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Anesthesiology sample

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Contents :
Anesthesiology instruments
General features of anesthetic instruments
Anesthetic cylinders
Pin index
Anesthetic gases
Anesthetic machines and circuits
Mapleson system
Oxygen control devices
Devices for co2 absorption
Dead space
Endotracheal tube
Laryngoscopy and endotracheal intubation
Nasotracheal intubation
Laryngeal mask airway
Trendelenberg position
General features of monitoring during anesthesia
Central venous pressure monitoring
Pulmonary artery catheter
Capnogram
Anesthetic complications
Air embolism
Respiratory complications
Malignant hyperthermia
Intraoperative and postoperative complications
Resuscitation
Mendelson syndrome
Hypothermia in anesthesia
Clinical anesthesia
History of anesthesia
Stages of anesthesia
Preanesthetic assessment
Pediatric anesthesia
Anesthesia in head injury
Cardiovascular anesthesia
Anesthesia in ent
Obstetric anesthesia
Anesthesia in orthopedics
Respiratory anesthesia
Day care anesthesia
Drugs of anesthesia
Preanesthetic drugs
General features of anesthetic drugs
Inhalational anesthetics
Minimum alveolar concentration
Partition coefficient
General features of inhalational anesthetics
Xenon
Nitrous oxide
Trilene
Ether
Helium
Chloroform
Halothane
Enflurane
Isoflurane
Desflurane
Sevoflurane
Methoxyflurane
Intravenous anesthetics
General features of intravenous anesthetics
Propofol
Ketamine
Thiopentone
Etomidate
Local anesthetics
General features of local anesthetics
Bupivacaine
Lignocaine
Prilocaine
Cocaine
Procaine
Bier’s block/IVRA
Peribulbar and retrobulbar block
Stellate ganglion block
Brachial plexus block
Celiac plexus block
Neuromuscular blockers
General features of neuromuscular blockers
Depolarising muscle relaxants – Succinly choline
Features of non depolarizing muscle blockers
D-tubocurarine
Pancuronium
Vecuronium
Mivacurium
Atracurium
Gallamine
Alcuronium
Spinal, epidural and caudal anesthesia and pain management
Splanchnic block
Neuraxial blockade
Spinal anesthesia
Epidural anesthesia
Caudal anesthesia
Other blocks
Pain
General features of pain
Assessment of pain
Analgesic drugs
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Anesthesiology sample

  1. 1. ANESTHESIOLOGY medpgnotes
  2. 2. ANESTHESIOLOGY www.medpgnotes.com 1ANESTHESIOLOGY INSTRUMENTS CONTENTS ANESTHESIOLOGY INSTRUMENTS................................................................................................................................. 4 GENERAL FEATURES OF ANESTHETIC INSTRUMENTS ............................................................................................... 4 ANESTHETIC CYLINDERS............................................................................................................................................ 4 PIN INDEX.................................................................................................................................................................. 4 ANESTHETIC GASES................................................................................................................................................... 4 ANESTHETIC MACHINES AND CIRCUITS.................................................................................................................... 5 MAPLESON SYSTEM .................................................................................................................................................. 5 OXYGEN CONTROL DEVICES...................................................................................................................................... 5 DEVICES FOR CO2 ABSORPTION ............................................................................................................................... 6 DEAD SPACE.............................................................................................................................................................. 6 ENDOTRACHEAL TUBE .............................................................................................................................................. 7 LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION............................................................................................... 7 NASOTRACHEAL INTUBATION................................................................................................................................... 9 LARYNGEAL MASK AIRWAY....................................................................................................................................... 9 TRENDELENBERG POSITION...................................................................................................................................... 9 GENERAL FEATURES OF MONITORING DURING ANESTHESIA .................................................................................. 9 CENTRAL VENOUS PRESSURE MONITORING .......................................................................................................... 10 PULMONARY ARTERY CATHETER............................................................................................................................ 10 CAPNOGRAM .......................................................................................................................................................... 11 ANESTHETIC COMPLICATIONS .................................................................................................................................... 11 AIR EMBOLISM........................................................................................................................................................ 11 RESPIRATORY COMPLICATIONS .............................................................................................................................. 