Anesthesia mask stories

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Anesthesia face masks are rubber or silicone masks that cover both the mouth and nose of the patient. From: Sedation Sixth Edition In Sedation Sixth Edition Anesthesia mask stories, Because of the variations in Anesthesia mask stories size and shape of faces, several different sizes of face masks should always be available. Typically, face masks are made from a clear plastic or rubber that allows the patient's mouth and nose to be seen so that foreign material e.

Many different connectors of various materials, shapes, and with or without sample ports attach the face mask to the anesthesia circuit, continuing to connect to the anesthesia machine. John E. David E. The most appropriate anesthesia face mask for spans vertically from Anesthesia mask stories bridge of the nose to just below the lower lip, without compressing the nasal passages. It should contain the least volume i. The pediatric face mask should be constructed with a clear nonlatex plastic that allows recognition of cyanosis, the condensation of exhaled gas, and the presence of excess secretions or vomitus.

A constant challenge in pediatric anesthesia, especially for small infants, is to find a face mask that conforms to the shape of an infant's face without a ificant leak. During positive pressure ventilation the anesthesiologist often must twist or torque a face mask without applying undue pressure against 's face to reduce the amount of air that escapes Anesthesia mask stories within the mask.

To achieve these purposes, a variety of face masks have been used in the pediatric population. The most common anesthesia face mask in use today is the plastic disposable type that contains an adjustable pneumatic cushion, which when inflated or deflated with air can be altered to conform to the shape of 's face. A variety of different manufacturers produce this type of face mask Fig. An alternative variety for use in pediatric patients is the Rendell-Baker-Soucek mask, which remains in use in many centers Fig. This mask is available in malleable rubber or nonlatex silicone and allows an effective seal on 's face while minimizing internal dead space.

It was originally deed on the basis of anatomic molds taken from a large of children Rendell-Baker and Soucek, Doreen Soliman MD, Peter J. Mask ventilation must be accomplished by avoiding trauma and friction by the anesthesia mask Fig. Direct laryngoscopy is generally uncomplicated in infants with EB. In older children and adolescents, however, scarring and ankylosis can create airway management challenges, and fiberoptic bronchoscopy for intubation may be needed. The LMA has been successfully used in airway management; petroleum jelly gauze around the shaft can minimize trauma to the lips and mouth.

Cuff pressure needs to be low to maintain the shape of the LMA and avoid trauma to the airway. ETTs are secured in a manner that avoids damage to the skin and lips e. Selecting smaller ETT size and careful inflation of the cuff can minimize the risk of postoperative croup and airway edema. The perioperative use of steroids is recommended.

The choice of anesthetic agents generally depends on the EB patient's underlying comorbid disease. David M. There are numerous options for management of the airway in outpatient anesthesia. In many cases, an anesthesia mask alone is used—for example, during myringotomy and tube placement.

This minimizes the risk of airway irritation but requires at least one of the anesthesiologist's hands be occupied. It is contraindicated in the event of a full stomach and may be problematic in patients who easily obstruct their airways, such as those with adenotonsillar hypertrophy. The endotracheal tube remains the gold standard for the secured airway. This eliminates the need for reversal or for concerns of residual neuromuscular blockade, but mandates skillful judgment of anesthetic depth to avoid cord injury or laryngospasm.

Just as in any anesthetic, one must choose the tube's size carefully so as to avoid producing injury or irritation to the vocal cords and trachea. This is especially critical in a patient who is going to be discharged home the same day. Supraglottic airway devices, although useful, have not supplanted the need to intubate a patient for many outpatient surgery cases that may still benefit from the placement of an endotracheal tube. Intracavitary operations, including laparoscopic operations, are generally best performed with an endotracheal tube, although brief laparoscopic examinations, such as laparoscopic examination of the contralateral side during herniorrhaphy, can be effectively performed with a supraglottic airway device.

Surgery in or near the airway including tonsillectomy, adenoidectomy, and upper GI endoscopy can be performed with a LMA, but this remains somewhat controversial. Supraglottic airway devices may cause less laryngeal irritation than endotracheal tubes and can be placed without visualization of the airway Brimacombe, The LMA, developed by Dr.

Brain, is the first of these devices and is available in multiple pediatric sizes. All of these devices offer a less stimulating means of maintaining the airway while freeing the hands of the anesthesiologist for other tasks. As was mentioned above, a of studies have demonstrated that the ability to maintain a stable airway without stimulating the larynx and trachea can decrease the incidence of adverse respiratory events in children with active or recent URIs Tait et al. The same might be true for patients with asthma, where the airway is also hyperirritable, although there are no data in children at this time.

