Clinical Conference Anesthesia Machines don ’ t fail, do they? James H. Philip M(E)E, MD Brigham...
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Transcript of Clinical Conference Anesthesia Machines don ’ t fail, do they? James H. Philip M(E)E, MD Brigham...
Clinical Conference Anesthesia Machines don’t fail,
do they?
James H. Philip M(E)E, MD
Brigham and Women’s Hospital
October 30, 2002
© Copyright 2002, James H Philip, all rights reserved
Case 1
57 yo F for Laparoscopy
PMHHypertension on Atenalol, GERD successfully Tx’s w Prilosec, Mild COPD.Otherwise healthy
5’2” 165# + COPD
Elect GETA
Plan Propofol, Succinylcholine, Tube, Desflurane, Vecuronium if necessary
Preparation
Resident starts IV
I check the Anesthesia Machine
Desflurane vaporizer is missing
I page Anes Tech
Tech and Vaporizer arrive
He attaches vaporizer
Remainder of Check out
What am I doing here?
What is my FGF set to?
What pressure am I trying to hold?
What pressure do I not want to exceed?
How big can the bag get?
Denitrogenate
Mask - Tight or Loose?
FGF - High or Low?
Pop-off valve - Open or Closed?
Selector Switch - Bag or Vent?
What is good about the bellows?
What is bad about the bellows?Low opening pressure
Tachycardia and Hypertension
What is good about the bellows?
What is bad about the bellows?Low opening pressure
Tachycardia and HypertensionIn the anesthesiologist
Who feels total obstruction
Expiratory Valve - Missing O Ring
How did this happen?
PEEP Valve incorrectly removed
Note that Cage and Valve are depressed !