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001 Respiratory Therapy > Intraoperative Consideration > Flashcards

Intraoperative Consideration Flashcards

1
Q

Hypoxemia

A

Complication that can result from all other respiratory complications

Can easily be assessed through pulse oximetry and/or ABG

When there is inadequate oxygenation for the heart it will increase the workload of the heart and result in an increase in both blood pressure and heart rate

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2
Q

Coughing

A

Adequate anesthesia should be used to prevent coughing

When you are removing the ability for the patient to cough you are also removing their ability to clear secretions, meaning that we need to suction in order to reduce the chance of aspiration

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3
Q

Breath Holding

A

Usually noted during inhalation induction only

Tends to be temporary and will disappear as anesthesia deepens

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4
Q

Airway Obstruction

A

Common in unconscious patient whose head/neck allows for the tongue to fall backwards

Neck flexion/jaw thrust will help to alleviate this

Oropharyngeal and endotracheal airways will prevent this

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5
Q

What type of ETT can be used in order to help prevent the kinking of the ETT

A

Armored ET tubes or careful visualization of prone pts will preclude kinking of ET tubes.

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6
Q

Laryngospasm

A

Can only occur in a spontaneously breathing non-intubated patient

The vocal cords will shut resulting in stridor, obstruction, and low or absent flow rates

If the laryngospasm is only for a short period of time then you can just wait it out, if the laryngospasm is lasting longer then you can use Lidocaine in order to help the vocal cords relax

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7
Q

Laryngospasm Causes

A

Causes include the irritation of the airway during light anesthesia

Treatment for this includes the removal of the irritation, increasing anesthesia, and/or intubation

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8
Q

Hypoventilation

A

Will lead to hypercapnia and subsequently to hypoxemia

Can be avoided

The PETCO2should alert us to hypercapnia

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9
Q

Hypoventilation Causes

A

CNS depression

Inadequate recovery from muscle relaxant

Small minute volume etc.

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10
Q

Hypoventilation Tx

A

Ventilation from the machine or from a bag/mask and then the cause can be dealt with

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11
Q

Bronchospasm

A

Susceptible patient should be pretreated with bronchodilators

These drugs (Ventolin etc) can also be given intraoperatively

Some anesthetic agents may cause mast cell release of histamine but other are well known bronchodilators (ISO)

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12
Q

Barotrauma

A

Airway pressure during controlled ventilation can become high enough that it leads to a pneumothorax in compromised chronic lung patient and in a trauma patient

Surgical procedure and position can increase this risk

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13
Q

What will increase the risk for aspiration

A
  • Pregnancy
  • Pyloric or interstitial obstruction
  • Diaphragmatic hernia
  • Esophageal Diverticula
  • Massive Obesity
  • Damaged airway protective reflexes
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14
Q

Esophageal Diverticula

A

Holes/pouches in the esophagus

More common in chronic alcoholics

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15
Q

Aspiration pH

A

When the aspirated material is acidic enough (pH 2.5) there will be an immediate bronchospasm and tracheal damage

Chemical pneumonitis can be seen on the chest x-ray in 12-24 hours

ARDS may result which will increase respiratory rate and heart rate and will result in crackles and wheezes

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16
Q

RSI and Aspiration

A

Rapid sequence induction can help to minimize the risk of aspiration

If surgery can be delayed, then the stomach should be emptied and/or agents should be used that will help to reduce acidity

When people have GERD they will always be intubated due to the risk for aspiration, surgery may also be delayed in order to have time to empty out the stomach

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17
Q

Aspiration of solids

A

Aspiration of solids may cause blockage and absorption atelectasis distal to the blockage

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18
Q

Phenylephrine

A

Phenylephrine is generally neither chronotropic nor inotropic

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19
Q

What to do is aspiration has already occurred

A

Intubate

Suction

Ventilate with PEEP

Antibiotics

Possible bronchoscopy removal of foreign bodies should be considered

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20
Q

What May Cause Hypotension

A

Induction will often cause a 10-15% reduction in the blood pressure of healthy patients

When you are intubating it may cause hypertension, and once you have intubated hypotension may occur

When people have a cardiovascular disease there is an even greater risk for hypotension

Certain agents may also result in the depression of the circulatory system

21
Q

Hypovolemia Risk

A

Surgery may result in hypovolemia

This may be due to a decrease in venous return due to ventilation and/or surgery

22
Q

When is a drop in blood pressure considered an emergency

A

Any fall in blood pressure more than 20% is considered an emergency and will require an intervention

23
Q

What interventions can be used for hypotension

A

FiO2should be increased to 100% in order to assure oxygen delivery

The cause of hypotension should be corrected

Blood or fluid replacement should be used for hypovolemia

Release of tension pneumothorax and checking pressure on the vent in order to help when there is a decreased venous return

