MAC Anesthesia, LMA placement

Question 1

MAC technique

Answer 1

Anesthesia with local (infiltrated by surgeon) or block

-Different depth of anesthesia but patient will most likely will not remember

Question 2

Medications used in MAC

Answer 2

Versed, fentanyl, propofol

-Propofol: Bolus up front, then titrate. Start slow, can always give more. Is painful on injection-give lidocaine

Question 3

Airway management in MAC cases

Answer 3

Nasal cannula
-<6LPM, ~30% O2
Simple face mask
-6-10LPM, 35-50% O2
Non-rebreather mask
-12-15LPM, 80-100% O2

*Careful with procedures above the ziphoid process - fire risk

Question 4

2 key elements of mask ventilation MAC cases

Answer 4

1: Maintenance of seal between facemask and patients face
2: An unobstructed upper airway

Question 5

Peak inspiratory pressures during mask ventilation MAC cases

Answer 5

<20 cmH20

-Higher pressures should be avoided to prevent gastric insufflation, vomiting, and aspiration

Question 6

How to size oral airway

Answer 6

Corner of patients mouth to angle of the jaw or earlobe

Question 7

How to size nasal airway

Answer 7

Measure from tip of nose to tip of earlobe

Insert with bevel facing the septum