Mechanics and physiology of lung isolation/ one-lung ventilaion,
Anaesthetic implications of one-lung ventilation and management strategies
West zones of the lung
Ventilation-perfusion mismatch, V-Q
Hypoxic pulmonary vasoconstriction
Bronchial blockers are inflatable devices that can be used to selectively isolate one lung during surgery by occluding a bronchial opening. They are indicated when a double lumen endotracheal tube cannot be used due to difficult airway, cervical spine injuries, or other anatomical issues. Common types of bronchial blockers include the Univent tube, Cohen bronchial blocker, Fogarty embolectomy catheter, and Arndt endobronchial blocker, each with their own advantages and limitations.
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
Oxygen is essential for aerobic respiration in humans. It undergoes a "cascade" of decreasing partial pressure from the atmosphere into the mitochondria of cells. Key steps include uptake in the lungs (PaO2 of 100 mmHg), transport in blood bound to hemoglobin and dissolved in plasma, delivery to tissues, and cellular uptake and use. Hemoglobin's oxygen-binding curve allows for efficient oxygen loading in the lungs and unloading in tissues. Factors like pH, CO2, and 2,3-DPG regulate the curve to facilitate oxygen transport.
Low flow anaesthesia systems aim to reuse exhaled gases and minimize fresh gas flow. John Snow recognized in 1850 that most inhaled anaesthetics are exhaled unchanged, and rebreathing exhaled gases could prolong their effects. Developments over the 20th century led to widespread use of circle absorption systems. Factors like cost and pollution concerns have renewed interest in low flow anaesthesia. It requires a well-functioning circle system, gas monitoring, and attention to factors like circuit volume and gas solubility when initiating and maintaining the desired anaesthetic concentrations with minimal fresh gas flows.
Anesthesia Consideration in Pediatric and ObstetricsRifhan Kamaruddin
Pediatric patients have important physiological differences compared to adults that impact anesthesia care. Their respiratory systems have higher minute ventilation, oxygen consumption, and risk of airway closure. Blood volume is higher in neonates compared to older children and adults. The liver and kidneys are immature, increasing risk of hypoglycemia and difficulty excreting drugs. Thermoregulation is less developed, requiring measures to prevent hypothermia. Pre-operative assessment includes medical history, physical exam, and investigations to evaluate risk. Post-operative care focuses on preventing nausea, vomiting and adequately managing pain.
THRIVE is a method using warmed, humidified high flow oxygen via the nose to increase apnea time in patients with difficult airways. It works by flushing carbon dioxide from the nasopharynx, providing mechanical splinting and distention pressure, and allowing apneic oxygenation. A case series of 25 patients with difficult airways found THRIVE increased the median apnea time to 17 minutes without any oxygen saturations dropping below 90%, allowing more time for airway management. While observational and involving expert airway management, the study concludes THRIVE can safely extend the apnea window for difficult airway situations.
Cardiomyopathies are diseases of the heart muscle that cause it to be structurally and functionally abnormal without other known causes like coronary artery disease. There are several types including dilated, hypertrophic, restrictive, arrhythmogenic right ventricular, and Takotsubo cardiomyopathy. Anesthesia management aims to minimize negative inotropic effects, maintain appropriate preload and afterload, and prevent hypotension, arrhythmias, and tachycardia. Goals depend on the type of cardiomyopathy and whether systolic or diastolic dysfunction predominates. Close monitoring is important due to potential hemodynamic instability from anesthesia and surgery.
Bronchial blockers are inflatable devices that can be used to selectively isolate one lung during surgery by occluding a bronchial opening. They are indicated when a double lumen endotracheal tube cannot be used due to difficult airway, cervical spine injuries, or other anatomical issues. Common types of bronchial blockers include the Univent tube, Cohen bronchial blocker, Fogarty embolectomy catheter, and Arndt endobronchial blocker, each with their own advantages and limitations.
This document provides an overview of anesthesia considerations for laparoscopic surgeries. It discusses the history of laparoscopy, physiological effects of pneumoperitoneum including on the cardiovascular, respiratory, central nervous and renal systems. It also outlines respiratory complications like subcutaneous emphysema, pneumothorax, gas embolism and their treatment. The effects of patient positioning and conduct of anesthesia are summarized.
Oxygen is essential for aerobic respiration in humans. It undergoes a "cascade" of decreasing partial pressure from the atmosphere into the mitochondria of cells. Key steps include uptake in the lungs (PaO2 of 100 mmHg), transport in blood bound to hemoglobin and dissolved in plasma, delivery to tissues, and cellular uptake and use. Hemoglobin's oxygen-binding curve allows for efficient oxygen loading in the lungs and unloading in tissues. Factors like pH, CO2, and 2,3-DPG regulate the curve to facilitate oxygen transport.
Low flow anaesthesia systems aim to reuse exhaled gases and minimize fresh gas flow. John Snow recognized in 1850 that most inhaled anaesthetics are exhaled unchanged, and rebreathing exhaled gases could prolong their effects. Developments over the 20th century led to widespread use of circle absorption systems. Factors like cost and pollution concerns have renewed interest in low flow anaesthesia. It requires a well-functioning circle system, gas monitoring, and attention to factors like circuit volume and gas solubility when initiating and maintaining the desired anaesthetic concentrations with minimal fresh gas flows.
Anesthesia Consideration in Pediatric and ObstetricsRifhan Kamaruddin
Pediatric patients have important physiological differences compared to adults that impact anesthesia care. Their respiratory systems have higher minute ventilation, oxygen consumption, and risk of airway closure. Blood volume is higher in neonates compared to older children and adults. The liver and kidneys are immature, increasing risk of hypoglycemia and difficulty excreting drugs. Thermoregulation is less developed, requiring measures to prevent hypothermia. Pre-operative assessment includes medical history, physical exam, and investigations to evaluate risk. Post-operative care focuses on preventing nausea, vomiting and adequately managing pain.
THRIVE is a method using warmed, humidified high flow oxygen via the nose to increase apnea time in patients with difficult airways. It works by flushing carbon dioxide from the nasopharynx, providing mechanical splinting and distention pressure, and allowing apneic oxygenation. A case series of 25 patients with difficult airways found THRIVE increased the median apnea time to 17 minutes without any oxygen saturations dropping below 90%, allowing more time for airway management. While observational and involving expert airway management, the study concludes THRIVE can safely extend the apnea window for difficult airway situations.
Cardiomyopathies are diseases of the heart muscle that cause it to be structurally and functionally abnormal without other known causes like coronary artery disease. There are several types including dilated, hypertrophic, restrictive, arrhythmogenic right ventricular, and Takotsubo cardiomyopathy. Anesthesia management aims to minimize negative inotropic effects, maintain appropriate preload and afterload, and prevent hypotension, arrhythmias, and tachycardia. Goals depend on the type of cardiomyopathy and whether systolic or diastolic dysfunction predominates. Close monitoring is important due to potential hemodynamic instability from anesthesia and surgery.
One-lung ventilation (OLV) is used for thoracic surgeries to isolate one lung from the other. It requires skill to place lung isolation equipment like double-lumen endotracheal tubes (DLT) and prevent hypoxemia. DLTs have two lumens allowing independent ventilation of each lung. Placement is checked by auscultation and bronchoscopy to ensure proper position before surgery. Complications can include airway damage if the tube is malpositioned or overinflated. Careful technique and monitoring are needed for safe OLV.
