Anesthesia Ippv

Front 1

What is IPPV?

Back 1

intermittent positive pressure ventilation

Front 2

What are things to consider when ventilating an animal?

Back 2

controlled ventilation for patients
-failure to ventilate (PaCO2 >60mmHg)
-Failure to oxygenate (PaO2< 60mmHg)
-difficulty maintain anesthetic plane
-Surgery related (thorax, brain diaphragm)
-Respiratory muscle fatigue

Front 3

What does a capnograph help monitor?

Back 3

help determine ventilation adequacy

Front 4

What does pulse oximetry help monitor?

Back 4

hemoglobin saturation with oxygen

Front 5

What do blood gases help monitor?

Back 5

PaCO2 and PaO2

Front 6

What are causes of respiratory inadequacy due to depression of respiratory centers?

Back 6

-Drug induced (anesthesia)
-Metabolic (acidosis or alkalosis)
-Physical (head trauma)

Front 7

What are causes of respiratory inadequacy due to inability to expand the thorax

Back 7

-pain (fractured rib)
-chest trauma
-Thoracic surgery (PDA)
-Weakness of thoracic muscles (myasthenia gravis)

Front 8

What are causes of respiratory inadequacy due to inability to expand the lungs?

Back 8

-pneumothorax
-diaphragmatic hernia
-lung disease
-Neoplasia
-Pneumonia
-Atelectasis
-positioning
-airway obstruction
-edema
-respiratory arrest

Front 9

What breathing system can you use for ventilation?

Back 9

Mapleson D
Mapleson F
Rebreathing systems

Front 10

How can you perform manual IPPV?

Back 10

-close the pop-off valve
-squeeze bag
-watch pressure manometer (5-20cm H2O PIP)
-Watch chest
-release/open valve

Front 11

How do you manually control oxygen flow rate?

Back 11

close flow (5-10ml/kg/min) to avoid rapid filling of reservoir bag
-check APL valve
--open for economics
--closed if IPPV
-assisted (closed flow not necessary)

Front 12

What was the first ventilator?

Back 12

iron lung

-no intubation, provided negative pressure with a ribber seal wound the patients neck
-upper airway obstruction
-claustrophobia and discomfort
-leak, heavy and bulky

Front 13

What happens during IPPV?

Back 13

-gas will flow along pressure gradient between upper airway and alveoli
-the magnitude, rate and duration of flow are determined by the operator
-flow
-breath expiration is passive

Front 14

What is a volume controlled ventilator?

Back 14

present tidal volume constant
-preset tidal volume constant
--lung compliance and resistance change
--guaranteed volume regardless of procedure or condition of lungs

Front 15

What is pressure controlled ventilators?

Back 15

achieves a fixed inspiration pressure
-does not guarantee fixed volume
-tidal volume varies
--lung compliance and resistance
-frequent assessment is required

Front 16

What is the I:E ratio?
What should it be in cat?
Dog?
Horse?

Back 16

time of inspiration: expiration

1:2 cat
1:2-3 dog
1:4 horse

Front 17

What is PEEP?

Back 17

Positive end Expiratory pressure
used to open small airways
-prevent or treat atelectasis
-lung trauma
-pulmonary edema

Front 18

What are modes of operations?

Back 18

assist
-patient will trigger the ventilatory devise by initializing an inspiration effort

control
-operator dictates respiratory rate
ventilator does not respond to patients inspiration efforts

Assist-control
-operator will set minimal RR and patient can also trigger ventilator

Front 19

What is an exhaust valve?

Back 19

opens to allow driving gas outside bellows to be exhausted

Front 20

What is the spill valve?

Back 20

scavenging

Front 21

What is the ventilator hose connection?

Back 21

connects breathing system to ventilator

Front 22

What are bellows?

Back 22

rubber bog inside the housing "new bag"

Front 23

What are the effects spontaneous inspiration?
During IPPV?

Back 23

decreased intrathoracic pressure
Increased intrathoracic prssure

Front 24

What can be seen with an increase in thoracic pressure?

Back 24

-a transient increase in pressure to right atrium and vena cava
-decrease venous return
-decrease venous return
-decrease cardiac output
-this may decrease patients arterial blood pressure
-which may decrease perfusion to vital tissues
-cause a vagal response
-by stimulating the parasympathetic system
-which can cause a bradycardia
-may contribute to a decrease cardiac output (CO)

Front 25

What are the effects of IPPV?

Back 25

-lung and chest wall compliance
-the level of intra thoracic pressure which is airway pressure
--increase peak inspiratory pressure (PIP)
--increase positive end Expiratory pressure (PEEP)

Front 26

What are negative effects of IPPV?

Back 26

-can damage lungs
-may worsen pre-existing lung pathology
-can have negative impact systemically

Front 27

What is optimal ventilatory strategy?

Back 27

-achieve minute ventilation of PaCO@ (35-45mm/Hg)
-maintain good oxygeneation to your patients tissues
-do not maintain PIP longer that necessary to a make tidal volume
-aim for longer expiration
-inflate lungs rapidly but ling enough to evenly distributive gas
-minimize resistance
-decrease dead space

Front 28

What are the steps of "weaning" the patient off the ventilator?

Back 28

monitor CO2 levels
decrease rate of frequency
decrease anesthetic depth
reverse NMBs in needed

Front 29

What is a respiratory assist device?

Back 29

demand valves
-places on end of ET tube and is capable of delivering oxygen on demand from patient initiated breath or from operator