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Classification

 
  1. Sellick’s Maneuver: Firm pressure over cricoid cartilage prior to induction to prevent regurgitation of gastric contents into hypopharynx and subsequent aspiration.
  2. Mendelson’s Syndrome: perioperative aspiration of gastric content. Also known as acid aspiration syndrome.
    1. Signs/Symptoms: 
      1. Dyspnea,
      2. tachypnea, 
      3. bronchospasm,
      4. cyanosis, 
      5. hypoxemia,
      6. bilateral infiltration and metabolic and respiratory acidosis.
    2. Treatment: 
      1. E.T. suction,
      2. bronchoscopic removal of gastric content. 
      3. IPPV with PEEP,
      4. fluids, 
      5. steroids,
      6. antibiotics, 
      7. Bronchial lavage is contraindicated.
      8. Mechanical ventilation may be required
    3. Prevention:
      1. Metoclopramide,
      2. antacids, 
      3. cricoid pressure,
      4. Ranitidine.
  3. Rapid Sequence Induction
    1. It is the choice of Anaesthesia in patient prone for aspiration pneumonitis.
    2. Following are the conditions in which rapid sequence induction is indicated.
      1. Pregnancy
      2. Hiatus hernia
      3. Diabetes
      4. Head injury
      5. Emergency surgery where fasting guidelines not followed
  4. Rapid Sequence induction
    1. Preparation — prepare all necessary equipment, drugs and back-up plans
    2. Preoxygenation — with 100% oxygen for 3 min
    3. Premedication — depending on the patient, just the hypnotic agent
    4. sellicks maneuver — cricoid pressure is applied, 25- 30 newton
    5. Paralyze — suxamethonium or rocuronium
    6. Pass the tube — visualize the tube going through the vocal cords
    7. Proof of placement — using a reliable confirmation method
    8. Post intubation care — secure the tube, ventilate




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