Couple of Anesthetic Questions (Hope Judith Hutchinson is listening)....?

Question

Could Anyone help me with a few of these?

1) What is the protocols for intubation vs LMA?

2) True/False- fasting for ops protocol is 6hrs solids, 2hrs fluids?

3) True/False - rapid sequence induction is about putting a pt under rapidly with cricoid pressure/etc, in pts at a higher risk of vomitting, (is there any other indication?)

4) For diabetic Patients - apart from ceasing metformin and starting insulin infusion, is there any other major anesthetic consideration

5) When using the laryngoscope, does one push the epiglottis back with the blade of the laryngoscope?

I know, I know, that yahoo answers isnt Ideal to learn this stuff from, but I get lots of good stuff from time to time here, so pls answer some of the above if you know, instead of ppl telling me not to ask this stuff on yahoo answers.

Any help would be much appreciated!!!!!!

Thanks

Answer 1

Judith Hutchinson is Pangolin , the top answerer in here you can go see it by www.medicalminute.com

I am sure she can answer it

Lets wait

Answer 2

Hi

Who is J Hutchinson?

Just being curious.

1)type of surgery and length of surgery and body habitus

2)true

3)not fasted, indeed, so emergency intubations

4) pts with diabetes, please! pts with IDDM and insulin pumps will want to manage their own DM (like me) and you will have to do ABG's to establish their BGLs intraoperatively, and give them extra dextrose IV if BGLs are low-ish. They are also first on op lists. Just because we are special he he.

5) push tongue down with blade. Epiglottis is situated hanging from above, not resting down below...

6) Don't take my word for it will ya. Check and double check, it will serve you well during your years of practice. Always check what you've been told, do not take anyones word for anything if you can help it! Emergencies are a different ball game. This isn't one of them.

Good luck.

Answer 3

Hi Peter.

1.  Lots of things, including (but not limited to):  the procedure being done (need for paralysis, usually);  fasting vs. full stomach; any risk of aspiration, like obesity, reflux disease, diabetes (gastroparesis), prior stomach surgery, airway abnormalities; patient position during surgery; surgeon and/or anesthesiologist preference.

2.  It varies by facility, and by patient.  Patients at risk for aspiration should not have the clear liquids (not fluids - has to be clear liquids).  Those are the most liberal guidelines.  Many places get a bit stricter for many reasons, like cases moving earlier, patients confusing "clear liquids" with "Doritos", and that sort of thing.  Solids 8 hrs and clr liquids 3-4 hours is probably more common.  The hospital where I work is NPO after midnight.  If that is violated, we take it on a case-by-case basis.

3.  It's not a higher risk of vomiting, but of passive regurgitation of stomach contents.  That includes anyone not NPO, all pregnant women after about 12 weeks gestation, morbidly obese patients, stroke patients with airway protection issues, patients with uncontrolled reflux disease.  Some people include all trauma patients, as not much leaves the stomach if you're in that bad shape.

4.  We don't start insulin on Type 2 DM, unless a fingerstick shows very high glucose (over 300-350 might get the case postponed, tho).  We have them stop all oral hypoglycemic meds the day before surgery, check sugars and cover with insulin if needed.  Diabetics are prone to gastroparesis, so may need a RSI (as above), and we have to be alert for CAD (silent MI common), renal dysfunction, peripheral neuropathy (positioning issues) and other things.  Too much to go into here.

5.  Yes with a Miller blade, no with a Macintosh blade.  Mac (curved blade) goes into the vallecula and the whole supraglottic area is lifted to reveal the cords.

Hope that helps.