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Question: A 68-year-old female is undergoing oesophagectomy with one-lung
anaesthesia. During the surgery, the oxygen saturation
drops from 85 %. What would be the appropriate steps?
A. Check pipeline pressure and gas analyser, and anaesthetic flow meter. B. Check breathing circuit for disconnection. C. Increase the FiO2 to 100%. D. Before troubleshooting, ask the surgeon to stop surgery and re-inflate lungs. E. Check the position of the tube.
Explanation:
OLV is associated with significant changes in lung physiology and it is not uncommon to notice a drop in oxygen saturation. All the above steps will have to be performed. The first step is ventilation with 100 % oxygen, if not doing so already. This will allow time for the necessary equipment checks and troubleshooting. Unrelenting deterioration may need to be managed by stopping surgery and reinflating both lungs. Inform the surgeon early before the situation gets out of control. Attention should be paid to maintain perfusion by treating hypotension.
Management of hypoxaemia during one-lung ventilation is as follows:
- Increase O2 to 100%
- Check the position and patency of the endotracheal tube
- Check the rest of the circuit and the anaesthetic machine
- Do a fibre-optic bronchoscopy if the airway pressures are high
- Treat hypotension and ensure adequate cardiac output
- Insufflate ate oxygen to the non-ventilated lung and apply continuous positive airway pressure
(CPAP) if no improvement - Apply positive end-expiratory pressure (PEEP) to the ventilated lung
- If the above measures fail, intermittent inflation of the collapsed lung should be performed
- Clamping the pulmonary artery to remove the shunt may be necessary for some thoracic surgeries.
Answers:
- true
- true
- true
- false
- true
Cardiopulmonary bypass Module
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- The basic CPB circuitry.
- Myocardial injury and preservation during CPB.
- Conduct and complications of CPB.
- The perioperative considerations surrounding the management of a patient undergoing CPB.
ANAESTHETIC IMPLICATIONS OF THE CARDIAC IMPLANTABLE ELECTRONIC DEVICES (CIEDs)
Cardiovascular physiology module by targetedaic
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The ‘MCQs for EDAIC FRCA FCAI’ section covers a different topic each day with the intent that candidates can prepare one small topic each day, making steady progress in their exam preparation.
