Anestesia 2 Flashcards
(154 cards)
1
Q
What are the effects of general anesthesia?
A
Amnesia, hypnosis, analgesia, skeletal muscle relaxation
2
Q
How is general anesthesia delivered?
A
With inhalation agents and intravenous medications
3
Q
Name the most commonly used inhalation anesthetic agents.
A
- Nitrous oxide (N2O)
- Isoflurane (Forane)
- Desflurane (Suprane)
- Sevoflurane (Ultane)
4
Q
What is nitrous oxide and its characteristics?
A
A sweet-smelling gas that acts rapidly but lacks potency; nonirritating with few aftereffects
5
Q
What procedures is nitrous oxide sufficient for?
A
Minor procedures that do not produce intense pain
6
Q
Why should nitrous oxide be avoided in certain cases?
A
It diffuses into gas-filled spaces, causing expansion which can be problematic in bowel obstruction or pneumothorax
7
Q
What must be monitored when using nitrous oxide?
A
The concentration to prevent hypoxia
8
Q
What are volatile anesthetic agents?
A
Liquid at room temperature but evaporate easily; includes isoflurane, desflurane, and sevoflurane
9
Q
What is a unique feature of desflurane?
A
Provides excellent relaxation with the most rapid onset and emergence
10
Q
What is desflurane’s suitability for obese patients?
A
It is the agent of choice due to its low fat solubility
11
Q
What is a disadvantage of desflurane?
A
Its pungent odor can cause gagging and laryngospasm
12
Q
What is the induction inhalation agent of choice for children?
A
Sevoflurane
13
Q
Why has isoflurane usage declined?
A
It has the longest induction and emergence times of commonly used agents
14
Q
What does isoflurane not do in relation to the cardiovascular system?
A
It does not destabilize the cardiovascular system or sensitize the myocardium to catecholamines
15
Q
What is the function of the vaporizer in an anesthesia machine?
A
Transforms volatile anesthetic agents from liquid into gas for delivery to the patient
16
Q
What color coding is used for oxygen, nitrous oxide, and air in anesthesia machines?
A
- Oxygen: Green
- Nitrous oxide: Blue
- Air: Yellow
17
Q
What does the one-way valve in the breathing circuit do?
A
Carries anesthetic gases to the patient and returns expired gases
18
Q
What is the purpose of the carbon dioxide absorber in the anesthesia machine?
A
Removes carbon dioxide from exhaled gases
19
Q
What is a potential health hazard associated with waste anesthetic gases?
A
Nausea, dizziness, headaches, fatigue, irritability, drowsiness, decreased mental performance, reduced fertility, miscarriages, and various diseases
20
Q
What did NIOSH set in 1977 regarding waste anesthetic gases?
A
Limits for exposure to 25 parts per million (ppm) of nitrous oxide over an 8-hour time-weighted average
21
Q
How are intravenous agents typically administered?
A
Directly into the circulatory system through a peripheral vein
22
Q
What are examples of barbiturates used for induction of anesthesia?
A
- Thiopental sodium (Pentothal)
- Sodium thiopental
- Methohexital sodium (Brevital)
23
Q
What is a significant effect of barbiturates?
A
They are potent respiratory depressants
24
Q
What is the most popular nonbarbiturate agent for rapid induction?
A
Propofol (Diprivan)
25
What must be considered when handling propofol?
Strict aseptic technique is required due to its potential for microbial growth
26
What is etomidate used for?
Induction in patients with a positive cardiac history or who cannot tolerate blood pressure changes
27
What are the effects of ketamine hydrochloride?
Produces a catatonic state with amnesia and analgesia
28
What is a common postoperative effect of ketamine?
Hallucinations
29
What are some narcotics used intraoperatively?
* Fentanyl
* Sufentanil
* Alfentanil
* Morphine
* Hydromorphone
* Remifentanil
30
What is the role of naloxone (Narcan)?
An opiate antagonist that reverses the effects of narcotics
31
What are the complications of naloxone administration?
