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Anesthesia Practice 1 > Exam 1 > Flashcards

Exam 1 Flashcards

2
Q

HHealthcare Associated Infections (HAIs)

A

5% - 10% (approx. 2 million people) of hospitalized patients acquire 1 or more HAIs yearly 90,000 deaths annually $4.5 - $5.7 billion in excess healthcare costs annually 4 most prevalent cases responsible for 80% of cases: UTIs (35% and catheter related), surgical site infection (20% of cases but 1/3 of excess costs), bloodstream infections (15% majority are intravascular-catheter related) and pneumonia (usually ventilator-associated, 15% of cases, 25% of attributable mortality) Organisms in 70% of these infections are resistant to 1 or more antibiotics

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3
Q

NIOSH vs. OSHA

A

National Institute for Occupational Safety and Health (NIOSH) - makes rules Occupational Safety and Health Administration (OSHA) - enforces rules

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4
Q

Methylmethacrylate

A

Glue used for ortho cases OSHA 8 hrs avg 100 ppm (280 ppm max) Exposure for factory workers Causes respiratory (asthma), cutaneous, genitourinary, allergic sensitizer issues

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5
Q

Latex Allergy

A

70% rxn reported were healthcare workers Anesthesia sensitivity - 13-16% Can’t be reversed Caution for ppl with Spina Bifida (have severe latex allergy) History of Hay fever, Rhinitis, asthma, eczema Food allergies (avocado, kiwi, banana, chestnuts, stone fruit) Schedule elective surgery as first case of the day Post signs indicating “LATEX ALLERGY”

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6
Q

Radiation Hazards

A

Exposure: diagnostic radiographs, fluoroscopy, radiation therapy, PACU Lead aprons and shields Dosimeters - measure exposure Maintaining distance: E = 1/d2 Gonads = greatest sensitivity You can stand behind someone w/ the lead jacket and be okay

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7
Q

Laser Hazards

A

Risks include thermal burns, eye injury, electrical hazards, fire & explosion (O2) Plume contains viral DNA and toxic chemicals Need to wear high efficiency laser mask & special glasses If operating around the head w/ laser, you need to decrease FiO2

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8
Q

Major Reason for Error in Anesthesia Management

A

Fatigue - 64%

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9
Q

Requirements forTransmission of Infectious Agents

A

Source Stabile pathogen Adequate numbers Infectivity of agent Appropriate vector Portal of entry

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10
Q

Respiratory Transmission

A

Aerosolization Flu Measles Rhinovirus Tuberculosis Self Inoculation Rhinovirus Respiratory Syncital Virus

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11
Q

Influenza

A

Easily transmitted US 36k deaths, 200k hospitalizations Cells shed 5d

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12
Q

Rubeola & Rubella

A

Rubeola (aka Measles) Transmission: Aerosol Highly infective Maculopapular rash & Koplicks spots Fever and 3C’s - cough, coryza (runny nose), conjunctivitis Complications commons: M 1:1000, 30% immunosuppressed Rubella (German Measles) Causes misscarriages 1st trimester Birth defects or fetal defects Elective surgeries cancelled

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13
Q

Mumps (Epidemic parotitis)

A

Infection by airborne droplets Painful swelling salivary & parotid glands Symptoms not severe in children Most often children 5-9 YO

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14
Q

Respiratory Syncytial Virus (RSV)

A

Paramyxoviridae Most important / most common cause of lower respiratory disease in young 60% infants 100% 2-3 YO Infected by self-inoculation Prevalenet November-May Viable on surface for 6 hours Infected individual sheds virus for 7d Immunity not permanent Recurrent asthma symptoms in young kids for up to 6 mo

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15
Q

Rhinovirus

A

Most common viral infective agents in humans Causes common cold Transmission: self-inoculation and/or aerosolized particles Over 110 serologic virus types

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16
Q

Herpes Virus

A

Varicella-zoster (VZV) Chickenpox and herpes zoster (shingles) Communicability: 1-2 days before and last 5-6 days after HC workers >36 YO have VZV antibodies, 6.5% younger pop susceptible HSV 1 & 2 Type 1: Oral herpes Cytomegalovirus (CMV) Occurs during childhood 40-90% adults have antibodies Transmitted via direct contact Infection during pregnancy results in fetal infection 2.5%

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17
Q

Hepatitis B

A
  • Prevalence HBV US is 3-5%
  • Seoconversion up to 30%
  • 5% develop chronic hepatitis which develops into cirrhosis and ESLD
  • 1% develop fulminant hepatitis (>70% mortality)
  • Transmission via sexual contact, shared needles/syringes, and perinatally
  • HBV vaccines primary prevention strategy
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18
Q

Hepatitis C

A

Leading cause of chronic liver disease in US 9K new cases/yr Prevalence HCV in US ~ 3% 60% HCV infected patients will have chronic hepatitis / cirrhosis Seroconversion 1.8%

