Anesthesia Principles and Practice I: Lecture 3 - PACU/CriticalCare Flashcards

Question

Goals of Neuro-Resuscitation

Answer 1

Restore Cerebral Blood Flow (CBF) Maintenance of cerebral perfusion pressure (CPP) Reduction of intracranial pressure (ICP) Evacuation of space-occupying lesions Cranial Mass Cerebral hematoma Avoidance of Hypoxia Initiation of cerebral protection therapies Hypothermia each degree Celsius lowers metabolism 6-8%

Answer 2

Rupture of saccular intracranial aneurysm Very high morbidity among survivors and mortality May be due to initial bleed, cerebral vasospasm, or rebleeding

Answer 3

* Worst headache of my life * Brief LOC * Vomiting * Neck pain/stiffness * Sudden death: 22% do not make it to hospital

Answer 4

Initial Bleed- Aneurysm rupture results in critical reduction in CBF because of increased ICP Phenylephrine/pressors - To artificially increase CBF until embolized Secure Aneurysm via surgery or interventional radiology Hyponatremia common Resuscitate hypovolemia with NaCL

Answer 5

Decreased CBF results in ischemic neurological deficits All patients should receive nimodipine Increases microvascular flow

Answer 6

Most result from a thrombotic mechanism Transient Ischemic Attacks (TIA)- May warn of impending stroke Rapid Clot Lysis of Large Vessel Occlusion (LVO) * Neuroradiologist/vascular trained neurosurgeon * Light MAC if tolerated, GA if patient incapable of laying flat/being still * SBP goal ~180 mmHg with pressor support (usually phenylephrine) until evacuation of clot * 140 mmHg goal after treatment, may need nicardipine infusion (1-15 mg/hr) Hyperglycemia = BAD * During cerebral ischemia conditions are anaerobic and glycolysis predominates metabolism. * Glycolysis produces lactate worsening acidosis and subsequently outcomes

Answer 7

Circulatory failure resulting in severe hypotension and inadequate tissue perfusion

Answer 8

* Septic * Anaphylactic * Neurogenic Decreased SVR, sometimes associated with increased CO

Answer 9

low CO associated with increased SVR

Answer 10

Most common in ICU Cardiogenic, septic, and hypovolemic Septic shock represents 62% of ICU admissions Cardiogenic- 16% Hypovolemic- 16%

Answer 11

* Primary Pump Failure Cardiomyopathic- MI, Acute CHF exacerbation, myocarditis etc. Arrhythmic- sustained Ventricular Tachycardia, complete heart block Mechanical- severe aortic or mitral insufficiency, tamponade, atrial myxoma, septal rupture * Decreased CO leads to Reflex Vasoconstriction leads to Increased LV workload and myocardial O2 Demand Work to reduce myocardial O2 demand and increase O2 delivery to ischemic areas

Answer 12

Increase O2 supply and decrease oxygen demand Giving Inotropes

Answer 13

Most common cause of distributive shock (severe peripheral vasodilation) Mortality rate 40-50% Defined by use of vasopressor and lactate >2mmol/L despite sufficient fluid resuscitation. Tachypnea, Increased temperature and white blood cell count are all signs Systemic infection leads to Systemic inflammatory response syndrome leads to sepsis leads to Septic shock leads to Multiple Organ Dysfunction Syndrome (MODS) Gram positive pneumococcus and enterococcus are most common pathogens.

Answer 14

Cellular hypoxia- Reduced tissue perfusion/oxygen delivery Increased oxygen consumption Inadequate oxygen utilization Causes leakage of intracellular contents Increased serum lactate level represent hypoperfusion, and tissue hypoxia BP = CO x SVR CO = HR x SV Stroke volume determinants- Preload, Myocardial contractility, afterload SVR determinants- vessel length, blood viscosity, vessel diameter/tone

Answer 15

Intravascular volume expansion, use of inotropes, vasopressors to correct end organ blood flow and oxygen delivery. Myocardial ischemia- results in elevated troponins Renal dysfunction- increased creatinine and BUN, BUN/Creatinine ratio Trending of other indices of organ function to evaluate progress of treatment Fluid responsiveness- Pulse Pressure Variation PPV during mechanical ventilation.

