Oxygenation – Peri intubation, Apnoeic, THRIVE - Copy.pptxRitesh Pandey
This document discusses preoxygenation and apneic oxygenation techniques. It defines preoxygenation as administering oxygen prior to anesthesia induction to increase oxygen reserves and prolong safe apnea time. Effective preoxygenation requires achieving near 100% oxygen saturation through tidal volume breathing or deep breathing. Apneic oxygenation can further extend safe apnea time by allowing oxygen diffusion during apnea. The document describes several methods of apneic oxygenation including nasal prongs, nasopharyngeal catheters, and THRIVE which uses high flow humidified nasal cannula. Key points emphasize preoxygenation as a safety measure and the effectiveness of tidal volume breathing for preoxygenation.
Resp failure talk 9 10 bipap and hfnc emphasisStevenP302
This document discusses respiratory failure and the use of high flow nasal cannula (HFNC) and bilevel positive airway pressure (BiPAP). It describes the three types of respiratory failure - inability to oxygenate, inability to ventilate, and inability to protect airway. HFNC provides high flow oxygen but no positive pressure, while BiPAP provides adjustable inspiratory and expiratory pressures for both oxygenation and ventilatory support. The document reviews indications, advantages, disadvantages, settings and monitoring for BiPAP use in treating respiratory failure.
Dual controlled modes of mechanical ventilation [onarılmış]tyfngnc
Dual control modes of mechanical ventilation switch between pressure control and volume control modes within a single breath or between breaths based on measured patient characteristics. This allows the ventilator to maintain a minimum tidal volume while taking advantage of the flow patterns and reduced work of breathing associated with pressure control. Common dual control modes include volume-assured pressure support (VAPS) and pressure augmentation, which switch modes within a breath, and volume support and pressure regulated volume control (PRVC), which adjust pressure limits between breaths to achieve tidal volume targets. Settings must be optimized carefully in dual control modes to avoid delays in cycling or increases in air trapping.
NIV is a form of non-invasive ventilation that delivers mechanical ventilation without using an endotracheal tube. It is commonly used for respiratory failure from COPD exacerbations, pulmonary edema, and immunosuppressed patients. NIV includes CPAP, which provides continuous positive pressure, and BiPAP, which provides two pressure levels (IPAP and EPAP). Key factors in determining success include early improvement in gas exchange and symptoms within the first few hours of treatment.
1) Non-invasive positive pressure ventilation (NIPPV) delivers positive airway pressure without an invasive interface like an endotracheal tube.
2) NIPPV can benefit patients with respiratory failure from COPD, cardiogenic pulmonary edema, obesity hypoventilation syndrome, and other conditions by reducing work of breathing and improving oxygenation.
3) Bi-level positive airway pressure (BPAP) and continuous positive airway pressure (CPAP) are common NIPPV modes. BPAP delivers different pressures during inspiration and expiration while CPAP maintains a constant pressure.
Capnography is superior to capnometry as it provides a graphical display of expired carbon dioxide (CO2) levels over time, allowing analysis of the capnographic waveform. Measuring end-tidal CO2 (ETCO2) using capnography is the best non-invasive method to verify correct endotracheal tube placement and provides valuable information about ventilation, cardiac output, and metabolism. ETCO2 levels normally approximate arterial CO2 (PaCO2) but the correlation decreases with abnormalities that increase the ventilation-perfusion mismatch. Key features of the capnographic waveform include the baseline, rise and contour of the CO2 curve which can provide diagnostic clues about various clinical conditions.
This document provides an overview of non-invasive ventilation (NIV). It discusses the history of NIV, types of ventilators and modes used, interfaces, indications and contraindications. Guidelines are provided on how to start and monitor NIV, including adjusting settings based on patient response. Advantages, disadvantages and complications of NIV are reviewed. Applications of NIV for specific clinical conditions like COPD exacerbation and acute cardiogenic pulmonary edema are covered. The document aims to educate medical professionals on best practices for administering and monitoring patients receiving NIV treatment.
Bronchial asthma and COPD are chronic respiratory conditions characterized by airway inflammation and obstruction. Bronchial asthma involves reversible airflow limitation due to bronchospasm while COPD involves irreversible airflow limitation from lung damage. Key differences are that asthma typically presents earlier in life and has a family history, while COPD is mainly caused by smoking. Preoperative treatment aims to prevent bronchospasm during anesthesia and surgery by optimizing lung function and suppressing airway reflexes.