Pulmonary edema, hypertension, and rapid withdrawal symptoms
32
When are tranquilizers used in anesthesia?
Used for induction and as adjuncts to other anesthetic agents
33
What is the effect of flumazenil?
Reverses the effects of benzodiazepines without cardiovascular effects
34
What are tranquilizers commonly used intraoperatively?
Diazepam (Valium) and midazolam (Versed)
## Footnote
Tranquilizers help manage anxiety and produce amnesia during procedures.
35
What effect does diazepam produce?
Amnesia and reduces anxiety
36
What is a significant feature of midazolam?
Excellent amnestic and provides significant anxiolysis
37
What is flumazenil (Romazicon) used for?
To reverse the effects of benzodiazepines
38
What must be monitored after administering flumazenil?
Patients must be closely monitored for hypoventilation recurrence
39
What are the two primary indications for neuromuscular blockers?
* To relax the jaw and larynx for controlled breathing and tracheal intubation
* To increase muscle relaxation for ease of tissue handling during surgery
40
What is the mechanism of action of neuromuscular blockers?
Paralyze the neuromuscular junction and block impulses from motor nerves to skeletal muscle
41
What type of muscle relaxant is succinylcholine?
Depolarizing muscle relaxant
42
What does succinylcholine mimic at the neuromuscular junction?
Acts like acetylcholine, causing depolarization
43
What is the duration of paralysis produced by succinylcholine?
Paralysis occurs within seconds
44
What condition can succinylcholine cause in normal patients?
Transient increase in plasma potassium levels
45
What conditions increase susceptibility to succinylcholine-induced hyperkalemia?
* Burns
* Closed head injury
* Acidosis
* Guillain-Barré syndrome
* Cerebral stroke
* Drowning
* Severe intraabdominal sepsis
* Massive trauma
* Myopathy
* Tetanus
46
What is a known risk associated with succinylcholine?
Malignant hyperthermia
47
How do nondepolarizing muscle relaxants work?
Block the action of acetylcholine at the neuromuscular junction without causing depolarization
48
What is the onset of action for nondepolarizing agents compared to depolarizing agents?
Slower onset
49
What is the duration of action for intermediate-acting neuromuscular blocking agents?
Approximately 45 minutes
50
What is Pavulon considered in terms of muscle relaxants?
A long-acting agent
51
What method is used to monitor the degree of paralysis in patients?
A nerve stimulator applied to a peripheral nerve
52
What are the reversal agents for nondepolarizing agents?
* Pyridostigmine (Regonol)
* Neostigmine (Prostigmin)
53
What must be combined with anticholinesterases to counteract their effects?
Atropine sulfate or glycopyrrolate (Robinul)
54
True or False: Reversal agents make muscle paralysis disappear immediately.
False
55
What percentage of receptors at the neuromuscular junction could still be occupied even after reversal?
75–85%
56
Who integrated the four stages of anesthesia into a system in 1720?
Arthur Guedel
57
What are the four stages of anesthesia?
* Stage I: Relaxation
* Stage II: Excitement
* Stage III: Surgical anesthesia
* Stage IV: Danger
58
What characterizes Stage I of anesthesia?
Relaxation from administration of anesthesia to loss of consciousness. Patient response: dizziness, drowsiness, exaggerated hearing, decreased sense of pain.
59
What occurs during Stage II of anesthesia?
Excitement from loss of consciousness to onset of regular breathing. Patient response: irregular breathing, increased muscle tone, involuntary motor activity.
60
What defines Stage III of anesthesia?
Surgical anesthesia from onset of regular breathing to cessation of respiration. Patient response: regular thoracoabdominal breathing, relaxed jaw, loss of pain and auditory sensation.
61
What are the signs of Stage IV of anesthesia?
Danger from cessation of respiration to circulatory failure and death. Patient response: fixed and dilated pupils, rapid and thready pulse, paralyzed respiratory muscles.
62
What is the sequence of recovery from anesthesia?
Recovery occurs in reverse order from Stage IV to Stage I.
