Anesthesia Lab II: Lecture 1 - Emergence Flashcards
(33 cards)
What defines typical emergence from anesthesia?
A passive process involving a gradual return of consciousness after stopping anesthetic agents.
What protective reflexes usually return during emergence?
Coughing and swallowing reflexes.
Why must anesthetics be discontinued before surgery ends?
To allow sufficient time for metabolism and exhalation, facilitating a smooth emergence.
How does solubility of volatile agents affect emergence time?
Higher solubility means slower emergence: Isoflurane > Sevoflurane > Desflurane.
How do bolus vs infusion IV anesthetics affect emergence?
Bolus leads to faster recovery; prolonged infusion causes delayed emergence.
What factors affect emergence speed for volatile anesthetics?
- Inhaled concentration
- Fresh gas flow
- Duration
- Minute ventilation
- Cardiac output
What factors affect emergence speed for IV anesthetics?
- Liver/kidney function
- Drug half-life
- Drug combinations
- Infusion duration
What must be assessed before reversing neuromuscular blockers?
Degree of muscle relaxation and need for reversal agents.
What are examples of reversal agents for NMBAs?
- Neostigmine + glycopyrrolate
- Sugammadex
What are signs of returning consciousness during emergence?
- Spontaneous breathing
- Gag reflex
- Muscle tone return
- Tearing
- Grimacing
- Response to commands
What monitoring helps assess return of consciousness?
BIS monitor or other neuromonitoring if indicated.
What are the different BIS Values?
- Awake – 100
- 80-100 – Light/moderate sedation
- 60-80 – Deep sedation
- 40-60 – General anesthesia
- <40 – Deep hypnotic state
- 0 – Isoelectric EEG (flatline)
What steps are part of an awake extubation protocol?
- Preoxygenate
- Suction
- Insert bite block
- Confirm spontaneous breathing
- Obeying commands
- Remove tube
- Continue oxygen
What is the role of the bite block during emergence?
Prevents patient from biting down on the ETT, reducing risk of airway obstruction or negative pressure injury.
When is it safe to extubate a patient?
When they are fully awake, breathing adequately, and obeying commands.
What is a result of coughing and bucking on airway adjunct?
Bronchospasm.
What are airway-related complications during emergence?
- Macroglossia
- Laryngeal edema
- Vocal cord paralysis
- Laryngeal/tracheal obstruction
What can cause inadequate ventilation post-extubation?
Residual neuromuscular blockade or opioid-induced respiratory depression.
What are some causes of apnea post-extubation?
- Drug-related suppression
- Neurologic injury
- Hypothermia
What is laryngospasm and what can trigger it?
Involuntary closure of the vocal cords, often due to airway stimulation or secretions.
What is negative pressure pulmonary edema?
A condition caused by forceful inhalation against a closed airway (like biting ETT or laryngospasm), causing fluid shift into alveoli.
What risks can agitation during emergence indicate?
- Pain
- Hypoxia
- Inadequate NMBA reversal
- Respiratory distress
How is bronchospasm treated during emergence?
Administer opioids to reduce coughing, allow spontaneous ventilation, and avoid fighting the ventilator.
What should you prepare for patients with known airway obstruction history?
Use oral or nasal airway devices and ensure full reversal of anesthetics/narcotics.
