A Tracheal Tube

-Use of indiscriminate sedatives, benzos, and opioid’s, especially in post-op patient who retains Co2, may suppress the ventilator drive and lead to respiratory failure

BACKGROUND: Tracheal intubation may induce; hypertension, tachycardia, and/or arrhythmia. Fentanyl is a frequently used opioid that joins with hypnotic agents to diminish hemodynamic responses to tracheal intubation. Furthermore, lidocaine has a suppressive effect on the circulatory responses in patients undergoing laryngoscopy and tracheal intubation. However, intravenous lignocaine has shown variable results and large doses of fentanyl causes hypotension and cough. We compared the effectiveness of intravenous lignocaine 1.5mg/Kg bolus and intravenous fentanyl 2mcg/Kg bolus in attenuating the sympathetic response to laryngoscopy and tracheal intubation.

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

Muscle paralyzing drugs are given to cause paralysis in the muscles of the body. This is done to prevent muscle spasms around the area being operated on, and to prevent the patient from inadvertently moving during the procedure which could make some surgeries virtually impossible to perform. The muscles of the heart are not affected by muscle paralyzing medications, otherwise patients would not be able to stay alive while under general anesthesia. These muscle paralyzing medications also do not cause paralysis in the patient’s bladder or bowel muscles, this explains why patients under general anesthesia do not experience incontinence of urine or feces. Furthermore, muscle paralyzing medications only paralyze the muscles of the body, they do not have an effect on the patient’s brain function, this helps to explain how a person can be aware while at the same time be paralyzed. While the patient is paralyzed, they cannot move or speak, and they cannot breathe. To aide breathing during general anesthesia, patients are placed on an anesthesia ventilator, also known as a respirator which takes over the patient’s breathing while paralyzed by these medications (“Anesthesia Aware”,

Mr. Smith’s multiple medical conditions should be considered before administering N2O-O2 sedation. The clinician should check to see if he is on any medications dealing with his hypertension or diabetes that will contraindicate any portion of the procedure. However, Mr. Smith’s advanced COPD should be the first thing addressed because it is an absolute contraindication for N2O-O2 sedation. The clinician should explain that N2O-O2 sedation could potentially cause Mr. Smith to stop breathing. I found the following link to be a great piece of information the clinician could use to explain to Mr. Smith why N2O-O2 sedation wouldn’t be beneficial for him. The information can be found on page 4 under contraindications. What other issues do you think

Breathing is a fundamental component of life without which the sustainability of all body functions would be rendered obsolete. Therefore in patient care one of the most important assessments all healthcare providers must prioritise is the assessment of the patient’s airway patency and breathing function and in doing so identify and rectify any potentially life threatening abnormalities. Maintaining the mechanics of breathing allows the respiratory functions, vital to the homeostatic balance to remain prosperous and improve the prognosis of the recovering patient. During the course of this essay the use of respiratory support techniques will be critically reviewed in terms of the issues surrounding the administration of invasive and

Tracheostomy, also known as an artificial airway is a long-tern or permanent surgical procedure where a hole is made into the trachea (windpipe) called the stoma. A tracheostomy tube is then placed through the opening and into the trachea, in which it replaces a person’s nose and mouth as a secondary airway for breathing to provide oxygen to get into the lungs. Tracheostomies are most commonly used for purposes of mechanical ventilation in chronically ill patients, treatment of an upper airway obstruction and head trauma in coma patients. This procedure dates back at least 200 years and has been done in countries all around the world.

Editorial A. Anaesthesia UK : One-lung anaesthesia [Internet]. Frca.co.uk. 2017 [cited 8 March 2017]. Available from: http://www.frca.co.uk/article.aspx?articleid=100575

Thirty patients underwent anesthesia for DO device procedures, 17 male and 13 female patients, no dropouts, age ranged between 8 and 17 years (Table 2). Inhalational induction was performed on 16 patients and awake fiberoptic bronchoscope with sedation was performed on 14 patients. Mouth opening improved significantly (p 0.001*) and Cormack and Lehane score improved significantly (p 0.021*) between the initial presentation for placement of MDO devices and on removal of the destructor under GA(Table 3). There were no instances of either difficult bag mask ventilation or airway obstruction on induction. There were no instances of failed intubation, no patient required emergency tracheostomy and no case resulted in death. At removal of MDO,

Orlewicz (2016)This procedural sedation course includes overview of sedation, objectives of this course, American Society of Anaesthesiologists (ASA), characteristics or selection of patients for moderate or deep sedation, requirements for safe procedural sedation, credentialing, pre sedation assessment or guidelines and recovery

Furthermore, it is also important to record a baseline measurement of including heart rate, respiratory rate and oxygen saturation. Firstly this information can help to determine whether or not a patient is fit for sedation, type of sedation and which setting is most suitable for the provision of care. Adverse effects both haemo-dynamically and respiratory can occur with administration of sedation. Malviya et al. presented a large-scale prospective study looking at respiratory events during sedation, and found increased adverse sedation related events occurred within with ASA classifications of III, and IV 19. Comparable results where also noted by Hertzog et al. who looked at propofol sedation in pediatric patients

The relevancy of the article to the PICO question is demonstrated through its relationship to reducing the need for opioids following abdominal surgery. Lidocaine infusion effects on nausea were realized and may be contributed to the anti-inflammatory and propulsive effects of lidocaine. The statistical significance hewer was not apparent for nausea or vomiting. The authority of the researchers is unclear however the lead author is affiliated with the Institute of Oncology in Vilnius, Lithuania. Accuracy was demonstrated with known statistical calculations and means generation through SPSS statistical software. The values were compared to relative studies with the ability to show statistical significance. The purpose of the study was clearly stated, well defined and without bias throughout the presentation. The limitations of the research were clearly identified and noted. Pain scores were collected and analyzed for the immediate 24 hours following surgery. Pain and analgesic data were not collected for the remainder of the patient’s stay. The study was able to demonstrate advantages to lidocaine use but was not able to demonstrate significant advantage over the epidural methods of anesthesia. The study was unable to provide cost

Moderate Sedation/Analgesia (Conscious Sedation) is defined as a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway,

Patients and methods: After approval by ethical committee, 120 adult patients (ASA I-III) with anticipated difficult airway were included in this prospective study. Patients were randomly allocated to three equal groups to undergo tracheal intubation using either C-MAC D-blade (group 1), Airtraq (group 2), or Fiberoptic technique (group 3) after standardized induction of anesthesia. Intubation data, blood pressure, heart rate, and SpO2 were evaluated.

Indirect action on the afferent, central and efferent neural pathway as well as direct action in the lungs by these halogenated anaesthetic agents cause ventilator depression by overwhelming peripheral chemoreceptor drive by suppressing the central nervous system as well as the function of the intercostal muscles and diaphragm. In addition there is reduction in the bronchial smooth muscle tone, detrimental effect in the mucociliary function and dilatation of pulmonary vasculature which inhibits pulmonary vasoconstriction due to hypoxia