This document discusses low flow anaesthesia. It defines low flow as 500-1000 ml/min of fresh gas flow. The document outlines the technical requirements for safely conducting low flow anaesthesia, including monitors for inspired oxygen, end tidal CO2 and anaesthetic concentrations. It describes the initiation, maintenance and emergence phases of low flow anaesthesia, emphasizing achieving and maintaining an appropriate anaesthetic depth. The document discusses advantages like reduced cost and pollution compared to higher fresh gas flows.
This document provides an overview of obstructive sleep apnea (OSA) and its implications for anesthesia. It defines OSA and discusses its causes, diagnosis, and physiological effects. It outlines risks of anesthesia for those with OSA, including difficult intubation and postoperative respiratory depression. It recommends preoperative screening and treatment with CPAP or weight loss. Intraoperatively, it advises securing the airway and avoiding sedatives that could cause collapse. Postoperatively, supplemental oxygen is important due to risk of apnea and respiratory depression upon waking.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
This document summarizes the oxygen cascade from the atmosphere to tissues. It describes how oxygen partial pressure decreases stepwise from the lungs to mitochondria. Key points include how partial pressures, diffusion, hemoglobin binding, and the oxyhemoglobin dissociation curve influence oxygen delivery. Physiologic and pathologic factors that can shift the curve right or left, improving or impairing oxygen release, are also reviewed.
The document discusses one lung ventilation (OLV), which involves separately ventilating each lung during thoracic surgery. It covers the respiratory physiology of OLV, including how factors like anesthesia, paralysis, chest opening, and positioning impact ventilation and perfusion in the dependent versus non-dependent lungs. Specifically, it notes that while blood flow favors the dependent lung, ventilation is altered to favor the non-dependent lung due to changes in lung compliance. This can lead to ventilation-perfusion mismatches and hypoxemia.
This document discusses low-flow and minimal-flow anesthesia techniques. It begins by defining low-flow as a fresh gas flow of 1 L/min and minimal-flow as 0.5 L/min. Rebreathing systems allow reuse of exhaled gases after removal of carbon dioxide. Using these techniques can reduce costs by 55-75% and minimize environmental pollution from volatile anesthetic gases. Proper monitoring and maintenance of breathing gas conditions is important for patient safety when using low fresh gas flows.
This document provides information on the anaesthetic management of surgery for Tetralogy of Fallot (TOF). It describes the key anatomical features of TOF and its variants. It outlines the natural history of untreated TOF, including risks of cyanotic spells, heart failure and early death. The document discusses the goals of palliative and corrective surgeries, including the modified Blalock-Taussig shunt. It provides guidance on preoperative evaluation, intraoperative management and goals of anaesthesia to optimize hemodynamics and oxygenation during surgery.
COPD patients pose challenges for anesthesiologists due to increased risk of intraoperative and postoperative complications. The document discusses COPD definitions, pathophysiology, preoperative evaluation including pulmonary function tests, effects of smoking and benefits of smoking cessation. It also covers preoperative preparation including bronchodilation and options for anesthetic technique including benefits of neuraxial anesthesia for COPD patients.
This document discusses options for lung isolation during surgery, including double lumen tubes (DLTs) and bronchial blockers. It provides details on:
1) The history and development of DLTs from the 1950s onward, including specific DLT designs like the Carlens tube.
2) Guidance on proper DLT placement using bronchoscopy to position the endobronchial cuff below the carina in the left or right bronchus.
3) Both advantages and disadvantages of DLTs and bronchial blockers for lung isolation are outlined. Positioning DLTs requires bronchoscopy while blockers can be placed through a standard endotracheal tube but dislodge
The document provides information on the management of intra-operative bronchospasm, including risk factors, triggers, diagnosis, prevention, and treatment approaches. Bronchospasm can be caused by airway irritation or anaphylaxis and presents with signs of wheezing, increased airway pressures, and falling oxygen saturation. Differential diagnoses must be ruled out. Management involves deepening anesthesia, administering bronchodilators, optimizing ventilation, and considering anaphylaxis or postponing surgery. A case example demonstrates treatment of bronchospasm potentially caused by succinylcholine-induced anaphylaxis.
A breathing system connects the patient's airway to the anesthesia machine, creating an artificial atmosphere for breathing. It has components like a fresh gas entry port, reservoir bag, patient connection port, and expiratory port. Breathing systems are classified based on gas flow direction and whether they absorb carbon dioxide. Common systems include the non-rebreathing system, circle system, and Bain circuit. The optimal fresh gas flow depends on the system and whether ventilation is spontaneous or controlled. Proper functioning relies on minimizing apparatus dead space and balancing the fresh gas flow with alveolar ventilation.
An anesthesia circuit connects the anesthesia machine to the patient to deliver anesthetic gases and remove carbon dioxide. Various circuit designs exist, including open, semi-open, semi-closed, and closed systems. The ideal circuit is reliable, safe, and easy to use while imposing minimal resistance and dead space. The circle system allows for rebreathing of gases using low fresh gas flows and includes unidirectional valves, tubing, a Y-piece, reservoir bag, and carbon dioxide absorber. Soda lime is commonly used for carbon dioxide absorption but its interaction with anesthetic agents can produce toxic compounds.
The 2000 ASTM F1850-00 standard states that anesthesia gas supply devices must be designed so that whenever oxygen supply pressure is reduced below the manufacturer's minimum specification, the delivered oxygen concentration does not decrease below 19% at the common gas outlet. The standard also requires alarms to sound within 5 seconds if oxygen supply pressure falls below approximately 200 kPa. Safety features of anesthesia machines include oxygen/nitrous oxide proportioning systems, oxygen failure safety devices, oxygen supply failure alarms, and vaporizer interlocks.
The document discusses various paediatric breathing circuits used in anaesthesia. It describes the key components and classifications of breathing circuits. The most commonly used circuits include the Mapleson A (Magill) system, which is best for spontaneous breathing but requires high fresh gas flows. The Mapleson D and Bain circuits are efferent reservoir systems that work efficiently for controlled ventilation. The Ayre's T-piece is a simple no-valve circuit designed for paediatric use. The document provides details on the construction, functioning and advantages of these different breathing circuit designs.
Anaesthetic considerations for laser surgeryAnamika yadav
This document discusses anaesthetic considerations for laser surgery. It begins by outlining the objectives which are to discuss the types of lasers used, preoperative assessment and preparation, airway management and ventilation options, laser hazards and prevention, and crisis management for airway fires. It then provides details on the types of lasers used clinically, biological effects of lasers, and clinical applications of lasers. The role of anesthesiologists is to maintain oxygenation, remove carbon dioxide, keep the patient anesthetized, and reduce risks. Various airway management techniques and their advantages/disadvantages are discussed such as intubation, spontaneous ventilation, insufflation, and jet ventilation. Laser hazards like atmospheric contamination, perforation
1. Tonsillectomy requires maintaining deep general anesthesia to prevent reflex responses during the procedure while allowing for rapid recovery of airway reflexes.
2. Intubation is usually done under deep inhalational or muscle relaxant anesthesia to prevent bucking, and the tube is secured to prevent aspiration of blood or secretions.
3. During the procedure, inhaled anesthetics with opioids or muscle relaxants are used to maintain adequate depth while monitoring for blood loss or airway issues.
