsal recumbancy

Question 18

How to confirm a proper intubation?

Answer 18

Patient may cough, but not always.
Should not be able to vocalize
Watch for movement from the reservoir bag & flutter valve.

Question 19

Choices of anesthetic techniques based on a variety of factors. What are these factors?

Answer 19

Facilities
Skill and Experience
Temperment of patient
Species and breed of animal
Age and general health
Site and nature of surgery
Duration of surgery

Question 20

What are the advantages of injectable anesthertics?

Answer 20

rapid onset of drug
ability to titrate dose and control / monitor depth
rapid recovery

Question 21

What are some disadvantages of injectable anesthetics?

Answer 21

Small veins are hard to access without an IV catheter

restraint is critical

Question 22

What are some common drugs for induction?

Answer 22

Ketamine & Diazepam (diazepam drawn first)
Telazol (Tiletamine and Zolazepam)
Propofol

Question 23

What injectable induction agents are not often used anymore

Answer 23

Thiopental - can cause respiratory depression.

Etomidate - Expensive

Question 24

Information regarding Masking and Induction chambers

Answer 24

Allow patient to breathe 100% 02 for 2-3 minutes.
Set anesthetic vaporizer to deliver 0.5%
Induction usually takes 5 - 10 minutes
Be cautious with waste gasses