Answer 16

Pulse Pressure Variation is a marker for position on the Frank-Starling curve, it is not an indicator of blood volume or preload marker Increasing preload gives a decrease in PPV from point 2-3. PPV is minimal on plateau of curve (points 3 and 4) Decreasing preload causes increase in PPV from 2 to 1, as does increased contractility (4—2)

Answer 17

First-line drug providing potent vasoconstriction and modest CO increase Alpha and Beta stimulation gives potent vasoconstriction and modest CO increase. May see reflex bradycardia

Answer 18

* 1-2 mcg/kg/min - Primarily Dopamine-1 receptor, may increase urine output * 5-10 mcg/kg/min - Beta-1 increases SV and CO * >10 mcg/kg/min - Alpha vasoconstriction, increased SVR

Answer 19

Mostly Beta-1 increases inotropy and chronotropy. Increases CO with decreased SVR Drug of choice in cardiogenic shock and medically refractory heart failure. NOT used in sepsis- risk of hypotension

Answer 20

Potent Beta 1&2 and alpha 1 effects increase contractility, HR, and SVR. Agent of choice in anaphylaxis Can cause dysrhythmias, decreased splanchnic perfusion, increased lactate.

Answer 21

Potent vasoconstrictor. Can be used to decrease norepinephrine dose. 0.04 units/min standard dose Large increase in BP Useful in vasodilatory shock/sepsis Was recently removed from ACLS

Answer 22

Phosphodiesterase (PDE) inhibitor used in patients with impaired cardiac function/refractory heart failure. Used for Cardiogenic shock Vasodilatory properties see it often paired with norepinephrine

Answer 23

It worsens acidosis and negatively impacts outcomes

Answer 24

Intubate to protect airway

Answer 25

Approximately 180 mmHg with pressor support

Answer 26

Each degree Celsius lowers metabolism by 6-8%

Answer 27

Early recognition and management of immediate post-op issues can be life saving. Quality of PACU Care has several metrics Time per patient spent in recovery Clinical Outcomes Patient satisfaction Complication rate ## Footnote Quality of PACU Care is measured by time per patient, clinical outcomes, patient satisfaction, and complication rate.

Answer 28

Typically standardized review of patient history and OR course including: * Patient ID * Allergies * PMH * Important Home Meds * Preop meds * Access * Anesthetic Type * Airway Management (relaxant/reversal) * Antibiotics * Analgesics * Antiemetics * Other Meds (Pressors, adjuvants) * Intra-op problems * Ins and Outs (Crystalloid, colloid, blood products, EBL, urine, etc.) * Anticipated Post-op Issues (Hyper/hypotension, nausea) Always make sure RN’s questions are answered and that they are comfortable taking over care of the patient!!!!! ## Footnote This ensures RN's questions are answered and they are comfortable taking over care.

Answer 29

Monitoring and staffing ratios similar to ICU to ensure full recovery from anesthesia and return of vital signs to near baseline.

Answer 30

Transition from intensive observation to stabilization for care on surgical floor or hospital discharge. Includes patient education about surgeon’s post-op instructions and any prescribed discharge meds.