Elderly patients represent the fastest growing population globally. They experience many age-related physiological changes that increase surgical risk. Preoperative evaluation and optimization is important to identify risks like cardiovascular disease and pulmonary issues. Anesthesia in the elderly requires lower doses of induction agents and opioids due to pharmacokinetic changes. Regional anesthesia may provide benefits over general anesthesia. Close postoperative monitoring is needed due to risks of complications like delirium, cognitive dysfunction, hypotension, and hypothermia.
The document discusses strategies for safe suctioning of patients to avoid potential cardiac hazards. It covers anatomy related to suctioning, a brief history of suctioning techniques, definitions, indications for suctioning, and various hazards associated with suctioning including patient anxiety, changes in intracranial pressure, trauma, infection, pneumothorax, and hypoxia. The objectives are to familiarize nursing staff with safe suctioning techniques and ways to reduce cardiac hazards through both theoretical and practical teaching.
This document discusses gastrointestinal intubation, specifically nasogastric tubes. It describes the different types of tubes used, their indications, and the process for intubating a patient and ensuring proper tube placement. Complications from nasogastric intubation and feeding are also outlined.
One-lung ventilation (OLV) is used for thoracic surgeries to isolate one lung from the other. It requires skill to place lung isolation equipment like double-lumen endotracheal tubes (DLT) and prevent hypoxemia. DLTs have two lumens allowing independent ventilation of each lung. Placement is checked by auscultation and bronchoscopy to ensure proper position before surgery. Complications can include airway damage if the tube is malpositioned or overinflated. Careful technique and monitoring are needed for safe OLV.
This document discusses low flow anaesthesia. It defines low flow as 500-1000 ml/min of fresh gas flow. The document outlines the technical requirements for safely conducting low flow anaesthesia, including monitors for inspired oxygen, end tidal CO2 and anaesthetic concentrations. It describes the initiation, maintenance and emergence phases of low flow anaesthesia, emphasizing achieving and maintaining an appropriate anaesthetic depth. The document discusses advantages like reduced cost and pollution compared to higher fresh gas flows.
This document provides an overview of obstructive sleep apnea (OSA) and its implications for anesthesia. It defines OSA and discusses its causes, diagnosis, and physiological effects. It outlines risks of anesthesia for those with OSA, including difficult intubation and postoperative respiratory depression. It recommends preoperative screening and treatment with CPAP or weight loss. Intraoperatively, it advises securing the airway and avoiding sedatives that could cause collapse. Postoperatively, supplemental oxygen is important due to risk of apnea and respiratory depression upon waking.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
This document summarizes the oxygen cascade from the atmosphere to tissues. It describes how oxygen partial pressure decreases stepwise from the lungs to mitochondria. Key points include how partial pressures, diffusion, hemoglobin binding, and the oxyhemoglobin dissociation curve influence oxygen delivery. Physiologic and pathologic factors that can shift the curve right or left, improving or impairing oxygen release, are also reviewed.
The document discusses one lung ventilation (OLV), which involves separately ventilating each lung during thoracic surgery. It covers the respiratory physiology of OLV, including how factors like anesthesia, paralysis, chest opening, and positioning impact ventilation and perfusion in the dependent versus non-dependent lungs. Specifically, it notes that while blood flow favors the dependent lung, ventilation is altered to favor the non-dependent lung due to changes in lung compliance. This can lead to ventilation-perfusion mismatches and hypoxemia.
This document discusses low-flow and minimal-flow anesthesia techniques. It begins by defining low-flow as a fresh gas flow of 1 L/min and minimal-flow as 0.5 L/min. Rebreathing systems allow reuse of exhaled gases after removal of carbon dioxide. Using these techniques can reduce costs by 55-75% and minimize environmental pollution from volatile anesthetic gases. Proper monitoring and maintenance of breathing gas conditions is important for patient safety when using low fresh gas flows.
This document provides information on the anaesthetic management of surgery for Tetralogy of Fallot (TOF). It describes the key anatomical features of TOF and its variants. It outlines the natural history of untreated TOF, including risks of cyanotic spells, heart failure and early death. The document discusses the goals of palliative and corrective surgeries, including the modified Blalock-Taussig shunt. It provides guidance on preoperative evaluation, intraoperative management and goals of anaesthesia to optimize hemodynamics and oxygenation during surgery.
COPD patients pose challenges for anesthesiologists due to increased risk of intraoperative and postoperative complications. The document discusses COPD definitions, pathophysiology, preoperative evaluation including pulmonary function tests, effects of smoking and benefits of smoking cessation. It also covers preoperative preparation including bronchodilation and options for anesthetic technique including benefits of neuraxial anesthesia for COPD patients.
This document discusses options for lung isolation during surgery, including double lumen tubes (DLTs) and bronchial blockers. It provides details on:
1) The history and development of DLTs from the 1950s onward, including specific DLT designs like the Carlens tube.
2) Guidance on proper DLT placement using bronchoscopy to position the endobronchial cuff below the carina in the left or right bronchus.
3) Both advantages and disadvantages of DLTs and bronchial blockers for lung isolation are outlined. Positioning DLTs requires bronchoscopy while blockers can be placed through a standard endotracheal tube but dislodge
The document provides information on the management of intra-operative bronchospasm, including risk factors, triggers, diagnosis, prevention, and treatment approaches. Bronchospasm can be caused by airway irritation or anaphylaxis and presents with signs of wheezing, increased airway pressures, and falling oxygen saturation. Differential diagnoses must be ruled out. Management involves deepening anesthesia, administering bronchodilators, optimizing ventilation, and considering anaphylaxis or postponing surgery. A case example demonstrates treatment of bronchospasm potentially caused by succinylcholine-induced anaphylaxis.
A breathing system connects the patient's airway to the anesthesia machine, creating an artificial atmosphere for breathing. It has components like a fresh gas entry port, reservoir bag, patient connection port, and expiratory port. Breathing systems are classified based on gas flow direction and whether they absorb carbon dioxide. Common systems include the non-rebreathing system, circle system, and Bain circuit. The optimal fresh gas flow depends on the system and whether ventilation is spontaneous or controlled. Proper functioning relies on minimizing apparatus dead space and balancing the fresh gas flow with alveolar ventilation.
An anesthesia circuit connects the anesthesia machine to the patient to deliver anesthetic gases and remove carbon dioxide. Various circuit designs exist, including open, semi-open, semi-closed, and closed systems. The ideal circuit is reliable, safe, and easy to use while imposing minimal resistance and dead space. The circle system allows for rebreathing of gases using low fresh gas flows and includes unidirectional valves, tubing, a Y-piece, reservoir bag, and carbon dioxide absorber. Soda lime is commonly used for carbon dioxide absorption but its interaction with anesthetic agents can produce toxic compounds.
The 2000 ASTM F1850-00 standard states that anesthesia gas supply devices must be designed so that whenever oxygen supply pressure is reduced below the manufacturer's minimum specification, the delivered oxygen concentration does not decrease below 19% at the common gas outlet. The standard also requires alarms to sound within 5 seconds if oxygen supply pressure falls below approximately 200 kPa. Safety features of anesthesia machines include oxygen/nitrous oxide proportioning systems, oxygen failure safety devices, oxygen supply failure alarms, and vaporizer interlocks.
The document discusses various paediatric breathing circuits used in anaesthesia. It describes the key components and classifications of breathing circuits. The most commonly used circuits include the Mapleson A (Magill) system, which is best for spontaneous breathing but requires high fresh gas flows. The Mapleson D and Bain circuits are efferent reservoir systems that work efficiently for controlled ventilation. The Ayre's T-piece is a simple no-valve circuit designed for paediatric use. The document provides details on the construction, functioning and advantages of these different breathing circuit designs.