Oxygenation – Peri intubation, Apnoeic, THRIVE - Copy.pptxRitesh Pandey
This document discusses preoxygenation and apneic oxygenation techniques. It defines preoxygenation as administering oxygen prior to anesthesia induction to increase oxygen reserves and prolong safe apnea time. Effective preoxygenation requires achieving near 100% oxygen saturation through tidal volume breathing or deep breathing. Apneic oxygenation can further extend safe apnea time by allowing oxygen diffusion during apnea. The document describes several methods of apneic oxygenation including nasal prongs, nasopharyngeal catheters, and THRIVE which uses high flow humidified nasal cannula. Key points emphasize preoxygenation as a safety measure and the effectiveness of tidal volume breathing for preoxygenation.
Resp failure talk 9 10 bipap and hfnc emphasisStevenP302
This document discusses respiratory failure and the use of high flow nasal cannula (HFNC) and bilevel positive airway pressure (BiPAP). It describes the three types of respiratory failure - inability to oxygenate, inability to ventilate, and inability to protect airway. HFNC provides high flow oxygen but no positive pressure, while BiPAP provides adjustable inspiratory and expiratory pressures for both oxygenation and ventilatory support. The document reviews indications, advantages, disadvantages, settings and monitoring for BiPAP use in treating respiratory failure.
Dual controlled modes of mechanical ventilation [onarılmış]tyfngnc
Dual control modes of mechanical ventilation switch between pressure control and volume control modes within a single breath or between breaths based on measured patient characteristics. This allows the ventilator to maintain a minimum tidal volume while taking advantage of the flow patterns and reduced work of breathing associated with pressure control. Common dual control modes include volume-assured pressure support (VAPS) and pressure augmentation, which switch modes within a breath, and volume support and pressure regulated volume control (PRVC), which adjust pressure limits between breaths to achieve tidal volume targets. Settings must be optimized carefully in dual control modes to avoid delays in cycling or increases in air trapping.
NIV is a form of non-invasive ventilation that delivers mechanical ventilation without using an endotracheal tube. It is commonly used for respiratory failure from COPD exacerbations, pulmonary edema, and immunosuppressed patients. NIV includes CPAP, which provides continuous positive pressure, and BiPAP, which provides two pressure levels (IPAP and EPAP). Key factors in determining success include early improvement in gas exchange and symptoms within the first few hours of treatment.
1) Non-invasive positive pressure ventilation (NIPPV) delivers positive airway pressure without an invasive interface like an endotracheal tube.
2) NIPPV can benefit patients with respiratory failure from COPD, cardiogenic pulmonary edema, obesity hypoventilation syndrome, and other conditions by reducing work of breathing and improving oxygenation.
3) Bi-level positive airway pressure (BPAP) and continuous positive airway pressure (CPAP) are common NIPPV modes. BPAP delivers different pressures during inspiration and expiration while CPAP maintains a constant pressure.
Capnography is superior to capnometry as it provides a graphical display of expired carbon dioxide (CO2) levels over time, allowing analysis of the capnographic waveform. Measuring end-tidal CO2 (ETCO2) using capnography is the best non-invasive method to verify correct endotracheal tube placement and provides valuable information about ventilation, cardiac output, and metabolism. ETCO2 levels normally approximate arterial CO2 (PaCO2) but the correlation decreases with abnormalities that increase the ventilation-perfusion mismatch. Key features of the capnographic waveform include the baseline, rise and contour of the CO2 curve which can provide diagnostic clues about various clinical conditions.
This document provides an overview of non-invasive ventilation (NIV). It discusses the history of NIV, types of ventilators and modes used, interfaces, indications and contraindications. Guidelines are provided on how to start and monitor NIV, including adjusting settings based on patient response. Advantages, disadvantages and complications of NIV are reviewed. Applications of NIV for specific clinical conditions like COPD exacerbation and acute cardiogenic pulmonary edema are covered. The document aims to educate medical professionals on best practices for administering and monitoring patients receiving NIV treatment.
Bronchial asthma and COPD are chronic respiratory conditions characterized by airway inflammation and obstruction. Bronchial asthma involves reversible airflow limitation due to bronchospasm while COPD involves irreversible airflow limitation from lung damage. Key differences are that asthma typically presents earlier in life and has a family history, while COPD is mainly caused by smoking. Preoperative treatment aims to prevent bronchospasm during anesthesia and surgery by optimizing lung function and suppressing airway reflexes.
