Ventilation Under Anesthesia Flashcards
1
Q
Predictors of difficult mask ventilation?
A
- Obesity/large tongue
- Facial hair/beard
- Edentulous/Prominent overbite
- Neck/facial trauma
- Foreign body/pharyngeal abscess or mass
- Airway swelling
2
Q
Causes of ineffective mask ventilation?
A
- Soft tissue airway obstruction
- Not enough pressure in circuit (usually leak around mask)
- Too much pressure in circuit (APL close too much)
4.
3
Q
If airway obstruction is present, the anesthetist can relieve the obstruction by:
A
- Using a nasal or oral airway
- Doing a jaw thrust and using a double handed masking technique
4
Q
Protocol for difficult mask ventilation?
A
- Properly align airway axis’
- Place oral or nasal airway
- Double handed mask technique with oral airway in place
- LMA
- Wake patient up, or try to intubate the patient
5
Q
Disadvantages of mask ventilation?
A
- Hands are “not free”
- May be difficult to ventilate some patients with <20cmH20 pressure (obese, tendelenburg position, etc.)
- Airway is not protected
6
Q
Benefits of LMA?
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A
- Relieves all airway obstruction
- Creates a seal in the pharynx
- Accomplishes everything masking does, but now the anesthetists hands are “free”!
7
Q
Limitations of LMA?
A
- Limited to using <20cmH20 pressure
- LMA doesn’t protect the airway
- Ventilator should not be used, unless it is in pressure control and set to <20cmH20
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8
Q
Types of ventilation under anesthesia
A
- Spontaneous ventilation (Patient breathes on thier own, and must be in “bag” mode)
- Assist ventilation (Squeezing bad occasionally just as patient starts to inhale)
- Control ventilation (mechanical ventilation)
9
Q
Absolute contraindications for LMA
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A
- Full stomach (Delayed gastric emptying, not NPO, bowel obstruction)
- Narcotic use, trauma, diabetic patients, neonates
- Laboring pregnant patients
- Liver failure with ascites
- Obesity
- Decreased tone of the lower sphincter
- Hiatal hernia
- Surgery requiring paralysis (abdominal, laparoscopic, hip replacement, cardiothoracic, etc.)
- Patients having to be on ventilator
- Long procedures, when you need greater than >20cmH20