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Anesthesia > Inhalation and airway management > Flashcards

Inhalation and airway management Flashcards

1
Q

Advantages to endotracheal intubation

A

-airway remains protected with seal
-good seal provides more stable anesthesia
-can ventilate lungs
-minimal workspace pollution

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2
Q

Disadvantages to endotracheal intubation

A

-technical failures
-can become obstructed if not clean or very small diameter airway (birds)
-laryngeal trauma
-mucosal irritation or pressure necrosis

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3
Q

Principles of intubation

A
  1. Surgical plane- removes laryngeal reflexes
    -Risk of aspiration is high during this period
    -intubation at light depths promote regurgitation (ruminants, dogs, cats)
  2. Secure tubes in place

3.Use gentle technique

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4
Q

Methods that can be used to check placement

A

-Water vapor in tube
-Air flow (test with hair)
-Palapte neck
-Auscultate both sides of the thorax with IPPV
-Capnogram

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5
Q

Cuffed Endotracheal Tube

A

-Used in almost all patients to ensure good seal is obtained. Not used in birds because they have complete tracheal rings

-Bevel allows tube to slip between vocal cords
-Size- Want diameter to be very close to trachea size. Size indicated is inside diameter
-Murphy Eye- safety measure to ensure airflow even if occlusion occurs. Careful not to occlude murphy eye

**lube of tube used to increase seal of cuff

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6
Q

Tube types and apparatus

A

-cuffed and non-cuffed tubes
-red rubber (prone to kinking so not used often) and clear tubes
-high volume/low pressure cuff or opposite
-select largest diameter and correct length

**always check tubes are serviceable before use

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7
Q

Correct placement of tube

A

Choose correct diameter and length prior to anesthesia
-can use laryngeal scopes
-Palpate trachea to select between 3 possible diameters
-Pre-measure fro thoracic inlet to the incisors
-ET tube appropriate length

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8
Q

Where to tie kling with tube?

A

-Right around the connector, however tube could slip off and be swallowed if disconnected.
VS
-Directly onto tube- Tying on tube can cause some obstruction.

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9
Q

Problems with endotracheal tubes

A

-kinked tubes with neck flexion
-damaged tubes
-endobronchial intubation
-tracheal damage

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10
Q

Steps to inflate cuff

A

**inflate as soon as you can
1.Ventilate lungs (10-15 cm H2O) with O2
2. Listen for leaks around cuff
3. Inflate cuff until you cannot hear a leak with IPPV
4. Turn on anesthetic vapourizer

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11
Q

Deflate cuff

A

**prior to extubation
-Swallow in a dog
-Ear flick/palpebral reflex in a cat
-Wait to see muscle tone for brachycephalics

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12
Q

V-gels: Supraglottic airway device

A

-Designed for rabbits and cats; have to be sized correctly for each individual
-Need special lube

*Problems with poor fitting and potential for obstruction if moving the animal. Need a capnogram

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13
Q

Pollution of workplace

A

-Avoid chronic exposure to trace amounts of anesthetic gases
-Intubate patient when possible
-Check for leaks before every anesthetic

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14
Q

Anesthetic agent uptake

A
  1. Depth of anesthesia is related to the partial pressure of the inhalant within the brain
    -control partial pressure of agent with the vapourizer
    -Changes the alveolar and blood partial pressures
  2. Rapid induction/recovery
    -Less lipophilic=high MAC (less potent)
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15
Q

Order of anesthetic inhalants??

A
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16
Q

Factors affecting minimal alveolar concentration

A

-Sedation and powerful opioid analgesics lower the amount of anesthetic required (especially in dogs)
-Body temp (hypothermia causes CNS depression)
-Species variation
-Age (older animals require less anesthetic)

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17
Q

Factors affecting anesthetic uptake

A
  1. delivered concentration
  2. blood solubility of agent
  3. lipid solubility of agent
  4. lung ventilation
  5. Cardiac output
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18
Q

Delivered concentration affecting anesthetic uptake

A

-set vapourizer high=faster uptake
-promotes movement of drug from breathing system to lungs

19
Q

Blood solubility of agents affect on anesthetic uptake

A

-Have larger blood compartment
-slower onset- takes longer to reach equilibrium

20
Q

Lipid solubility of agents affect on anesthetic uptake

A

-Fat soluble agents have slower uptake
-Will go to fatty tissues

21
Q

Lung ventilation affects on anesthetic uptake

A

-more alveolar ventilation enables more drug to enter and leave

22
Q

Cardiac outputs affect on anesthetic uptake

A

The higher the CO= the slower the uptake
-hard to mask down excited patients
-sick animals with hypovolemia require less anesthetic