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
Patient monitoring involves both non-instrumental and instrumental assessment. Non-instrumental monitoring includes visual observation of factors like respiratory pattern, bleeding, and IV lines. Instrumental monitoring provides quantitative data through devices like ECG, blood pressure cuffs, pulse oximetry, capnography, and muscle relaxation monitors. Together, non-instrumental and instrumental monitoring provide clinicians with vital information about patients' physiological status to guide care in settings like operating rooms and intensive care.
This document discusses chronic obstructive pulmonary disease (COPD) and considerations for anesthesia. It defines COPD and describes related conditions like chronic bronchitis and emphysema. It covers risk factors, pathogenesis, pathophysiology including airway obstruction, hyperinflation, and gas exchange impairment. Clinical features, investigations, disease classification, and treatment approaches including smoking cessation and bronchodilators are summarized. Key points for anesthetists regarding airway challenges, ventilation/perfusion abnormalities, and development of auto-PEEP are highlighted.
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices and their purpose of maintaining airway patency above the glottic opening. It then classifies supraglottic devices based on generation, sealing mechanism, number of lumens, and discusses some common devices like the LMA Classic, Unique, Flexible, and Ambu Aura. Indications, contraindications, advantages, disadvantages, proper sizing, insertion technique and signs of correct placement are outlined. Potential problems and methods to reduce aspiration are also reviewed.
The document provides an overview of the Esophageal-Tracheal Combitube, which is a double-lumen airway device that can be inserted blindly to secure a patient's airway. It has two tubes, one that enters the esophagus and one that positions in the pharynx. Balloons on each tube are inflated to seal the pharynx and esophagus. The device prevents vomiting and can function as an endotracheal tube if inserted into the trachea. Indications for use include injuries, bleeding, difficult intubation, and respiratory arrest. Contraindications include patient height and age restrictions and medical history. Placement and use of the device is described.
Anesthetic Management of Nasopharyngeal Angiofibroma Resection with Carotid I...Carlos D A Bersot
This document describes the anesthetic management of a 13-year-old patient undergoing resection of a nasopharyngeal angiofibroma tumor invading the carotid artery and facial sinuses. Key aspects included:
1) Preoperative embolization of feeding arteries to reduce bleeding risk.
2) Intraoperative profuse bleeding requiring massive transfusion during tumor resection near the ethmoid cells.
3) A long 9-hour procedure with careful hemodynamic management and volume resuscitation.
4) Postoperative tracheostomy to protect the airway given risk of edema from surgical manipulation.
Mechanical ventilation of bronchial asthma, is it a real dilemmaMohammad Samak
This document provides guidance on managing a patient with severe asthma exacerbation who requires mechanical ventilation. Key recommendations include:
1. Initially use low tidal volumes (6-8 mL/kg), respiratory rate (8-10 breaths/min), and inspiratory flow rate (80-100 L/min) to allow longer expiration and prevent dynamic hyperinflation.
2. Monitor plateau pressures to estimate alveolar pressure and avoid excessive pressures (>30 cmH2O) that can cause barotrauma.
3. Use deep sedation, paralysis, and PEEP to splint airways open, reduce work of breathing, and prevent dynamic hyperinflation, while closely monitoring for complications.
This document discusses oxygen delivery devices and their indications. It describes:
1. Oxygen delivery devices are classified based on the level of dependency needed - low, medium, and high. Low dependency devices include nasal cannulas and masks, which can provide 30-35% oxygen.
2. Medium dependency devices provide supplemental oxygen and respiratory assistance using CPAP masks. High dependency devices provide full respiratory support through NIPPV or IPPV and require intensive care.
3. Variable and fixed performance low dependency devices are further described. Variable devices' oxygen concentration depends on equipment and patient factors, while fixed devices use a venturi to provide consistent concentrations from 24-40%.
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.
1. Bilevel positive airway pressure (BPAP) delivers two levels of positive airway pressure - a higher pressure during inspiration and a lower pressure during expiration - to reduce work of breathing and improve oxygenation.
2. BPAP is effective for acute exacerbations of COPD and cardiogenic pulmonary edema by reducing mortality, need for intubation, and treatment failure compared to standard care.
3. For pneumonia, outcomes are worse with post-obstructive pneumonia, pleural effusions, hypoxic hypercapnic respiratory failure with effusions, and over 24 hours on BPAP therapy.
