perio 3c

Question 1

Sedation

Answer 1

• Administration of sedatives (i.e. Midazolam) and analgesia
• Produces depressed level of consciousness
• May be able to respond to commands or physical stimuli
• May require airway support
• Often used in endoscopy or administration of local
  anaesthetic

Question 2

Local Anaesthetic Toxicity

Answer 2

• Occurs if accidental overdose of local anaesthetic or accidentally
  injected into bloodstream (importance of aspiration!!!)
• Can be life threatening = circulatory collapse, convulsions
• Requires immediate cessation of local anaesthetic and
  administration of lipid emulsion (Intralipid)
  For intra-op infiltration, always check LA dose with anaesthetist or
  surgeon.

Question 3

Mallampati Score

Answer 3

Used to examine patient’s oral cavity and soft palate visually, in
order to predict any possible difficulties with tracheal intubation

Question 4

Mallampati Score
class1
class 2
class 3 
class 4

Answer 4

complete visualisation of the soft palate
complete visualisation of the uvula
visualisation of only the base of the uvula
soft palate is not visible at all

Question 5

Intubating Equipment

Answer 5

• Laryngoscope handle and blades (i.e. Mac, Mil)
• Appropriate sized tubes + lubricant
• 10ml syringe - cuff inflation
• Tape to secure tube
• Suction: Yankauer & Y-suction catheter
• Malleable introducer
• Magill forceps
• Intubating Bougie

Question 6

Airway Support/Management

Techniques

Answer 6

• Chin lift
• Jaw Support
• Jaw Thrust

Question 7

Artificial Airways

Answer 7

• Face masks (bag-mask ventilation) - ensure good seal
• Oral (Guedel)/Nasopharyngeal airways - adjunct
• Laryngeal Mask Airway (LMAs)- sits above vocal cords
• Endotracheal Tubes (ETTs)
• sits below vocal cords & requires laryngoscope

Question 8

Rapid Sequence Induction

Answer 8

Undertaken if risk of aspiration:

• Unknown fasting time/emergency surgery
• Trauma
• Pregnancy
• Hiatus Hernia
• Bowel Obstruction
• Gastrointestinal Bleeding
• Gastric reflux

Question 9

Airway Complications

Answer 9

Laryngospasm

Bronchospasm

Question 10

Laryngospasm

Answer 10

• Irritation of vocal cords leading to spasm
  = partial/complete obstruction
• Can occur during ‘twilight’ stage (Induction/Emergence)

Question 11

Laryngospasm management

Answer 11

• Remove stimulus
• Apply PEEP and 100% O2
• Deepen anaesthesia (Propofol or Gas)
• Muscle Relaxant

Question 12

Bronchospasm

Answer 12

• Characterised by expiratory wheeze
• May result from airway irritation (secretions, equipment)
• Patients who smoke, hx asthma, recent respiratory infection
  more susceptible

Question 13

Management: Bronchospasm

Answer 13

• 100% O2
• Deepen anaesthetic
• Use of bronchodilators

Question 14

CICO

Answer 14

Can’t Intubate,
Can’t Oxygenate
cricothyroid ligand membrane

Question 15

Malignant Hyperthermia

specific

Answer 15

muscle rigidity
increased co2 production
rhabdomyolysis
makred temperature elevation

Question 16

Malignant Hyperthermia

non- specific

Answer 16

tachycardia
tachynopnea
acidosis
hyperkaleamia