Anaesthetic considerations for laser surgeryAnamika yadav
This document discusses anaesthetic considerations for laser surgery. It begins by outlining the objectives which are to discuss the types of lasers used, preoperative assessment and preparation, airway management and ventilation options, laser hazards and prevention, and crisis management for airway fires. It then provides details on the types of lasers used clinically, biological effects of lasers, and clinical applications of lasers. The role of anesthesiologists is to maintain oxygenation, remove carbon dioxide, keep the patient anesthetized, and reduce risks. Various airway management techniques and their advantages/disadvantages are discussed such as intubation, spontaneous ventilation, insufflation, and jet ventilation. Laser hazards like atmospheric contamination, perforation
1. Tonsillectomy requires maintaining deep general anesthesia to prevent reflex responses during the procedure while allowing for rapid recovery of airway reflexes.
2. Intubation is usually done under deep inhalational or muscle relaxant anesthesia to prevent bucking, and the tube is secured to prevent aspiration of blood or secretions.
3. During the procedure, inhaled anesthetics with opioids or muscle relaxants are used to maintain adequate depth while monitoring for blood loss or airway issues.
Elderly patients represent the fastest growing population globally. They experience many age-related physiological changes that increase surgical risk. Preoperative evaluation and optimization is important to identify risks like cardiovascular disease and pulmonary issues. Anesthesia in the elderly requires lower doses of induction agents and opioids due to pharmacokinetic changes. Regional anesthesia may provide benefits over general anesthesia. Close postoperative monitoring is needed due to risks of complications like delirium, cognitive dysfunction, hypotension, and hypothermia.
The document discusses strategies for safe suctioning of patients to avoid potential cardiac hazards. It covers anatomy related to suctioning, a brief history of suctioning techniques, definitions, indications for suctioning, and various hazards associated with suctioning including patient anxiety, changes in intracranial pressure, trauma, infection, pneumothorax, and hypoxia. The objectives are to familiarize nursing staff with safe suctioning techniques and ways to reduce cardiac hazards through both theoretical and practical teaching.
This document discusses gastrointestinal intubation, specifically nasogastric tubes. It describes the different types of tubes used, their indications, and the process for intubating a patient and ensuring proper tube placement. Complications from nasogastric intubation and feeding are also outlined.
This document provides information about bag valve masks (BVM), including:
- What a BVM is and its components
- Its history of being discovered in 1953 by a German engineer and anesthesiologist
- Its uses in respiratory failure, arrest, ventilator failure, and patient transfers
- Potential complications if not used properly like gastric insufflation and lung injuries
- Tips for its proper use including ensuring a seal and using two rescuers when possible
We are having the broadest ranges of laryngoscopes available, including options to manage difficult airways, and improve procedural efficiency. For bulk orders feel free to visit our website.
Enteral Feeding Tubes for Drug AdministrationSurya Amal
The placement of a feeding tube in the gastrointestinal tract opens the possibility of drug delivery through this via, also reducing the risk of administration of injectable dosage forms.
This document discusses the anatomy of the tracheobronchial tree and its clinical applications. It begins by outlining the anatomical and physiological divisions of the tracheobronchial tree. It then describes the anatomy of the trachea, bronchi, bronchopulmonary segments, and alveoli. It discusses clinical uses such as foreign body removal, changes in endotracheal tube position with neck movement, localization of lung infections based on patient position, and lung isolation techniques for thoracic surgery. Postural drainage techniques are also covered. The document provides detailed diagrams and notes on landmarks and procedures related to the tracheobronchial tree.
URINARY CATHETER SKILLS AND CARE: DR SWAPNIL TOPLE, DNB UROLOGYDr. Swapnil Tople
The document discusses urinary catheters, including their history, types, uses, and procedures for insertion and care. It was originally developed as an open drainage system in the 1920s and later evolved to include closed drainage systems. Catheters are used to drain and collect urine from the bladder for various indications such as urinary retention, monitoring output, drainage after surgery, and instilling medications. Complications include urinary tract infections and difficulties removing catheters due to encrustations or entrapped balloons.
The document discusses nasogastric tube insertion and feeding. It defines a nasogastric tube and describes its purposes such as feeding when oral intake is not possible or relieving vomiting. The procedure for NGT insertion is outlined, including measuring tube length, lubricating it, and passing it through the nose into the stomach. Types of feeding like bolus and continuous are covered, as well as preparing feeds, monitoring placement, and managing complications like feeding intolerance.
This document outlines guidelines for caring for and ensuring proper placement of nasogastric (NG) and nasojejunal (NJ) feeding tubes in ICU patients. It discusses measuring and marking tubes for insertion, checking placement with pH testing and x-rays, recommended check times, and implications for practice including daily checks, replacing tubes every 4-6 weeks, and following guidelines if placement is uncertain. The aim is to follow Trust policy and NPSA guidelines to safely care for tubes and prevent potential harm from misplacement.
A blended approach to training Registered Nurses in Nasogastric Tube Insertio...Henry Fuller
This presentation was delivered by Henry Fuller at the 2014 Show and TEL event hosted by Health Education England and the Higher Education Academy. It discusses the benefits of using e-Learning as part of a blended approach to deliver the theoretical knowledge required for nasogastric tube insertion and ongoing care for adults. It also gives best practice guidance for different approaches to instructional design.
Manual respiratory bypass (MRB), also known as a bag valve mask (BVM), is a hand-held device used to provide ventilation to patients who are not breathing adequately. It consists of an ambu bag, valve, and face mask. The ambu bag was developed in the 1950s and works by using a one-way valve to direct gas from the bag into the patient's lungs when compressed. MRB is commonly used in emergency situations until a patient can breathe on their own or more advanced care is available. It provides oxygenation and ventilation by sealing the face mask and squeezing the ambu bag to inflate the lungs.
The document provides instructions for placing a nasogastric tube, including preparing the necessary equipment, explaining the procedure to the patient, inserting the tube into the stomach, confirming proper placement, securing the tube, feeding the patient through the tube, and removing the tube. It also describes how to check gastric aspirate to evaluate for abnormalities and how to care for the tube and patient during use of the nasogastric tube.
One-lung ventilation (OLV) involves separating the lungs so each functions independently using devices like double-lumen endotracheal tubes (DLTs) or bronchial blockers. DLTs have two lumens and cuffs to isolate each mainstem bronchus. The most commonly used DLT is the Robertshaw tube, which comes in sizes from 28-41 French. Placement is confirmed with auscultation and fiberoptic bronchoscopy. Complications include impaired oxygenation and airway trauma. Bronchial blockers like the Univent tube can also achieve OLV but require a single-lumen tube. Wire-guided bronchial blockers are advantageous for difficult airways but do not allow su
This document provides information on nasogastric tube feeding including:
1. It defines nasogastric tube feeding as administering food directly into the stomach through a tube inserted through the nose or mouth.
2. It lists indications for nasogastric tube feeding such as head/neck injuries, coma, obstruction of the esophagus or oropharynx, and increased metabolic needs from burns or cancer.
3. It describes the procedure for nasogastric tube feeding including assessing the patient, placing the feeding tube, administering the feeding slowly by gravity, and monitoring the patient after feeding.
The document describes several medical devices used in pediatric care including laryngoscopes, oxygen masks and reservoirs, nebulizers, tongue depressors, clinical thermometers, infant feeding tubes, and simple rubber catheters. It provides information on the indications, uses, sizes, and procedures for each device.
