Unit 1 Flashcards
Which events fulfill the definition of a failed laryngoscope intubation? Name Two.
- Airway not successfully intubated within 5-10 minutes
- Glottis not intubated after 4 attempts
What percentage of anesthesia induced atelectasis occurs in anesthetized patients?
90%
What is the only anesthetic not associated with anesthetic induced atelectasis?
Ketamine
What percentage of the lung is atelectatic during uneventful general anesthesia?
15-20%
How does stimulating noradrenergic, noncholinergic mechanisms affect bronchiolar smooth muscle tone?
Leads to bronchoconstriction through the release of tachykinins, vasoactive intestinal peptide, adenosine, and calcitonin gene-related peptide
What does agonizing the acetylcholine M3 receptors lead to?
Bronchoconstriction
How does an influx of calcium into the bronchial smooth muscle affect the tone?
It increases the tone (Bronchoconstriction)
How does the stimulation of a2-receptors affect bronchial smooth muscle?
Relaxes the smooth muscle
Which nerve is most likely injured following the placement of an LMA? Which cranial nerve? Which others?
- Hypoglossal (CN12)
Also - the lingual and RLN
What is most likely to cause a nerve injury with an LMA?
Overinflation of the cuff
Which type of patients are at higher risk of difficult extubating?
- Abnormal or complicated airway issues like dental damage during intubation
- Surgical issues create airway issues like cervical fusion
- General risk factors such as OSA or neuromuscular weakness
Does a supine patient create an increased risk of difficult extubation?
No
What is the recommended time that a patient stops smoking before surgery?
8 weeks
When does the Hgb P50 return to normal after smoking cessation?
12 weeks
What is the P50 of Hgb? What is normal ?
When 50% of hgb is saturated with oxygen.
Normal is approximately 27 mmHg
Carbon monoxide binds to Hgb at what rate compared to oxygen?
240 times - this reduces the amount of available O2 to tissues
What type of shift does smoking / carbon monoxide cause?
A leftward shift because it forces the Hgb to hold onto the oxygen
Smoking cessation causes which shift on the P50?
A right shift
-Allows O2 onto the Hgb which is released to the body to improve oxygenation
What is seen at the 48–72-hour mark of smoking cessation?
Increased secretions and a more reactive airway
What is seen at the 2–4-week mark of smoking cessation?
Decreased secretions and less reactive airway
What is seen at the 4-6-week mark of smoking cessation?
Immune system and metabolism normalize
Return of pulmonary function
What is seen at the 8-12-week mark of smoking cessation?
Improved mucociliary transport and small airway function
Carotid bodies are linked to? Carotid sinuses are linked to?
Bodies - chemoreceptors
Sinuses - baroreceptors
What is the pathway of from peripheral chemoreceptors to the brain?
- Carotid bodies >
Carotid sinus n. (Hering’s) >
Glossopharyngeal n. (CN9) >
Dorsal center of medulla
2.
Transverse aortic arch >
Vagus n. (CN10)>
Dorsal center of medulla
What can decrease the glossopharyngeal afferent nerve activity? What happens because of this?
Opioids + Benzodiazepines + >0.1 Mac of volatile gases
Hypoxemia and hypercapnic respiratory insufficiency
Which drugs must always be given during an awake fiber optic intubation ?
- Antisialogogue
-Local anesthetic
-Topical vasoconstrictor
Which drugs should be avoided during an awake fiber optic intubation?
Propofol + narcotics
What signs and symptoms will be seen with a post obstructive pulmonary edema?
(also called negative pressure pulmonary edema)
-SOB
-Pink frothy secretions
-Tachypnea
-SpO2 < 95%
-Cough
What is the most accurate description of the respiratory effect of obesity?
Increased respiratory rate
What happens to dead space with obesity?
Increased
What happens to residual volume with obesity?
Unchanged
What happens to FRC with obesity?
Decreased due to decreased ERV
What does your FRC include?
RV + ERV
What does your Inspiratory Capacity include?
IRV and TV
What happens to IRV with obesity?
Slightly increased
After identifying a grade 4 Cormack Lehane view, what are the next best steps?
- Alternate approach
- Optimal external laryngeal manipulation
Contraindications to a supraglottic airway?
Delayed gastric emptying
Intestinal blockage
Subglottic obstruction
Can a supraglottic airway be used in a T&A?
I GUESS????!!!!!
What does the Plateau pressure measure?
The pressure in small airways after reaching the target tidal volume
(no airflow)
Does airway resistance affect Plateau pressure?
No
Which conditions most likely affect Plateau pressures?
Pulmonary edema
Pneumothorax
Subq emphysema
Which conditions affect peak pressures?
Kinked tube
ET obstruction
Acute asthma
Bronchospasm
In order to maintain tracheal capillary perfusion, what is the highest cuff pressure? What is normal capillary perfusion ?
Anything less than 25
Normal is 20
Which type of lung disease is caused by intraabdominal pressure?
Restrictive
Which pulmonary functions are reduced with an unsupported airway?
FRC
Respiratory compliance
Arterial oxygenation
What is the first step when a patient begins vomiting while holding cricoid pressure?
Release cricoid
Which injury is likely a contraindication for ET intubation?
Laryngeal cartilage disruption
