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Clin Med - II (Surgery) > Anesthesia > Flashcards

Anesthesia Flashcards

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1
Q

Pre-op Evaluation

A 
Type of sx or reason for sx
Allergies to meds/drug intolerances
Medical problems / comorbidities
Meds (Prescription and OTC), other drugs, including alcohol
Sx hx
Anesthesia hx
POS
Height / Weight
NPO status
Mallampati classification
Smoking (pack/years)
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2
Q

Pre-op eval - Anesthesia hx

A 
N/V
Intubation
Anesthetic type
Reactions
Bleeding
Prolonged paralysis
Awareness
FHx
- Malignant hyperthermia
- Dantrolene
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3
Q

Pre-op eval - ROS

A 
General
Respiratory
CV (CHF, CAD, valve dz)
Renal
GI
Hematologic
Neurologic (CVA)
Endocrine (DM, thyroid)
Psychiatric
Orthopedic
Dematologic
Recent infections (URI, UTI, sepsis)
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4
Q

American Society of Anesthesiologists Physical Status Classification

A 
ASA 1 (PS1) - A normal healthy pt
ASA 2 (PS2) - A pt with mild systemic dz
ASA 3 (PS3) - A pt with severe systemic dz
ASA 4 (PS4) - A pt with severe systemic dz that is a constant threat to life
ASA 5 (PS5) - A moribund pt who is not expected to survive w/o the operation
ASA 6 (PS6) - A declared brain-dead pt whose organs are being removed for donor purposes
E - Emergency
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5
Q

Physical Exam - in general

A 
Airway
Cardiac
Respiratory
IV Sites
ROM of extremities
Neurologic
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6
Q

Physical Exam - Airway

A 
Cervical ROM
Thyroid cartilage to mentum distance
Mouth opening
Dentition
Jaw Protrusion
Beard
Mallampati score
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7
Q

Mallampati score

A

Class 1 - wide open (Grade 1)
Class 2 - uvula can be partially visualized (Grades 1-4)
Class 3 - soft palate can be visualized (Grades 1-4)
Class 4 - No visualization of the soft palate (Grade 4)

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8
Q

Grading portion of the Mallampati score

A

Grade 1 - complete visualization of the vocal cords
Grade 2 - partial visualization of the vocal cords
Grade 3 - partial visualization of the trachea
Grade 4 - no visualization of the trachea

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9
Q

NPO status Guidelines

A

No solid food eaten after evening meal or 8h prior to nonemergent sx
Formula 6h / breast milk 4h
NPO after midnight, except sips of clear liquids to take oral meds
Clear liquids up to 2h before checking in for sx
Important in DM (keep BG ~120)

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10
Q

Drug continued Pre-op

A 
Anti-HTN / Cardiac meds
BB
Steroids
Antacids / reflux meds
Insulin
Pain med
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11
Q

What is a concern with giving antihypertensives pre-op?

A

Watch for hypotension with general anesthesia and ACE-I / ARBs

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12
Q

Drugs d/c pre-op

A

Anticoagulants
Herbs / OTC
Oral diabetic meds morning of sx

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13
Q

Anticoagulants - Pre-op

A

Stop asa, coumadin, plavix

Some exceptions (Bleeding vs. peri-operative MI)

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14
Q

Herbs / OTC

A

Garlic / gingko / ginseng = platelets
Ephedra = increased BP / HR / Stroke
Vitamin E = bleeding

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15
Q

Smoking and sx

A

The earlier the pt quits the greater the chance they have of avoiding post-op complications

Calculate pack years

If possible no smoking 12-24h prior to sx

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16
Q

Pack years

A

Packs/day * years smoked

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17
Q

Pre-op labs / tests

A 
EKG
CBC
CMP
Coagulopathy studies
Type and Screen / hold
FSBS - morning of sx
PG test
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18
Q

CBS as a pre-op lab

A

WBC
PLTs
HBG
HCT

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19
Q

CMP as a pre-op lab

A 
Creatinine
BUN
K
Na
Ca
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20
Q

Coagulopathy studiesas a pre-op lab

A

PT
PTT
INR

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21
Q

Who should get a PG test prior to sx?

A

Any female of childbearing age unless postmenopausal or previous hysterectomy

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22
Q

Goals of anesthesia

A

Amnesia
Analgesia
Hypnosis
Muscle relaxation

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23
Q

Succinylchoine

A

Depolarizing med
Lasts 1-2 minutes
K goes up (Don’t give in trauma or burns)

