Inhalational Induction: A Case Study

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.

We report two cases where combination of dexmedetomidine and ketamine as procedural sedation was used in patients undergoing maxillofacial surgery. We were able to achieve a calm, sedated and cooperative patient with preserved airway reflexes and respiratory drive and minimal haemodynamic wavering in both cases. Procedural sedation using dexmedetomidine and ketamine infusion was successfully used as an alternative technique for providing anaesthesia that confers analgesia, while preserving patients airway reflexes and respiratory drive.

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

General anesthesia may be needed if there are complications. This is because you need special care when you are under general anesthesia.

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

Counselling of patients and their caregivers, performed by health care professionals, plays a key role in inhaler use so as to minimize errors and optimize treatment.( 9 , 17 , 22 , 26 ) Poor inhaler technique is a risk factor for poor control of respiratory diseases,( 12 , 13 ) being associated with poor treatment adherence.( 30 ) It is noteworthy, however, that this is a modifiable risk factor, and some findings of the present study can act as reference points in the inhaler technique to be targeted for improvement , as well as allowing the identification of the profile of those patients who will potentially require further clarification regarding inhaler use.

Situations in which OLV are indicated can be classified into, either to separate both lungs as in case of hemothorax, massive hemorrhage, bronchopleural fistulae and unilateral pulmonary diseases or to facilitate surgical procedures such as pneumonectomies, lobectomies, thoracoscopies and esophageal resection (4).Intraoperative hypoxemia during OLV is observed in approximately from 1 % up to 27% of patients inspite the use of high inspiratory oxygen fraction (Fio2) (5, 6). The incidence of this hypoxemia is affected by many factors e.g. used ventilator settings, the kind of surgery performed, the patient's position during surgery, and anesthesiologist's experience in OLV thoracic anesthesia (7).

Although ventilation is not usually provided during the apnoeic period, some anaesthetists will give a single breath, or several gentle breaths, to both confirm that mask ventilation is possible and reduce the development of hypercapnia, acidaemia, and hypoxia. Some guidelines advocate use of mask ventilation for this reason in patients at elevated risk of hypoxia, for example, the pregnant patient.4,5

Inhalation challenges are used for diagnosing occupational asthma (OA). The aim was to design equipment, called the GenaSIC (Specific Inhalation Challenge), that allows and generates various agents regardless of the formulation and to assess the usefulness of its use in patients investigated for occupational asthma (Caron, Boileau, Malo, & Leblond, 2010:1). The GenaSIC is a closed-circuit generation chamber; i.e., it enables continuous generation of low and stable concentrations of agents, dust in an airtight enclosure with controlled atmospheric conditions (Caron et al, 2010:2). Each new agent must be validated before exposure. In short, by expanding the use of such equipment may greatly contribute to a more precise diagnosis of occupational

One lung ventilation (OLV) or lung isolation is a common term used in the practice of thoracic anesthesia. OLV refers to ventilation of one lung, while the other one is passively deflated which allow adequate surgical access to be achieved by the surgeon (1,2). Some examples of surgeries that necessitate OLV are lobectomy, pneumonectomy, pleural decortication, bronchopulmonary lavage, esophagogastrectomy, thymectomy, and mediastinal mass resections etc (3). OLV is accomplished by different techniques such as using Double-Lumen Tube (DLT), Bronchial blockers (Univent tube), and Single-Lumen tube (3).

|Q|Several patients with various respiratory disorders have been prescribed inhalers. Based on the nurse’s judgment, which patient will most likely benefit from using a spacer?

The classification I am writing about is Inhalants. Some examples of Inhalants are hairspray, paint thinner, markers, gasoline, lighter fluid, helium, glue perfume, etc. The age group is 12–15 most people at this age commonly abuse glue, shoe polish, spray paints, gasoline, and lighter fluid. It’s around those ages because that’s the age where kids start exploring more and experimenting.

I analysed that experience in clinical practice required more knowledge to evaluate the incidents with the patients. Moreover assess, plan, intervention and evaluate of the patients aided in delivering the care to the patients. The procedure encompassed the knowledge and attitude in performing the skill on the tracheostomy patients. The most important part I really had to have the knowledge about the tracheostomy patients. The assessment on the patients breathing could indicate the respiratory problems occur. Audible bilaterally is the breath sounds signify that the air is flowing freely through the tracheostomy tube(Astle, 2003, p35). The indication of sound explain by McConnell (2002, p17) are the coarse breath sounds, noisy breathing, and

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.

Inhaled Sedation: This contains nitrous oxide also known as the laughing gas given to the patient by placing the mask on the nose. By breathing this gas, patient is relaxed during the treatment. The dentist can control the level of sedation you receive.