Answer 31

Bypassing Phase I (MAC and Extremity Blocks) GA and Neuraxial Block usually require phase 1 recovery 23 Hour Admit and ICU Step down units also available in some facilities

Answer 32

Airway Patency, Respiratory Rate (RR), SpO2, Heart Rate (HR), Blood Pressure (BP), ECG, Mental Status, Temp, pain and N/V are all assessed. Supplemental Oxygen is continued and weaned as appropriate Assessment of neuraxial block- return of motor/sensory function Pain Management- IV analgesics, PCA, OnQ Catheters Vitals repeated q 15 min

Answer 33

General Condition * Oriented x 3 * Adequate skeletal muscle strength * Absence of acute anesthesia/surgical issues Cardiovascular stability * BP, HR, cardiac rhythm, fluid volume status Ventilation and oxygenation * Acceptable saturation and respiratory rate Airway maintenance * Normal Airway Reflexes, no evidence of obstruction * No need for artificial ventilation * Pain adequately controlled * Renal Function intact, patients often need to void before leaving recovery * Ambulatory without dizziness * Controlled Post-op Nausea/Vomiting.

Answer 34

The five principal neurotransmitters are: * Muscarinic M1 * Dopamine D2 * Histamine H1 * 5-hydroxytryptamine (HT)-3 serotonin * Neurokinin 1 (NK1). May require unanticipated hospital admission and delays discharge from recovery Patient’s often rate PONV as worse than pain

Answer 35

fear, pain, anxiety, conditioned nausea to environmental cues, stimulation of the vestibular system (tympanoplasty etc.) Stim of Central Pattern Generator in Medulla.

Answer 36

Direct gastric stimulation (trauma, blood, toxins) to Substance P release to activate vagal/splanchnic 5-HT3 Receptors These afferents terminate in the area postrema (chemoreceptor trigger zone.) Bowel surgery/blood in GI tract from Ear, Nose, Throat surgery cause N/V from this pathway

Answer 37

Opioids/inhaled anesthetics may cause nausea through this pathway Area Postrema again to Central Pattern generator Via dopamine and serotonin to trigger vomiting

Answer 38

Risk factors include: * Preop Nausea and Vomiting * Female Gender * History of PONV or motion sickness * Nonsmoking Age < 50 POV in children rare <3 yo, increases until puberty * Chemotherapy-induced N/V.

Answer 39

Anesthetic Technique Use of Volatile Anesthetic Nitrous Oxide- modest increase Duration of Anesthesia Neostigmine (used to be thought more PONV with it) vs Sugammadex Recent research says maybe no difference Opioid Admin and Reduction Precedex in kids

Answer 40

Postoperative Nausea and Vomiting (PONV).

Answer 41

Multimodal/opioid sparing or opioid-free strategy when possible.

Answer 42

GYN/Cholecystectomy/Laparoscopy Peds Strabismus Adenotonsillectomy- up to 70% w/o prophylaxis Otoplasty- up to 60% Inguinal/scrotal/penile

Answer 43

Multimodal/opioid sparing or opioid free strategy when possible. Risk Stratification Patient specific risk of PONV (number of risk factors) What sequalae could N/V cause? Wound Dehiscence, increase in ICP, Clot disruption after angiographic procedure, procedures ending in maxillomandibular fixation Patient/clinician preference When to change to TIVA Narcotics activate mu opioid receptors in the chemoreceptor trigger zone (CTZ)

Answer 44

Consider regional over GA if possible, and TIVA if GA is necessary Opioid sparing anesthetic (adjuvants like precedex, Celebrex, Tylenol, etc) Scopolamine- (Transderm Scop ® class-anticholinergic) patch early! Transdermal medication take time to work, up to 4 hrs Discontinue 24 hours after surgery (Can be left on longer but minimal PONV coverage after 24 hours) Contraindicated with narrow/closed angle glaucoma Dexamethasone (Decadron ® class glucocorticoid) 4-8 mg IV after induction (ENT, Maxillofacial surgeons may ask for more). With kids and the type of surgery might even use 10-12 mg Ondansetron (Zofran® Class-5-HT3 antagonist) 4 mg IV 30 min before end of surgery If no scop patch consider Dimenhydrinate (Dramamine® class- antihistamine) 25-50 mg IV Prochlorperazine (Compazine ® Class- phenothiazine mainly D2 blocker) 5-10 mg may be better than Promethazine (Phenergan ®- class-phenothiazine antihistamine H1) 6.25-12.5 mg or less Haloperidol (Haldol ®- class- antipsychotic D2) 1 mg ## Footnote Decadron caution in Diabetics: In patients with diabetes, the use of Decadron (brand name for dexamethasone, a potent corticosteroid) requires caution because it can raise blood glucose levels, sometimes significantly.

