PROBLEMS FOLLOWING INTUBATION
Following
apparently successful intubation, several scenarios may develop that require
immediate atten-tion. Anesthesia staff MUST confirm that the tube is correctly
placed with bilateral ventilation imme-diately following placement. Detection
of end-tidal CO2 remains the gold standard in this regard, with the
caveat that cardiac output must be present for end-tidal CO 2
production.
Decreases
in oxygen saturation can occur fol-lowing tube placement. This is often
secondary to endobronchial intubation, especially in small chil-dren and
babies. Decreased oxygen saturation peri-operatively may be due to inadequate
oxygen delivery (oxygen not turned on, patient not ventilated) or to
ventilation/perfusion mismatch (almost any form of lung disease). When
saturation declines, the patient’s chest is auscultated to confirm bilateral
tube place-ment and to listen for wheezes, rhonchi, and rales consistent with
lung pathology. The breathing cir-cuit is checked. An intraoperative chest
radiograph may be needed to identify the cause of desaturation. Intraoperative
fiberoptic bronchoscopy can also be performed and used to confirm proper tube
place-ment and to clear mucous plugs. Bronchodilators and deeper planes of
inhalation anesthetics are administered to treat bronchospasm. Obese patients
may desaturate secondary to a reduced FRC and atelectasis. Application of positive
end-expiratory pressure may improve oxygenation.
Should
the end-tidal CO2 decline suddenly, pul-monary (thrombus) or venous
air embolism should be considered. Likewise, other causes of a sudden decline
in cardiac output or a leak in the circuit should be considered.
A
rising end-tidal CO2 may be secondary to hypoventilation or
increased CO 2 produc-tion, as occurs with malignant hyperthermia,
sep-sis, a depleted CO 2 absorber, or breathing circuit malfunction.
Increases
in airway pressure may indicate an obstructed or kinked endotracheal tube or
reduced pulmonary compliance. The endotracheal tube should be suctioned to
confirm that it is patent and the lungs auscultated to detect signs of
broncho-spasm, pulmonary edema, endobronchial intuba-tion, or pneumothorax.
Decreases
in airway pressure can occur second-ary to leaks in the breathing circuit or
inadvertent extubation.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.