This document reviews tracheal bronchi and strategies for one-lung ventilation in patients with this anomaly. It begins with background on tracheal bronchi, including that they are a congenital anomaly occurring in 0.1-3% of people. It then discusses three classifications of tracheal bronchi and strategies for one-lung ventilation using double lumen tubes, bronchial blockers, or a single lumen tube. Key approaches involve using the classification to select the best device and techniques like sequential lung isolation.
The document discusses nasogastric or gavage feeding, which is an artificial feeding method that involves inserting a tube through the nose and into the stomach. It is used when oral feeding is not possible, such as for children undergoing oral surgery or who are unconscious. The document outlines the procedure for nasogastric tube placement and feeding, including necessary equipment, measuring the tube, inserting the tube into the nose and stomach, securing it, and feeding the patient. It also discusses aftercare once the feeding is complete.
This document provides information on the use of a laryngoscope, including indications, contraindications, and procedures. It is used prior to intubation in infants for conditions like neonatal asphyxia or respiratory distress, and in older children for resuscitation or anesthesia. Direct laryngoscopy is also used to examine the larynx for issues like cord palsy or foreign bodies. The procedure involves lubricating and advancing the laryngoscope behind the epiglottis while examining various structures, with risks including mechanical injury or stimulating a vago-vagal response.
Oropharyngeal , nasopharyngeal and naso tracheal suctioningJessica Saldana
This document provides guidance on oropharyngeal, nasopharyngeal, and tracheal suctioning. It discusses the purposes of suctioning, including removing secretions to clear the airway and facilitate ventilation. Assessment factors like respiratory sounds and oxygen saturation are outlined. Proper planning includes delegation considerations and sterile technique for some procedures. Equipment needs and step-by-step implementation instructions are detailed for oral/oropharyngeal and nasopharyngeal/nasotracheal suctioning. Positioning, catheter insertion depth, and suction pressure levels are addressed.
This document discusses the procedure for nasogastric tube insertion and removal. It describes the types of NG tubes used, the equipment needed, and steps to take to ensure proper placement. Key steps include lubricating the tube, having the patient swallow as it's advanced, checking placement by aspirating stomach contents and using a pH test strip, and securing the tube to the nose with tape. For removal, the tube is flushed, untaped, and gently withdrawn while having the patient hold their breath.
PHYSIOLOGY OF One lung ventilation.pptxananya nanda
This document discusses the physiology of one lung ventilation during pulmonary resection surgery. It covers respiratory physiology in supine and lateral decubitus positions, changes during one lung ventilation including hypoxic pulmonary vasoconstriction. It emphasizes the importance of pre-anesthetic assessment including pulmonary function tests, cardiac evaluation, and cardiopulmonary exercise testing to evaluate patient risk and suitability for lung resection surgery.
This document discusses one lung ventilation (OLV), which involves ventilating one lung while collapsing the other lung to provide surgical access. It begins by outlining the principles and history of OLV. It then discusses the advantages and absolute/relative indications for OLV. The document goes on to explain the changes in respiratory physiology and ventilation-perfusion matching that occur with OLV compared to two lung ventilation in various positions (awake, anesthetized, open chest). It also covers hypoxic pulmonary vasoconstriction and strategies to optimize oxygenation during OLV.
This document summarizes anesthesia considerations for pneumonectomy. It discusses pre-operative assessment of cardiopulmonary function to determine risk. Intra-operatively, techniques for lung isolation include double lumen tubes, bronchial blockers, or endobronchial tubes. Positioning is lateral, and one-lung ventilation requires strategies to manage hypoxemia. Post-operative monitoring and pain management involve thoracic epidural analgesia, intercostal blocks, and systemic opioids or NSAIDs to prevent complications like respiratory failure, hemorrhage, or pulmonary edema.
Here are a few options to achieve selective ventilation of the left lower lobe:
1. Use a left sided DLT and position the bronchial lumen just above the take off of the left lower lobe bronchus under fiberoptic guidance. This would allow ventilation of the remaining left lung while isolating the left lower lobe.
2. Use a bronchial blocker like an Arndt blocker under fiberoptic guidance to occlude just the left lower lobe bronchus, allowing ventilation of the rest of the left lung.
3. Use a Fogarty catheter under fiberoptic guidance to occlude just the left lower lobe bronchus.
For the post right pneumonectomy patient now with
Anesthesia for thoracic surgery (2).pptxssuserb91f2d
1. Anesthesia for thoracic surgery requires establishing adequate lung separation, maintaining gas exchange, and ensuring circulatory stability during one-lung anesthesia.
2. One-lung anesthesia involves isolating the bronchus of the dependent lung using a double-lumen endotracheal tube to permit ventilation while the non-dependent lung is deflated for surgery.
3. Hypoxemia during one-lung ventilation can be managed by optimizing patient positioning, applying PEEP to the dependent lung, increasing FiO2, and occasionally converting briefly to two-lung ventilation.
1. Anesthesia for thoracic surgery requires establishing adequate lung separation, maintaining gas exchange, and ensuring circulatory stability during one-lung anesthesia.
2. One-lung anesthesia involves isolating the bronchus of the dependent lung using a double-lumen endotracheal tube to permit ventilation while the non-dependent lung is deflated for surgery.
3. Management of anesthesia focuses on controlled ventilation, suppression of cough and reflexes, and permitting rapid recovery. Positioning of the double-lumen tube must be confirmed with fiberoptic bronchoscopy to ensure proper lung isolation.
one lung ventilation and anaesthetic management and considerationsganeshrhitnalli
This document discusses one lung ventilation (OLV) techniques and physiology. It describes how OLV is used to selectively ventilate one lung during thoracic surgery on the other lung. Double lumen endotracheal tubes are most commonly used for OLV, allowing independent ventilation of each lung by blocking gas flow to one bronchus. Placement of the tube and resulting ventilation/perfusion changes in each lung are impacted by patient position, anesthesia, and muscle paralysis. Hypoxic pulmonary vasoconstriction plays an important role in minimizing blood flow and shunt in the non-ventilated lung.
High frequency ventilation (HFV) uses very high rates of breathing (2.5-15 Hz) combined with low tidal volumes (0.5-5 ml/kg). There are several types of HFV including high frequency oscillatory ventilation and high frequency jet ventilation. HFV works through mechanisms like convection, pendelluft effect, and molecular diffusion to improve gas exchange with small tidal volumes. It allows adequate gas exchange and oxygenation using lower airway pressures, reducing the risk of lung injury. Settings like mean airway pressure, amplitude, and frequency are adjusted based on the patient's oxygenation and ventilation needs. HFV is effective for various lung conditions but requires careful monitoring to optimize outcomes.
One lung ventilation (OLV) allows individual ventilation of each lung during thoracic surgery. It provides advantages like preventing contamination between lungs and optimal surgical exposure. OLV is indicated for procedures involving one lung, lung isolation, or severe hypoxemia. The lateral decubitus position is used, with gravity redistributing perfusion to the dependent lung. Methods for OLV include double lumen endotracheal tubes and bronchial blockers. Hypoxic pulmonary vasoconstriction helps redistribute blood flow away from hypoxic lung regions to minimize shunting. Care must be taken to optimize dependent lung ventilation and avoid hypoxemia during OLV.