The document discusses several newer modes of mechanical ventilation including volume assured pressure support (VAPS), volume support (VS), pressure regulated volume control (PRVC), and adaptive support ventilation (ASV). VAPS switches between pressure control and volume control modes within a breath to ensure a minimum tidal volume. VS adjusts pressure support levels between breaths to maintain a target tidal volume. PRVC aims to deliver a set tidal volume with the lowest possible airway pressure by modifying flow and time. ASV automatically adapts support levels to provide a minimum minute ventilation with the least work of breathing.
ANESTHETIC MANAGEMENT LAP CHOLECYSTECTOMY WITH COPDram krishna
This document discusses anesthetic considerations for laparoscopic cholecystectomy in a patient with COPD. It provides background on the patient's history and comorbidity of COPD. It then summarizes the key respiratory effects of pneumoperitoneum during laparoscopy including increased airway pressures and changes in ventilation. It also discusses the cardiovascular effects, including a transient increase then decrease in cardiac output due to changes in venous return. Finally, it notes other potential risks such as respiratory acidosis, endobronchial intubation, subcutaneous emphysema, and hypothermia that the anesthesiologist must consider in a patient with COPD undergoing laparoscopic surgery.
Anesthesia in Transurethral resection of prostateAshish Dhandare
1) The document discusses preoperative considerations and risks for anesthesia in transurethral resection of the prostate (TURP), with a focus on risks in elderly patients.
2) It provides details on TURP syndrome, a cluster of symptoms caused by absorption of irrigating fluid during surgery, and treatments for TURP syndrome and its complications like glycine toxicity, hemolysis, hypothermia, and bleeding.
3) Factors that can minimize risks of TURP syndrome are limiting surgery duration to under 1 hour, maintaining fluid bag height below 60cm, frequent bladder drainage, and careful surgical technique to preserve prostatic capsule integrity. Spinal anesthesia is recommended for its benefits in T
Anaesthetic management of a patient with perioperative asthmaDr Nandini Deshpande
1. A 74-year-old female with a history of asthma and hypertension presented for an emergency CBD re-exploration surgery.
2. During induction, the patient aspirated, which precipitated a severe bronchospasm that led to irreversible hypoxia, hypotension, and cardiac arrest.
3. Despite maximal treatment and resuscitation efforts, the patient could not be revived and was declared dead. The case highlights the challenges of managing perioperative bronchospasm and aspiration in a high-risk asthmatic patient.
OXYGEN DELIVERY DEVICES - Dr ADIL FAROOQAdil Farooq
Dr. Adil Farooq presented on oxygen therapy and different devices used to deliver oxygen to patients. There are many ways to prescribe oxygen that are often not followed properly. The goal of oxygen therapy is to treat hypoxemia, decrease work of breathing, and decrease myocardial work. The appropriate oxygen delivery method depends on factors like the needed FiO2 level, humidification needs, and patient comfort. Common devices include nasal cannulas, masks, Venturi masks, hoods and tents. Proper prescription and monitoring are important to provide benefits while avoiding risks like hypoventilation.
This document defines key concepts related to vaporisers such as vapor, vapor pressure, boiling point, and defines a vaporiser as an instrument that facilitates the change of a liquid anaesthetic into a vapor and adds a controlled amount to gas flow. It discusses factors that affect vaporiser performance such as carrier gas composition, temperature, back pressure and flow rate. It also classified vaporisers based on methods of regulating concentration and vaporization, and location in the breathing system. Modifications to vaporisers to address issues related to back pressure are described.
The document describes the Baska Mask, a new supraglottic airway device that aims to address limitations of existing laryngeal masks by having a smaller opening to reduce risk of aspiration, a tab to aid in placement, dual gastric channels for ventilation and suctioning, and a cuffless design that inflates with ventilation rather than requiring separate cuff inflation. Standard placement and removal techniques for the Baska Mask are provided.
NIV, or non-invasive ventilation, is a form of ventilation therapy that is applied non-invasively through a mask rather than an endotracheal tube. It is commonly used to treat conditions like COPD exacerbations, pulmonary edema, and respiratory failure. Key settings that must be adjusted include IPAP, EPAP, Ti min/max, trigger sensitivity, and backup rate. Modes include spontaneous, timed, and bi-level positive airway pressure. Proper mask fitting and troubleshooting issues like leaks are important for ensuring effective ventilation. Regular monitoring of parameters like ABGs, SpO2, and ventilation is needed to optimize NIV therapy.