11 MALIGNANT HYPERTHERMIA ................................................................................................................................. 12 INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS .................................................................................... 12 RESUSCITATION....................................................................................................................................................... 13 MENDELSON SYNDROME........................................................................................................................................ 13 HYPOTHERMIA IN ANESTHESIA............................................................................................................................... 14 CLINICAL ANESTHESIA................................................................................................................................................. 14 HISTORY OF ANESTHESIA........................................................................................................................................ 14 STAGES OF ANESTHESIA.......................................................................................................................................... 14 PREANESTHETIC ASSESSMENT................................................................................................................................ 14 PEDIATRIC ANESTHESIA .......................................................................................................................................... 15
  3. 3. ANESTHESIOLOGY www.medpgnotes.com 2ANESTHESIOLOGY INSTRUMENTS ANESTHESIA IN HEAD INJURY ................................................................................................................................. 15 CARDIOVASCULAR ANESTHESIA.............................................................................................................................. 15 ANESTHESIA IN ENT ................................................................................................................................................ 16 OBSTETRIC ANESTHESIA.......................................................................................................................................... 16 ANESTHESIA IN ORTHOPEDICS................................................................................................................................ 16 RESPIRATORY ANESTHESIA ..................................................................................................................................... 16 DAY CARE ANESTHESIA ........................................................................................................................................... 17 DRUGS OF ANESTHESIA .............................................................................................................................................. 17 PREANESTHETIC DRUGS.......................................................................................................................................... 17 GENERAL FEATURES OF ANESTHETIC DRUGS ......................................................................................................... 17 INHALATIONAL ANESTHETICS ..................................................................................................................................... 18 MINIMUM ALVEOLAR CONCENTRATION................................................................................................................ 18 PARTITION COEFFICIENT......................................................................................................................................... 18 GENERAL FEATURES OF INHALATIONAL ANESTHETICS........................................................................................... 18 XENON..................................................................................................................................................................... 19 NITROUS OXIDE....................................................................................................................................................... 19 TRILENE ................................................................................................................................................................... 20 ETHER...................................................................................................................................................................... 20 HELIUM ................................................................................................................................................................... 20 CHLOROFORM......................................................................................................................................................... 20 HALOTHANE............................................................................................................................................................ 20 ENFLURANE............................................................................................................................................................. 21 ISOFLURANE............................................................................................................................................................ 22 DESFLURANE ........................................................................................................................................................... 22 SEVOFLURANE......................................................................................................................................................... 