3 - Complications and PACU Flashcards by Joanna Brown

Estimated mortality related to anesthesia

1:10,000

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Incidence of Awareness during general anesthesia

20:10,000

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Incidence of Damage to Teeth

2-5:10,000

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Percentage of Elderly Patients with Post-Op cognitive dysfunction

16%

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Key Factors in prevention of patient injury

Vigilance Adequate Monitoring Up-To-Date Knowledge

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What are critical incidents?

Near misses

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What are sentinel events?

single, isolated events that may indicate a systemic problem

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To be successful in a malpractice suit, the plaintiff must prove: (4)

Duty: That the anesthesiologist owed the patient a duty

Breach of duty: That the anesthesiologist failed to fulfill his or her duty

Causation: That a reasonably close causal relation exists between the anesthesiologist’s acts and the resultant injury

Damages: That actual damage resulted because of a breach of the standard of care.

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doctrine of res ipsa loquitor

“The thing speaks for itself”

Burden of proof is on the physician instead of the patient if:

typically would not occur in the absence of negligence.

caused by something under the exclusive control of the anesthesiologist.

not attributable to any contribution on the part of the patient.

evidence for the explanation of events is more accessible to the anesthesiologist than to the patient.

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What are the three types of damages?

General: damages for pain and suffering

Special: actual damages from bills, lost income etc

Punitive: intended as punishment

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Proof in a malpractice case only means:

more likely than not

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What is a Type I hypersensitivity reaction?

immediate hypersensitivity

occurs with 15-30 min

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What is the most important moderator of type 1 hypersensitivity reactions?

Histamine

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What are the two triggers of Type 1 hypersensitivity reactions?

IgE (requires prior exposure to substance)

Non-IgE (anaphylactoid, can occur on first exposure to substance)

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What is the treatment for Type 1 hypersensitivity reactions?

Anithistamines

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Most anesthesia related hypersensitivity reactions are _________

Type I IgE mediated Type 1 reactions

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Which anesthetic drugs account for 50-70% of hypersensitivity reactions?

NMBAs

Believed to be caused by the ammonium structure

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What is a Type II hypersensitivity reaction?

Cytotoxic hypersensitivity

Mediated by IgM or IgG

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What are some examples of Type II hypersensitivity?

Type I DM

Myasthenia Gravis

Thrombocytopenia

Transfusion Reactions

Goodpasture’s nephritis

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What is the treatment for a Type II hypersensitivity reaction?

Anti-inflammatory and immunosuppressive agents

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What is a Type III hypersensitivity reaction?

Immune complex hypersensitivity

Failure of the immune system to get rid of antibody-antigen complexes

These complexes lodge in joints and tissues where they activate complement and stimulate mediators

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What are some examples of Type III hypersensitivity reactions?

SLE

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What is a Type IV hypersensitivity reaction?

cell mediated or delayed type hypersensitivity

takes 24 hours to 14 days

NO ANTIBODIES INVOLVED

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What are some examples of Type IV hypersensitivity reactions?

Contact hypersensitivity (like poison ivy)

granulomatous sensitivity (TB or leprosy)

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What is a Type V Hypersensitivity Reaction?

results from auto-antibodies that bind and stimulate specific cell targets

What is an example of a Type V Hypersensitivity Reaction?

Graves Disease antibodies stimulate the TSH receptor on the thyroid gland, leading to excessive secretion of thyroid hormone

What is alloimmunity?

response of the immune system towards the tissues of other members of the same species blood transfusions, GVHD, organ transplants

What is transient neonatal disease?

Alloimmunity Rhogam

What is autoimmunity?

Abnormal response to self antigens resulting in production of self-antibodies and damage to self tissues

The highest incidence of MH is in \_\_\_\_\_\_\_\_

children under 15

How is MH susceptibility inherited?

autosomal dominant

What drug should never be administered with dantrolene?

Ca Channel Blockers Leads to life threatening myocardial depression and hyperkalemia

What does dantrolene do?

Binds to the ryanodine calcium channel and reduces calcium efflux from SR

Which patients should have core temperature monitoring?

Any patient under GA for more than 30 minutes

Why is mild respiratory acidemia expected in PACU patients?

atelectasis and decreased M_V

A laryngospasm can be overcome by:

1. Continuous positive pressure of 10-20mmHg 2. Small dose of succ (not an induction dose) or propofol

A severe laryngospasm can be caused by excision of the \_\_\_\_\_\_\_

parathyroid d/t acute hypocalcemia

What effect does histamine have on bronchial smooth muscle tone?

Vasoconstricts

Patients who have increased airway pressure preop are at risk for _________ post op

bronchospasm

Increased airway resistance is manifested by:

wheezing

Which has more cardiovascular effects: albuterol or racemic epi?