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
Patient monitoring involves both non-instrumental and instrumental assessment. Non-instrumental monitoring includes visual observation of factors like respiratory pattern, bleeding, and IV lines. Instrumental monitoring provides quantitative data through devices like ECG, blood pressure cuffs, pulse oximetry, capnography, and muscle relaxation monitors. Together, non-instrumental and instrumental monitoring provide clinicians with vital information about patients' physiological status to guide care in settings like operating rooms and intensive care.
This document discusses chronic obstructive pulmonary disease (COPD) and considerations for anesthesia. It defines COPD and describes related conditions like chronic bronchitis and emphysema. It covers risk factors, pathogenesis, pathophysiology including airway obstruction, hyperinflation, and gas exchange impairment. Clinical features, investigations, disease classification, and treatment approaches including smoking cessation and bronchodilators are summarized. Key points for anesthetists regarding airway challenges, ventilation/perfusion abnormalities, and development of auto-PEEP are highlighted.
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices and their purpose of maintaining airway patency above the glottic opening. It then classifies supraglottic devices based on generation, sealing mechanism, number of lumens, and discusses some common devices like the LMA Classic, Unique, Flexible, and Ambu Aura. Indications, contraindications, advantages, disadvantages, proper sizing, insertion technique and signs of correct placement are outlined. Potential problems and methods to reduce aspiration are also reviewed.
The document provides an overview of the Esophageal-Tracheal Combitube, which is a double-lumen airway device that can be inserted blindly to secure a patient's airway. It has two tubes, one that enters the esophagus and one that positions in the pharynx. Balloons on each tube are inflated to seal the pharynx and esophagus. The device prevents vomiting and can function as an endotracheal tube if inserted into the trachea. Indications for use include injuries, bleeding, difficult intubation, and respiratory arrest. Contraindications include patient height and age restrictions and medical history. Placement and use of the device is described.
Anesthetic Management of Nasopharyngeal Angiofibroma Resection with Carotid I...Carlos D A Bersot
This document describes the anesthetic management of a 13-year-old patient undergoing resection of a nasopharyngeal angiofibroma tumor invading the carotid artery and facial sinuses. Key aspects included:
1) Preoperative embolization of feeding arteries to reduce bleeding risk.
2) Intraoperative profuse bleeding requiring massive transfusion during tumor resection near the ethmoid cells.
3) A long 9-hour procedure with careful hemodynamic management and volume resuscitation.
4) Postoperative tracheostomy to protect the airway given risk of edema from surgical manipulation.
Mechanical ventilation of bronchial asthma, is it a real dilemmaMohammad Samak
This document provides guidance on managing a patient with severe asthma exacerbation who requires mechanical ventilation. Key recommendations include:
1. Initially use low tidal volumes (6-8 mL/kg), respiratory rate (8-10 breaths/min), and inspiratory flow rate (80-100 L/min) to allow longer expiration and prevent dynamic hyperinflation.
2. Monitor plateau pressures to estimate alveolar pressure and avoid excessive pressures (>30 cmH2O) that can cause barotrauma.
3. Use deep sedation, paralysis, and PEEP to splint airways open, reduce work of breathing, and prevent dynamic hyperinflation, while closely monitoring for complications.
This document discusses oxygen delivery devices and their indications. It describes:
1. Oxygen delivery devices are classified based on the level of dependency needed - low, medium, and high. Low dependency devices include nasal cannulas and masks, which can provide 30-35% oxygen.
2. Medium dependency devices provide supplemental oxygen and respiratory assistance using CPAP masks. High dependency devices provide full respiratory support through NIPPV or IPPV and require intensive care.
3. Variable and fixed performance low dependency devices are further described. Variable devices' oxygen concentration depends on equipment and patient factors, while fixed devices use a venturi to provide consistent concentrations from 24-40%.
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.
1. Bilevel positive airway pressure (BPAP) delivers two levels of positive airway pressure - a higher pressure during inspiration and a lower pressure during expiration - to reduce work of breathing and improve oxygenation.
2. BPAP is effective for acute exacerbations of COPD and cardiogenic pulmonary edema by reducing mortality, need for intubation, and treatment failure compared to standard care.
3. For pneumonia, outcomes are worse with post-obstructive pneumonia, pleural effusions, hypoxic hypercapnic respiratory failure with effusions, and over 24 hours on BPAP therapy.
The document discusses several newer modes of mechanical ventilation including volume assured pressure support (VAPS), volume support (VS), pressure regulated volume control (PRVC), and adaptive support ventilation (ASV). VAPS switches between pressure control and volume control modes within a breath to ensure a minimum tidal volume. VS adjusts pressure support levels between breaths to maintain a target tidal volume. PRVC aims to deliver a set tidal volume with the lowest possible airway pressure by modifying flow and time. ASV automatically adapts support levels to provide a minimum minute ventilation with the least work of breathing.