Anesthesia for thoracic surgery (2) (4).pptxssuserb91f2d
1. Anesthesia for thoracic surgery requires establishing adequate lung separation, maintaining gas exchange, and ensuring circulatory stability during one-lung anesthesia.
2. This is typically achieved through use of a double-lumen endotracheal tube or bronchial blocker to isolate the lungs, along with positive pressure ventilation, intravenous induction and maintenance of anesthesia, and thoracic epidural analgesia.
3. Challenges include ventilation/perfusion mismatching when the dependent lung is compressed but still highly perfused during surgery in the lateral decubitus position.
Here is a presentation about the double lung ventilation or independent lung ventilation
I hope it will be helpful
There are some videos in the presentation , here is the links :)
http://www.youtube.com/watch?v=w1cgx2AVC6k&list=UUUIWCsRV3siWB-jzBmNg6pA
http://www.youtube.com/watch?v=JZkOiy4PXxg&list=UUUIWCsRV3siWB-jzBmNg6pA
http://www.youtube.com/watch?v=mlS35eUUxqA&list=UUUIWCsRV3siWB-jzBmNg6pA
This document discusses surgical lung volume reduction (LVRS) and bronchoscopic lung volume reduction (BLVR) for treating COPD. LVRS involves removing 20-35% of the most damaged lung regions, improving lung function. BLVR inserts valves in damaged lung regions to cause atelectasis and improve function. However, BLVR is less effective in patients with collateral ventilation between lung regions, which prevents full atelectasis. Collateral ventilation is increased in emphysema due to destroyed bronchioles but reduced in fibrosis due to decreased lung volume. Techniques like xenon scans and MRI can measure collateral ventilation levels.
This document discusses one-lung ventilation (OLV) using double-lumen tubes (DLTs). OLV separates the lungs to isolate and ventilate only one lung during thoracic surgery. It provides protection from infection/bleeding and improved surgical exposure. The document covers DLT placement techniques, checking placement, and managing gas exchange and ventilation during OLV to optimize oxygenation and prevent hypercarbia. Factors that increase the risk of desaturation during OLV like preoperative lung function abnormalities are also discussed.
One Lung Ventilation (OLV) is a technique used during thoracic surgery to isolate one lung allowing it to function independently. There are several methods to achieve OLV including using a double lumen endotracheal tube, Univent tube, or endobronchial blockers. OLV provides benefits like protecting the healthy lung during surgery on the other lung but also causes physiological changes and risks like hypoxemia. Care must be taken to properly position the lung isolation device and monitor for complications during OLV.
This document summarizes bronchoscopic lung volume reduction therapies for treating emphysema. It describes the pathophysiology of emphysema and indications for lung volume reduction surgery. Several minimally invasive bronchoscopic techniques are discussed, including endobronchial valves, thermal vapor ablation, airway bypass stents, and biological sealants. Endobronchial valves and thermal vapor ablation are best suited for treating heterogeneous emphysema, while airway bypass stents can target homogeneous emphysema. These bronchoscopic therapies provide alternatives to lung volume reduction surgery with fewer complications.
The document discusses factors that can predict and cause hypoxemia during one-lung ventilation (OLV) for thoracic surgery. It notes that preoperative pulmonary function tests are not reliable predictors, but that oxygen levels during two-lung ventilation or with high oxygen are better predictors. The main cause of hypoxemia is inadequate hypoxic pulmonary vasoconstriction in the non-ventilated lung from issues like double lumen tube malposition or collapse. Strategies to prevent hypoxemia include high oxygen levels, continuous positive airway pressure to the non-ventilated lung, and re-inflating the lung if needed. Future techniques may involve modulating pulmonary blood flow pharmacologically.
Similar to Anaesthetic problems of open chest and pathophysiology of one lung ventilation (20)
This document discusses trigeminal neuralgia (TN), a painful neurological condition that causes severe, sporadic facial pain. It begins with background on TN, describing its distinctive clinical history and pain patterns. The document then covers TN's anatomy and potential pathophysiologies, risk factors, characteristics, treatment options, complications, and prognosis over time. TN is caused by compression or irritation of the trigeminal nerve and presents as sudden, severe facial pain that may be triggered by everyday activities like chewing. While medication can provide initial relief, over time additional treatments like surgery may be needed to control breakthrough pain from this disabling condition.
Pulmonary artery catheterisation, Cardiac surgeries, Non cardiac surgeries, LVEDD and PA pressure relationship, Technique and complications of PA placement
This document discusses extracorporeal circulation, specifically cardiopulmonary bypass (CPB) used during open heart surgery. It describes the basic CPB circuit including components like the venous cannula, reservoir, pump, heat exchanger, oxygenator, and arterial cannula. It outlines the steps of CPB including priming, anticoagulation, cannulation, initiating bypass, maintenance on bypass, weaning from bypass, and potential complications. CPB temporarily takes over the functions of the heart and lungs to provide a still, bloodless field for cardiac surgery using mechanical devices placed outside the body.
Effects of anaesthetic agents on the cardiovascular systemaratimohan
The document discusses the cardiovascular effects of various anesthetic agents. It notes that volatile agents like halothane and enflurane cause decreases in blood pressure mainly through effects on myocardial contractility, while isoflurane, desflurane and sevoflurane lower blood pressure primarily by decreasing systemic vascular resistance. These agents also attenuate the baroreceptor reflex. Intravenous induction agents can cause an initial drop in blood pressure due to vasodilation, which is compensated for by an increase in heart rate, but may lead to hypotension in vulnerable patients. Barbiturates, benzodiazepines and other intravenous agents have varying effects depending on their class.
Physiology of coagulation.
Coagulation disorders, evaluation, treatment and anaesthetic implications.
Thromboelastography and its relevance to Liver transplant and anaesthetic management of the same. Complete with TEG images of liver transplant patients at various phases of the surgery
Anaesthesia for joint replacement surgeriesaratimohan
This document provides an overview of the anaesthetic management considerations for joint replacement surgeries. It discusses the common joints replaced, patient characteristics, comorbidities to assess, and techniques for hip and knee replacements. For hip replacements, it covers surgical approaches, positioning risks, blood loss management using controlled hypotension, and cement implantation syndrome risks. For knee replacements, it discusses nerve blocks, tourniquet use risks like nerve injury, and managing tourniquet pain. Thromboprophylaxis guidelines are also reviewed.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
Anaesthetic problems of open chest and pathophysiology of one lung ventilation
1. DR. ARATI MOHAN BADGANDI
PROBLEMS OF OPEN
CHEST AND
PATHOPHYSIOLOGY OF
ONE-LUNG VENTILATION
2. INTRODUCTION
Principle of one lung ventilation is one lung for the surgeon
and one for the anesthetist.
The collapsed lung gives good access to surgeon and the
uncollapsed lung is used by the anesthetist to oxygenate.
Originally One Lung Ventilation was carried out to prevent
spillage of infected materials, mucous, tumour materials from
diseased Lung to normal Lung during Lung Surgeries.
GALES and waters first reported the use of selective Lung
Ventilation during thoracic surgeries in 1931.
1949 Carlens originated P.V.C disposable DLT.
Rowbatham introduced a DLT in 1962.
3. ADVANTAGES OF OLV
Independent channel for ventilation and suctioning.
Isolation of normal lung from diseased, thereby preventing
contamination by infected secretion, mucous, tumour
materials.
Independent collapse of lung to be operated and reexpansion
when needed.
Provides optional operating condition facilitating easy
approach; retraction of affected area with minimal stretching
and trauma to tissues.