63
What should the circulating nurse focus on once the patient is in the operating room?
Providing emotional support, ensuring patient dignity, instituting safety measures, and assisting the anesthesia provider.
64
What is the purpose of induction in anesthesia?
| From when to when
Covers the time from administration of the first anesthetic drug until the patient is stabilized at the desired level of anesthesia.
65
What equipment should be ready prior to anesthesia induction?
* Working suction with catheter
* Safety strap
* ECG leads
* Blood pressure cuff
* Intravenous line
66
How to maintain patient dignity during induction?
Adjust the patient’s gown, close operating-room doors, cover windows, keep unnecessary personnel out.
67
What is the nurse's role during induction?
Remain at the patient's side, speak calmly, explain the process, and provide nonverbal support.
68
True or False: Hearing is the first sense lost before unconsciousness.
False
69
What is the preferred method of induction for young children who may not tolerate IV placement?
Inhalation agent administered by mask.
70
What does the typical sequence for general anesthesia include?
* Patient breathes 100% oxygen
* Narcotic/benzodiazepine injected
* Propofol or similar agent injected
* Ventilation monitored
* Intubation with muscle relaxant
71
What is the purpose of preoxygenation in general anesthesia?
To provide a safety margin in case of airway obstruction or brief apnea during intubation.
72
What confirms correct endotracheal tube placement?
* Fog in the tube
* Bilateral chest excursion
* Bilateral breath sounds
* CO2 expiration monitoring
73
What is the purpose of the cuff in an endotracheal tube?
To prevent secretions from entering the trachea and lungs.
74
What is the technique of choice for patients at high risk for aspiration?
Regional anesthesia
75
What is the first priority for the perioperative nurse during rapid-sequence intubation?
Remain at the patient’s side, prepared to assist until intubation is complete.
76
What is the Sellick maneuver?
Application of cricoid pressure to decrease the chance of stomach contents entering the larynx.
77
What should the perioperative nurse confirm before repositioning the patient?
That moving the patient will not compromise the airway or ventilation.
78
What is unintended intraoperative awareness?
Occurs in approximately one patient per 1,000 receiving general anesthesia and may involve recalling surroundings or sensations.
79
What device assesses depth of anesthesia on a scale of 0 to 100?
Bispectral analysis monitor (BIS)
80
What is malignant hyperthermia (MH)?
An inherited muscle disorder triggered by certain types of anesthesia that may cause a fast-acting, life-threatening crisis.
## Footnote
MH is associated with specific anesthetic agents and can lead to severe physiological complications.
81
What is the estimated incidence of malignant hyperthermia?
One in 5,000 to one in 65,000 administrations of general anesthesia with triggering agents.
## Footnote
The incidence varies based on geographic area and the concentration of MH-carrier families.
82
What are the potential consequences of untreated malignant hyperthermia?
Cardiac arrest, kidney failure, blood coagulation problems, internal hemorrhage, brain injury, and death.
83
How has the mortality rate of malignant hyperthermia changed over time?
Reduced from as high as 70% to less than 5% due to better screening and treatment protocols.
84
What role does dantrolene sodium play in the treatment of malignant hyperthermia?
| O que é e o mecanismo de ação
It is a skeletal muscle relaxant that blocks the release of calcium from the sarcoplasmic reticulum, decreasing muscle contractions.
85
What happens to intracellular calcium levels during malignant hyperthermia?
Intracellular calcium increases, leading to sustained contracture of skeletal muscle.
86
What are some classic symptoms of malignant hyperthermia?
Tachycardia, unstable blood pressure, generalized rigidity, masseter muscle spasm, metabolic acidosis, increased end-tidal CO2, fever, profuse sweating, and cyanotic mottling of the skin.
87
Which anesthetic agents are known triggers of malignant hyperthermia?
Succinylcholine, desflurane, enflurane, sevoflurane, isoflurane (rarely used).
88
What is the primary nursing responsibility if a patient is suspected to be susceptible to malignant hyperthermia?
Postpone surgery until a skeletal muscle biopsy test is performed to confirm the diagnosis.