22 METHOXYFLURANE................................................................................................................................................. 23 INTRAVENOUS ANESTHETICS...................................................................................................................................... 23 GENERAL FEATURES OF INTRAVENOUS ANESTHETICS ........................................................................................... 23 PROPOFOL............................................................................................................................................................... 24 KETAMINE ............................................................................................................................................................... 24 THIOPENTONE......................................................................................................................................................... 25 ETOMIDATE............................................................................................................................................................. 26 LOCAL ANESTHETICS ................................................................................................................................................... 26 GENERAL FEATURES OF LOCAL ANESTHETICS......................................................................................................... 26
  4. 4. ANESTHESIOLOGY www.medpgnotes.com 3ANESTHESIOLOGY INSTRUMENTS BUPIVACAINE .......................................................................................................................................................... 28 LIGNOCAINE............................................................................................................................................................ 28 PRILOCAINE............................................................................................................................................................. 29 COCAINE.................................................................................................................................................................. 29 PROCAINE................................................................................................................................................................ 29 BIER’S BLOCK/IVRA ................................................................................................................................................. 29 PERIBULBAR AND RETROBULBAR BLOCK................................................................................................................ 30 STELLATE GANGLION BLOCK................................................................................................................................... 30 BRACHIAL PLEXUS BLOCK........................................................................................................................................ 30 CELIAC PLEXUS BLOCK............................................................................................................................................. 30 NEUROMUSCULAR BLOCKERS .................................................................................................................................... 31 GENERAL FEATURES OF NEUROMUSCULAR BLOCKERS.......................................................................................... 31 DEPOLARISING MUSCLE RELAXANTS – SUCCINLY CHOLINE ................................................................................... 31 FEATURES OF NON DEPOLARIZING MUSCLE BLOCKERS......................................................................................... 33 D-TUBOCURARINE................................................................................................................................................... 33 PANCURONIUM ...................................................................................................................................................... 33 VECURONIUM ......................................................................................................................................................... 34 MIVACURIUM.......................................................................................................................................................... 34 ATRACURIUM.......................................................................................................................................................... 34 GALLAMINE............................................................................................................................................................. 34 ALCURONIUM ......................................................................................................................................................... 35 SPINAL, EPIDURAL AND CAUDAL ANESTHESIA and pain management ...................................................................... 35 SPLANCHNIC BLOCK ................................................................................................................................................ 35 NEURAXIAL BLOCKADE............................................................................................................................................ 35 SPINAL ANESTHESIA................................................................................................................................................ 35 EPIDURAL ANESTHESIA ........................................................................................................................................... 37 CAUDAL ANESTHESIA.............................................................................................................................................. 37 OTHER BLOCKS........................................................................................................................................................ 38 PAIN ............................................................................................................................................................................ 38 GENERAL FEATURES OF PAIN.................................................................................................................................. 38 ASSESSMENT OF PAIN............................................................................................................................................. 38 ANALGESIC DRUGS.................................................................................................................................................. 39
