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PRINCIPLES > OFFSITE ANESTHESIA > Flashcards

OFFSITE ANESTHESIA Flashcards

1
Q

OVERVIEW:

VOCAB:

OFFSITE ANESTHESIA

A

anesthesia delivered by an anesthesia provider in a location other than the operation room

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2
Q

OVERVIEW:

WHY ARE MORE PROCEDURE PERFORMED MORE FREQUENTLY OUTSIDE THE OR (2 REASONS)

A
  1. rapid technological development
  2. increasing financial constraints
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3
Q

OVERVIEW

WHY IS AN ANESTHESIA PROVIDER NECESSARY FOR OFFSITE PROCEDURES (2 REASONS)

A
  1. more comples procedures
  2. higher acuity patients
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4
Q

CHALLENGES

(7 without details)

A
  1. Procedure suite layouts not conducive to anesthesia delivery
  2. Lac of equipment routinely used in OR
  3. Lack of immediately accessible emergency equipment
  4. Remote location to experienced anesthesia help
  5. Lack of standardization of equipment/monitors/ pt preop prep
  6. Personnel lack understanding of anesthesia & not trained to help
  7. Unfamiliarity of the procedure & physical surroundings to anesthesia provider
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5
Q

CHALLENGES

  1. PROCEDURE SUITE LAYOUT (4)
A
  • no room for anesthesia machine, monitors
  • limited access to patient
  • unable to adjust thermostat
  • heavily shielded radation-proof room, only remote monitoring is possible
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6
Q

CHALLENGES

LACK OF EQUIPMENT ROUTINELY USED IN OR (3)

A
  • Scavenging system
  • pipelined O2, air, nitrous oxide
  • suction
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7
Q

CHALLENGES

LACK OF IMMDIATELY ACCESSIBLE EMERGENCY EQUIPMENT (3)

A
  • defibrillator
  • difficult airway cart
  • malignant hyperthermia cart
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8
Q

SAFE ANESTHESIA

ASA RECOMMENDATIONS (15)

A
  1. O2 - reliable source
  2. Suction - adequate functioning / reliable
  3. Scavening system - adequate & reliable
  4. Resuscitator bag - self-inflating - deliver 90% O2 as means to deliver positive pressure ventilation
  5. Anesthesia Monitors
  6. Anesthesia Medications
  7. Anesthesia Equipment
  8. Anesthesia machine - maintained to current OR standards
  9. Electrical outlets
  10. Illumination - of pt, monitors, & machine
  11. Space - for equipment, personal, for rapid access to pt, machine, monitors
  12. Emergency cart w/ defibrillator, drugs, equipment for CPR
  13. Staff - trained to support anesthesia provider
  14. Codes - building & safety codes observed
  15. Post anesthesia management
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9
Q

SAFE ANESTHESIA

AIRWAY CONSIDERATIONS

EQUIPMENT (2 airways, adjunct, 2 tubes)

A

oral or nasal airways

laryngoscopes / other intubation adjuncts

ETT / LMAs

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10
Q

SAFE ANESTHESIA

ASA “STANDARDS FOR BASIC MONITORING (4)

SPECIFICS (7)

A
  1. Circulation
  2. Oxygenation
  3. Ventilation
  4. Temperature
  5. EKG
  6. BP (q5min)
  7. Pulse oxymetry
  8. Capnography or capnmetry
  9. Oxygen analyzer (general anesthesia)
  10. Low oxygen alarm
  11. Temperature
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11
Q

SAFE ANESTHESIA

ASA PRE-OP GUIDELINES

same as OR

A
  • gather pertinant medical, anesthetic history
  • review relevant diagnostic test, labs
  • focused physical exam
  • dicussion of anesthetic plan with pt and CONSENT
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12
Q

DETERMINANTS OF ANESTHESIA TECHNIQUE (6)

A
  1. age
  2. position
  3. level of immobility
  4. patient condition
  5. patient/surgeon request
  6. airway risk
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13
Q

MONITORED ANESTHESIA CARE (MAC)

VOCAB:

CONSCIOUS SEDATION / MODERATE SEDATION

DEEP SEDATION

A
  1. sedated / relaxed / able to purposefully respond to verbal or physical stimulation / self maintained patent airway / spontaneous ventiation / protective airway reflexes
  2. controlled, depressed LOC / purposeful response w/ repeated or painful stimulatoin / adequate spontaneous ventilation / may need help with patency / protective airway reflexes lost
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14
Q

OFFSITE LOCATIONS (5)

A
  1. Gastrointestinal endoscopy suite
  2. cardiac cath & electrophysiology lab
  3. radiology suite
    a. inerventional radiology (neuroradiology/angiography)
    b. MRI / CT scan
  4. elecgtroconvulsive therapy unit
  5. physicians’ procedure rooms (dentist / podiatrist / dermatologist)
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15
Q