89
What should be prepared in the operating room for a patient at risk for malignant hyperthermia?
Cooling blanket, malignant hyperthermia cart, and supplies.
90
What is moderate sedation/analgesia also known as?
Conscious sedation or IV conscious sedation.
91
What are the goals of moderate sedation/analgesia?
* Allay fear and anxiety
* Enhance cooperation
* Maintain consciousness and the ability to respond to verbal stimulation
* Maintain respirations unassisted
* Provide adequate analgesia
* Maintain stable vital signs
* Achieve partial amnesia
* Facilitate prompt return to activities of daily living.
92
What common agents are used for moderate sedation/analgesia?
Diazepam (Valium), midazolam (Versed), morphine sulfate (Duramorph), meperidine (Demerol), and fentanyl (Sublimaze).
93
What are the reversal agents for narcotics and benzodiazepines?
Naloxone hydrochloride (Narcan) for narcotics and flumazenil (Romazicon) for benzodiazepines.
94
What is required for a nurse monitoring a patient receiving moderate sedation/analgesia?
No other responsibilities during the procedure that would require leaving the patient unattended.
95
What monitoring equipment is necessary during moderate sedation/analgesia?
* Airway management devices
* Oximeter
* Non-invasive blood pressure monitor
* Electrocardiograph
* Suction equipment.
96
What criteria should be met for a patient to be discharged after receiving moderate sedation/analgesia?
* Return to preoperative, baseline level of consciousness
* Stable vital signs
* Sufficient time since the last antagonist administration
* Use of an objective patient assessment scoring system
* Absence of protracted nausea
* Adequate pain control
* Intact protective reflexes
* Return of motor/sensory control.
97
True or False: A patient receiving moderate sedation/analgesia must be continuously monitored for any reaction to drugs.
True.
98
What are the criteria for discharge after surgery?
Criteria may include:
* Return to preoperative, baseline level of consciousness
* Stable vital signs
* Sufficient time interval since last antagonist administration
* Use of an objective patient assessment scoring system
* Absence of protracted nausea
* Adequate pain control
* Intact protective reflexes
* Return of motor/sensory control
## Footnote
Reference: AORN, 2015, p. 557
99
Why should patients be given written postoperative instructions?
Because medications used in moderate sedation/analgesia can diminish the ability to recall information given verbally.
100
Fill in the blank: One criterion for discharge is the return to _______ level of consciousness.
[preoperative, baseline]
101
True or False: Stable vital signs are not a part of the discharge criteria.
False
102
What is an example of an objective patient assessment scoring system?
[Aldrete score]
103
Fill in the blank: Adequate _______ control is a criterion for discharge.
[pain]
104
What should be absent for a patient to be discharged postoperatively?
Absence of protracted nausea
105
What is necessary to prevent resedation of the patient before discharge?
Sufficient time interval since last antagonist administration
106
Fill in the blank: Patients should have intact protective _______ before discharge.
[reflexes]
107
What must return for a patient to be considered for discharge?
Return of motor/sensory control
108
What are the techniques included in regional anesthesia?
Regional anesthesia techniques include:
* spinal block
* epidural block
* caudal block
* intravenous block
* nerve block
* local infiltration
* topical administration
## Footnote
Each technique serves different surgical needs and patient conditions.
109
What factors influence the decision to use regional anesthesia?
Factors include:
* patient condition
* surgical procedure
* surgeon/anesthesia provider/patient preference
## Footnote
These factors help determine the most appropriate anesthesia method.
110
Why is regional anesthesia suitable for patients with certain medical conditions?
It maintains stability in respiratory and cardiac systems, making it suitable for patients with severe metabolic, renal, cardiac, pulmonary, or hepatic disease
## Footnote
It is especially useful when general anesthesia is contraindicated.
111
What is a potential risk when providing regional anesthesia?
Providing too much sedation alongside regional anesthetic can lead to aspiration
## Footnote
Aspiration can cause serious complications during and after the procedure.
