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POA Exam #2 > Unit 3: Mask Anesthesia > Flashcards

Unit 3: Mask Anesthesia Flashcards

1
Q

What are face mask use for?

A

to administer gases directly from the breathing system to the patient

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2
Q

What kind of respirations can you give with the face mask?

A

assisted or controlled

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3
Q

What are the three types of mask?

A

Anatomical (common)
Trimar (similar to anatomical but shallower and less dead space)
Patil-Syracruse (has endoscopic port for insertion of fiber optic endoscope and ET TUBE/ may be used in spontaneous breathing pt or pt with positive pressure ventilations)

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4
Q

Mask application

A

Fit properly & tight.
Pre-oxygenate with 100% 02 at 4-6l/min for denitrogenation and oxygenation
Application of positive pressure ventilation

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5
Q

When is mask fit challenging?

A

Edentulous patients
Bearded patients (indication for intubation)
Maxillofacial injuries or deformites
Drainage tubes

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6
Q

In edentulous patients with a loss of distance between the points where the mask rest on the mandible and nose, what intervention should take place?

A

Insertion of an oropharynx airway will increase the distance by opening the mouth

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7
Q

Should the relief valve remain open or close during mask anesthesia?

A

open

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8
Q

Should the anesthetist always hold mask during care?

A

Yes this is the mainstay in resuscitation and delivery of anesthesia.
Left hand: holds mask
Right hand: on reservoir bag to ventilate
Proper mask fitting demonstrates forward DISplacement of the mandible

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9
Q

LMA stands for

A

Laryngeal Mask Airway
It causes less airway irritation and damage
Replacement for mask NOT ET tube

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10
Q

LMA size 1

A

neonates/infants up to 5 kg

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11
Q

LMA size 1 1/2

A

Infants 5-10 kg

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12
Q

LMA size 2

A

infants/children 10-20 kg

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13
Q

LMA size 2 1/2

A

Children 20-30 kg

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14
Q

LMA size 3

A

Children/ small adults 30-50 kg

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15
Q

LMA size 4

A

Adults (females) 50-70 kg

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16
Q

LMA size 5

A

Adults (males) 70-100 kg

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17
Q

LMA size 6

A

Large adults 100 kg

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18
Q

LMA and anesthesia

A

requires a deeper level of anesthesia than is required for insertion of an oropharyngeal airway
Propofol 2.5 mg/kg has been found to suppress airway reflexes

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19
Q

LMA best used in what cases?

A

spontaneous breathing pt not at risk for aspiration
nonemergency case requiring GA in the supine position
ASA l or ll
no gastric or respiratory procedures
hernias ok NOT hiatal hernias
Some side lying cases (thin, no comorbidities)
Emergency cases when intubation is impossible (rescue airway)
Assist pt ventilations is best (PCV-PRO mode)-pressure controlled ventilation mode <20 cm H20

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20
Q

Which LMA is used for intubation?

A

Fast Track

21
Q

Which LMA used for NG insertion?

A

ProSeal

22
Q

Potential Complications of LMA?

A

INJURY TO AIRWAY STRUCTURES
(soft tissue, nerves, vessels, hypoglossal and lingual nerve palsy, dysphonia, tongue cyanosis, intracuff pressure < 60 cmH20, teeth)

SORE THROAT
(dry throat, abrasion, traumatic insertion)

RISK OF ASPIRATION
(not secured, tip of device somewhat occludes esophagus)

23
Q

If suspected aspiration with LMA? (7)

A
  1. Do not remove LMA
  2. Turn pt head down and to side
  3. Suction LMA
  4. Give 100% O2
  5. Ventilate gently
  6. Bronchoscope
  7. Intubate if aspiration noted below vocal cords
24
Q

LMA extubation

A

NOT stimulating so can be removed awake
Bite guard***
Deep extubation on agent
Remove inflated to DECREASE airway secretions in airway

25
Q

Contraindications to use LMA?

A

Risk of aspiration
Poor lung compliance; High airway resistance (COPD)
Glottic or subglottic airway obstruction (tumors)
Limited mouth opening ( <1.5cm)

26
Q

Complications of Mask Anesthesia

A

Contact Dermatitis
Pressure
User Fatigue ( holding mask for long period of time/ failure to maintain correct jaw position may result in loss of airway patency and air may be forced into the stomach)

27
Q

Pt at increased risk for vomiting and aspiration?

A 
emergency surgery (no fasting)
inadequate anesthesia
abdominal pathology
obesity
opiod medication (slow down GI motility)
neurological deficit
lithotomy position (abdominal pressure)
difficult airway/intubation (ventilation pushes air into stomach)
reflux
hiatal hernia
diabetes (autonomic neuropathy)- (gastric empty delayed
28
Q

Aspiration of acidic gastric contents causes?