23
Q

Setting the vapourizer dial

A

Ask whether you are inducing or maintaining anesthesia? Assess depth of anesthesia
-know MAC values, whether anesthetic sparing

1.Rebreathing systems
-dilute fresh gas input because of low oxygen flows and recycled exhaled gases

  1. Non-breathing systems
    -what you dial up is what they get
24
Q

Assessing depth of anesthesia

A

-Eye- will roll ventral medial
-Muscle tone
-Palpebral

25
Q

Measuring anesthetic agents

A

-Rely on experience and vapourizer settings
-assess depth of anesthesia
>only give volatile agent that animal needs, no more
>alveolar exhaled % most accurate measurement
-monitors can measure gas composition (expensive)

26
Q

Isoflurane

A

Colour= Purple
-rapid induction and recovery
-good muscle relaxation
-questionable analgesia
-0.2% metabolized by liver
-most commonly used; many species

27
Q

MAC Isoflurane

A

Dog= 1.28

Horse=1.31

Cat=1.71

28
Q

Isoflurane Cardiopulmonary effects

A

-Dose dependent cardiopulmonary depression
-most respiratory depressant of all inhalational drugs
-little effect on ANS
-direct relaxation of smooth muscle in blood vessels (interference with calcium)
-vasodilation more pronounced compared to myocardial depression (hypotension likely to occur)
-little myocardial sensitization to catecholamines
-stable HR

29
Q

Acepromazine with isoflurane

A

-tends to produce more hypotension (both vasodilate blood vessels)

30
Q

Clinical use of isoflurane

A

Induce with 2-4%

Maintain with 1-2% (but actual value will depend on other anesthetis sparing drugs used)

May need to ventilate lungs because of respiratory depression

31
Q

Sevoflurane

A

Colour= Yellow
-rapid induction and recovery
-not as irritating to airways/mucous membranes as isoflurane
-Metabolism produces few FI- ions
-used in many species; exotics
-expensive (3x more than isoflurane)
-minimal advantages compared to isoflurane

32
Q

MAC of sevoflurane

A

Dogs= 2.4%

33
Q

Sevoflurane and CO2 absorber form

A

Compound A and carbon monoxide
-Will result in these toxic byproducts accumulating in rebreathing systems with low O2 flow

34
Q

Sevoflurane cardiopulmonary effects

A

-comparable to isoflurane
-dose dependent cardiopulmonary depression
-vasodilation is greater than myocardial depression (hypotension likely)
-hepatic blood flow preserved
-minimal respiratory depression (animals breath well spontaneously)

35
Q

Sevoflurane clinical use

A

Induce with 3-7%
-usually well tolerated, sweet smell

Maintain with 2-4%
-actual values depend on anesthetic sparing drugs

36
Q

Sevoflurane metabolism

A

Rapid elimination from lungs reduces amount available for metabolism

37
Q

Sevoflurane metabolism into Fluoride ions?

A

Fluoride can be nephrotoxic in high amounts
-Enzyme (P450-2E1) used for sevoflurane FI- metabolism BUT not enough is present in the kidney to cause nephrotoxicity

**Sevoflurane is NOT associated with clinical renal problems

38
Q

CO2 absorbers and sevoflurane degradation

A

CO2 absorbers contain hydroxide bases to remove CO2
-Mono-valent hydroxides (Na, K) cause more breakdown of inhalant compared to di-valent hydroxides (Ca)

**Special di-valent CO2 absorbers is used for sevoflurane

39
Q

Soda lime absorber

A

Has Na-OH and some K-OH (mono-valent)

40
Q

Barium hydroxide lime

A

Has K-OH

-produces high operating temperatures and more sevoflurane breakdown

41
Q

CO2 absorbers and heat

A

**Exothermic Rxn

-CO2 absorber canister temperatures normally are 25-45 degrees BUT high temperatures (80degrees) can occur if you use very low O2 flow and very dry absorber

42
Q

Sevoflurane and FIRE

A

Sevoflurane creates the most heat and can cause canister fires

Ev. 2.4% sevoflurane and very dry absorber= 300 degrees C

**ensure fresh absorber… will crumble when pinched

43
Q

Partial intravenous technique (PIVA)

A

IH drugs have little anesthesia and can depress the cardiovascular system (dose dependent).
-Use other drugs as infusion or bolus to help reduce IH concentration needed
-Anesthetic sparing effect

**useful for debilitated animals or animals undergoing invasive procedures

Anesthesia (24 decks)

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