perio 3c Flashcards
Sedation
- Administration of sedatives (i.e. Midazolam) and analgesia
- Produces depressed level of consciousness
- May be able to respond to commands or physical stimuli
- May require airway support
- Often used in endoscopy or administration of local
anaesthetic
Local Anaesthetic Toxicity
- Occurs if accidental overdose of local anaesthetic or accidentally
injected into bloodstream (importance of aspiration!!!) - Can be life threatening = circulatory collapse, convulsions
- Requires immediate cessation of local anaesthetic and
administration of lipid emulsion (Intralipid)
For intra-op infiltration, always check LA dose with anaesthetist or
surgeon.
Mallampati Score
Used to examine patient’s oral cavity and soft palate visually, in
order to predict any possible difficulties with tracheal intubation
Mallampati Score class1 class 2 class 3 class 4
complete visualisation of the soft palate
complete visualisation of the uvula
visualisation of only the base of the uvula
soft palate is not visible at all
Intubating Equipment
- Laryngoscope handle and blades (i.e. Mac, Mil)
- Appropriate sized tubes + lubricant
- 10ml syringe - cuff inflation
- Tape to secure tube
- Suction: Yankauer & Y-suction catheter
- Malleable introducer
- Magill forceps
- Intubating Bougie
Airway Support/Management
Techniques
- Chin lift
- Jaw Support
- Jaw Thrust
Artificial Airways
- Face masks (bag-mask ventilation) - ensure good seal
- Oral (Guedel)/Nasopharyngeal airways - adjunct
- Laryngeal Mask Airway (LMAs)- sits above vocal cords
- Endotracheal Tubes (ETTs)
- sits below vocal cords & requires laryngoscope
Rapid Sequence Induction
Undertaken if risk of aspiration:
- Unknown fasting time/emergency surgery
- Trauma
- Pregnancy
- Hiatus Hernia
- Bowel Obstruction
- Gastrointestinal Bleeding
- Gastric reflux
Airway Complications
Laryngospasm
Bronchospasm
Laryngospasm
- Irritation of vocal cords leading to spasm
= partial/complete obstruction - Can occur during ‘twilight’ stage (Induction/Emergence)
Laryngospasm management
- Remove stimulus
- Apply PEEP and 100% O2
- Deepen anaesthesia (Propofol or Gas)
- Muscle Relaxant
Bronchospasm
- Characterised by expiratory wheeze
- May result from airway irritation (secretions, equipment)
- Patients who smoke, hx asthma, recent respiratory infection
more susceptible
Management: Bronchospasm
- 100% O2
- Deepen anaesthetic
- Use of bronchodilators
CICO
Can’t Intubate,
Can’t Oxygenate
cricothyroid ligand membrane
Malignant Hyperthermia
specific
muscle rigidity
increased co2 production
rhabdomyolysis
makred temperature elevation