Airway pressure and resistance in anesthetized adults without lung disease have been shown to be lower with the LMA compared with an endotracheal tube, and it has been shown to induce less bronchoconstriction Berry et al. Although the LMA may diminish lower respiratory tract stimulation, it does not appear to decrease the incidence of postoperative sore throat Splinter et al. The findings by Tait et al. Infants appear to have a greater incidence of problems with supraglottic airway devices than older children.

There is a high incidence of infolding of the epiglottis and malposition in children under 10 kg and a ificantly higher incidence of airway complications such as laryngospasm, breath-holding, obstruction, and coughing when compared with a conventional mask with oral airway Harnett et al.

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Latex is present in many medical devices, including surgical and examination gloves, catheters, intubation tubes, anesthesia masksand dental fillers. Reported allergic reactions range from contact urticaria to anaphylaxis [ 1 ]. There has been a marked worldwide increase during recent years in the rate of reactions to latex. These reactions are due to either or both:. The formulation chemicals vulcanizers, stabilizers, preservatives.

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These cause mainly local delayed hypersensitivity reactions. However, some of these chemicals are also carcinogenic, and may have more serious and not immediately apparent consequences. Proteins in the latex. These can cause generalized systemic allergic reactions, including anaphylaxis, which can be severe and life-threatening. Latex condoms degrade over time. The FDA has issued a final regulation requiring that the labelling of latex condoms shall contain an expiry date based on physical and mechanical testing performed after exposing the product to varying conditions that age latex, both on the outside packaging and on the individual packaging [ 2 ].

The agency has also stipulated that if a latex condom contains spermicide and if the expiry date based upon spermicidal stability testing is different from the expiry date based on latex integrity testing, the product shall bear only the earlier expiry date. Howard J. Perhaps the better question is: can the surgical procedure be performed under regional anesthesia, avoiding endotracheal anesthesia altogether? If general anesthesia is required, perhaps a mask anesthetic or use of the laryngeal mask airway would limit the stimulation inherent in endotracheal intubation.

Selected patients may be candidates for deep extubation. Patients at risk for aspiration and those with difficult airways are not candidates for deep extubation. Typically deep extubation is accomplished with the patient breathing spontaneously, deeply anesthetized with a volatile agent, with airway Anesthesia mask stories suppressed.

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Brian J. Charles J. Emergence or recovery has been Anesthesia mask stories divided into early extubation, eye opening, following commands and late drinking, discharge time from postanesthesia care unit or hospital. Although most studies have demonstrated a more rapid early recovery after less soluble anesthetics, —, few have demonstrated a more rapid late recovery.

The speed of emergence and recovery from anesthesia are discussed in earlier text. The incidence of complications, such as airway reflex responses and vomiting during emergence from anesthesia, after mask anesthesia or tracheal intubation, are similar with most inhalational agents.

Moreover, the incidence of airway Anesthesia mask stories responses after removing a laryngeal mask airway LMA deep during desflurane anesthesia was ificantly greater than was the incidence after removal of an LMA after recovery from desflurane awake or after isoflurane anesthesia. The high energy of the laser and its potential for combustion can cause an airway fire when the surgical field is near to the airway Fig. When a laser strikes the unprotected external surface of a tracheal tube during laser airway surgery, the surface starts to disintegrate and can catch fire.

If the fire is not recognized and the laser continues to be applied, it can produce a hole in the tracheal tube and expose the burning surface to the oxidant-rich gas within the anesthesia system. At this stage, an explosive blowtorch-like fire may occur and rapidly spread in a distal and proximal manner. Any airway fire is a life-threatening complication, but the blowtorch fire is especially feared Fig. If the cuff of an ETT is punctured, the oxidant-rich gas within the circuit becomes exposed to the external surface of the ETT, and the risk of an airway fire, including a blowtorch fire, is increased ificantly.

Examination of an ETT after a blowtorch laser fire reveals total or near-total destruction of the ETT, with molten material, smoke, and other particulate material spreading out from the distal end of the tube Figs.

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It is thought that operating room fires are under-reported and that there are probably to operating room fires in the United States per year. One or two deaths per year are caused by airway fires. Many options are available for anesthesia management during airway laser surgery.

Selection of the ventilation method and type of laser depends on the nature and location of the lesion, the condition of the patient, and the availability of equipment and expertise. Different anesthesia management techniques have been described in the treatment of recurrent respiratory papillomatosis using the CO 2 laser.

However, there is no consensus with respect to anesthesia management. The possibility of complete airway collapse or an Anesthesia mask stories to ventilate must be taken into consideration when deciding on spontaneous or positive-pressure ventilation. When general anesthesia for laser airway surgery is conducted without an ETT, special techniques are used. They include Venturi jet ventilation, intermittent apneic technique, LMA, and insufflation, which are discussed later in this chapter. Surveys of otolaryngologists active in this type of surgery concerning the complications of CO 2 laser laryngeal surgery have found ETT fires or explosions to be the most common major complication.

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Fires require three components i.

Anesthesia mask stories

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