Anesthesia Student Survival Guide.pdf - Index of

Table 16.1 (continued)
Problem Differential diagnosis Remarks
Obesity or chest wall rigidity May be difficult to manage. High opioid dose can cause a “rigid chest syndrome.”
Acute Respiratory Distress Syndrome (ARDS) A common cause of high mean pressures, especially in the CU.
Hypocarbia Hyperventilation May see in anxious (awake) or mechanically hyperventilated (anesthetized) patients.
Leak of CO 2 in sampling tubing This may also cause an abnormality in the capnograph waveform or envelope.
Massive pulmonary embolus Can impair gas exchange, manifesting as a sudden drop in expired CO 2 .
Hypothermia Most evident in severe hypothermia as during cardiopulmonary bypass.
Cardiac Arrest mpaired circulation and CO 2 elimination.
Hypercarbia Hypoventilation Often from opioids, residual neuromuscular blockade, or low respiratory rate/ventilator tidal volumes.
CO 2 insufflation during laparoscopy May need to increase minute ventilation to overcome hypercarbia.
Malignant hyperthermia Uncoupling of calcium metabolism in mitochondria from a rare (1:15,000) genetic defect in the
ryanodine receptor of the calcium channel
Hyperthermia Metabolic rate increases 15% for every degree centigrade.
Convective losses are the #1 cause of heat loss in the OR (skin to air). Heat loss also occurs from
wet drapes and sheets, exposed skin or body cavities, non-heated breathing circuits.
Hypothermia Convective, conductive, radiative,
evaporative losses
Anesthetic effects on hypothalamus Anesthetics cause impaired central thermoregulation due to effects on the hypothalamus.
Administration of unwarmed fluid or blood Fluids should be warmed by an FDA-approved device.
products
Massive blood loss Difficult to keep patients warm after ³ 1 blood volume has been lost.
Hyperthermia Excessive warming Use the air-warming blanket at a room-temperature setting to cool the patient.
Fever from sepsis or transfusion reaction Give acetaminophen or ibuprofen in addition to a cooling blanket.
Stroke Sudden extreme hyperthermia (>105°F) may be from a stroke to the hypothalamus.
Neuroleptic malignant syndrome Uncommon side effect of antipsychotic medications (chlorpromazine, haloperidol, olanzepine).
Malignant hyperthermia (1) stop anesthetic, (2) give iv dantrolene, (3) call for help (see Appendix B, Malignant Hyperthermia)