Answer 45

Make sure to leave an antiemetic of a different class for rescue emetic Adequate hydration (at least 10 ml/kg) for all patients unless contraindicated D5LR 500cc bolus before or after surgery may help (Hypoglycemia correlated with nausea) Neurokinin 1 (NK1) receptor antagonist Newer drugs, may best most effective but $$$$ Aprepitant 40 mg PO Fosaprepitant (pro-drug)- 150 mg IV preoperatively Potentially Acupuncture of the P6 point (between palmaris longus and flexor carpi radialis 5 cm from base of hand) Isopropyl alcohol swap- great in a pinch as they are ubiquitous, not as good as meds

Answer 46

Dexmedetomidine Narcotic administration is generally lower with Precedex administration, so this may be related Lower circulating catecholamines may also help Midazolam May be related to stress reduction Combination with ondansetron has been shown to decrease PONV after middle ear surgery

Answer 47

Inadequate respiratory drive Opioid induced, linger after decrease in noxious stimuli, ETT removal, post op pain decrease (LA injection) Ventilatory Mechanics Increased airway resistance- bronchospasm and/or anaphylaxis swelling of soft tissues Decreased compliance- obesity, pulmonary edema, atelectasis Residual NMB- Pharyngeal Muscle Weakness d/t residual NMB is most common cause of upper airway obstruction Go get the sugammadex Increased deadspace Pulmonary Embolism (PE), ARDS, TRALI Increased carbon dioxide production Hyperthermia, Shivering, Infection, Sympathetic Discharge

Answer 48

Video from Powerpoint Slide 20

Answer 49

Distribution of Ventilation/Perfusion V-Q mismatch from loss of FRC and airway closure (atelectasis) #1 cause of post-op hypoxemia Loss of inspiratory muscle tone, gas-trapping, Lung compliance decreases and airway resistance increases FRC decreased 20% by general anesthesia, more in the Obese and COPD Impaired hypoxic pulmonary vasoconstriction Inadequate alveolar oxygen partial pressure Usually from inadequate ventilation Less likely, Second gas effect or diffusion hypoxia. Large quantity of N2O crosses from blood into alveoli diluting O2 Decreased mixed venous oxygen partial pressure Decrease CO, arterial O2 content Increased tissue Oxygen Extraction

Answer 50

Awake patient may complain of difficulty breathing or hoarseness, sedated patient cannot offer such feedback Signs include: * Tachypnea (RR<30) shallow respirations or labored breathing (nasal flaring, intercostal, suprasternal, or supraclavicular retractions) leads to Increased work of breathing/inadequate ventilation. Respiratory arrest can result if patient cannot maintain this effort * Bradypnea (RR<8) from excess opioids or other sedatives * Hypoxemia SpO2<93%- bluish skin hue and finger beds, abnormal breath sounds like stridor or wheezing. Supplemental O2 may hide underlying hypoventilation * Anxiety, Confusion, or Agitation may be signs of hypercapnia or hypoxia * Hypertension and Tachycardia may be d/t sympathetic discharge from hypoxemia/hypercapnia

Answer 51

Do you see retractions? Pull top of gown down to assess. Do you see uncoordinated breathing? Abdomen and chest moving out of concert. If the patient isn’t moving air, you won’t hear anything. Chin lift, OAW, escalate FiO2 delivery, Ambu Bag if SATs continue to decrease Stridor appreciated more on inspiration over the neck It usually indicates upper airway obstruction Wheezing more prominent on expiration over the chest It points to lower airway narrowing