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24
Q

Pre-op Meds

A 
Benzodiazepines (Anxiety in adults/peds)
Post -op N/V Prophylaxis
Opioid
Anti-reflux meds
Breathing tx
Stress dose steroids
Anticholinergics
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25
Anesthetic choice
``` Extent of sx procedure Site of sx procedure Pt positioning during sx procedure NPO status Elective vs, Emergent Pt's age and comorbidities Anticipated recovery time Pt preference Surgeon preference Anesthesiologist preference ```
26
Types of Anesthesia - in general
General Regional MAC
27
General anesthesia - IV induction
Anesthetic agents through the IV to render them unconscious Analgesia (opiates and inhalational agents) Amnesia (benzos, NO, inhalation agents) Muscle relaxation (neuromuscular-blocking drugs, inhaled agents or local anesthetics)
28
General anesthesia - Inhalational Induction
Pt breathes in anesthetic gases to render them unconscious | Children or airway reflexes need to be preserved throughout case
29
Regional anesthesia
Spinal Epidural Peripheral nerve block
30
MAC - in general
Monitored anesthesia Care IV sedation / local anesthetic to surgical site Pt given oxygen
31
Most common complications of anesthesia
Post-Op N/V Sore throat Dental damage (most common legal complaint)
32
Common complications of anesthesia
``` Anesthesia awareness (0.1%) Drug errors Peripheral nerve injury Obstetric complications Pediatric complications Malignant hyperthermia (Hypermetabolic state) Post-op visual loss Burns Equipment errors Pain management IV/arterial catheterization ```
33
Examples of complications of anesthesia involving peripheral nerve injury
Positioning - Ulnar N. most commonly injured Nerve blocks Eye injury in prone position
34
Examples of complications of anesthesia involving pediatric pts
Respiratory In peds, cases change QUICKLY!!!
35
Indications for General anesthesia
Sx including the head/neck, airway, CV, thoracic abdominal, laparoscopic Pt refusal of regional anesthesia (spinal/epidural) Long length of sx Emergency sx - NPO status followed Individual pt circumstances / sx circumstances
36
Contraindications for General anesthesia
``` Severe CV dz Severe respiratory dz NPO status not followed Pt refusal Difficult airway ```
37
Types pf airways during General anesthesia
Endotracheal intubation | LMA (laryngeal mask airway)
38
Indications for Regional anesthesia
Sole anesthetic for lower abdominal and lower extremity procedures In combination with general anesthetic Post-op pain relief Anesthesia when general is contraindicated or not best choice Pain relief, motor blockade and sympathetic blockade Allows pt to be alert w/o pain
39
Example of a sole anesthetic for lower abdominal and lower extremity procedures
Spinal or | Epidural
40
Example of a combination with general anesthetic
Epidural with general
41
Example of post-op pain relief that are given as regional anesthesia
Post-op epidural | Peripheral nerve block
42
Example of a pt in which Anesthesia when general is contraindicated or not best choice
Patient with COPD
43
Example of a procedure where the pt is alert w/o pain
C-section
44
What at the types of regional anesthesia
Spinal | Epidural
45
Advantages of regional anesthesia
``` Reduced risk of bleeding Difficult airway Respiratory depression / pneumonia / COPD Post-op N/V Less post-op cognitive defects Superior pain control Pt satisfaction Decreased immunosuppression Less alterations of hemodynamics Alternative to General anesthesia (example - malignant hyperthermia) ```
46
Absolute contraindications of Regional anesthesia
``` Pt refusal Infection at site of insertion Severe aortic or mitral stenosis Increased ICP Severe hypovolemia True allergy of local anesthetics Coagulopathy ```
47
What is the number one reason for nerve damage during sx?
Hematoma
48
Relative contraindications of Regional anesthesia
Pre-existing neurologic deficit Specific dz states (CV dz, respiratory failure) Lack of pt cooperation Lack of consciousness Demyelinating dz Existing back problems / previous back sx Sepsis
49
Complications of regional anesthesia
``` Spinal ha Hemodynamic changes Bleeding Infection Nerve damage Prolonged parasympathetic blockage (urinary retention) Back pain Inadequate or "patchy" block High spinal (respiratory compromise) ```
50
How are spinal ha tx?
Laying flat Lots of caffeine Blood patch
51
What is high spinal in regional anesthesia?
The pt's block has move up and they will begin to have arm/finger numbness, which will progress up their arms. As it continues to progress, it will stop the pts respirations. Tx by intubation and allowing the regional to wear off.
52
MAC - indications
ERCP Cartaracts Some carpal tunnel releases AV fistulas
53
MAC - monitoring
BP EKG Pulse Ox Temperature
54
Conscious Sedation / local - in general
Local anesthetic to surgical site Versed Doesn't involve anesthesia team Pt given oxygen
55
Conscious Sedation / local - indications
Minor sx
56
Conscious Sedation / local - monitor
BP EKG Pulse Ox Temperature
57
PACU
Postanesthesia Recovery Room Equipped with essentially the same monitors as the OR Specialized, short-stay ICU
58
D/c from PACU
``` After ~1h or When pt meets criteria - Monitoring of oxygenation, ventilation, circulation, level of consciousness and temperature Pain Post-op N/V ```
59
Common post-op problems
``` Hypothermia N/V Pain control Hypotension / HTN Hypoxemia Hypoventilation Agitation Arrhythmias ```
60
What do your pts need to know?
Make sure they are NPO for the appropriate time Make sure that they have had a complete H and P and f/u with any major complications Be aware of the different options your pt might have regarding anesthesia for different procedures Know what meds to stop or continue prior to sx

Clin Med - II (Surgery) (10 decks)

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