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Anesthesia Flashcards

(44 cards)

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1
Q

Who can provide anesthesia?

A

Anesthesiologist
Certified registered nurse anesthetist
Anesthesiologist assistant

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2
Q

ASA classifications

A

1 - healthy pt
2 - mild systemic disease/smoker
3 - severe systemic disease
4 - severe systemic disease that is a theeat to life
5 - moribund pt is not expected to survive without sx
6 - declared brain dead pt

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3
Q

What is choice of anesthesic influenced by?

A 
Pt preference 
Surgeon preference 
Pt coexisting diseases 
Pt mental/psychological state 
Length and type of sx
Position of pt in sx
Plans for post op
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4
Q

Role of nurse with anesthesia?

A 
Pre op assessment
NPO status
Brining pt to OR
Induction assistance 
Assistance during and after sx
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5
Q

What is covered in pre op assessment that relates to anesthesia?

A 
Age 
Allergies
Med hx
NPO status
Labs
VS
Anxiety/pain
Consent
Orders for abx
Questions
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6
Q

When can pt eat/drink before sx?

A

Normal - 8hrs
Light meal/non human milk & formula - 6hrs
Breast milk - 4hrs prior
CF - 2hrs prior

Decrease risk of aspiration

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7
Q

What is cricoid pressure?

A

Nurses may beed to apply during induction

Help visualize vocal cords and placement of tube
- do not release until positioned confirmed

Located below prominent thyroid cartilage

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8
Q

What is anesthesias equipment ?

A

Machine - delivery of O2 and inhaled gases
IV pump
Warming devices

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9
Q

Airway equipment options?

A 
Laryngeal airway mask
Laryngoscope
Video laryngeal device
Fiberoptic bronchoscope
Endotracheal tube
Oral and nasopharyngeal airway
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10
Q

Monitoring during anesthesia?

A 
Pulse oximeter
Bp
ECG
Skin esophageal temp
End tidal carbon dioxide
Nerve stimulation 
Urine output
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11
Q

What is bispectral index monitoring?

A

Depth of anesthesia

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12
Q

Cardiovascular monitoring during anesthesia?

A

Arterial line
Central venous pressure line
Pulmonary artery catheter
Transesophageal echocardiography

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13
Q

Types of anesthesia?

A

General - reversible state of unconsciousness

Regional - local anesthetic near nerve fibers to cause reversible loss of sensation

Monitored anesthesia care - administeres sedatives and other agents

Moderate sedation - admin of sedatives, analgesic and/or anxiolytic

Local - does not involve anesthesia or sedation, infiltrated or topical to part of body

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14
Q

Which types of anesthesia do not need anesthesiologist?

A

Moderate sedation

Local

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15
Q

3 phases of anesthesia

A

Induction - IV or inhale to put to sleep

Maintenance - keep anesthesitized

Emergence - agents are reversed

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16
Q

IV induction?

A

Most common in adults
Short acting
Rapid onset
Ex propofol

Narcotics and sedatives often given during induction

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17
Q

Inhalation induction?

A

Common in children
Can become agitated and thrash

Ex. Sevoflurane

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18
Q

Muscle relaxants?

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A

Help facilitate intubation and optimize surgical conditions

Ex.
Succinylcholine - short acting
Cisatracurium - intermediate
Pancuronium - long acting

19
Q

Maintaining airway?

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A 
Mask ventilation - short periods
Supraglottic airway device 
- no muscle relaxants needed
ET tube
- requires muscle relaxants
20
Q

Maintenance of general anesthesia?

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A

Maintained with inhalation and IV agents or combo of both

Muscle relaxants can be given during maintenance

Inhalation ex: sevoflurane, isoflurane
IV ex: propofol, remifentanil

21
Q

Total intravenous anesthesia?

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A

Infusions if short acting iv agents without inhalation anesthesia

22
Q

Reversal agents for muscle relaxants?

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A

No reversal agent for succinylcholine

Others can be reversed with neostigmine or edriophonium

Sugammadex - reversal for rocuronium, vecuronium and pancuronium

23
Q

What can reverse benzodiazepines?

24
Q

What can narcotics be reversed with?

25
Regional anesthesia examples?
Epidural Spinal Peripheral nerve block Eye block Injecting local anesthetic next to nerves
26
Local anesthetic used for regional?
Lidocaine Bupivacaine Ropivacaine Tetracaine
27
What are 2 neuraxial anesthesia?
Spinal - subarachnoid space is entered and local anesthetic is injected directly into spinal canal Epidural - space between ligamentum flavum and dura, loss of resistance noted and in right place - single dose or catheter placed
28
How might epidurals be used?
May be used in combo with GA for intra op and post op pain control
29
Peripheral nerve block?
Local anesthetic injected near nerves Ex. Femoral block Often combines with GA for post op pain control
30
IV regional anesthesia? (Bier block) | And steps
Used for procedures on hand, wrist or forearm 1 - IV placed usually in hand 2 - double tourniquet applied 3 - arm raised and exsanguinated 4 - proximal tourniquet cuff inflated 5 - local injected into IV 6 - distal cuff inflated and proximal deflated 7 - anesthetic lasts until tourniquet is deflated * risk of bolus of anesthesia, release slowly
31
Nurse roles with moderate sedation?
No competing responsibilities Continually assess and provide moderate sedation/analgesia Cardiac monitoring Be able to admin reversal agents and provide cardiac life support Competent airway assessment m, monitoring and emergency resuscitative equipment and drugs
32
Reversal agents for moderate sedation?
Flumazenil - benzo overdose | Naloxone - narcotic overdose
33
Local anesthesia?
``` May be used alone without sedation Can be used for healthy pt or high risk pt Amino esters - procaine, tetracaine Amino amides - lidocaine, bupivacaine Ropivacaine ```
34
Pt monitoring for local?
BP ECG Pulse ox HR
35
What is LAST?
Local anestehtic systemic toxicity - unsafe amount enter the blood stream Slowly - local absorbed overtime Quickly - accidentally injected into blood vessel Causes seizures and resp/cardiac arrest
36
S&S of LAST?
Ringing in ears Tingling around lips Metallic taste in mouth Dizzy
37
Malignant hyperthermia?
Triggered by inhaled general anesthetic agents and muscle relaxant succinylcholine Can lead to cardiac arrest, brain damage, organ failure, and death
38
S&S of malignant hyperthermia?
``` Tachy, HTN Tachypnea High end tidal carbon dioxide Rigidity Mottling Hyperthermia ```
39
Treatment for malignant hyperthermia?
Dantrolene** Stop sx Get MH cart Call for help Hyperventilate with 100% O2 with flow rate 10L/min Give dantolene Obtain blood gases Treatment of dysthymia’s and abnormal electrolytes
40
Risk of hypothermia?
< 36 ``` Conditions in OR - thin gown - exposed skin - cool temp Age - elderly, children Women more prone then men Low body weight Medical conditions - hypothyroid - burns - CHF - hypotension ```
41
Warming methods?
Passive - blankets - drapes Active - forced air warming - increasing room temp - warmed fluids
42
Monitoring of temp in OR?
``` Pulmonary artery Forehead Distal esophagus Nasopharynx Tympanic membrane Urinary bladder ```
43
What is capnography?
Graphic measurement of how much CO2 a person is exhaling
44
Treatment of LAST?
20% lipid emulsion therapy

Anesthesia (1 decks)

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