Answer 52

Does Auscultation reveal potential lower airway pathology? Localized wheeze- May indicate mucus plug or foreign body (FB) Generalized wheeze- Typically Bronchospasm. In severe bronchospasm may not hear wheezing as too little air is being exchanged. Rales (Crackles)- Start thinking atelectasis or pulmonary edema. Aspiration pneumonitis may sound like diffuse crackles Rhonchi- Usually airway secretions than can be cleared with coughing Is the Patient obtunded? Consider reversal of benzo/opioid Give more O2, Support Ventilation, and Clear Secretions

Answer 53

Suction- blood and secretions that may be triggering Positive Pressure with jaw thrust Larson’s maneuver- dig into periauricular notch betwixt mastoid and ramus Deepen anesthesia- Propofol/lidocaine bolus Sux to be you- 0.1 mg/kg IV Succinylcholine You can give it IM if no IV access Induction agent and Intubating dose of NMB- if all else fails to rescue airway

Answer 54

Airway or major neck surgery ↓Venous Drainage from Trendelenburg, prone position or head turned to the side Multiple/traumatic intubation attempts In absence of these look to consider angioedema/anaphylaxis Angioedema treatment-antihistamines/corticosteroids Anaphylaxis treatment is always Epi

Answer 55

Is Patient Intubated? Perform Leak test during spontaneous ventilation Consider simultaneous direct or video laryngoscopy to assess Elevate head Glucocorticoids- Decadron Is Patient is Extubated? Consider nebulized racemic epinephrine Diuretic- if fluid overload is suspected Reintubate- if edema persists to prevent losing the airway

Answer 56

Partial or complete obstruction of the upper airway: Episodic desaturation Hypoxia and Hypercapnia Acute increase in Pulmonary Artery pressure  Right Ventricular Hypertrophy CPAP devices of Surgery to mitigate

Answer 57

Common causes include: * Opioid-induced respiratory depression * Increased airway resistance * Decreased compliance * Residual neuromuscular blockade.

Answer 58

A decrease of >20% from baseline blood pressure, which can result in organ hypoperfusion. Acidosis, Oliguria, MI Requires prompt attention and treatment

Answer 59

Treatment options include: * Fluid bolus * Phenylephrine 50-100 mcg * Ephedrine 5-10 mg Not doing the trick: * Epi Small boluses 10-30 mcg * Norepinephrine 4-8 mcg * Vasopressin 1-2 units Rare to need the big guns but can tide you over until an infusion can be ordered/made What is the underlying cause?

Answer 60

Assessing hypovolemia * Surgical blood loss * Third-Spacing * Ongoing bleeding * Inadequate fluid replacement. Bolus 250-500 cc crystalloid Order CBC if continued bleeding is suspected

Answer 61

Drug Effects Preop meds- ACE/ARB May need Vasopressin 1-2 units at a time Methylene Blue is alternative treatment 1-2 mg/kg over 20 min reduces vessel response to Nitric Oxide Anti-hypertensive Agents Hydralazine, Labetalol, Metoprolol Anesthetic agents Too much narcotic in absence of pain: consider 40 mcg Naloxone Dexmedetomidine- may cause post op sedation/bradycardia/hypotension at higher dose

Answer 62

Sympathectomy d/t Neuraxial Anesthesia High block level and preop HTN = higher risk Discontinue infusion if present Pressors/volume resuscitation as necessary Adrenal Insufficiency Rare, seen in those on chronic steroids Resistant to Pressors and Fluids Treatment: 100 mg hydrocortisone or dexamethasone 4 mg Hypotensive Emergencies Shock of any etiology Local Anesthetic Systemic Toxicity LAST Tension Pneumothorax- require needle decompression Pulmonary Embolus Left Ventricular Outflow Obstruction (LVOTO) In patient with hypertrophic cardiomyopathy Phenylephrine, fluids, beta blockers

