Ventilation Under Anesthesia Flashcards
When is mask ventilation used?
- when a patient goes apneic and doesn’t have advanced airway in place
- if patient stops breathing from being sedated
What should be used for longer duration ventilation but anesthetist doesn’t think the ventilator is necessary?
LMA
What are some limitations to mask vent?
- hands not free to draw up drugs
- limited on positive pressure
Predictors of Difficult Mask Vent
- Obesity/large tongue
- Facial hair/beard
- Edentulous
- Overbite
- Neck/facial trauma
- Foreign body in trachea
- Pharyngeal abscess/mass
- Airway swelling
What is Ludwig’s Angina?
- swelling of the tongue, neck pain, and breathing problems.
What should you do if you have a difficult mask vent AND a difficult intubation?
- awake fiberoptic intubation or potentially have a surgeon perform a tracheotomy
Causes of Ineffective Mask Vent
- Soft tissue obstruction
- Not enough pressure in the circuit (leak around mask)
- Too much pressure in the circuit
If a patient has an airway obstruction (soft tissue) what would you do to improve the airway?
- Use an oral/nasal airway
- Jaw thrust (Thumbs on the mask/lower fingers underneath the angle of the mandible to LIFT the jaw) w/ double handed masking technique
Protocol for Difficult Mask Vent (Try each step first before moving on)
- Position: make sure axis are aligned (nose above abdomen/ or close)
- Oral/Nasal Airway if you can’t mask
- Double handed masking technique w/ oral airway in place
- LMA placement
- A: Wake the patient up if they aren’t paralyzed
B: Try to intubate (if paralyzed)
Benefits of LMA:
- Relieves airway obstruction
- Creates a seal in the pharynx
- LMA = mask vent w/ hands freed!
Limitations of LMA
- Providers limtied to using <20cm/H2O pressure
- Doesn’t protect the airway
- Ventilator CANNOT be used unless pressure control set at <20cm/H2O
Indications for LMA:
- GA where intubation is unecessary
2. Use as rescue device in the nightmarish “can’t mask, can’t intubate” scenario
Absolute Contraindications of LMA Placement:
- Patients who are considered “full stomach”
- gastroparesis
- not NPO
- bowel obstructions - Decreased tone in LES
- Surgery that requires muscle paralysis
- Patient must be on a ventilator (ventilation parameters must be controlled)
- brain surgery/EtCO2 must be maintained stable
- Cardiothoracic surgery/ lung inflation must be controlled - Pharyngeal/neck (possible awake fiberoptic intubation?)
Delays Gastric Emptying
- Narcotics
- Trauma (Sympathetic response)
- Diabetic
4. Neonates
5. Laboring pregnant patients
6. Liver failure/ascites
7. Obesity? ( bc of the gastric volume; residual volume is still higher than a normal person)
What is the Nissen Fundoplication?
The LES is strengthened by wrapping the fundus around the lower portion of the esophagus.
