Anesthesia Lab II: Lecture 4 - Maintenance Flashcards
(48 cards)
Drugs when Low BP and HR
Insufflation with a Laparoscopic Surgery
Insufflation can cause vagal response.
Once you see it on monitor:
- Ask surgeon to deflate, while running another blood pressure
- Start getting ready to grab Glycopyrrolate or Atropine for administration based on your BP
Stable Bradycardia = Glycopyrrolate
Unstable Bradycardia = Atropine - Stabilize heart rate with drugs and the desufflation
- Tell surgeon he can resume, but ask him to insufflate slowly
Drug and Alcohol Use on Drugs DOA and Incision
As soon as you hear that patient uses a drug(s) and/or consistent alcohol use, start to think:
- Will I need more Induction agent?
- Patient could be good through intubation and surgical prep with normal doses, but that does not mean they are deep enough for painful stimulation/incision
- Be ready to administer a little bump of pain control before incision
- Remember can still feel pain even if sedated. Indicators can be any combination of elevated HR, BP, RR… see elevated HR, always run another BP
What are the goals of an anesthetic plan?
Sedation, Muscle relaxation, Amnesia, Analgesia, Hemodynamic stability, Aspiration risk
What factors should be evaluated in the preoperative assessment?
Co-morbidities, Blood loss risk, Anemia, Abnormal heart rhythm, Electrolyte or sugar levels
What is the significance of the Type and Screen, Type and Crossmatch?
To prepare for potential blood transfusions
What are the components of hemodynamic monitoring?
BP, HR, Glucose levels, Temperature, Fluids, Oxygenation, Ventilation, Organ perfusion
What should be considered when choosing induction methods?
LMA, ETT, MAC with NC, regional/spinal/epidural blocks
What are the types of anesthesia mentioned?
GETA, TIVA, MAC
Fill in the blank: The anesthesia plan must take into account the patient’s _______.
Comorbidities
What are multi-modal analgesia options?
- Dilaudid
- Morphine
- Ofirmev (Tylenol)
- Ketorolac
What are the ASA standard monitors?
Pulse ox, BP cuff, EKG, Temperature, Capnograph
What considerations are there for fluid management?
- Crystalloids: 0.9% Normal saline, Lactated Ringers, Plasma lyte
- Colloids: Albumin, Hexastarch
True or False: Lactated Ringer’s solution can cause clotting when giving blood products.
True
What should be monitored for oxygenation during surgery?
Supplemental oxygen needs, Oxygen saturation levels
What are common risk factors for PONV?
- Female
- Non-smokers
- History of PONV
- Use of volatile agents or N2O
- GYN and ENT procedures
- Duration of surgery
- Pre-op anxiety
- History of migraine
What medications can be used to manage PONV?
- Reglan
- Bicitra
- H2s (antacids)
- Ondansetron
- Decadron
- Emend (PO)
What is Allowable Blood Loss (ABL)?
ABL = ( EBV x (Hgb_i - Hgb_f) ) / Hgb_i
What are neuraxial blockades used for?
To lessen the need for anesthetics, eliminate pain, and may allow quicker patient recovery
What are potential contraindications for neuraxial blockades?
- Severely hypovolemic
- Bleeding disorders
- Anticoagulants
Fill in the blank: The duration of a spinal block typically lasts ______ hours.
4
What should be communicated preoperatively with the surgical team?
Patient positioning and antibiotic administration
What is a significant consideration when managing anesthesia for a patient with uncontrolled GERD?
Use an ETT and perform rapid sequence intubation (RSI)
What factors influence the choice of anesthesia technique?
Surgeon’s preference, anesthesiologist’s preference, patient’s comorbidities