ANESTHETIC MANAGEMENT LAP CHOLECYSTECTOMY WITH COPDram krishna
This document discusses anesthetic considerations for laparoscopic cholecystectomy in a patient with COPD. It provides background on the patient's history and comorbidity of COPD. It then summarizes the key respiratory effects of pneumoperitoneum during laparoscopy including increased airway pressures and changes in ventilation. It also discusses the cardiovascular effects, including a transient increase then decrease in cardiac output due to changes in venous return. Finally, it notes other potential risks such as respiratory acidosis, endobronchial intubation, subcutaneous emphysema, and hypothermia that the anesthesiologist must consider in a patient with COPD undergoing laparoscopic surgery.
Anesthesia in Transurethral resection of prostateAshish Dhandare
1) The document discusses preoperative considerations and risks for anesthesia in transurethral resection of the prostate (TURP), with a focus on risks in elderly patients.
2) It provides details on TURP syndrome, a cluster of symptoms caused by absorption of irrigating fluid during surgery, and treatments for TURP syndrome and its complications like glycine toxicity, hemolysis, hypothermia, and bleeding.
3) Factors that can minimize risks of TURP syndrome are limiting surgery duration to under 1 hour, maintaining fluid bag height below 60cm, frequent bladder drainage, and careful surgical technique to preserve prostatic capsule integrity. Spinal anesthesia is recommended for its benefits in T
Anaesthetic management of a patient with perioperative asthmaDr Nandini Deshpande
1. A 74-year-old female with a history of asthma and hypertension presented for an emergency CBD re-exploration surgery.
2. During induction, the patient aspirated, which precipitated a severe bronchospasm that led to irreversible hypoxia, hypotension, and cardiac arrest.
3. Despite maximal treatment and resuscitation efforts, the patient could not be revived and was declared dead. The case highlights the challenges of managing perioperative bronchospasm and aspiration in a high-risk asthmatic patient.
OXYGEN DELIVERY DEVICES - Dr ADIL FAROOQAdil Farooq
Dr. Adil Farooq presented on oxygen therapy and different devices used to deliver oxygen to patients. There are many ways to prescribe oxygen that are often not followed properly. The goal of oxygen therapy is to treat hypoxemia, decrease work of breathing, and decrease myocardial work. The appropriate oxygen delivery method depends on factors like the needed FiO2 level, humidification needs, and patient comfort. Common devices include nasal cannulas, masks, Venturi masks, hoods and tents. Proper prescription and monitoring are important to provide benefits while avoiding risks like hypoventilation.
This document defines key concepts related to vaporisers such as vapor, vapor pressure, boiling point, and defines a vaporiser as an instrument that facilitates the change of a liquid anaesthetic into a vapor and adds a controlled amount to gas flow. It discusses factors that affect vaporiser performance such as carrier gas composition, temperature, back pressure and flow rate. It also classified vaporisers based on methods of regulating concentration and vaporization, and location in the breathing system. Modifications to vaporisers to address issues related to back pressure are described.
The document describes the Baska Mask, a new supraglottic airway device that aims to address limitations of existing laryngeal masks by having a smaller opening to reduce risk of aspiration, a tab to aid in placement, dual gastric channels for ventilation and suctioning, and a cuffless design that inflates with ventilation rather than requiring separate cuff inflation. Standard placement and removal techniques for the Baska Mask are provided.
NIV, or non-invasive ventilation, is a form of ventilation therapy that is applied non-invasively through a mask rather than an endotracheal tube. It is commonly used to treat conditions like COPD exacerbations, pulmonary edema, and respiratory failure. Key settings that must be adjusted include IPAP, EPAP, Ti min/max, trigger sensitivity, and backup rate. Modes include spontaneous, timed, and bi-level positive airway pressure. Proper mask fitting and troubleshooting issues like leaks are important for ensuring effective ventilation. Regular monitoring of parameters like ABGs, SpO2, and ventilation is needed to optimize NIV therapy.
