Choice of Anesthesia Flashcards
(59 cards)
1
Q
4 Types of Anesthesia to choose from
A
- General Anesthesia
- MAC (Monitor Anesthesia Care)
- Peripheral Nerve Block
- Regional Anesthesia
2
Q
11 items to consider when choosing which anesthesia type to provide
A
- preference of patient, surgeon, anesthesiologist
- coexisting diseases
- site of surgery
- body position of patient
- elective or emergency surgery?
- increased amount of gastric contents
- suspected difficult airway
- duration of surgery
- patient age
- anticipated recovery time
- post anesthesia care unit discharge criteria
3
Q
What anesthesia type would be best for a COPD patient on oxygen?
A
Spinal (regional anesthesia) instead of general due to risk with suppressing their airway. Should try to convince patient if they decline regional.
4
Q
What is Anesthesia? (6 Modes of Action)
A
- analgesia
- amnesia
- immobility –loss of motor reflexes
- unconsciousness
- skeletal muscle relaxation
- block autonomic responses
5
Q
MAC (meaning and how it is administered)
A
- monitored anesthesia care
* administered through IV –continuous or boluses
6
Q
What 3 drugs are used for MAC?
A
fentanyl, midazolam, propofol
7
Q
_______ should always be given with succinylcholine in children because pronounced bradycardia may occur.
A
atropine
8
Q
general anesthesia checklist (6 items)
A
- pre-anesthetic assessment
- administration of GA drugs
- airway management
- cardio-respiratory monitoring
- fluid management
- analgesia (during and post op pain relief)
9
Q
When pre-oxygenating patients, how much O2 do you give and for how long?
A
100% at 10L/min flow for 3 minutes or 8VC/1min
10
Q
When should you use a CPAP during pre-oxygenation?
A
When there is a decreased functional residual capacity.
*esp. in infants, obese, pregnant women
11
Q
What value are you looking for with CPAP use?
____ cmH2O for ___ min
A
+5 to +25 cmH2O for 3 min
12
Q
Which induction has a faster onset…inhalational or IV?
A
IV due to onset being 10-20 secs
(inhalational induction takes 30+ secs
13
Q
3 advantages to IV induction
A
- faster onset than inhalational
- induces total unconsciousness
- avoidance of the excitatory phase of anesthesia
14
Q
3 ways to administer General Anesthesia
A
- IV
- inhalational
- combination
15
Q
Loss of consciousness causes?
A
- loss of protective airway reflexes
- loss of airway patency (ex. soft tissue obstruction)
- irregular breathing pattern due to meds
16
Q
Standard steps in sevoflurane mask induction
A
- 70% N2O with 30% O2 for 30 secs
- sevoflurane to 8%
- can start IV after 1-2 min of breathing sevoflurane mix
17
Q
7 Indications for intubation
A
- A need to deliver positive pressure ventilation
- To protect respiratory tract from aspiration of gastric contents
- head, neck, thorax, or abdomen surgery
- non-supine positions that preclude airway support
- profound disturbance in consciousness with inability to protect airway
- cannot control secretions in throat (tracheobrochial toilet)
- severe pulmonary or multisystem injury associated with respiratory failure. (ie. sepsis, airway obstruction, hypoxemia, hypercarbia)
- *hypercarbia is too much CO2 in bloodstream)
18
Q
When to Mask ventilate
A
- short, supine case
- low or no risk of aspiration
- does NOT protect airway
19
Q
When to use LMA for ventilation
A
- need to free up both hands
- low or no risk of aspiration
- -does NOT protect airway
20
Q
5 ways to confirm you have placed ETT properly
A
- capnography reads 35-45 mmHg
- bilateral breath sounds
- -evidence ETT is not advanced too far and only in one lung
- upper part of chest expands
- reservoir bag partially empties during inspiration
- pulse oximeter continues to read >95% after 2 min
21
Q
Main reason for RSI
A
to prevent aspiration
22
Q
Who gets RSI
A
- not NPO for 6 hours solids and 2-4 hours liquids
- trauma victims
- unknown NPO status
- longstanding diabetes (risk of gastroparesis)
- pregnant > 9-12 weeks
- GERD
- morbidly obese
23
Q
RSI steps
A
- preoxygenate
- Administer Meds: Induction agent/narcotic
Rocuronium (90 secs and no
fasciculations)
**Succinylcholine (45-90 secs with
fasciculations) - Cricoid Pressure after induction agent given and held until ETT is confirmed in
(research shows succinylcholine is preferred for RSI due to faster onset than Roc)
24
Q
What is the largest group of patients that receive Inhalational Induction of GA?
