Week 8&9 - Dr. White Flashcards Preview

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Flashcards in Week 8&9 - Dr. White Deck (61)
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1

o what is mandatory for all airway management scenarios:

preparation!!

2

o the first step in airway management

Bag and mask ventilation (BMV) is

3

no sign of chest rising, no end-tidal CO2 detected, no mist in the clear mask

these are signs of:

ineffective ventilation

4

o Difficult mask ventilation is often found in patients with

morbid obesity,
beards,
craniofacial deformities.

5

a life saving temporizing measure in patient with difficult airways (b/c they cannot be ventilated or intubated)

LMA
(i-gel LMA is what Dr. White talked about)

6

Difficult airway - LEMON Trial:

 Look
• Facial trauma
• Large incisors
• Beard
• Large tongue
 Evaluate 3-3-2
• Interincisor distance (3 fingers)
• Hyoidmental distance (3 fingers)
• Thyroid to floor of mouth (2 fingers)
 Mallampati
 Obstruction
 Neck Movement – chin to chest

7

Predictors of Difficult Intubation

o B – Beard
o O– Obesity
o N – No teeth
o E – Elderly
o S – Snores

8

type of intubation not for an unstable neck:

direct laryngoscopy

9

type of intubation good for an unstable neck:

awake blind nasal intubation

10

nebulized anesthesia - 4% lidocaine blocks for how long?

15 mins MAX

11

most important element for a successful awake fiberoptic intubation?

Preparation

12

Surgical airway - Invasive technique required when you "can't intubate, can't ventilate".

A few important things to remember:

-16 or 14g IV cannula required to pass through CTM.
-jet ventilation system usually found on the back of vent
-catheter MUST BE SECURE!
-short 1s bursts of Oxygen
-Avoid barotrauma; pt may develop subcutaneous or mediastinal emphysema


**If no jet ventilation; 3ml syringe can attache to catheter with plunger removed. a 7.0mm TT connector can be inserted into the syringe to attach to breathing circuit or an ambu bag.

13

• Poor functional status has been identified as a risk factor for surgical site

infection and postoperative complications.

14

• Frailty is a perioperative risk factor for

complications and mortality.

15

Frailty is classified as primary or secondary.

o Primary frailty occurs as part of the intrinsic process of aging.

o Secondary frailty is related to the end-stage of chronic illnesses and is caused by inflammation and wasting, for example heart failure, COPD, inflammation, and wasting associated with cancer.

16

• By some estimates, over half of elderly patients also take over-the-counter herbal products.
o The American Society of Anesthesiologists (ASA) recommends that whenever possible, herbal products be discontinued at least

1–2 weeks prior to surgery.

17

o Garlic extract and ginkgo biloba increase the risk of

perioperative bleeding.

18

• IV anesthetics have more pronounced hemodynamic effects, and smaller doses are required to achieve the same anesthetic depth. Dose of an induction drug and opioids should be decreased by at least

25%.

19

• The strongest predisposing factor for postoperative delirium is

preexisting dementia

20

• The basic principles in ethical decision making that apply to the older adult are the same as those that apply to all patients.
o In health care the most common principles are

 autonomy ** most important
 beneficence
 nonmaleficence
 justice.

21

Patient's right to self-determination. defined:

autonomy **

22

An obligation or responsibility to help the patient; “to do good”

beneficence

23

To not intentionally harm the patient; "do no harm"

nonmaleficence

24

To treat the patient fairly

justice

25

What body part/ organ is especially vulnerable to laser surgery?

the eyes


all OR personnel should wear laser-specific eye goggles with side protectors to prevent injury.
• The eyes of a patient undergoing laser treatment must be protected by taping them shut, followed by the application of wet gauze pads and a metal shield.

26

• Minimally invasive robotic surgery is associated with improved patient outcomes including :

decreased length of stay,
faster recovery, reduced perioperative blood loss, and reduced postoperative pain

27

** Regardless of the procedure the anesthetic plan must take into consideration the following factors:

-prolonged surgical times
-spatial restrictions associated with use of the robot
-inability to alter patient position after docking of the robot
-physiologic changes associated with extreme positioning
-risk of postoperative visual loss (POVL)
-physiologic consequences associated with the creation of pneumoperitoneum
-implementation of Enhanced Recovery after Surgery (ERAS) protocols

28

type and screen tests for

antibodies

29

if indicated b the surgical procedure, in robotic surgery, pt should be typed and cross matched for a minimum of

four units of blood

30

• Cardiovascular Changes seen in steep trendelenburg

Increased:
 Mean arterial Pressure (MAP)
 Central Venous Pressure (CVP)
 Pulmonary Capillary Wedge Pressure (PCWP)
 Systemic Vascular Resistance (SVR)

Unchanged:
 Heart rate (HR)
 Stroke Volume (SV)
 Mixed Venous Oxygen Saturation