Anesthesia Student Survival Guide.pdf - Index of

CliniCAl simulAtion in AnesthesiA eduCAtion ● 513
can switch to another agent, perhaps sevoflurane because of its rapid onset
as desflurane is eliminated from the patient. Although low fresh gas flows
are tempting, to preserve the desflurane in the body, this must be tempered
by the need to ensure high flow oxygen and eliminate nitrous oxide until
you can monitor oxygenation. Your BIS monitor can help you maintain
a reasonable plane of anesthesia during this transition. Total intravenous
anesthesia would eliminate the need for the anesthesia machine altogether,
but it is difficult to manage without infusion pumps. Longer acting intravenous
agents such as ketamine are possible backups. Your patient is paralyzed
with vecuronium, and you will have to make a judgment regarding
the relative merit of continuing its use vs. allowing the patient to regain the
ability to breathe spontaneously should the emergency continue.
How will you monitor the patient?
You will have to rely on your senses and manual monitors! Your twitch
monitor (neuromuscular blockade monitor) is battery powered and can still
be used, whether you continue vecuronium, allow it to wear off, or actively
reverse neuromuscular blockade, all of which are reasonable options
depending on the surgical requirements and your need for spontaneous
ventilation. The BIS monitor will work as long as its battery is charged.
Some pulse oximeters have battery backup (but yours does not appear to!).
You can attempt to monitor oxygenation grossly by the patient’s color, but
this will be difficult without a steady and bright light source. You can monitor
blood pressure with a manual cuff, which is present in every properly
set-up operating room. You can also use breath and heart sounds as qualitative
monitors of respiration and cardiac output, heart rate, and rhythm.
Palpating peripheral pulses is always prudent as a qualitative measure of
cardiovascular condition.
The battery backup on your ventilator has now run out of power and the
ventilator stops. The oxygen flowmeter drops to zero and you realize that the
pipeline oxygen supply has failed. How will you proceed?
You will activate the backup oxygen tank supplies in the back of the anesthesia
machine by opening the valve on the neck of the green tank. Now, it may
be prudent to reduce fresh gas flows to preserve your limited supply. You will
manually ventilate the patient through the anesthesia machine; the carbon