24
Q

Inotropic agents

A

Inotropic agents (ex. Dopamine, dig) can be used for cardiac insufficiency

25
Q

Ephedrine

A

Ephedrine should be used for low blood pressure

Ephedrine is a sympathomimetic and may cause tachycardia, arrhythmias, angina, ad rebound hypertension

26
Q

What Could Be a Cause of New Hypertension During Surgery

A

Noxious stimuli (tracheal intubation)

Hypercapnia and Hypoxemia

Fluid Overload

Surgical Procedure Itself

27
Q

Surgical Procedure Resulting in Hypertension

A

Treat through deepening anesthesia

28
Q

Fluid Overload Resulting in Hypertension

A

Diuretics such as Lasix

29
Q

Hypercapnia and hypoxemia Resulting in Hypertension

A

treat through ventilation and oxygenation

30
Q

Using Drugs to Decrease Hypertension

A

Caution should be used when giving drugs are used to decrease both SVR and BP in order to avoid over shooting and causing hypotension

31
Q

Arrhythmias

A

Causes include pre-existing heart disease, use of anesthetic agents, and manipulation of the patient, surgical procedures.

32
Q

Sinus Tachycardia

A

Usually benign

Possibly caused from administration of atropine, pancuronium, ketamine or from hypercapnia or hypoxemia.

33
Q

Atrial Flutter or Fibrillation

A

Pt. needs to be cardioverted or perhaps treated with digitalis

34
Q

Bradycardia/Asystole

A

Decrease heart rate is common in anesthesia

Can be treated with atropine (parasympatholytics)

35
Q

Premature Ventricular Contraction (PVC)

A

Use of halothane and epinephrine (for reduced blood loss) is associated with PVC

Hypercapnia can be a risk factor

Lidocaine drips can be used to reduce cardiac irritability

36
Q

Air Embolism

A

Certain cerebral procedures, cardiopulmonary bypass and intra-uterine procedures can result in air being entrained into the blood vessels.

37
Q

Air Embolism and Nitrous Oxide

A

If an air embolism is suspected then the use of nitrous oxide should be immediately discontinued as it may increase the size of the air embolism (compartment shift)

This is because nitrous oxide is so soluble that it will quickly enter into the blood stream and expand the air embolism

38
Q

Air Embolism and Treatment

A

Treatment is a FiO2 of 1.0 (possibly hyperbaric)

39
Q

Anaphylactic Shock

A

The most serious result of an allergic reaction to an agent or any other substance during the perioperative procedures

40
Q

Allergies

A

Pre-existing allergies need to be identified

Epinephrine need to be immediately used in order to maintain blood pressure

Treatment could also include a 50 mL IV bolus of antihistamine (Benadryl)

41
Q

Nerve Injury

A

Any peripheral nerve can be injured during anesthesia through stretch or compression

Anesthesia will paralyze the patient so that they will not receive pain and the normal protective muscle tone has been removed

Nerve injury may result in muscle palsy which will require long term physiotherapy

42
Q

Which nerve are most at risk for nerve injury

A

brachial plexus

ulnar

peroneal

facial

43
Q

How to avoid nerve injury

A

Should try to avoid extreme positions of the head and arm (brachial) and extremes during lithotomy positions (peroneal)

44
Q

Malignant Hyperthermia

A

Malignant hyperthermia is life-threatening pyrexia that is cause through a response to an agent

It is a hypermetabolic state that can be cause through all inhaled agents and succ

More common with pediatric than adults

Runs in families

No signs are seen until they are fully present

45
Q

How can malignant hyperthermia be tested

A

It can be tested for through a muscle biopsy challenged with caffeine and halothane to see if it hyper-reacts

46
Q

Malignant Hyperthermia Warning Signs

A

Hypercapnia (seen on PetCO2),

Increased HR, RR, PVCs

Increased muscle rigidity.

Increase sweating

Severe increased in body temperature.

Combined acidemia, electrolyte imbalance.

47
Q

What do they do if someone has had a malignant hyperthermia reaction

A

Only machines that have never had normal inhaled agents (or have been O2 flow purged for 12 hours) can be used on known MHS patients.

48
Q

Treatment for malignant hyperthermia

A

Dantrolene during and after the crisis will decrease reaction.

Sodium bicarbonate (2-4 mEq/kg) given conservatively and hyperventilation can treat the metabolic acidosis—watch for hypernatremia and hyperosmolarity.

49
Q

Dantrolene Dose

A

Dantrolene at 2 mg/ kg has been used as a prophylactic dose.

2-3 mg/kg as a bolus with repeat boluses totaling 10 mg/kg may abort the crisis.

Maintenance doses of 1-2 mg/kg every six hours for up to three days post crisis should be considered.

001 Respiratory Therapy (53 decks)

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