Extubation: An Important End Point Of General Anaesthesia

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

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

On arrival to UKMC the patient received a Glasgow Coma Score of 3, which is an indication that intubation is needed. Bipap therapy was attempted but failed, due to respiratory failure. This was confirmed by arterial blood gases. After being assessed by the team at UKMC, the patient was intubated for respiratory failure, as well as shock of an unclear etiology. Rapid sequence intubation drugs, Etomidate and Succinylcholine where administered prior to intubation. A 7.5 endotracheal tube was used

The anesthetiser jar with cork containing the cotton wool was sealed and left for fifteen minutes

The rationale for this intervention is that humidification can help to thin tenacious secretions, lower the risk of mucus plug formation and allow for better expectoration and easier extraction via suctioning (Branson, 2007). This is particularly relevant for patients with tracheostomies since air entering their lungs is not warmed by the nasal turbinates and can lead to dry secretions that are hard to remove (Lewis, 2014). To implement this intervention I consulted the patient’s chart to confirm that this was recommended. I then attached the patient’s tracheostomy mask to a constant flow of warm humidified

J Mann, 160 post-operative respiratory complications were found in 144 patients. All the patients received gas, oxygen and anaesthetic (Mann, 1949) It also suggests respiratory problems rise abruptly in males over the age of 40. Mr Street is 69 years old. Patients are at risk of the following post-surgery loss of lung volume, CR conditioning, pain on deep breathing, pain on coughing, infection which can also be related to stress and weight loss, DVT, atelectasis, low oxygen saturation, reduced thoracic expansion, low mood, loss of mobility due to obesity which can result in reduced joint range and muscle strength, anxiety (secondary to his diagnosis of a potentially life limiting

The positive impact of anesthesia advancements over the last 100 years have made the care that patient receives more effective and less life threatening. These innovations have brought about a transformation in the care of the patient. It has improved how the healthcare institutions operate and the patient has benefited from the advancements and so have the medical staff. The anesthesia used today, and the anesthesia used a century ago is similar because it was created for the welfare of the patient. It was produced to help numb or put the patient to sleep during a surgical procedure. However, the difference today is that research and advancements in the medical field have improved and designed more superior drugs over the years and made them

Respiratory emergencies can be caused by obstructions, inflammations, trauma, and several different disease processes. The most common obstruction of the airway is the tongue. This usually occurs when the patient has become unconscious secondary to another cause such as intoxication, low blood sugar, or trauma. While tongue obstruction of the airway can have deadly results, it can be easily solved by re-positioning the airway using the either the jaw thrust maneuver if trauma is suspected, or the head-tilt chin-lift if no trauma is suspected. Also if the patient is unconscious and has no gag reflex you can use an oropharyngeal airway to hold the tongue up and out of the airway. However, using an oropharyngeal airway does not mean that you can

Patients undergoing general anesthesia were typically given one or a combination of the following agents: propofol, nitrous oxide, desflurane, halothane, isoflurane, and sevoflurane. Once the patients were intubated, they were placed in the prone position on a standard operating frame. When the general anesthetic course was complete, the anesthetic agents were discontinued and 100% O2 was administered via endotracheal intubation or ventilation mask. Patients were then extubated when appropriate and transported to the PACU. Patients were monitored by the PACU nursing staff until they were deemed awake, alert, and responsive, and stable before transfer to the floor. IV analgesia was also administered patients during their PACU stay, and patients were given a patient-controlled analgesia

During maintenance of the anesthesia 4mg of dexamethasone and 4mg of ondansetron were given to prevent nausea. She received 300ml of lactated ringers. She was ventilated with pressure support. She remained hemodynamically stable throughout the case. The anesthesia gas was switched to desflurane towards the end of the case to facilitate an awake extubation. She received an additional 40mg of diprivan with emergence and 25mcg of fentanyl.

Preoperative examination of the airway is essential. Identification of patients with a potentially difficult airway before anesthesia allows time to plan an appropriate anesthetic technique. Previous anesthetic records should always be consulted. However, a past record of normal tracheal intubation is no guarantee against difficulty on subsequent occasions as airway anatomy can be altered as in trauma affecting the airway. The presence of stridor or hoarse voice is warning sign for the anesthetist. As it is impossible to identify all patients with a difficult airway during preoperative assessment, the anesthetist must be prepared to manage the unexpected difficult laryngoscopy (Alan et al,. 2001).

The patients received 1 mL single doses with zero lockout time, and could press the self-administration button at any point of discomfort or pain during the procedure (Mazanikov et al., 2012). Many data points were collected, some of which included: amount of propofol used during procedure, vital signs during procedure, vital signs after procedure, Aldrete scores, pain intensity, sedation level, patient satisfaction, endoscopists satisfaction, and post-procedural nausea or vomiting (Mazanikov et al., 2012). PASW 18 analyzed all figures presented in the article (Mazanikov et al., 2012). The researchers learned that less propofol used was in the A2 group (Mazanikov et al.,

Nearly 50% of patients with infective airway diseases are at an increased risk of developing Acute Lung Injury or Acute Respiratory Distress Syndrome (ALI/ARDS). Endotracheal intubation may be lifesaving in these situations, as they allow provision of adequate tissue oxygenation, reduce the respiratory muscle effort and avert hemodynamic embarrassment. Over the last 20 years, many clinical evidences have highlighted the harmful consequences of invasive mechanical ventilation such as Ventilator associated pneumonia (VAP) and excessive mechanical stress leading to perpetuation of lung injury.

Airway management expertise is essential in every medical speciality but it is one of the fundamental skills of an anaesthesiologist. An anesthesiologist has the responsibility to mitigate the adverse effects of anaesthesia on the respiratory system by maintaining airway patency and ensuring adequate ventilation and oxygenation and failure to do so, even for a brief period of time, can be life threatening. Respiratory events is the second most common cause of anaesthetic related injuries, following dental damage. Inadequate ventilation, oesophageal intubation and difficult tracheal intubation are the most common respiratory system damaging events1.

Tracheostomy is a surgical procedure where a small hole is made in the neck for a trachea tube to be inserted in. Trach tube goes from outside of the neck into the trachea and is held in place by a strap that goes around the neck. This method of oxygen deliver is used when a person cannot breathe due to blockage in airway whether it’s from disease or injury. Tracheostomy is also used when an individual has been on the ventilator for a long time. Because, when we compare size trach tube and oral ventilator tube. Trach tube is smaller which makes little easier to breathe and with less effort. Also risk of damaging the airway is higher in the oral tube compared to trach tube. Another reason for the tracheostomy procedure is when the individual