112
How can ultrasound imaging improve the administration of regional anesthesia?
It facilitates the identification of the pre-puncture location of vessels for needle insertion, wire placement, and catheter placement
## Footnote
This reduces complications and increases proficiency.
113
What is spinal anesthesia used for?
Spinal anesthesia is used for:
* lower abdominal procedures
* pelvic procedures
* lower extremity procedures
* urologic procedures
* cesarean sections
## Footnote
It is effective for surgeries requiring lower body anesthesia.
114
Describe the process of administering spinal anesthesia.
Anesthetic agent is injected into the cerebrospinal fluid in the subarachnoid space, typically through a lumbar interspace between L2 and L3
## Footnote
Proper needle placement is crucial to avoid spinal cord injury.
115
What factors determine the spread and level of spinal anesthesia?
Factors include:
* cerebrospinal pressure
* injection site
* amount and concentration of anesthetic
* speed of injection
* patient position during and after injection
## Footnote
These factors influence the effectiveness and safety of the anesthesia.
116
What are common agents used for spinal anesthesia?
Common agents include:
* lidocaine (Xylocaine)
* tetracaine (Pontocaine)
* bupivacaine (Marcaine)
## Footnote
A narcotic may also be added to enhance analgesia.
117
What is the role of the perioperative nurse during spinal anesthesia administration?
The nurse assists in positioning the patient, supports the anesthesia provider, and reassures the patient
## Footnote
Patient cooperation and comfort are essential for successful anesthesia administration.
118
What are possible complications of spinal anesthesia?
Complications include:
* rapid drop in blood pressure
* nausea and vomiting
* total spinal anesthesia
* post-dural headache
* neurological or integumentary positioning injury
## Footnote
Awareness of these risks is crucial for management.
119
What is total spinal anesthesia?
Total spinal anesthesia occurs when the level of anesthesia paralyzes respiratory muscles, causing respiratory distress
## Footnote
This is an emergency situation requiring immediate intervention.
120
What is epidural anesthesia used for?
Epidural anesthesia is useful for:
* ano-rectal procedures
* vaginal procedures
* perineal procedures
* obstetric surgeries
## Footnote
It can also be combined with general anesthesia for orthopedic procedures.
121
What is the common method for administering a Bier block?
A Bier block involves:
* inserting an intravenous catheter into the operative extremity
* placing a double-cuffed tourniquet
* exsanguinating the extremity
* injecting a local anesthetic
* deflating the proximal cuff after the anesthetic takes effect
## Footnote
This method is used for surgeries of the upper extremities lasting an hour or less.
122
What are the risks associated with rapid release of a tourniquet after a Bier block?
Rapid release can lead to cardiovascular collapse or central nervous system toxicity
## Footnote
Careful management of tourniquet release is critical.
123
What are the indications for nerve blocks?
Nerve blocks are used for:
* surgical intervention
* sustained relief in chronic pain
* increasing circulation in vascular diseases
## Footnote
They can be tailored to specific surgical needs.
124
What is local infiltration anesthesia?
Local infiltration involves injecting an anesthetic agent into subcutaneous tissue at or near the incision site
## Footnote
It is commonly used for minor, superficial procedures.
125
What is a key responsibility of the perioperative nurse during local anesthesia?
Monitoring the patient’s vital signs and response to medications
## Footnote
This includes blood pressure, heart rate, respiratory rate, and signs of toxicity.
126
What is bupivacaine liposome (Exparel)?
A local anesthetic comprised of bupivacaine encapsulated in a liposome, releasing the drug slowly over time
## Footnote
It is used for postoperative pain relief lasting approximately 24 hours.
127
What precautions should be taken when administering bupivacaine liposome?
It should be injected no sooner than 20 minutes after other local anesthetics and not given with other forms of bupivacaine
## Footnote
This prevents overdose and ensures effective pain management.
128
What are common topical anesthetics?
Common topical anesthetics include:
* tetracaine (Pontocaine) for the eye
* cocaine for nasal passages
* lidocaine (Xylocaine) for throat, nose, esophagus, and genitourinary tract
## Footnote
These anesthetics are absorbed quickly and act rapidly.