Gestione dell'aspirazione tracheale nei pazienti adulti con vie aeree naturali e artificiali. Prevenzione delle complicanze. Slide preparate ed utilizzate da Stefano Bambi nelle lezioni universitarie dei corsi di laurea triennale in infermieristica e a medicina
Questa presentazione contiene i dati più recenti riguardo l' uso del test all' atropina per la discriminazione di pazienti con malattia aritmica atriale e sospetta disfunzione del nodo senoatriale. A mio avviso ed anche dalla mia esperienza personale può essere utile per escludere i pazienti con risposta cronotropa normale (una specificità abbastanza alta) che peraltro non possono essere sottoposti a test da sforzo o altro per una valutazione appropriata. I candidati ideali sarebbero pazienti di età maggiore a 75 anni con sintomatologia fugace e non specifica ai quali non si può risalire ad un interpretazione univoca dei sintomi e prima di ricorrere all' impianto a un loop recorder ed infine un PM. Tengo a sottolineare che suddetto test fu usato molto quando l` impianto del loop recorder non era diffuso e cmq i costi erano alti (tuttora pero i costi rispetto al test rimangono elevati). In ogni caso è un test semplice, bedside, non costoso e molto ben tollerato dai pazienti. Il resto viene ben descritto nella presentazione.
Pomeriggio SEID Campania dedicato alle nuove linee guida ESGE su PEG e PEJ tenutosi su piattaforma ZOOM
1- Indicazioni e controindicazioni alla PEG e PEJ- Dott. L. Ruggiero
4. Quali vantaggi?
• Percentuale elevata di successo
• Rischio minimo di traumatismo
• Massima sicurezza
• Nessuna ventilazione in maschera o, se in narcosi, in
respiro spontaneo
• Privo di effetti collaterali da farmaci (miorilassanti)
• Ispezione endoscopica prima dell'intubazione
5. …….
• Nessun rischio di intubazione esofagea o
endobronchiale
• Controllo definitivo di posizionamento
• Eseguibile in pz di ogni età
• Eseguibile anche in posizione estrema del paziente
(gravi deviazioni della colonna; dispnea in clinostatismo;
grave obesità)
15. Caso clinico
• O.D., donna di 76 aa
• Colecistite acuta.
• APP: tumore lingua ed arcata mandibolare, sottoposta
ad intervento di asportazione parziale lingua e
courettage ramo mandibolare sinistro, rimozione m.
Pterigoideo e massetere sin.
• Radioterapia post-operatoria, con trisma e processo
degenerativo sull’articolazione temporo-mandibolare
• Impossibilità all’apertura della bocca con distanza
interdentale < 1 cm
16. Le 5 P…
• Preoperative airway assessment
• Planning
• Procedures (techniques used to execute the plan)
• Post procedure (extubation and follow-up)
• Publicity (telling others)
17. Valutazione vie aeree
• Distanza interincisiva < 1 cm
• Normale estensione del rachide cervicale
• Articolazione temporo-mandibolare sinistra fissa, con
incapacità di apertura della bocca (impossibilità ad
alimentarsi con cibi solidi)
• Mallampati non valutabile
18. Planning
• Piano A: intubazione con fibroscopio da sveglia per via
nasale
• Piano B: tracheostomia chirurgica in anestesia locale
21. Lista dei materiali
• Fibroscopio flessibile OD 5 mm con fonte luminosa
• Tubi endotracheali armati o da fast-trach n. 6-6,5-7-7,5
• Sondino naso-faringeo
• Cannula di Berman (in caso di intubaz. oro-tracheale)
• Maschera di Bullard
• Anestetico locale: lidocaina 2%
• Adrenalina 1:10.000 (I mg diluito a 10 ml con sol.fisiol. e di questa
aspirata 1 ml)
• 2 siringhe da 5 ml: 1 per lidocaina 2% ml 5, 1 per lidocaina 2% ml
4+ adrenalina 0,1 mg)
• 1 siringa da 2 ml con lidocaina 2% 2 ml
• Reggitubo o cerotto per fissare il tubo a fibroscopio
• Gel ad acqua
• Sistema McKenzie
• Cateterino peridurale 16G per il sistema “spray as you go” (SAYGO)
22. Premedicazione ed analgesia
cosciente
• Atropina 0,01 mg/kg ev (sempre prima dell'anestesia
locale!)
• Midazolam 0,02-0,05 mg/kg ev
• Remifentanyl 0,075 mcg/kg/min ev
• In alternativa fentanyl 0,01-0,015 mg/kg ev
25. Anestesia topica
• Anestesia delle narici con sistema McKenzie e siringa da 5 ml
con lidocaina 2% ed adrenalina (già diluita)
• Anestesia del cavo orale con spray xylocaina 10% sui pilastri
tonsillari e chiedendo al pz di inspirare lentamente
• Anestesia topica sulle corde vocali ed in trachea con
cateterino peridurale (spray as you go)
26.
