Successful bite block placement with the laryngeal mask airway (LMA) may seem mundane, but without care and thoughtfulness on the part of the anesthetist, key variables can be missed. The consequences range from minor – the bite block not proficiently performing its designated task – to disastrous – severe pulmonary edema or needless dental or soft tissue damage.
Case Report
A 41-year-old Caucasian female presented for open-reduction, internal-fixation of a left tibial plateau fracture resulting from a direct blow by a cow six days prior to the surgery date. The patient’s only prior medical history included remote hypertension and right axillary artery occlusion repaired a year ago. The patient’s lone current medication was 1 milligram (mg) lorazepam by mouth to be taken the morning of surgery; the patient had been off all antihypertensive prescriptions for two months, with a current baseline blood pressure of 116/72.
In the holding room the patient was medicated with 2 mg intravenous (IV) midazolam and 100 micrograms (mcg) IV fentanyl. Following pretreatment with 100 mg IV lidocaine, intravenous induction was accomplished with 200 mg propofol. A size 4 LMA was placed with ease. Throughout the two-and-a-half hour procedure, the patent remained anesthetized with a combination of volatile (1.4% isoflurane) and periodic IV boluses of fentanyl, for a total of 275 mcg given. Upon completion of the surgery, the isoflurane was discontinued.
During emergence the patent demonstrated sustained masseter rigidity, such that the anteriorly-located soft gauze bite block proved insufficient in preventing the patient from biting the LMA. Although not occluded enough to preclude the delivery of sufficient tidal volumes, the LMA was unable to...
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Unpleasant breathlessness that comes on suddenly or without expectation can be due to a serious underlying medical condition. Pneumonia can impact the very young and very old, asthma tends to affect young children, smokers are at greater risk of lung and heart disease and the elderly may develop heart failure. However, medical attention always needed by all these conditions as it can affect any age group and severe breathlessnes. There are short and long term causes of dyspnea. Sudden and unexpected breathlessness is most likely tend to be caused by one of the following health conditions. There is accumulating evidence that in many patients, dyspnea is multifactorial in causes, and that in most patients, there is no single, all-encompassing explanation for dyspnea.
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
A pneumothorax is defined as “the presence of air or gas in the plural cavity which can impair oxygenation and/or ventilation” (Daley, 2014). The development of a pneumothorax to a tension pneumothorax can be caused from positive pressure ventilation.
IV sedation is reserved for our most complicated procedures and patients with very high levels of fear and anxiety. IV sedation creates a sleep-like state that allows you to wake up from a procedure with no memory of the sights, smells, sounds, or sensations that occurred during the treatment. This form of sedation is administered through an intravenous line and only by a licensed
Anesthesia, “We take it for granted that we can sleep through operations without feeling any pain. But until about 150 years ago, the operating room was a virtual torture chamber because surgeons had no way to prevent the pain caused by their healing knives.”
Patients with atelectasis will vary in their manifestations, depending on the degree of area affected. Typically, breath sounds will be reduced or diminished on the side of the alveolar collapse and oxygen saturation will be decreased because air is unable to fill the alveolar sacs where the process of ventilation-perfusion is supposed to take place (Lewis et al., 2014). According to Porth (2015), the patient may also exhibit tachypnea, diminished chest expansion, intercostal retractions, dyspnea, and tachycardia. These symptoms demonstrate how the body reacts and its attempt to compensate for the lack of oxygen. This lack of oxygenation to tissues results in cyanosis (Porth, 2015). An individual undergoing such difficulty to breath will present distressed and anxious. A thorough assessment of the patient and presence of some of these manifestations contribute to the diagnosis of atelectasis, which would be supplemented by a chest radiograph for confirmation (Porth, 2015). Most post-operative patients who fall victim to atelectasis and present with the signs and symptoms described, usually have risk factors that increase their probability of acquiring the
Wildgruber and Rummeny (2012) define tension pneumothorax is a life-threatening condition where air enters the pleural cavity during inspiration but cannot escape during expiration. It is more common in patients with chest traumas and those with mechanical ventilations (Briggs, 2010). Increased the thoracic pressure will compress against the heart and the unaffected lung impairing cardiac functions and ventilation (Pons, & National Association of Emergency Medical Technicians, 2011). Rapid intervention is required to prevent fatal conditions include hypoxia, shock, cardiorespiratory arrest and death (Wildgruber & Rummeny, 2012; Day, 2011; Bethel, 2008).