129
What nursing responsibilities vary according to the type of regional anesthesia?
Nursing responsibilities can include:
* patient education and reassurance
* monitoring vital signs
* assisting in positioning and administration
## Footnote
These responsibilities are crucial for patient safety and comfort.
130
What should be done to alleviate patient anxiety during regional anesthesia?
Provide reassurance, answer questions, and remain close to the patient
## Footnote
Even patients who are sedated should be aware that the nurse is close by and is available to provide support.
131
Why is it important for some patients to be alert during procedures requiring regional anesthesia?
To facilitate cooperation with the surgeon
## Footnote
The perioperative nurse can provide encouragement, support, and information that the patient needs.
132
What type of conversation should occur during procedures involving awake patients receiving regional anesthesia?
Respectful conversation
## Footnote
Patients may be startled by noise or made anxious by inappropriate conversation.
133
What should be provided to patients during the placement of needles for regional anesthesia?
Pillows and blankets for comfort
## Footnote
This prevents unnecessary exposure and embarrassment.
134
Why is it important to maintain patient dignity during incision site preparation?
To minimize embarrassment and anxiety
## Footnote
Exposing the patient may be necessary for antiseptic scrub.
135
Who is responsible for monitoring patients receiving regional anesthesia?
The perioperative nurse
## Footnote
Monitoring is determined by anesthesia technique, preoperative assessment, and facility policy.
136
What is the role of an anesthesia provider during spinal, epidural, and caudal anesthesia?
An anesthesia provider is present
## Footnote
This applies to intravenous block and nerve block as well.
137
Who is responsible for administering topical and local infiltration anesthetics?
The surgeon
## Footnote
Monitoring the patient's status is the responsibility of the perioperative nurse.
138
What baseline data must a nurse establish for a patient receiving local anesthesia?
Blood pressure, cardiac rate and rhythm, respirations, oxygen saturation, skin condition, and mental status
## Footnote
This is crucial for recognizing changes.
139
What must the perioperative nurse be familiar with regarding medications?
The drugs used and appropriate responses to possible drug reactions
140
What is the maximum recommended dose of 1% lidocaine without epinephrine?
4.5 mg/kg of body weight, maximum total dose 300 mg
141
What is the risk of using lidocaine with epinephrine on fingers or toes?
Jeopardizes circulation and can cause vascular compromise
142
What should nursing interventions for patients receiving regional anesthesia include?
Preparation for toxic systemic reactions and cardiovascular collapse
143
What must be immediately available during monitoring of patients receiving anesthesia?
Resuscitation equipment
## Footnote
The perioperative nurse must be able to use it competently.
144
What is a critical requirement for the perioperative nurse?
Current cardiopulmonary resuscitation (CPR) certification
145
What does The Joint Commission’s National Patient Safety Goal focus on?
Improving the safety of using medications
146
What is the shared responsibility of the perioperative nurse in the scrub or circulating role?
To ensure the correct patient receives the correct medication(s) in accurate doses, at the correct time, and via the correct route
147
What must all medications/solutions on and off the sterile field be?
Labeled
## Footnote
Many operating rooms have sterile labeling kits for this purpose.
148
What should the circulating nurse confirm before dispensing a medication?
That the medication is not contraindicated due to patient allergy or interactions
149
What should the scrub person and circulating nurse do when delivering a medication to the sterile field?
Visually, verbally, and concurrently confirm the medication details
150
What should be included in the hand-off report when personnel are relieved?
Verification of all medications
## Footnote
Any unlabeled medications or solutions should be discarded.
151
What is essential to ensure when receiving a verbal medication order during surgery?
Clear communication and validation of understanding
152
What should be done with a verbal medication order at a minimum?
It should be repeated and confirmed
153
What should the perioperative nurse ensure regarding the patient's medication list?
That it is readily available and checked for completeness
154
What does the responsibility for medication reconciliation depend on?
Facility and department policy