Provides blood less field and shortens the duration of surgery.
Complete collapse of lung facilitates other surgeries - spinal,
laproscopic assisted vagotomy, oesophageal.
Avoids complication of prone position.
6. TECHNIQUES OF PROVIDING OLV
In general three techniques are used-
1. DLT.(DOUBLE LUMEN TUBE).
2. Bronchial Blockers(univent tubes)
3. Single Luman Endobronchial tubes.
Arterial hypoxemia is the main pathophysiological change
during OLV.
7. Pathophysiology in awake patient
with closed chest in lateral
decubitus
During spontaneous ventilation the dependent lung is better
ventilated than the non-dependent one.
On induction of GA with NM paralysis both lungs move down
on the pressure volume curve.
Perfusion:
Dependent lung better perfused.
Blood flow to non dependent lung is decreased by 10%
Rt lung Bf :45% (55%)
Lt lung Bf :35% (45%)
8.
9.
10.
11.
12. PATHOPHYSIOLOGY IN Anesthetised
PATIENT WITH closed chest IN LDP
Perfusion : induction of anesthesia does not cause any change
in perfusion .
Ventilation : GA decreases FRC hence compliance
Mediastinum rests on dependent lung thus impeding
expansion.
Weight of abdominal contents pushing the diaphragm impedes
lower lung expansion.V/Q MISMATCH
13. Compression (with loss of FRC) of the dependent lung and
restriction of its excursion (decrease in compliance) by the
mediastinum.
Cephalad movement of the abdominal organs against the
flaccid diaphragm, and exaggerated flexed position with chest
rolls to free the axillary contents occurs in LDP.
The net result is that the non-dependent lung is better
ventilated - FRC 1.5 times that of the dependent lung.
This leads to (V/Q) mismatching, as the dependent lung is
better perfused and under ventilated and the non-dependent
lung is under perfused and better ventilated.
Gravity has no significant effect on distribution of ventilation
during IPPV in the lat. decubitus position.
14. PATHOPHYSIOLOGY OF ANAESTHETISED
PATIENT WITH OPEN CHEST IN LDP
Perfusion : not altered (dependent> nondependent).
Ventilation: upper lung is better ventilated as it is no longer
restricted by chest wall.
When the non-dependent hemithorax is opened, there is
further increase in FRC and compliance of the non-dependent
lung and a decrease of these parameters of the dependent lung
with two-lung ventilation.
This causes further deterioration of ventilation perfusion
mismatch.
When the non-dependent lung is collapsed, the blood flow to
that lung is not oxygenated leading to increased P (A-a) O2
gradient and impaired oxygenation.
15.
16. PATHOPHYSIOLOGY OF LDP & OLV-
V/Q MISMATCH
V/Q Mismatch is due to creation of an OBLIGATORY RT TO LT
TRANS PULMONARY SHUNT .
During 2 Lung Ventilation in LDP-60% of Cardiac Output (CO)
goes to dependent Lung and 40% to Non dependent Lung
Normal Venous admixture is 10% and is equally shared(5%+5%)
between two lungs.
So average percentage of CO participating in gaseous exchange
in Non-dependent-Lung is 35%; and in dependent Lung in 55%.
In OLV: the dependent lung ventilated with whole of tidal
volume and non-dependent lung in NOT Ventilated, but still
perfused.
17. The result is creation of an obligatory R-L TRANS
PULMONARY SHUNT through Non ventilated non dependent
lung that is 35% of CO-not oxygenated .
Un-inhibited H.P.V. reduce 50% of blood flow to the NON-
VENTILATED Lung - blood flow becomes 17.5% (35/2) and
shunt will be also 17.5% only.
If this is added to 5% of existing shunt the total shunt in NON-
VENTILATED Lung will be 22.5(17.5+5)%.
So altogether in OLV the shunt will be 27.5% (22.5+5) causing
impairement optimal PaO2.
Other factors like absorption atelectasis due to circum ferential
compression of dependent lung
Accumulation of secretion and fluid transudate (particularly in
prolonge surgery and anesthesia) in dependent lung low V/Q
and increase P(A-a) O2 gradient and impaired oxygenation.
21. PHYSIOLOGY OF LDP & OLV-
V/Q MISMATCH
RECTIFIED BY:
Adequate ventilation to dependent lung- increase FIO2
Adjustment of I:E (1:2) ratio
RR to keep CO2 40mg Hg.(20% increase)
Limiting Inspiratory flow and Expiratory airway resistance
(unchanged Minute Ventilation)
Vigilent monitoring of peak inspiratory pressure. Sao2,PETCO2
if possible ABG.
Maintaining optimal CO
Suctioning of dependent lung as and when needed.
Avoiding Over enthusiastic Hyperventilation.
22. Hypoxemia in OLV
FRC REDUCTION is another important cause of hypoxemia.
Causes are-
1. In LDP-Shifting intra abdominal content, causes cephaled
shift of Diaphragm reducing FRC.
2. GA and the mechanical effects of ventilation.
3. Weight of sagging Mediastinum
4. Sub-optimal position of the patient with rolls and packs on
the operation table as shoulder support
23. Hypoxemia in OLV
CAN BE OPTIMISED BY:
Vigilent Monitoring of vital parameters
Optimal ventilatory settings of dependent lung so that-
inspiratory pressure not more than 30cm.
PEEP to the ventilated lung to recruit collapsed under
ventilated alevoli of dependent lung
will improve FRC/V/Q ratio and oxygenation
24. Hypoxemia in OLV
Application of CPAP to Non-Ventilated lung,
increases oxygenation by improving V/Q ratio and causing
vasoconstriction; then diversion of perfused blood to dependent
lung.
This can be possible only when there is no major leak of
bronchial tre as not helpful with broncho plural fistula and
massive pulmonary hemorrhage etc.,
Institution of both lung ventilation periodically in long surgical
procedure.
Maintaining optimal CO through out the procedure.
25. HYPOXIC PULMONARY VASOCONSTRICTION
HPV is an auto regulatory mechanism that maintain Pao2 by
decreasing amount shunt flow through hypoxic non
ventilated lung.
HPV primarily occurs in pulmonary arterioles of 200µm
diameter which are situated close to small bronchiole and
alveoli.
Precise mechanism of HPV not known.
Various theories have been put forth:
Direct action on pulmonary smooth muscle cells, sensed
by mitochondrial electron transport chain ,reactive oxygen
species(H2 O2superoxide ) acting as second messengers to
increase calcium content resulting in vasoconstriction.
Endothelial derived products potentiate (eg:leucotrines)
and attenuate (NO PGI2) HPV.
26. Factors determining HPV are:
1. Distribution Hypoxia (in non ventilated lung) causing
vasoconstriction and directing CO to normoxic lung and
reducing shunt fraction.
2. Atelectasis of non ventilated lung-causing increased PVR and
vasoconstriction and direct blood flow to normoxic lung, then
decreasing shunt traction.
3. Vasodilator drugs directly inhibits HPV but indirectly by
decreasing CO and lower Pvo2 thereby producing potent
stimulation of HPV in normoxic lung and offset HPV in the
original hypoxia lung and results in no flood diversion from
more obviously Hypoxia Lung.
27. 4. Vasoconstrictors will preferentially constricts pulmonary
vessels perfusing both lung segments and may direct blood to
hypoxia lung due to vasoconstriction in normoxic lung vascular.