On October 16th, 1846 the world of surgery changed forever. Taking place in the Ether Dome at Mass General Hospital was the surgical removal of a tumor in a man’s neck. The surgeon was the world renowned Doctor John Warren. Before Doctor Warren could slice into the man’s neck, William TJ Morten, a dentist, ran into the room. He presented a bag filled with a gas called Ether, and swore that he could erase all of the patient’s pain. He had tested this gas on himself, his dog, and his goldfish. Doctor John Warren gave him permission to try out this relatively untested gas on his patient. For the first time in surgical history, the Ether Dome stayed silent throughout the surgery. No screaming, no flailing, and no burly men needed to hold the patient down (Decoding The Void). Soon Doctors all over the world were using general anesthesia, and history was made.
...llen S. “Dysphagia and Aspiration Pneumonia in Older Adults.” Journal of the American Academy of Nurse Practitioners 22 (2010) 17-22 *
The base of tongue resides close to the glottic aperture. During traditional direct laryngoscopy, the base of tongue falls posteriorly, obstructing the line of sight into the glottis. Visualizing the larynx requires displacing the base of tongue anteriorly so that the line of sight to the glottis is restored. The tongue is frequently displaced with a hand-held rigid laryngoscope, to which Macintosh and Miller blades are most commonly attached. These laryngoscopes push the tongue anteriorly and, in so doing, move it from a posterior obstructing position to a new anterior nonobstructing position. The new position is within the mandibular space. The mandibular space is the area between the two rami of the mandible. Even with the tongue maximally displaced into the mandibular space, visualization of the larynx is sometimes inadequate. A tongue which is large compared with the size of the mouth (oropharynx) and mandible takes up excessive space in the oropharynx and thus interferes with
VAP develops in a patient after 48 hours or more of endotracheal intubation. According to a study by Relio et al. (as citied in Fields, L.B., 2008, Journal of Neuroscience Nursing, 40(5), 291-8) VAP adds an additional cost of $29,000-$40,000 per patient and increases the morality rate by 40-80%. Mechanically ventilated patients are at an increased risk in developing VAP due to factors such as circumvention of body’s own natural defense mechanisms in the upper respiratory tract (the filtering and protective properties of nasal mucosa and cilia), dry open mouth, and aspiration of oral secretions, altered consciousness, immobility, and possible immunosuppression. Furthermore, the accumulation of plaque in the oral cavity creates a biofilm that allows the patient’s mouth to become colonized with bacteria.
Describe how the client was monitored by the anesthesiologist or nurse anesthetist during the procedure. Include what type of anesthesia the client received and how the airway was maintained and monitored.
Certain individuals avoid the dentist at all costs, choosing to live with cavities, gum disease and more, as they fear the chair more than anything. Others put off visiting a dental practitioner until the pain has become so overwhelming they can no longer live with it. This phobia is more common than many people realize, and it shows in oral health statistics. This doesn't need to be the case, however, thanks to sedation dentistry. Dentists use sedation for those dentists who experience anxiety, whether they are simply having a cavity filled or need to have their teeth cleaned. It's no longer reserved only for major work.
As a caregiver of a client in this condition, setting goals and outcome is needed. The goal and outcome for a client suffering from dysphagia are; the client can effectively swallow without choking within seven days, and the client will be free from aspiration evidence by clear lung sound within five days (Ackley & Ladwig, 2011).
Our group was assigned the topic on vasopressor syncope, a common emergency in the dental settings precipitated due to fear, anxiety and stress associated with dental treatment. Our emergency scenario highlighted a young woman, in her late twenties, who avoids visiting the dentist for extended periods of time due to dental fear. Her appointment for NSPT required her to get local anesthetic.She displayed classic signs & symptoms such as being pale, sweaty, feeling warm and clenching the armrest (white knuckles syndrome) and was in an overall state of panic. After seeing the needle, she loses consciousness and the dental team quickly use ammonia vaporole to help her regain consciousness. In the event, she did not regain consciousness BLS procedures are performed and she is placed in supine position with feet higher than her head.