  5. 5. ANESTHESIOLOGY www.medpgnotes.com 4ANESTHESIOLOGY INSTRUMENTS ANESTHESIOLOGY INSTRUMENTS GENERAL FEATURES OF ANESTHETIC INSTRUMENTS Rotameter Constant pressure, variable orifice, flow meter for gases and liquids Rotameter Height of bobbin rise indicates flow rate MC cause of inaccurate reading in Rotameter 1 st Static Electricity, 2 nd Dirt Wright spirometer Used for calculation of expired volumes Types of Pneumatographs measuring airway resistance Fleisch’s type, Venturi type, Turbine type Used to protect airway LMA, endotracheal tube, combitube Least damage to blood elements Membrane oxygenator ANESTHETIC CYLINDERS Filling ratio of anesthetic cylinder Filling ratio is the weight of the fluid in the cylinder divided by weight of water required to fill the cylinder Color of oxygen cylinder Black cylinder with white shoulders Color of ethylene cylinder Purple Color of nitrous oxide cylinder Blue Color of cyclopropane cylinder Orange PIN INDEX Pin index of nitrous oxide 3,5 Pin index Pin is present on machine, not effective if wrong gas is filled in cylinder, hole position on cylinder valves System preventing Incorrect gas Cylinder attachment Pin Index Safety system ANESTHETIC GASES Gas filled as liquid in cylinders CO2, N20, cyclopropane Gas stored in liquid form N2O Nitrous oxide Cylinder blue in color, MAC 105 Tare weight is used for Gas Cylinders For high pressure storage of gases, cylinders are made of Molybdenum steel Pressure of N2O at 20*C 745 psi High pressure in gas cylinder indicate Impurities in N2O Critical temperature of air -140.6*C Critical temperature of oxygen -119*C Critical temperature of N2O 36.5*C
  6. 6. ANESTHESIOLOGY www.medpgnotes.com 5ANESTHESIOLOGY INSTRUMENTS ANESTHETIC MACHINES AND CIRCUITS Anesthesia breathing circuit Cylinder is a part of high pressure system, O2 flush delivers < 35 liters Boyle’s machine Continuous flow, low resistance Boyle’s law At constant temperature, volume of a given mass varies inversely with its absolute pressure High pressure system in anesthesia machine is delivered by Hanger yoke Principle of Boyle’s apparatus Continuous Flow Heidbrink meter in Boyle’s apparatus Indicates flow of gases Bernoulli principle In laminar flow, velocity of flow through a tube is inversely related to its pressure against the size of tube Modified bernoulli Pressure change = 4 * (velocity)^2 Clayton is used in closed breathing circuit as Indicator MAPLESON SYSTEM Most efficient anesthetic circuit for GA with spontaneous respiration Mapleson A Air flow in Magill’s circuit (Mapleson A) Equal to minute volume Magill’s circuit Ideal for adults, semiclosed, spontaneous breathing is must NOT suited for both controlled and assisted ventilation Mapleson A No corrugated tube in Mapleson C Bain circuit Mapleson type D, can be used for both controlled and spontaneous ventilation Bain circuit Inner tube for inspiration, circuit of choice for controlled ventilation, light weight, fresh gas flow should be 1.5 times of minute volume Mapleson system used in children Ayer T tube Ayre’s T piece Mapleson E Features of Ayre’s T piece No reservoir bag, no expiratory valve Most appropriate circuit for ventilating spontaneously breathing infant during anesthesia Jackson Ree’s modification of Ayre’s T piece Rebreathing prevention valve Light, well designed, used at expiratory end of tube Rebreathing circuit To and fro circuit, circle system, water system OXYGEN CONTROL DEVICES Assessment of oxygen in a cylinder attached to anesthesia machine Bourdon pressure gauge Used for proper oxygen flow to patient Proportionator between N2O and O2 control valve, different pin index, calibrated oxygen corrected analysis System Maintaining O2 concentration by limiting N2O flow Pneumatic Interlock Oxygen Ratio Monitor Controller (ORMC)
  7. 7. ANESTHESIOLOGY www.medpgnotes.com 6ANESTHESIOLOGY INSTRUMENTS System Maintaining 25% O2 concentration and Maximum N2O:O2 flow ratio of 3:1 Link 25 Proportion Limiting system(Datex Ohmeta System) Safety measures to prevent delivery of hypoxic mixture to patient Location of oxygen valve after N2O valve, location of fail safe valve downstream from nitrous oxide supply source Oxygen concentrator Zeolite activation, delivers O2,requires power supply Oxygen content in anesthetic mixture 33% Fixed performance oxygen provided by Venturi mask Delivery of oxygen in basic life support Through mask Humidification of air is needed in Face mask Oxygen delivery regulated by Oxygen tent, oxygen apparatus, poly mask, venti mask Maximum O2 concentration achieved in venturi mask 60% Side effects of oxygen therapy Absorption atelectasis, decreased pulmonary compliance, decreased vital capacity, endothelial damage Oxygen given during anesthesia to prevent Hypoxia 90% oxygen by Non rebreathing mask Safe oxygen concentration in therapy is to achieve PaO2 > 50 mm Hg Humidity of dry 100% oxygen 0 mg H2O litre Artificial nose Heat and moisture exchanger DEVICES FOR CO2 ABSORPTION