OFFSITE LOCATIONS

GASTROINTESTINAL ENDOSCOPY PROCEDURES

  • TYPES OF PROCDURES
  • NEED TO CONFIRM…
  • WHAT DO FIRST
  • MAC vs. GA CONSIDERATIONS (5)
  • POSITIONING
A
  • EGD / colonoscopy / ERCP (endoscopic retrograd choleangio-pancreatography)
  • NPO status. Pt at high risk for aspiration
  • Preoxygenate
  • emergent cases / full stomach / pathology / pt medical history / body habitus
  • pt prone with heard turn to side and arms bent up at 90 degress
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16
Q

OFFSITE LOCATIONS

CARDIAC CATH / ELECTOPHYSIOLOGY LAB

-TYPE OF PROCEDURES (7)

A
  1. coronary stents
  2. percutaneous closure of septal defects
  3. percutaneous valve repair & replacemnt
    a. pacemaker / defibrillator placements
    b. percutaneous catheter-based therapy/ablation
  4. biventricular pacemaker lead placement
  5. implantable cardiac defibrillators
  6. lead extraction
  7. battery changes
17
Q

OFFSITE LOCATIONS

CARDIAC CATH / ELECTOPHYSIOLOGY LAB

TRANSESOPHAGEAL ECHOLCARDIOGRAM/ CARDIOVERSION

  • purpose
  • things to consider ___ vs ____
  • things to consider ___ vs ____
  • what do first / with what / for how long
  • med swish & swallow
  • drugs may use
A
  1. direct current electric shocks to convert abnormal cardiac rhythm
  2. elective vs. semi-emergent
  3. heavy sedation vs light GA
  4. preoxygenate with 100% O2 for 3-5 minutes
  5. lidocaine
  6. short acting agents

propofol, etomidate, methohexital, benzodiazepines

18
Q

OFFSITE LOCATIONS

RADIOLOGY

INTERVENTIONAL NEURORADIOLOGY

  • what type of patient seen here
  • name 2 procedures
A
  1. patients with abnormal vascular pathology of brain and/or spinal cord
  2. arterial venous malformations emoblicationscerebral aneurysm coiling
19
Q

OFFSITE LOCATIONS

RADIOLOGY

RADIATION THERAPY (MAC vs GA)

  • what is it
  • protect yourself (5)
  • retinoblastoma pt population
  • inpt or outpt
A
  • repeated exposure to therapeutic radation
  • radiation sheild apronsthroid shieldseyewearbadges - radiation exposuredistance
  • 2months - 5 years old
  • outpt
20
Q

OFFSITE LOCATIONS

RADIOLOGY

MRI (MAC vs GA & LMA vs ETT)

  • explain about the atoms
  • why must anesthesia be used frequently during the procedure
  • why must monitors be placed beyond MRI’s field of strength
  • where place ECG leads
  • what kind of cables should use if possible and why
  • where place Sao2 detectors & where avoid placing wires and why
A
  • the nucleus of certain atoms, when placed in a magnetic field, absorb or emit radiation. Nuclei with an odd number of protons respond to MRI
  • b/c pt must lay completely still

–some monitors can act as an atntennae & distort images

  • close to the magnetic center & in close proximity to one another
  • fiberoptic cables & electrodes to avoid interference w/ tracings
  • as far away from magnetic core.

skin

heat generated by electrical currents passing thru the electrical oximetry lead wires may cause burns

21
Q

OFFSITE LOCATIONS

RADIOLOGY

CT SCAN (computerized tomography)

  • who is at risk for aspiration (2)
  • patient movement may cause (2)

OTHER STUFF TO KNOW

pediatric patients

stereotactic-guided surgery

MAC vs GA

A

-pts w/ oral contrast

with emergency procedure

  • kinking of oxygen tubingdisconnection of breathing circuit
22
Q

OFFSITE LOCATIONS

ELECTROCONVULSIVE THERAPY (ECT)

  • pt population
  • what place on pt
  • goal of therapy
  • goal of anesthetist
  • what must anesthetist do first
  • what must anesthetist do until pt resumes spontaneous respirations
A
  • pts with severe acute depression / suicidal tendencies / no response to antidepressant pharmaceutical regimens
  • unilateral or bilateral electrodes are placed over pt head
  • produced generalized therapeutic seizures 30-60s induced seizures cause a tonic phase then clonic phase
  • to maintain pt airway, cardiovascular monitoring & medications to ensure amnesia & muscle paralysis to prevent injuries
  • preoxygenate
  • controlled mask ventilation
23
Q

OFFSITE LOCATIONS

DENTAL OFFICE

-why is communication with dentist essential

OTHER INFO TO KNOW

MAC vs GA

inpt vs outpt

pediactric & mentally challenged pt groups

A

-for airway safety

PRINCIPLES (5 decks)

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