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Anesthesiology > Monitoring the Anesthetized Patient - 2 > Flashcards

Monitoring the Anesthetized Patient - 2 Flashcards

1
Q

How to measure minute ventilation (V)?

A

TV (tidal volume) x frequency

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2
Q

What is the end product of cellular metabolism?

A

CO2

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3
Q

What is CO2 transported as in the venous system?

A

HCO3-

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4
Q

The production and elimination of CO2 is linked to ____, perfusion, and _____.

A

The production and elimination of CO2 in linked to METABOLISM, perfusion, and VENTILATION.

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5
Q

Capnography is a noninvasive method to measure systemic ____, ____, ____, and cardiac output.

A

Capnography is a noninvasive method to measure systemic METABOLISM, PULMONARY PERFUSION, PULMONARY VENTILATION, and cardiac output.

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6
Q

If CO2 production (metabolism), cardiac output, and pulmonary perfusion are all constant, but there is a change in the End-tital CO2, what caused the change?

A

A change in ventiation

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7
Q

EtCO2 monitors exhaled CO2 noninvasively and is an indirect measurement of ____ CO2.

A

Arterial CO2 (PaCO2)

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8
Q

EtCO2 will be ____ mmHg less than PaCO2.

A

3 - 5

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9
Q

What is the most useful value for detection of apnea and hypoventilation?

A

EtCO2

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10
Q

What are the advantages of a sidestream capnography sampling tube?

A
  1. Light weight
  2. Ease of manipulation
  3. Ability sample other gases
  4. Small sample chamber
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11
Q

What are the disadvantages of a sidestream capnography sampling tube?

A
  1. Need to scavenge aspirated gases
  2. Plugging of sample line by secretions
  3. 2-3 second delay
  4. Dilution of sample from leaks in breathing circuit
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12
Q

What are the advantages of a mainstream capnography sampling tube?

A
  1. No scavenging of aspirated gases needed

2. Real-time measurement

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13
Q

What are the disadvantages of a mainstream capnography sampling tube?

A
  1. Added dead space
  2. Weight can cause kinking of the ET tube
  3. Sensing chamber can be contaminated by secretions
  4. Patients may be burned by heated cuvette (sensors are heated to prevent condensation of water vapor)
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14
Q

What are 5 specific causes of increased EtCO2 values?

A
  1. Metabolism : fever, malignant hyperthermia
  2. Pulmonary perfusion : increased CO, increased BP
  3. Alveolar ventilation : hypoventilation, rebreathing
  4. Technical errors : exhausted soda lime, faulty one-way valves, inadequate fresh gas flow
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15
Q

What are 5 specific causes of decreased EtCO2 values?

A
  1. Metabolism : hypothermia, hypothyroidism, muscle relaxants
  2. Pulmonary perfusion : decreased CO, decreased BP, cardiac arrest, pulmonary embolism
  3. Alveolar ventilation : hyperventilation, apnea, partial esophageal obstruction
  4. Technical error : leak in sample line, patient disconnect, high FGF in NRB system
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16
Q

What is the typically difference between EtCO2 and PaCO2 in a horse?

A

EtCO2 ~ 10-15 mmHg

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17
Q

What is normal blood pH?

A

7.4

18
Q

What do you call an increased PaCO2?

A

Respiratory acidosis

19
Q

What do you call a decreased PaCO2?

A

Respiratory alkalosis

20
Q

What do you call an increased HCO3-?

A

Metabolic alkalosis

21
Q

What is PaCO2?

A

The partial pressure of CO2 in arterial blood

22
Q

Would a decreased PaCO2 likely be associated with hyperventilation or hypoventilation?

A

Hyperventilation

23
Q

Based on the side effects of many of the drugs we give patients for anesthesia, would you most commonly see an increase or decrease in PaCO2?

A

Increased PaCO2

24
Q

What is PaCO2 in a normal, awake patient?

A

35 - 45 mmHg

25
Q

What value will tell the TRUE PaCO2 - EtCO2 difference?

A

ABG (arterial blood gas)

26
Q

What are 3 causes of dark pink mucous membranes?

A
  1. Vasodilation
  2. Endotoxemia
  3. Increased CO2
27
Q

There are 5 factors that can affect the function and accuracy of a pulse oximeter. Name 3.

A
  1. Movement artifact
  2. Dark mucous membranes
  3. Fluorescent light
  4. Poor peripheral blood flow (hypotension)
  5. Increased carboxyhemoglobin and methemoglobin levels
28
Q

Pulse oximetry is most helpful when patients are __1__ or __2__.

A
  1. Breathing room air

2. Transitioning (induction, recovery)

29
Q

What is an ideal SpO2?

A

> 93-95 %

30
Q

What is a normal PaO2 in room air?

A

90-100 mmHg

31
Q

A normal PaO2 in patients breathing 100% oxygen should be what?

A

> 250-650 mmHg

32
Q

There are 5 consequences of hypothermia. Name 3.

A
  1. Decreased MAC
  2. Impaired platelet function
  3. Decreased coagulation
  4. Impaired wound healing
  5. Increased risk of surgical infection
33
Q

What are the consequences of hyperthermia?

A
  1. Increased circulatory work
  2. Cellular hypoxia
  3. Increased metabolic rate
34
Q

How would you treat hyperthermia? (Name 2)

A
  1. Active cooling

2. Supplement with O2

35
Q

What is the purpose of the demand valve for large animals?

A

Demand valve delivers intermittent positive pressure ventilation

36
Q

What volume of oxygen does the demand valve deliver each minute?

A

200 L/min

37
Q

There are multiple indications for the use of the demand valve. What are 3 of those indications?

A
  1. Apnea
  2. Head trauma
  3. Significant hypoventilation
  4. Intra-thoracic surgery
  5. Horse anesthesia
  6. Use of neuromuscular blocking agents
38
Q

What does the bellow take the place of in the breathing circuit?

A

Reservoir bag

39
Q

Which animals do you NOT wean from IPPV? What is the exception?

A

Do not wean horses, except in brain cases (head trauma, tumor, etc.)

40
Q

What 2 steps are involved in weaning a patient from IPPV?

A
  1. Lower the respiratory rate to increase PaCo2

2. Discontinue the inhalant to decrease CO2 set point in the brain

Anesthesiology (6 decks)

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