CuSO4 present in Amsorb Ba (OH)2 present in Baralime Decrease CO2 absorption High flow, medium granule, No resistance in circuit Decreases CO2 absorption Increased tidal volume, increased dead space Increases CO2 absorption Resistance in circuit Soda lime is used to absorb CO2 in Closed circuit system Reacts with soda lime Trilene Main component of soda lime in closed circuit Calcium hydroxide Composition of soda lime 90% Ca(OH)2 + 5% NaOH + 1% KOH NOT a component of sodalime Ba OH2 Soda lime does NOT contain CaCl NOT true about soda lime Used in treatment of alkalosis Water is used for hardening in Soda lime Color change in Mimoza 2 Red to white Signs of soda lime exhaustion Change of color of granules, rise in ETCO2 in capnography, rise in BP followed by fall, rise in pulse rate, deepening of spontaneous respiration, increased oozing from wound, increased sweating DEAD SPACE Normal dead space 30% of tidal ventilation
  8. 8. ANESTHESIOLOGY www.medpgnotes.com 7ANESTHESIOLOGY INSTRUMENTS Anatomical dead space is increased by Atropine, Halothane, Inspiration Dead space is increased by Anti cholinergic drugs, standing, hyperextension of neck Physiological dead space is decreased by Neck flexion Anatomical dead space in Supine position Decreases Anatomical dead space decreased by Massive pleural effusion Dead space NOT increased by Endotracheal intubation Least amount of CO2 present in Anatomical dead space - end inspiration phase ENDOTRACHEAL TUBE Size of endotracheal tube in 1 – 6 months aged 2 – 4 mm Size of endotracheal tube in 6 months to 1 year aged 3.5 – 4.5 mm Size of endotracheal tube in 1 – 6 years [Age/3] + 3.5 Size of endotracheal tube more than 6 years [Age/4] + 4.5 Length of endotracheal tube in neonate 10 – 11 cm Length of endotracheal tube in elder children [age/2] + 12 Reasonable size of endotracheal tube in 3 year old 4.5 mm Curved blade in adult laryngoscope is Macintosh Endotracheal cuff High volume low pressure, low volume high pressure Size of endotracheal tube in children less than 6 years (Age/3.5)+3.5 Diameter and length of endotracheal tube in full term infant 3.5 mm and 12 mm McIntosh tube for Adults Magill’s tube Children Armoured endotracheal tube is used in Neurosurgery RAE endotracheal tube Red RAE tube is used in LASER surgery Diameter of ET tube in child less than 1000 g 2.5,3 Direct laryngoscope in right handed person Left hand Type of endotracheal tube and blade in children Uncuffed tube with straight blade Cuff pressure in ET tube should not exceed 23 mm Hg LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION High airway resistance seen in Main bronchus Airway assessment Mallampatti grading, Cormack and Lehare (based on laryngoscopy), Wilson’s scoring, LEMON law LEMON law Look externally, evaluate 3-3-2 rule, Mallampatti, Obstruction, Neck mobility Normal thyromental distance >6.5 cm Mallampatti grading for Inspection of oral cavity before intubation
  9. 9. ANESTHESIOLOGY www.medpgnotes.com 8ANESTHESIOLOGY INSTRUMENTS Mallampatti classification is based on Opening of mouth Clinical predictor of a difficult intubation is postulated to be responsible for a grade III Mallampatti view of oral cavity Large tongue NOT an indication for endotracheal intubation Pneumothorax Both orotracheal and nasotracheal intubation is contraindicated in Acute laryngotracheobronchitis Difficulty in intubation Burns in head and neck, Still’s disease, Down’s syndrome Features of difficult airway Miller’s sign, TMJ ankylosis, micrognanthia and macroglossia Used in difficult intubation Helium O2 mixture, entoxon, sevoflurane Maneuver performed during laryngoscopy and intubation Flexion of neck, extension of head at atlantooccipital joint, in straight blade laryngoscope epiglottis is lifted by tip, upper incisors are most vulnerable to damage by laryngoscopy so laryngoscope should not be levered against them Endotracheal intubation in children Small morbidity on prolonged intubation NOT seen during laryngoscopy Hypotension Sellick’s original description of cricoid pressure Extending head Sellick maneuver is used to prevent Gastric aspiration Sellick maneuver is effective in prevention of Passive regurgitation and subsequent aspiration NOT a maneuver performed during laryngoscopy Laryngoscope is lifted upwards levering over the upper incisors Effective adjuvant in attenuating hypertension and tachycardia associated with laryngoscopy and intubation Succinylcholine High potassium level with scoline for intubation occurs with Chronic paraplegia Most accurate measurement of correct placement of ET tube End Tidal CO2 Correct placement of endotracheal tube judged by Arterial CO2, Breath sounds, Chest X ray Speedy intubation, breath sounds were observed to be decreased on left side and high end tidal CO2 Endobronchial intubation Laryngoscopy and intubation is associated with Hypertension and tachycardia, raised IOT, raised ICT, decreased lower esophageal sphincter tone, arrhythmia Endotracheal intubation Reduces normal anatomical dead space A child has been intubated and connected to anesthesia machine. A problem has occurred in anesthesia machine and the child collapsed after 2 minutes. What to do next Increase the flow Laryngeal complication of Prolonged ET intubation Stenosis, Ulceration, Abductor paralysis Prevention of intubation induced laryngeal spasm Local anesthesia, fentanyl, diltiazem Drug that can precipitate reflux Promethazine Treatment of severe tracheal stenosis due to endotracheal intubation for more than 2 weeks Tracheal resection and end to end anastomosis