A

chemical pnuemonitis or Mendelson’s Pneumonia
(bronchospasm, hypoxemia and atelectasis)
Increase incidence in OB, pecs, emergency

29
Q

When is morbidity rate increased in aspiration patients?

A

pH 25cc
or
when aspirate is particulate

30
Q

How to prevent aspiration?

A

Delay surgery 8-12 for know full stomachs
Non particulate antacids (Bicitra, Alka Seltzer gold); good combined with Reglan
H2 blockers (Cimetidine or Ranitidine-Zantac) increase the pH, Pepcid 20 mg IV (famotidine); better than Ranitidine
Metaclopramide 10 mg (Reglan) inceases esophageal sphincter tone and accelerates gastric emptying time; useful for pregnancy, emergency, gastroparesis secondary to DM. Do not use in bowel obstruction( use pepcid).
RSI and intubation
If give Reglan and extrapyramidal activity occurs give Benadryl

31
Q

Pt at r/f regurgitation and aspiration

A 
full stomach (non fasted/ emergency cases)
pregnant pt
bowel obstruction
hiatal hernia, heart burn, reflux
obese pt
pediatric patients
obtunded patients
poor mask fit
facial/head and neck surgeries
obvious facial deformities
NG tubes
32
Q

Causes of passive regurgitation and aspiration

A

errors in judgement
fault in airway management technique
inadequate patient preparation
improper ventilation by mask or upper airway obstruction (tongue, laryngospasm due to light anesthesia) (light anesthesia can precipitate airway reflexes)
increase gastric content
incompetent cardiac sphincter (hiatal hernia)
esophageal diverticulum

33
Q

Signs and symptoms of possible regurgitation/ aspiration during ventilation

A 
swallowing 
retching
coughing
vomiting
wheezing (bronchoconstriction)
increased airway resistance
hiccoughs (can occur before vomiting/retching
34
Q

When is regurgitation/aspiration likely to occur?

A

During intubation or emergence

can be silent regurgitation

35
Q

Treatment for aspiration with face mask

A 
Turn head to side 
Suction oropharynx
Trendelenburg position 
100% O2
Laryngoscope, intubate w/ cuff tube
(propofol, succs, intubate)
Suction ET tube prior to pos. pressure ventilations
36
Q

Why does eye damage occur?

A

Pt loose the abilty to blink and tear under general anesthesia
dry eyes
corneal abrasions
pressure on eyes (occulocardiac reflex and supraorbital nerve palsy)
exposure keratitis

37
Q

Define occulocardiac reflex?

A

traction on the extraocular muscles or pressure on the globe causes bradycardia an hypotension

38
Q

Stage l of Anesthesia

A

Stage of analgesia or stage of disorientation

Beginning of induction of induction of anesthesia to loss of consciousness

39
Q

Stage ll of Anesthesia

A

Stage of Excitement or stage of Delirium
Loss of consciousness to onset of automatic breathing
EYELASH REFLEX DISSAPEAR

40
Q

Stage lll of Anesthesia

A

Stage of Surgical anesthesia
Onset of automatic respirations to respiratory paralysis
This stage has 4 planes

41
Q

Stage lll- Plane l

A

Automatic respiration to cessation of eyeball movement

***Eyelid reflex is lost, swallowing reflex disappears

42
Q

Stage lll- Plane ll

A

Cessation of eyeball movement to paralysis of intercostal muscles
Laryngeal reflex lost and all other reflexes
Increased secretion of tears ( sign of light anesthesia)
***Respiration is automatic and regular, movement and deep breathing as a response to skin stimulation disappears

43
Q

Stage lll- Plane lll

A

Beginning to completions of intercostal muscle paralysis
***Laryngeal reflex lost in plane ll can still be initiated by painful stimuli arising from the dilatation of anus or cervix
Desired plane when muscle relaxant not used

44
Q

Stage lll- Plane lV

A

from complete intercostal paralysis to diaphragmatic paralysis (***apnea)

45
Q

Stage IV

A

stoppage of respiration til death
***Anesthetic overdose causes medullary paralysis with respiratory arrest and vasomotor collapse
Pupils are widely dilates and muscles are relaxed

46
Q

Steps for induction of Mask Anesthesia

A

pre oxygenate with 4-6 liter flow for 3 minutes ( to increase PaO2 and to de-nitrogenate lungs)
listen to breath sounds (place precordial on left chest)
assess reservoir bag for movement (relief valve open)

hyperextend neck, tilt chin, left hand mandible and mask, right hand occiput

47
Q

How to assess patient for loss of consciousness?

A

snoring or airway obstruction
deep sigh
absence of lash reflex

48
Q

Indications for mask anesthesia

A 
short cases (usually less than an hour)
D & C
hernias (mostly pediatrics; adults SAB)
cystoscopy
some extremity cases (arthroscopy, hand, foot)
breast biopsy
cast application
cases that do not require NMB

POA Exam #2 (3 decks)

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