Answer 63

>20% Increase in baseline BP Increased morbidity and mortality Myocardial ischemia, bleeding, increased ICP Evaluation/Differential Diagnosis Pain- admin pain meds Hypoventilation/Hypercarbia- Adequate ventilation Hypothermia with shivering- Rewarm/BairHugger ™ Bladder Distention- Drain Bladder Emergence Delirium- Versed/Precedex etc Essential Hypertension- Give appropriate meds Initial Treatment Labetalol 5-10 mg HR>60 bpm Metoprolol 1-5 mg HR>60 bpm Hydralazine 5-10 mg HR<60 or resistant previous agent Less predictable and delayed onset

Answer 64

Alcohol withdrawal- HTN, tachycardia, sweating, nausea, anxiety as early as 6-24 hours after last drink. Delirium tremens and worsening HTN 48-96 hours out. Opioid withdrawal- HTN, tachycardia, mydriasis, dysphoria. In chronic users post-op HTN may be worsened by inadequately treated pain from tolerance and hyperalgesia. Recent use of cocaine, amphetamine, phencyclidine, or MDMA Consider continuous infusion of nitroglycerine or nicardipine or Hydralazine 5-10 mg Avoid Beta Blockers in acute cocaine intoxication Unopposed Alpha-adrenergic stimulation can occur

Answer 65

Treatments include: * Glucocorticoids * Nebulized racemic epinephrine * Diuretics * Reintubation if edema persists.

Answer 66

Opioids may cause respiratory depression and are associated with longer recovery times.

Answer 67

40 mcg ## Footnote Naloxone is an opioid antagonist used to reverse opioid overdoses.

Answer 68

Post op sedation, bradycardia, hypotension ## Footnote Dexmedetomidine is used for sedation but can cause significant cardiovascular effects.

Answer 69

Discontinue infusion, pressors, volume resuscitation as necessary ## Footnote Sympathectomy can lead to severe hypotension, especially with high block levels.

Answer 70

Rare condition seen in chronic steroid users; treated with 100 mg hydrocortisone or 4 mg dexamethasone ## Footnote Patients may be resistant to pressors and fluids.

Answer 71

Shock of any etiology, local anesthetic systemic toxicity (LAST), tension pneumothorax, pulmonary embolus, LVOTO ## Footnote Each of these conditions requires immediate evaluation and treatment.

Answer 72

>20% increase in baseline BP ## Footnote This condition can lead to increased morbidity and mortality.

Answer 73

Labetalol 5-10 mg, Metoprolol 1-5 mg, Hydralazine 5-10 mg ## Footnote Dosing depends on heart rate and previous treatment resistance.

Answer 74

HTN, tachycardia, sweating, nausea, anxiety ## Footnote Symptoms may escalate to delirium tremens after 48-96 hours.

Answer 75

Pain, hypovolemia, anemia ## Footnote Most arrhythmias are transient and not pathological.

Answer 76

Most arrythmias in PACU are not lasting and not pathological If new arrythmia persists order 12 lead EKG Hypoxemia, hypoventilation, anemia, and electrolyte abnormalities may exist Sinus Tachycardia- Likely d/t pain, hypovolemia, or anemia. PE, MI, MH very unlikely but keep in back of mind. Common. Atrial Fibrillation- Can be indication of acute fluid overload, myocardial irritation, sympathetic activity. Less common. PVCs- Occasional PVCs are relatively common, usually resolve without treatment. New frequent PVCs can degenerate into pathological rhythms 3 or more beats in a row = non sustained V Tach Consider Beta Blocker or Ca Channel Blocker for rate >100 Lidocaine or amiodarone may help return to NSR V Fib/Tach- Treat with ACLS protocol. Rare. Torsades de pointes- methadone, droperidol, ondansetron may prolong QT. Very Rare

Answer 77

Atropine 0.5 mg, may repeat up to 3 mg ## Footnote Treatment is indicated for symptomatic bradycardia.