  10. 10. ANESTHESIOLOGY www.medpgnotes.com 9ANESTHESIOLOGY INSTRUMENTS Surgery for extensive tracheal stenosis Grillo or Barclay procedure NASOTRACHEAL INTUBATION Merits of nasotracheal intubation Good oral hygiene Nasal intubation is contraindicated in CSF rhinorrhoea LARYNGEAL MASK AIRWAY Supraglottic type of airway management Laryngeal mask airway NOT a definite airway Laryngeal mask apparatus NOT an advantage of laryngeal mask airway Aspiration is prevented Laryngeal mask airway NOT used for Large tumor in oral cavity Laryngeal mask airway is used for Maintenance of airway Laryngeal mask airway More reliable than face mask, alternative to endotracheal tube, does NOT require laryngoscope and visualization LMA Intubation can be done, size 1 for neonates, size 3 for adults Plan C of anesthetic airway management Insertion of laryngeal mask airway and fibroptic bronchoscopy TRENDELENBERG POSITION Maximum vital capacity decreased in Trendelenberg position Trendelenberg position decrease Vital capacity, FRC, compliance Trendelenberg position does NOT cause decrease in Respiratory rate Position with least vital capacity in GA Trendelenberg GENERAL FEATURES OF MONITORING DURING ANESTHESIA Individual operative awareness by Bispectral imaging Organ at greatest risk of ischemia under conditions of normovolemic hemodilution Heart Best to monitor intraoperative myocardial ischemia Transesophageal echocardiography Most sensitive and practical technique to detect myocardial ischemia in perioperative period Regional wall motion abnormality detected with help of 2D transesophageal echocardiography 5th vital sign Pulse oximetry Pulse oximetry At 660 nm, oxyhemoglobin reflect more light than deoxyhemoglobin, reverse is true at 940 nm Pulse oximetry detects inaccurately in presence of Nail polish, methemoglobinemia, skin pigmentation Inadequate ventilation during intraoperative period is best assessed by Pulse oximetry Beer Lambert Law Pulse oximetry
  11. 11. ANESTHESIOLOGY www.medpgnotes.com 10ANESTHESIOLOGY INSTRUMENTS Oxygen saturation is measured by Pulse oximeter Used to monitor respiration in non intubated neonate Impedance pulmonometry Non ventilated baby is in incubator, best way to monitor baby’s breathing and detect apnea Impedance pulmonometry A postoperative patient with pH 7.25 MAP 60 mm Hg treated with Fluid therapy with CVP monitoring Least affected during anesthesia Brainstem auditory evoked potential Somatosensory evoked potential is important during Thoracic and abdominal aorta surgery MC nerve used for monitoring during anesthesia Ulnar nerve Modality best utilized for neuromuscular monitoring during maintenance of anesthesia Train of four NOT a cause of bacterial sepsis in ICU patient on invasive monitoring Humidified air CENTRAL VENOUS PRESSURE MONITORING MC vein for CVP monitoring Right Internal Jugular Vein While inserting CVP, patient developed respiratory distress Pneumothorax MC complication of central venous catheter Catheter related infection Complications of CVP line Airway injury, hemothorax, septicemia, air embolism, pulmonary edema CVP monitoring is most useful in Guiding hemodynamic therapy In a patient with multisystem trauma, presence of hypotension with elevated CVP is suggestive of Cardiopulmonary problem CVP does NOT indicate Tissue perfusion PULMONARY ARTERY CATHETER Swan Ganz catheter measure PCWP, mixed venous oxygen saturation, Right atrial pressure While introducing Swan Ganz catheter, its placement in pulmonary artery can be identified by PA pressure tracing has dicrotic notch from closure of pulmonary valve > diastolic pressure is higher in PA than in RV Swan Ganz catheter is used to measure Pulmonary artery pressure, pressure of cardiac chambers, pulmonary capillary wedge pressure, cardiac output and cardiac index, blood sample for mixed venous oxygen saturation, to measure temperature of pulmonary artery Pulmonary wedge pressure is indirectly Left atrial pressure Measurement of intravascular pressure by pulmonary artery catheter At the end of expiration Left atrial filling pressure closely resembles Pulmonary capillary wedge pressure
  12. 12. ANESTHESIOLOGY www.medpgnotes.com 11ANESTHETIC COMPLICATIONS CAPNOGRAM Capnography is based on Luft principle NOT a cardiovascular monitoring technique Capnogram Flat capnogram Disconnection of anesthetic tubing, accidental extubation, mechanical ventilation failure Phases of capnogram Phase 0 – inspiratory phase, phase 1 – dead space and little or no CO2, phase 2 – mixture of alveolar and dead space gas, phase 3 – alveolar plateau with peak representing end expiratory and end tidal CO2 ANESTHETIC COMPLICATIONS AIR EMBOLISM End tidal CO2 decreased during surgery Air embolism Significant air embolism occurs with volume 100 cc Diagnosing air embolism with tracheoesophageal echocardiography Very sensitive investigation, continuous monitoring to detect venous embolism, interferes with Doppler when used together Factors favoring embolism is a patient with major trauma Mobility of fracture, diabetes Air embolism in neurosurgery is maximum in Sitting position Most sensitive investigation for air embolism Transesophageal echo > Doppler ultrasound Known case of thyrotoxicosis posted for abdominoperineal resection. sudden drop in BP and end tidal CO2, Mill Wheel murmur Air embolism Most serious complication of sitting position Air embolism Transesophageal echocardiography Can quantify the volume of air embolised, Very sensitive investigation, Continuous monitoring is needed to detect venous embolism RESPIRATORY COMPLICATIONS Anesthetic complication with respiratory infection Bacteremia, Increased mucosal bleeding, laryngospasm Aspiration pneumonitis Affected by volume of aspiration and pH of aspiration fluid, increased incidence during induction, inflammation, infection Obstruction of respiration in comatose patients is mainly due to Falling back of tongue NOT a cause of respiratory insufficiency in immediate post operative period Mild hypovolemia

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