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Anesthesia > Monitoring > Flashcards

Monitoring Flashcards

1
Q

Aims of monitoring

A
  1. ensure proper depth
  2. maintain normal physiology
  3. ensure safety of patient and personnel
    -use of pulse oximetry (3-4x decrease in death)
  4. legal implications
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2
Q

What do we monitor?

A

-circulation
-ventilation
-oxygenation

**ensures adequate perfusion

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3
Q

Arterial blood pressure

A

-Mean arterial blood pressure is driving pressure for organ perfusion
*always monitor patients with GA

two methods:
1. Invasive (direct)
2. Noninvasive (indirect)

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4
Q

Indirect blood pressure monitoring

A
  1. Oscillometric method
  2. Doppler method

Based on occlusion of blood flow to extremity, and detection of reappearance of blood flow during deflation

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5
Q

Cuff

A

Width: should be 30-40% of circumference of limb
>too wide= underestimate
>too narrow= over estimate

Position= should be placed at level of heart
>below=false high
>above= false low

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6
Q

Doppler probe

A

-sends ultrasonic signal
-reflected by moving structures (RBCs)
-changes frequency and is converted to audible signal

**shave animals leg and place coupling gel

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7
Q

Doppler reading

A
  1. inflate cuff until blood flow is occluded and doppler sound disappears
  2. deflate cuff slowly
  3. pressure at which blood flow (whoosh) returns= SYSTOLIC BP
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8
Q

Advantages of dopplers

A

-any size of animals
-exotics- put over heart to monitor heart
-cold blooded animals

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9
Q

Disadvantages to doppler

A

-operator experience, labor intensive

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10
Q

Oscillometric method

A

-similar to doppler, cuff around limb or tail
-detects pressure changes in cuff during its deflation as pulsatile flow returns
>systolic is first (max oscillation)
>diastolic is last

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11
Q

Advantages to oscillometer

A

-non invasive, automatic, less labour
-programmed to take many readings

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12
Q

Disadvantages to oscillometric method

A

-poor with cardiac arrhythmias, bradycardia, severe hypotension. movement, shivering

-not continuous

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13
Q

Direct blood pressure monitoring

A

GOLD STANDARD
-continuous of systolic, mean, and diastolic BP
-catheter placed in peripheral artery
-must be zeroed to ambient air at level or right atrium
-used in large animals and critically ill small animals

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14
Q

Palpation of pulse

A

-pulse pressure does not equal blood pressure!
It tells you difference between systolic and diastolic BP

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15
Q

Mucous/CPT

A

-info for blood oxygen and tissue perfusion

Normal less than 2secs , pink

Blue=cyanosis
Pale= anemia, or vasoconstriction
Red= vasodilation

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16
Q

Monitoring respiratory system

A
  1. Capnography
  2. Pulse oximetry
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17
Q

Pulse oximetry

A

-non invasive, continuous
>pulse rate, SpO2 (should be 95-100%)

-changing volume of tissue bed can be measured by change in light absorption because deoxyhemoglobin and oxyhemoglobin is absorbing red differently

18
Q

Pulse oximetry probes

A
  1. transmittance (clip on tongue)
  2. Reflectance (rectal or esophageal)
19
Q

Reflectance use

A

-tongue
-toe web
-pinna
-prepuce or vulva

**remember that it squeezes and reduced blood flow. Reposition regularly

20
Q

Saturation and arterial PaO2 relation

A

Sat=90% , Pa O2=60 mmHg = hypoxemia

Want SpO2= 95-100%= closed to 100mmHg

21
Q

Disadvantages of pulse oximetry

A

-poor probe positioning
-poor perfusion (hypotension, vasoconstriction)
-arrhythmias, slow HR
-venous congestion
-patient movement, shivering
-different forms of hemoglobin

22
Q

Capnometry

A

-Measures and displays end tidal CO2
-displays respiratory rate
-non invasive

23
Q

Mechanism of capnography

A

End tidal CO2=arterial CO2
*end tidal CO2 is about 2-5mmHg less than paCO2

24
Q

What determines blood/end tidal CO2 levels?

A
  1. Metabolism- rate of production of CO2 by cells
  2. Circulation: CO if circulation stops and ventilation continues then End tidal CO2 decreased
  3. Alveolar ventilation: if it decreased, then alveolar CO2 and therefore end tidal CO2 increased
25
Q

Capnia levels

A

Hypocapnia: <35mmHg

Normocapnia: 35-45mmHg

Hypercapnia: >45mmHg

26
Q

Benefits to capnometry

A

-easy use
-non invasive
-continuous measurement
-provides info on intubation, circuit disconnection, ID of airway obstruction, rebreathing, severe circulatory issues

27
Q

two methods of capnography

A

Infrared absorption spectroscopy- infra red light absoroption is proportional to CO2 levels

  1. Mainstream sensor
  2. Sidestream sensor
28
Q

Sidestream

A

measuring chamber in computerized monitor
-measures gas sampled from breathing system at ET tube connector
-usually 50-200ml/min

-anesthetic gas should be scavenged or returned to system
>water vapour needs to be removed, sampling tubes may be kinked, measurement delay

29
Q

Mainstream

A

Measuring chamber is placed directly between endotracheal tube and breathing system
-delicate chambers prone to being dropped and broken
-more accurate than sidestream
-immediate reading without delay
-increase in apparatus dead space

**no scavenging!

30
Q

Waveforms of capnometry

A

1.normal= square
2. Small bumps= esophageal intubation

31
Q

Curare cleft- surgeon notches

A

on capnogram

-diaphragmatic activity- animal fights the ventilator, spontaneous ventilation returning after neuromuscular blockade

OR surgeon leaning on chest

32
Q

Cardiogenic oscillations

A

ripples at end of exhalation
-normal, just cardiac movement of gas through airways

33
Q

Rebreathing of CO2

A

-on capnogram, tracing does not return to zero between breaths

-inspired CO2 increases to 5-15mmHg

-End tidal CO2 increases

34
Q

Causes of rebreathing of CO2 on capnogram

A

-incorrect fresh gas flow
-exhausted soda lime
-malfunctioning valves- unidirectional valves get stuck

35
Q

Sloping/shark fin on capnometry

A

-partial obstruction of airway: secretions or kinking of ET tube

-partial obstruction of lungs: bronchospasm, COPD

36
Q

Hypercapnia: high end tidal CO2 capnogram

A

-hypoventilation
-endobronchial intubation
-increased CO2 production
-malignant hyperthermia, hyperkalemic periodic paralysis
-increased metabolic rate

37
Q

Rapidly decreasing end tidal CO2 on capnogram

A

-impending cardiac arrest, severe hypotension
-pulmonary thromboembolism

**emergency!!

38
Q

Sudden zero end tidal CO2 (straight line) on capnogram

A

-circuit disconnection
-extubation
-resp arrest
- CO2 sampling line block or leak
-cardiac arrest

**emergency

39
Q

Electrography

A

-continuous monitoring
-not reliable, no info on mechanical activity, no info on CO, BP
-standard lead configuration (3 electrodes)

40
Q

Auscultation

A

heart and lung sounds
-non continuous info
-external and esophageal stethoscope

41
Q

Visual assessment

A

Resp rate, depth, breathing patterns
-chest excursions (visual, palpation)
-observation of rebreathing bag

Anesthesia (24 decks)

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