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19 Cards in this Set
- Front
- Back
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Which of the following is incorrect regarding the obese patient ?
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B. Morbid Obesity = Class III obesity, with
BMI > 40 |
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List the EQUIPMENT issues associated with an Obese Patient.
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1. Bed : > 150 kg will require a bariatric bed
( < 450kg limit) 2. ECG: very low voltages due to increased soft tissue thickness 3. Vascular access : Longer cannulas + ultrasound likely required |
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List the General issues associated with the Obese airway .
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1. Increased soft tissue weight / volume
a. Distorted airway when supine b. Difficult laryngoscope elevation /lifting 2. Increased abdominal size preventing diaphragmatic excursion. desaturation times |
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What does the Mnemonic "BIGRAM and 4P's" stand for in regards to the obese airway
management ? |
B = Buy time
I = Indications for Intubation ? G = Get Help R = Ramp patient A = Apnoeic oxygenation M = Minimal drugs P = Pre-oxygenate with NIV P = Paralyse only if necessary P = Plan for failure P = Post intubation care |
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List the components of the "Buy Time"
phenomenon in obese airway management. |
1. Improved position
2. Improved oxygenation a. Non-rebreather mask b. Bag-valve mask with PEEP valve c. Non-invasive ventilation 3. Consider other non - RSI intubation methods : |
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What are some important considerations in "Getting Help" In the airway management of the obese patient ?
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- Ensure that the "help" is experienced
( Anaesthetic Consultant vs. Registrar ) - Ensure a well verbalised Plan A and Plan B and Plan C are performed. |
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What are the benefits of "ramping" ? :
( "Ear to sternal notch positioning") |
1. Optimises upper airway patency
2. Optimises Laryngoscopic view 3. Facilitates bag-mask ventilation 4. Extends "safe apnoea" period. 5. Shortens time with mask ventilation to return to normal oxygenation 6. Improves mechanics of ventilation post intubation |
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In regards to "M" [ Minimal drugs ]of "BIGRAM" and 4 P's ] , what are the options for optimising sedation and ETT placement ?
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1. Ketamine 1.5 - 2.0 mg / kg
2. Ketofol ( 50% ketamine 100 mg / 50% propofol 100mg) 3. Fentanyl + midazolam ALSO consider : 4. 5 mL 1% lignocaine nebulised to anaesthetise cords. |
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Which is incorrect regarding Preoxygenating with Non-Invasive ventilation prior to
intubation ? |
C. It is.
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In regards to Rocuronium paralysis in "BIGRAM and 4 P's", which of the following is incorrect ?
A. Rocuronium has minimal histamine release. B. It has minimal cardiovascular side effects. C. It has the same onset time as suxamethonium if given in a dose of 0.7 -1.0 mg / kg. |
C. Rocuronium dosed at 1.2 - 1.4 mg /kg gives an equivalent paralysis onset time to
suxamethonium. |
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In regards to paralysis and the use of
suxamethonium in the " BIGRAM and 4P's" Obese airway Acronym, which of the following is incorrect ? |
D. It potentially can.
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In regards to "Planning for Failure" as part of the "BIGRAM and 4P's", which of the following is incorrect ?
A. Obese patients feature prominently in airway disaster cases. B. Getting "Help" should involve ENT surgeons as well as Anaesthetics. C. The Needle -Seldinger technique is inferior to the Surgical / scalpel airway. Needle-Seldinger technique may be impaired by kinking of the wire. |
C. neither is considered superior.
The needle-Seldinger technique may have some advantages in the obese patient, including : 1. Easier to traverse neck with stiff needle 2. Less active bleeding 3. less visual obscuration than with blood and fat impairing view of cricothyroid membrane . |
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Which of the following is incorrect regarding Post intubation care in the obese airway?
A. High pressures are usually encountered when ventilating. B. Ramping is not usually required after intubation. C. There is usually poor lung mechanics D. Aiming to get an ICU ventilator ASAP is an important goal post intubation. |
B. Maintaining ramp, as well as tilting the bed feet down, can assist with ventilation.
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List the 10 changes in Pulmonary
Physiology that are encountered in the Obese patient, that result in : |
1. Decreased chest wall compliance
2. Increased abdominal contents - impairing lung inflation 3. Diminished lung capacity ( VC + RV) 4. Diminished vital capacity ( IRV + Vt + ERV ) 5. Decreased FRC ( RV + ERV) 6. Increased airway resistance 7. VQ mismatch ( collapse of small airways) 8. Increased O2 consumption 9. Increased CO2 production 10 Relative room air - hypoxia and hypercarbia |
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List the Gastrointestinal Physiological changes that are encountered in the Management of the Obese airway, and contribute to :
1. An increased risk of aspiration 2. An increased risk of lung injury. |
1. Increased abdominal size and intrabdominal pressure
2. Hiatus herniae 3. Reflux 4. larger gastric volume 5. Lower gastric content pH |
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Which is incorrect regarding the Obese airway management ?
A. Obesity reliably predicts difficult mask ventilation B. Lipophilic drugs are dosed on IDEAL body weight. C. Suxamethonium is dosed on total body weight D. Ketamine is dosed on Lean body mass. |
B. Lipophilic drugs = total body weight
Hydrophilic drugs = Ideal body weight |
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List the drugs that are dosed based on IDEAL body weight (IBW) , for intubating the obese
airway. |
1. Propofol
2. Rocuronium 3. Ketamine dosed on "lean body mass" |
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List the drugs that are dosed based on TOTAL body weight (TBW) for intubating the obese
airway. |
1. Midazolam
2. Fentanyl 3. Suxamethonium |
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Which of the following is incorrect regarding the obese airway Management ?
A. Under ideal circumstances, cricothyroidotomy takes > 100 seconds to achieve ventilation. B. PEEP of 10 cm H2O is used post intubation, for ventilation. C. Trendelenberg positioning assists with Ventilation. D. The external auditory meatus is aligned level with the sternal notch with successful "ramping" |
C. Reverse Trendelenberg.
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