Basic Anesthesia Case Management

Question 1

3 questions to answer before each general anesthetic

Answer 1

1. ) should i intubate or place an LMA?
2. ) should i let the pt breathe on their own or should i put them on ventilator?
3. ) if i’m going to use the ventilator, how am i going to suppress the respiratory drive, so that the pt will tolerate the vent?

Question 2

Contraindications for LMA

Answer 2

1. ) full stomach
2. ) gastroparesis (narcotic use, pt is diabetic, trauma/sympathetic response, bowel obstruction)
3. ) GERD/ hiatal hernia
4. ) obesity
5. )

Question 3

what is the effect of obesity

Answer 3

increase gastric volume, but delayed gastric emptying times

Question 4

which is better spontaneous ventilation or mechanical ventilation?

Answer 4

depends

Question 5

advantages to spontaneous ventilation

Answer 5

1. ) wake up easier

2. ) extra monitor is respiratory rate, therefore you cannot overdose or under dose the narcotic

Question 6

disadvantages of spontaneous ventilation

Answer 6

1. ) atelectasis and hypoventilation/hypercarbia

2. ) hard for patients to breathe through straw (obese pts shouldn’t spontaneously ventilate)

Question 7

ABSOLUTE contraindications to spontaneous ventilation (6)

Answer 7

1. ) intraabdominal sx
2. ) laparoscopic sx
3. ) cardiothoracic sx
4. ) EtCO2 must be tightly controlled
5. ) morbidly obese pts
6. ) certain types of joint replacement, depending on who surgeon is

Question 8

RELATIVE contraindications to spontaneous ventilation (3)

Answer 8

1. ) long operations
2. ) elderly patients
3. ) non supine position