27. Procedura
• Lubrificare il tubo scelto e montarlo sul fibroscopio,
fissandolo all'estremità prossimale
• Fuoco, bilanciamento del bianco, videocamera
• Ispezionare le narici per scegliere la migliore
• Posizionare nella narice opposta il sondino naso-
faringeo per O2
• Mantenere sempre contatto verbale con il pz
28.
29.
30. Post-procedure
• Applicazione di tubo di Frova prima del risveglio
• Risveglio tranquillo, respiro spontaneo
• Si rimuove il tubo orotracheale
• O2 dal tubo di Frova
• Nessun problema in respiro spontaneo
• Rimozione del tubo di Frova
31. Publicity
• Si consegna alla pz, in reparto, la lettera di descrizione
della procedura eseguita per l'intubazione tracheale
32.
33.
34.
35. Qualche numero….
• 5 Litri di sangue in un adulto
• 200 ml di O2 legato all'Hb per ogni litro di sangue (tot. 1
litro di O2)
• FRC: 3 litri, di cui 20% è O2 (600 ml)
• Basal Oxygen consumption: 250 ml/min
36.
37.
38.
39. • Nel 56% dei casi di intubazioni difficili le sequele
sono state la morte o il danno cerebrale permanente.
• Nel 60% dei casi la condotta anestesiologica è stata
inadeguata
Caplan RA, Posner KL, et al. Adverse respiratory events in
anesthesia: a closed claims analysis. Anesthesiology 1990;
72:828-33
40. Management of the difficult airway: a closed claims
analysis. * Anesthesiology. 2006 Mar; 104(3): 615-6;
author reply 616-7.
• CONCLUSIONS: Death/BD in claims from difficult airway
management associated with induction of anesthesia but
not other phases of anesthesia decreased in 1993-1999
compared with 1985-1992. Development of additional
management strategies for difficult airways encountered
during maintenance, emergence, or recovery from
anesthesia may improve patient safety.
41.
42.
43.
44.
45.
46.
47. Ministero del Lavoro, della Salute edelle Politiche Sociali
DIPARTIMENTO DELLA QUALITÀ
DIREZIONE GENERALE DELLA PROGRAMMAZIONE
SANITARIA, DEI LIVELLI DIASSISTENZA E DEI PRINCIPI
ETICI DI SISTEMA
UFFICIO III
Manuale per la Sicurezza in sala operatoria:
Raccomandazioni e Checklist
48. Ddl sicurezza in S.O.
• 4.6 Obiettivo 6. Gestire le vie aeree e la funzione
respiratoria
• “L’inadeguata gestione delle vie aeree, anche a seguito
di inadeguata identificazione dei rischi, rappresenta un
importante fattore che contribuisce alla morbilità e
mortalità evitabile associata all’anestesia.”
• ......................
49. • “La direzione aziendale dovrebbe predisporre ed
implementare una procedura per la corretta gestione delle vie
aeree anche nei casi critici e gli anestesisti di sala operatoria
dovrebbero essere adeguatamente formati e preparati a
metterla in pratica in caso di imprevista perdita della pervietà
delle vie aeree.
• La procedura dovrà prevedere che, allorquando il paziente
presenta caratteristiche anatomiche tali da far prevedere un
possibile quadro di difficoltà nella gestione delle vie aeree, o
una anamnesi suggestiva in tal senso, deve essere previsto
l’intervento di un secondo anestesista esperto e deve essere
predisposta l’intubazione tracheale mediante
fibrobroncoscopio con il paziente in respiro spontaneo,
garantendo, comunque, tutte le procedure idonee alla
risoluzione del problema.”
50. Get This…
• NEVER PARALYSE UNTIL POSSIBLE
VENTILATION HAS BEEN ESTABLISHED
• RECENT SUCCESSFUL INTUBATION DOES
NOT MEAN FUTURE POSSIBLE INTUBATION
• USE FOI EVERY TIME YOU THINK IT IS A
GOOD INDICATION FOR YOUR PATIENT
51. Il maestro disse ad un suo allievo: Yu, vuoi
che ti dica in che cosa consiste la
conoscenza? Consiste nell'essere
consapevoli sia di sapere una cosa che di
non saperla. Questa è la conoscenza.
Confucio, I Colloqui, II, 17