Week 8 - upper airway & thoracic anaesthesia

Question 1

What type of intubation is often used?

Answer 1

orotracheal intubation

Question 2

If orotracheal intubation can´t be performed ?

Answer 2

use pharyngostomy or tracheostomy

Question 3

Ventilation support -> Tindal volume

Answer 3

15 ml/kg

Question 4

Ration of inspiration to expiration is

Answer 4

1:2

Question 5

Mechanical ventilators: two types

Answer 5

1. Pressure cycled ventilators
2. Volume cycled ventilators

Question 6

Pressure cycled ventilators

Answer 6

delivers the gas volume until a present volume is reached

Question 7

Volume cycled ventilators

Answer 7

delivers the volume depending on the delivered pressure of the breath

Question 8

Ventilation support -> Important supplemental analgesia ..

Answer 8

fentanyl or oxymorphone

This drugs produce maximal analgesia and minimal cardiorespiratory depression

Question 9

Muscle relaxants

Answer 9

indicate in cases resistant to the ventilation

Atracurium and pancuronium produce minimal cardiovascular effect

Question 10

Monitoring in patient with pre – existing cardiorespiratory disease

Answer 10

1. Tindal volume
2. Oxygen status
3. Atrerial blood gas analysis

Question 11

Qualitative evaluation of respiratory function

Answer 11

1. Respiratory rate
2. CRT and colour of mucous membranes

Question 12

Quantitative methods evaluation of respiratory function

Answer 12

1. Respiratory gas analysis – arterial blood gas
2. Pulse oximetry – sensor on the mucous membrane (tongue)
3. Capnometry – measurement of carbon dioxide (evaluation of the integrity of respiratory tract)

Question 13

Patient after thoracotomy need (4)

Answer 13

1. Pulmonary reinflation
2. Evacuation of pleural cavity (blood, air)
3. Chest drain – prior to chest closure
4. Radiograph after surgery – tube localisation

Question 14

Intercostal nerve block – after lateral thoracotomy

Answer 14

1. Bupivacain 0,5% - analgesia for 6 – 8 hours
2. On either side of incision - blocation of two nerve segments (0,5 ml per nerve)

Question 15

For pain relief after thoracotomy – opioids:

Answer 15

1. Oxymorphone (0,05 – 0,1 mg/kg) or butorphanol
2. Morphine (0,1 – 0,3 mg/kg)

Question 16

Position of the tubus for orotracheal intubation

Answer 16

Position of the tubus – beyond the lesion!!

Question 17

Clinical appearance of myocarditis – cardiac arrhythmias; in those patient´s don´t use

Answer 17

1. Xylazine
2. Thiobarbiturates
3. Halotane

Question 18

Diaphragmatic hernia ->

Answer 18

Dopamine - diluted in 250ml bag of normal saline or 5 % dextrose – 60 drops/ml

Question 19

Cardiac patients - anesthesia

General considerations

Answer 19

Do not administer alfa2 agonists (xylazine, medetomidin, etc.)

vasoconstriction – afterload

arrhythmias

Question 20

Opioids + X are a good combination that has low potential for cardiac complications

Answer 20

1. Opioids
   Sedation / analgesia
   Maintain heart contractility
   sinus bradycardia (atropine)

+

2. Benzodiazepines
   sedation
   Minimal cardiorespiratory depression

Question 21

eg. opioids

Answer 21

Opioids
butorphanol (0.2-0.4 mg/kg IV, IM, SC)
morphine (0.2-0.5 mg/kg IM, SC)
methadone (0.2-0.5 mg/kg IM, SC, IV)
buprenorphine (0.01-0.02 mg/kg IV, IM, SC)

Question 22

eg. Benzodiazepines

Answer 22

Benzodiazepines
diazepam 0.2-0.4 mg/kg IV - insoluble
midazolam 0.2-0.4 mg/kg IM, SC, IV
hydrosoluble

Question 23

What drugs NOT to give in case of HCM (hypertrophic cardiomyopathy)

Answer 23

DO NOT GIVE
acepromazine, ketamine, atropine, glycopyrolate, a thiopental