Anesthesia Instruments *Identify: *Indications: *Contraindications: *Complications

Laryngeal Mask airway

Indications : LMA airways are indicated for use as an alternative to the face mask for achieving and maintaining control of the airway. LMA airways are not indicated as a replacement for the endotracheal tube. LMA airways are indicated for use in: Routine and emergency anesthetic procedures (support ventilation). Known or unexpected difficult airways Establishing an airway during resuscitation in the profoundly unconscious patient with absent glossopharyngeal and laryngeal reflexes when tracheal intubation is not possible

Contraindications: Non-fasted including patients whose fasting cannot be confirmed Grossly or morbidly obese >14 weeks pregnant Acute abdominal or thoracic injury/Multiple or massive injury Any condition associated with delayed gastric emptying Patient who have fixed decreased pulmonary compliance Complications: Mechanical: failed insertion, ineffective seal and malposition. Traumatic: sore throat, dysphagia and dysarthria. Pathophysiologic: coughing, vomiting, regurgitation and aspiration

Endo-Tracheal intubation:

Indications: Cardiopulmonary Arrest Patient in deep coma or unresponsive Shallow or slow respirations (less than 8 per minute) Progressive cyanosis Gastric lavage Surgical patients where body positioning or facial contours preclude the use of a mask To prevent loss of airway at a later time, i.e. a burn patient who inhales hot gases may be intubated initially to prevent his airway from swelling shu Contraindications: Obstruction of the upper airway due to foreign objects Cervical fractures Esophageal disease Ingestion of caustic substances Thermal or chemical burns Laryngeal edema

Complications : 1) During intubation Trauma to lip, tongue or teeth Hypertension and tachycardia or arrhythmia Pulmonary aspiration Laryngospasm Bronchospasm Laryngeal edema Arytenoid dislocation -> hoarseness Increased intracranial pressure Spinal cord trauma in cervical spine injury Esophageal intubation 2) During remained intubation Obstruction from klinking, secretion or overinflation of cuff Accidental extubation or endobronchial intubation Disconnection from breathing circuit Pulmonary aspiration Lib or nasal ulcer in case with prolong period of intubation Sinusitis or otitis in case with prolong nasoendotracheal intubation

3) During extubation Laryngospasm Pulmonary aspiration Edema of upper airway 4) After extubation Sore throat Hoarseness Tracheal stenosis (Prolong intubation) Laryngeal granuloma

Regional anesthesia

Indications: Pelvic, lower abdominal, lower limb procedures Labor & delivery Post-op pain control Conservative rib fracture (dorsal epidural) Contraindications: Absolute: patient refusal, infection at site of injection, high ICP, bleeding diathesis Relative: neurological defect, skeletal abnormalities (scoliosis), anticoagulant (stop heparin 6 hrs pre-op), sepsis, hypotension, hypovolemia Complications: Severe headache Hypotension Nerve damage Spinal Infection (meningitis or abscess) Allergic reaction to the anesthesia used Urine retention Nausea, vomiting Bleeding around the spinal column (hematoma) Seizures (this is rare)

SpinalEpidural Needle: fine, not marked, no catheterNeedle: hard, marked, with catheter Injected at L 4 -L 5 Injected at any site: cervical, dorsal, lumbar Fast actionDelayed action Needle goes into CSFNeedle stop before dura The difference between spinal & epidural anesthesia:

Chest tube

Device is usually attached to an underwater seal, below the level of the chest. This allows the air or fluid to escape from the pleural space, and prevents anything returning to the chest. The idea of underwater seal is to make intrapleural pressure –ve again Indications: Pneumothorax Pleural effusion:Pleural effusion  Chylothorax: a collection of lymphatic fluid in the pleural space Chylothoraxlymphatic  Empyema: a pyogenic infection of the pleural space Empyemapyogenicinfection  Hemothorax: accumulation of blood in the pleural space Hemothorax  Hydrothorax: accumulation of serous fluid in the pleural space Hydrothorax Contraindications: refractory coagulopathycoagulopathy lack of cooperation by the patient diaphragmatic hernia scarring in the pleural space (adhesions)

Complications: hemorrhage infection reexpansion pulmonary edema Chest tube clogging this will lead to: pericardial tamponade, tension pneumothorax, or in the setting of infection, an empyema Injury to: liver, spleen or diaphragm is possible if the tube is placed inferior to the pleural cavity. Injuries to the thoracic aorta and heart have also been described liverpleendiaphragm aortaheart Components (3 chambers): collection chamber water seal chamber to prevent the communication between –ve intrapleural pressure & atmospheric pressure, if bubble means there is still air leak suction control chamber

Done By: Dana Saud ALEssa Best wishes ;)