A
pediatrics at 95%
25
MAC ramsey scale
```
1= anxious, agitated, restless
2=cooperative, oriented, tranquil
3= drowsy but responds to commands
4= asleep, brisk response to stimuli
5= asleep, sluggish response to stimuli
6= asleep, no response
```
26
Where is the widest epidural space?
L-2 with 5-6mm
27
Where is the narrowest epidural space?
C-5 with 1-1.5mm
28
spinal anesthesia advantages
1. less time to perform
2. rapid onset
3. better quality motor and sensory block
4. less pain during surgery
29
What is the most used volatile agent for Inhalational Induction of GA?
sevoflurane
30
How long is the duration of action of IV induction agents during GA?
5-10 min
31
During GA, how is anesthesia maintained after IV induction agents serve their purpose?
allowing the patient to breath a controlled mixture of volatile agent and O2/N2O/Air
32
4 stages of GA
Stage 1: analgesia or induction phase (between induction med administration and loss of consciousness)
Stage 2: Excitement or delirium stage (period following loss of consciousness and marked by excited and delirious activity)
Stage 3: Surgical or operative phase (return of regular respiration)
Stage 4: Overdose or bulbar paralysis (toxic or dangerous stage)
33
MAC sedation ASA definitions
* minimal sedation
* moderate or conscious sedation
* deep sedation
34
minimal sedation definition
responds to verbal commands
35
moderate or conscious sedation definition
* responds to verbal commands with little stimuli
| * maintains own airway
36
deep sedation definition
* doesn't respond to verbal commands
* may or may not maintain their own airway
- -OAW or NAW may be used
37
3 types of regional anesthesia
1. spinal
2. epidural
3. caudal
38
Epidural Anesthesia Advantages
1. lower risk of post dural puncture headache (PDPH)
2. slower onset of hypotension
3. controlled, prolonged analgesia with indwelling catheters
4. post-op analgesia
39
Spinal Anatomy
33 total vertebrae
* 7 cervical
* 12 thoracic
* 5 lumbar
* 5 sacral
* 4 coccygeal
40
high points of vertebrae
C-5 and L-5
41
low points of vertebrae
T-5 and S-2
42
Spinal cord begins ____
foramen magnum
43
Spinal cord ends ___
L1
44
"key dermatomes and levels"
| C3-C5
keep the diaphragm alive
45
"key dermatomes and levels"
| T1-T4
cardio accelerator
46
"key dermatomes and levels"
| T4
nipple line
47
"key dermatomes and levels"
| T6
xyphoid process
48
"key dermatomes and levels"
| T10
umbilicus
49
"key dermatomes and levels"
| L2-L4
keeps the poop off the floor
50
"key dermatomes and levels"
| S2-S4
keeps the penis off the floor
51
What are 3 methods for locating peripheral nerves?
1. ultrasound
2. nerve stimulation
3. parensthesia
52
13 examples of peripheral nerve blocks
1. cervical plexus
2. brachial plexus
3. wrist block
4, ilio-inguinal
5. femoral
6. sephenous
7. lateral femoral cutaneous
8. intercostal
9. obturator
10. siatic
11. popliteal
12. ankle
13. IV regional neural anesthesia (Bier Block)
53
2 types of local anesthetics
1. Esters
| 2. Amides
54
4 Ester type anesthetics
procaine, chloroprocaine, tetracaine, cocaine
55
How are esters metabolized?
hydrolysis by pseusdo-cholinesterase enzyme
56
6 Amide type of local anesthetics?
lidocaine, mepivacaine, bupivacaine, etidocaine, prilocaine, ropivacaine
57
How are amides metabolized?
liver
58
PMS-MAIDS
P-ositioning M-onitors
M-achine check A-irway
S-uction I-IV equipment
D-rugs
S=pecial equipment
59
Drugs to have available
```
LA
Induction drug
opioid
benzo
anticholinergic
sympathomimetic
succinylcholine
rubinol
neostigmine
catecholamines
anti-hypertensives
```
