Mechanical Ventilation Facts

LOW FLOW #Anesthesia

🌧Low flow anesthesia allows for economy of volatile anesthetics, makes possible heating and humidification of gases and reduces environmental pollution 

🌧Sodalime contains 94% Calcium hydroxide, 5% Sodium hydroxide snd also Potassium hydroxide, Silica and dying agent

🌧 CO2 + 2NaOH --> Na2CO3 + water + heat

      Na2CO3 + Ca(OH)2 --> 2NaOH + CaCO3

..this sequence gets back Sodium hydroxide, back in the game💁♂️

🌧 1 Kg of Sodalime can absorb >120 L of CO2

🌧 Carbon monoxide which is a byproduct of protein metabolism can accumulate in the system, but levels are <4%

🌧 If there is intoxication by alcohol or poisoning by Carbon monoxide or severe diabetic ketosis, alcohol or CO or acetone from the expired gases, will recirculate and accumulate inside the system; so low flow anesthesia is contraindicated in such states

🌧 Prolonged anesthesia with sevoflurane may generate Compound A inside the system, which can cause acute tubular necrosis in rats at concentrations around 250 ppm, a dose that is nearly 200 times seen in clinical practice. So any proteinuria, glycosuria or enzymuria which does develop in such a context has not been shown to have any clinical significance, even in patients with proteinuria

Reference: Al-Shaikh B, Stacey S. Essentials of Anaesthetic Equipment, 2nd edn. Edinburgh: Churchill Livingstone, 2002; pp. 74–9 . Nunn G. Low-flow anaesthesia. Contin Educ Anaesth Crit Care Pain 2008; 8: 1–4. 

SJOGRENS SYNDROME-anesthesia implications ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖

🏳️🌈Preoperative abnormalities

1. Symptoms of the sicca syndrome include dryness of the eyes and skin.

2. Check for associated RA, SLE, scleroderma, the polymyositis, polyarteritis nodosa, chronic active hepatitis, and Grave's disease.

3.Lung / airway : desiccation of the nose and bronchial tree, obstructive airways disease, interstitial lung disease

4.sensory / motor neuropathy may occur and CNS lesions have been described.

5.The patient may be taking corticosteroids or occasionally immunosuppressive agents.

🏳️🌈Anaesthetist's concerns

1. Sometimes gross swelling of the salivary glands may make mask anaesthesia difficult.

2.The problems of pulmonary disease, if present.

3.The dry eyes are susceptible to damage during anaesthesia.

4.Allergy to antimicrobial agents, particularly penicillin, cephalosporins and trimethoprim

Management

1. careful assessment of the primary disease, and of any pulmonary involvement.

2. Drying agents should be avoided if possible.

3. The eyes should be protected with pads.

4. Anaesthetic gases should be humidified.

5. Steroid supplements may be required.

6. Care should be taken when prescribing antimicrobial agents

#anesthesia , #anaesthesia , #anesthesiology , #anaesthesiology , #PerioperativeCare , #comorbidities , #PreAnestheticCheckup , #PAC

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