Racemic Epi

Besides Levalbuterol and Epi nebs, what other meds can reduce elevated airway resistance?

isoproterenol neb IM or sublingual terbutaline Anticholinergics (atropine) Epinephrine drip (if severe)

What metrics indicate readiness to come off mechanical ventilation?

Raise head for 10 seconds Forced vital capacity of 10-12 ml/kg Insp \> -25 Tactile TOF

During anesthesia, how is CO2 production impacted?

Decreased by 60%

What is the difference between compliance and elasticity?

Compliance is the ease with which you can stretch something Elasticity is the strength of recoil from stretch

What are the three factors that influence lung compliance?

Elasticity of the lungs Elasticity of the chest wall Surface Tension

What happens to compliance and elasticity in pulmonary fibrosis?

The compliance decreases, because the lungs don't want to stretch. BUT the elasticity increases, because as the pressure goes up and volume goes down, elasticity increases

What happens to compliance and elasticity in emphysema?

The elastic tissue over alveoli and lung tissues is broken down, so elasticity is increased BUT compliance is increased (because the lung can easily inflate, but it can't snap back)

What happens to compliance and elasticity of the chest wall in patients with Ankylosing Spondylitis/Kyphosis/Scoliosis?

Chest wall compliance is decreased (difficult to expand) There isn't a huge change in elasticity, most of the disease process is due to decreased compliance

When alveolar surface tension is increased, what happens to compliance?

Compliance is decreased and elasticity is increased Very high work of breathing to get those alveoli to expand

What osmolality, pH, and sodium concentration in urine is reassuring that tubules are intact and functional?

They should be disparate from serum values if values closely resemble serum values, it is non-reassuring

What is the most common occular complication in general anesthesia?

Corneal abrasion

Which tooth is number one?

Back tooth on right side of upper mandible

The front teeth are numbered

8 & 9

The middle bottom two teeth are numbered

24 & 25

How long do sensory neuropathies usually last?

5 days

PACU stay is increased by ________ minutes by hypothermia

40-90 min

Postop hypothermia causes:

Increased SNS Decreased venous compliance Increased PVR

What diagnostics and labs would you perform on patient who has not emerged from anesthesia after 70 minutes?

End-tidal anesthetic concentration Nerve stimulator ABG CT Scan

What are some metabolic causes for delayed emergence?

Pseudocholinesterase Deficiency Hypercarbia/hypoxia Resp and metabolic acidosis Hyper/hyponatremia Hypo/hyperthermia

What drug crosses the blood brain barrier and is used to reverse the anticholinergic effects of scopolamine and atropine

Physostigmine

Emergence delirium is prevalent in which age bracket?

Children and young adults

What should you bear in mind when caring for a postop myringotomy?

They are hearing normally for the first time, and may be very sensitive to sound

When scopolamine is used in pre-treatment intraop, what can happen post op?

disorientation, combativeness, paranoia can be reversed with physostigmine

How long do most emergence reactions last?

10-15 minutes

Avoiding which drugs reduces the risk of post op delirium?

Benzos Anticholinergics meperidine

Which has a lower instance of PONV: TIVA or Inhalation?

TIVA, esp propofol

Laryngospasm may be caused by a closure of the glottis by \_\_\_\_\_\_\_\_\_ Or a closure of the larynx by \_\_\_\_\_\_\_\_\_\_

Glottis = intrinsic muscles larynx = extrinsic muscles

Glottic closure manifests as \_\_\_\_\_\_\_ Larnyx closure manifests as \_\_\_\_\_\_\_\_

intermittent obstruction complete obstruction

If succinylcholine is effective in resolving a laryngospasm, you must still:

support breathing for 5-10 min with bag ventilation

Negative-pressure pulmonary edema is caused by \_\_\_\_\_\_\_\_\_

a decrease in interstitial pressure

What is the most common cause of postop hypoxemia?

atelectasis

Virchow's Triad

Venous Stasis Hypercoaguability Vessel Damage

What is another name for chemical pneumonitis

Mendelson Syndrome

In an intubated patients, Bronchospasm is caused by increased ______ which manifests as \_\_\_\_\_\_

airway resistance increased peak inspiratory pressure

Increased _____ (electrolyte) and decreased ____ may prolong anesthesia blockade

magnesium potassium

Hypothermia contributes to which two dysrhythmias? Why?

sinus brady, a fib prolongs the refractory period

Name three herbal supplements that can cause delayed awakening

Kava kava St. John's Wort Valerian

Serotonin Syndrome can look like \_\_\_\_\_\_\_\_\_

MH or delayed awakening

How does zofran work?

Blocks serotonin receptors in the vomiting center

How does Haldol or Droperidol assist with nausea?

blocks dopamine receptor sites in the vomiting center

How do compazine and reglan work?

Block dopamine receptors

How do phenergan and benadryl help with nausea?

Block histamine receptors

How does a scop patch help with nausea?

Blocks muscarinic receptors

3 - Complications and PACU Flashcards

(84 cards)