Answer 78

Asymptomatic HR 40-60 bpm- Does not need treatment. BP Stable, no nausea Symptomatic- treat Glycopyrrolate 0.2 mg at a time up to 1 mg Ephedrine 5-10 mg as needed Severe Bradycardia HR<40 Atropine 0.5 mg, may repeat up to 3 mg

Answer 79

Patient- Old Age, Male Sex, Hx of Urinary Retention, Prior pelvic surgery, Neurologic Disease (MS, neuropathy etc) Procedural- Anorectal surgery, hernia repair, total joint, surgery for incontinence (bladder sling etc) Anesthetic- Excess fluid, long anesthetic, neuraxial, anticholinergic meds, opioids, beta blockers ## Footnote Procedural and anesthetic factors also contribute.

Answer 80

Intraop oliguria (urine <0.5 ml/kg/hr) has not been linked to AKI Antidiuretic hormone releases in response to pain/nausea Post-op <0.3 ml/kg/hr has been associated with AKI and increased creatinine.

Answer 81

Awareness and Recall Virtually non-existent in patients who are not paralyzed for surgery More likely with difficult airway, trauma CV Surgery, OB emergency, ant TIVA Visual Disturbance Corneal Abrasion- most common. May be from airway management or patient rubbing eyes. Partial or Complete loss of Vision- Ischemic Optic Neuropathy (ION), Retinal artery occlusion, retrobulbar hematoma from block Spinal Epidural Hematoma (SEH)- Highest risk in those receiving anticoaglulation/antiplatelet agents. Very low risk in OB If motor block does no resolve -->emergent MRI May require emergent laminectomy, recovery most likely if decompressed within 8 hours of onet

Answer 82

Prolonged Drug Effects? Residual NMB- can cause hypoventilation, hypoxemia, and hypercapnia leads to worsen sedation Combo of meds- Synergy from GABA meds (Propofol, midazolam, etomidate) with others Decreased liver or kidney function Old Age and Small Weight Hypothermia- slows metabolism and elimination Anticholinergic agents- Scopolamine or atropine overdose is exceptionally rare. Delirium, hyperthermia, Physostigmine 0.5-2 mg IV can reverse Glucose/electrolytes Hypo or hyperglycemia/hypermagnesemia Neurologic Disorders Acute Stroke Seizures- post ictal state can cause obtundation

Answer 83

Emergence delirium Agitation, disinhibition, crying, restlessness, confusion are all common but usually brief. More likely in peds patients than adult Eval and Treatment- Is this stage 2 of anesthesia? Reassurance and Reorientation before meds! Treat Acute pain Eval bladder distention/hypothermia Dexmedetomidine admin reduces hyperactive emergence delirium ## Footnote Symptoms include agitation, disinhibition, and confusion, especially in pediatric patients.

Answer 84

Drug effects Ketamine- may see hallucinations, nightmares, vivid dreams. Versed- routine preop benzo is correlated to emergence delirium R/O Serotonin Syndrome Haldol- 0.5-2mg if patient is danger to self or others Versed- 1-2 mg if residual neuromuscular blockade is suspected Dexmedetomidine- 0.125-0.25 mcg/kg or 10-20 mcgs in adult

Answer 85

Dexmedetomidine administration ## Footnote This medication helps to reduce hyperactive emergence delirium.

Answer 86

A condition leading to partial or complete loss of vision ## Footnote Often related to surgical positioning or airway management.

Answer 87

Residual neuromuscular blockade, prolonged drug effects, hypothermia ## Footnote Assessment of drug interactions and metabolism is crucial.

Answer 88

Reverses anticholinergic overdose effects ## Footnote Rarely needed but effective for scopolamine or atropine overdose.

Anesthesia Principles and Practice I: Lecture 3 - PACU/CriticalCare Flashcards

(113 cards)