5. Selectively decreasing FiO2 in normoxic compartment (1 to .5 to
.3) causes on increase in vascular resistance there by decreasing
blood flow diversion from hypoxic lung to normoxic lung.
31. Carlens, a left-sided + a carinal hook
a right-sided Carlens tube
Bryce-Smith, no hook but a slotted cuff/Rt
Robertshaw, most widely used
1. Type:
All have two lumina/cuffs, one terminating in the trachea and the
other in the mainstem bronchus
Right-sided or left-sided available
Available size: 26F, 28F, 32F ,35F, 37F, 39F, 41F.
32. Double lumen endotracheal
tubes
Selection of Double-Lumen Tube Size Based on Adult Patients’ Sex and Height
Sex
Height (cm) Size (Fr)
Female <160 (63 in.) * 35
Female >160 37
Male <170 (67 in.) † 39
Male >170 41
33. INDICATIONS FOR RT DLTs
*exophyptic tumour that compresses the entrance of lt
bronchus
*intraluminal tumour near entrance of lt bronchus
*lt-sided tracheo broncheal disruption
*descending thoracic aortic aneurysm compressing the main
stem bronchus.
34.
35. Insert tip of tube through cords and immediately rotate 90 degrees in direction of
bronchus you are aiming to intubate.
2. Advance tube until comes to a halt. (No xs force needed).
3. Inflate tracheal cuff until air leak disappears & check both lungs ventilate (just as you
would a single lumen tube).
4. Clamp tracheal lumen & check that only opposite side of chest moves and has air
entry. Remember to open cap on clamped side so air can escape and lung collapse. You
should feel a ‘whoosh’ of air as lung collapses. Make sure your clamp is proximal to the
open cap or you will have trapped the air in the lung.
5. Inflate bronchial cuff until no leak is heard via tracheal lumen. Need about 2 mls air
6. Repeat 4. By clamping bronchial lumen instead of tracheal.
7. Switch on ventilator and collapse lung to be operated on. Check
you can achieve a reasonable tidal volume without excessive
pressure and that the capnograph trace has not changed compared
to 2-lung ventilation.
INSERTION TECHNIQUE
38. These devices are either within a modified SLT as an enclosed bronchial
blocker (Torque Control Blocker Univent; Vitaid, Lewinston, NY) or are used
independently with a conventional SLT,
the Arndt wire-guided endobronchial blocker (Cook Critical Care, Bloomington, IN),
Cohen tip-deflecting endobronchial blocker (Cook Critical Care, Bloomington, IN),
and the Fuji Uniblocker (Vitaid, Lewinston, NY).
Bronchial blockers
39. Characteristics of the Cohen, Arndt, and Fuji Bronchial Blockers
Cohen
Blocker
Arndt Blocker
Fuji
Uniblocker
Size 9 Fr 5 Fr, 7 Fr, and 9 Fr 5 Fr, 9 Fr
Balloon shape Spherical Spherical or elliptical Spherical
Guidance
mechanism
Wheel
device to
deflect the
tip
Nylon wire loop that is
coupled with the
fiberoptic
bronchoscope
None,
preshaped tip
Smallest
recommended ETT
for coaxial use
9 Fr (8.0
ETT)
5 Fr (4.5 ETT), 7 Fr
(7.0 ETT), 9 Fr (8.0
ETT)
9 Fr (8.0
ETT)
Murphy eye Present Present in 9 Fr Not present
Center channel 1.6 mm ID 1.4 mm ID 2.0 mm ID
40. Arndt Endobronchial Blocker
set
Invented by Dr. Arndt, an anesthesiologist
Ideal for diff intubation,
pre-existing ETT and postop ventilation needed
Requires ETT > or = 8.0 mm
Similar problems as Univent
Inability to suction or ventilate the blocked lung
41.
42. It is useful when it is not possible to place a DLT or in situations where the patient
has already been intubated with a single lumen tube.
It has the appearance of a hollow bougie with a cuff.
The blocker has a guidewire in its lumen, the end of which can be hooked over a
bronchoscope so the blocker can be inserted under direct vision into the
lung that is to be collapsed.
This guidewire needs to be removed before air can be withdrawn from the blocker
and hence collapse the lung.
A disadvantage is that once the guidewire on the device has been
withdrawn,
it cannot be reinserted so the blocker cannot be reused or repositioned in
the patient.
INSERTION TECHNIQUE
43. Univent Tube
Developed by Dr. Inoue
Movable blocker shaft in external lumen of a single-
lumen ET tube
Easier to insert and properly position than DLT (diff
airway, C-s injury, pedi or critical pts)
No need to change the tube for postop ventilation
Selective blockade of some lobes of the lung
Suction and delivery CPAP to the blocked lung
44.
45. Bronchial blockers (BB)
Arndt
Cohen
Fuji
Size selection rarely an
issue
Easily added to regular
ETT
Allows ventilation during
placement
Easier placement in
patients with difficult
airways and in children
Postoperative two-lung
ventilation by
withdrawing blocker
Selective lobar lung
isolation possible
CPAP to isolated lung
possible
More time needed for
positioning
Repositioning needed more
often
Bronchoscope essential for
positioning
Non optimal right lung
isolation due to RUL anatomy
Bronchoscopy to isolated lung
impossible
Minimal suction to isolated
lung
Difficult to alternate OLV to
either lung
Advantages
Disadvantages
46. Univent tube Same as BBs
Less repositioning
compared with BBs
Same as for BBs
ETT portion has higher air flow
resistance than regular ETT
ETT portion has larger diameter
than regular ETT
Endobronchial
tube
Like regular ETTs,
easier placement
in patients with
difficult airways
Longer than
regular ETT
Short cuff
designed for lung
isolation
Bronchoscopy
necessary for placement
Does not allow for
bronchoscopy,
suctioning or CPAP to
isolated lung
Advantages disadvantages
47. Positioning
The majority of thoracic procedures are performed with the patient in
the lateral position, most often the lateral decubitus position, but,
depending on the surgical technique, a supine, semisupine, or semiprone
lateral position may be used .These lateral positions
have specific implications for the anesthesiologist.
48. Complications associated with
position
Dependent Arm (Compression Injuries)
Arm directly under thorax
Pressure on clavicle into retroclavicular space
Cervical rib
Caudal migration of thorax padding into the axilla *
Nondependent Arm (Stretch Injuries)
Lateral flexion of cervical spine
Excessive abduction of arm (>90%)
S emiprone or semisupine repositioning after arm fixed to
a support
49. Neurovascular Injuries Specific to the Lateral Position:
Dependent eye
Brachial plexus
Circulation
Dependent ear pinna
Cervical spine in line with thoracic spine
Dependent arm:
Nondependent arm * :
Dependent and nondependent suprascapular nerves
Nondependent leg: sciatic nerve
Dependent leg:
Peroneal nerve
Circulation
51. lculated as
Preoperative FEV1 х(1-nosegmentsremoved/19)
A PPOfev1 < 1 lt= retention of sputum
<800ml= contrindication( vent dependent)
<40%= perioperative complication.
ppoDLCO= PREOPERATIVE DLCOх( 1- no segments removed/19)
52.
53.
54. SUMMARY
On conclusion ventilation of One Lung with 100%O2, the
application of CPAP to Non ventilated lung and
intermittent positive pressure to dependent lung counter
act any drug mediated effects of HPV and maintain PaO2.
So maintaining uninhibited HPV is very important for
maintaining normal V/Q and Pao2.