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19
Q

Leading cause of chronic liver disease in US

A

Hepatitis C

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20
Q

HIV

A

Seroconversion 0.3% percutaneous exposure, 0.1% mucous membrane exposure Increased risk associated with visible blood on device, deep injury, needle placed intravascular, terminal illness Since 1957, 57 documented cases of HCW acquiring HIV through exposure

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21
Q

Tuberculosis

A

Viable bacilli on airborne particles 1-5 microns 7-8 million become infected every year 8000 die each day Groups with high prevalence include: personal contacts with active TB, immigrants, alcoholics, homeless, IV users Protection: N95 mask, patient kept in neg. pressure rooms 3 neg. sputum acid fast bacillus smears to determine that patient is no longer infectious Non elective procedures done at end of day High efficiency filter (99.97% particles >0.3 microns) Filter put on expiratory port of circuit to protect machine

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22
Q

What fluids are and are not considered infectious?

A

Infectious Blood CSF Amniotic fluid Pleural Pericardial Peritoneal Synovial Inflammatory exudates (pus) Not Infectious Urine

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23
Q
A
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23
Q

Precautions for Patients with Multi-Drug Resistant Microorganisms

A

Methicillin-Resistant Staphylococcus Aureus (MRSA) - most common bug on surface of skin Vancomycin-Resistant Enterococci (VRE) Clostridium Difficile (cdiff) Hand washing (EtOH alone not effective) Yellow gown and gloves

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24
Q

Droplet Precautions

A

Wear a mask w/in 3 feet of patients with: Mumps German measles Streptococcus Meningococcal Spatial separation of 3 feet with other patients, keep curtains drawn

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25
Q

Disposal of Contaminated Materials

A

Linen: BLUE container Sharps: RED Reusable sterile gowns: GREEN Paper Goods: trash can

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26
Q

Cleaning Antiseptic Disinfectant Sterile Sterilization

A

Cleaning: Removal of Foreign Material Antiseptic: chemical germicide for use on living tissue Disinfectant: chemical germicide for use on non-living items Sterile: completely free of all microorganisms Sterilization: process that results in probability of microorganism survival on an item

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27
Q

Disinfection Levels

A

High-Level Disinfection: kills fungi, viruses, and vegetative bacteria (except endospores) Intermediate Level: kills fungi, non small or nonlipid viruses and bacteria (except endospores) Low-Level: Kills fungi, some viruses (lipid/medium sized) and bacteria (except TB, endospores)

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28
Q

Chlorine (Hypochlorite)

A

Most widely used of the chlorine disinfectants. Used on tables, floors, surfaces, equipment 1:100 - 1:1000 effective against HIV 1:5 - 1:10 effective against hepatitis 1:10 (5.25%) for blood spills

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29
Q

Sterilization

A

Steam (Autoclaving) Chemical (Gas, Liquid) Radiation Plasma

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30
Q

Autoclaving

A

Type of steam sterilization Quick, cheap, effective with no residues Kills everything (pressure & temp) Minimum times: 15 mins @ 121 C 10 mins @ 126 C 3.5 mins @ 134 C Confirmed by indicator strip inside the wrapped metal trays

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31
Q

Handling Preservative-Free Medications

A

Check label Use aseptic technique (alcohol swab) to rubber septum or neck of glass ampule Discard vial / ampule or syringe after use

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32
Q

Multidose Vials

A

Aseptic technique (alcohol swabs) Uncontaminated vial may be used until manufacturer’s expiration date

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33
Q

Betadine Allergy

A

People allergic to Betadine also often allergic to contrast dye and shellfish

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34
Q

Prevention of Intravascular Catheter-Related Infections

A

Catheter Selection Single lumen is best Antimicrobial or antiseptic impregnated CVC Insertion Subclavian v. carries a lower risk Barrier Precautions Catheter Site Dressing Transparent, semi-permeable polyurethane dressings permit continuous visual inspection of the catheter site

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35
Q

Surgical Subspecialties: Cardiovascular Cases

A

CABG: Coronary Artery Bypass Graft Valve Replacement Aortic Arch Dissection - longitudinal tear Aneurysms Congenital Defects Transplants

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36
Q

Surgical Subspecialties: CV Anesthetic Concerns

A

General Anesthesia Sternotomy Cardio-pulmonary bypass Invasive Monitoring ICU Transport Chest Tube Placement

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37
Q

Surgical Subspecialties: Thoracic Cases

A

Tumor Resection: Lumpectomy, wedge, lobe, pneumonectomy Lung Reduction Transplant Esophageal Resection Tracheal Resection Thoracoscopy Bronchoscopy (put a scope down the ETT, so you have to do a TIVA)

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38
Q

Surgical Subspecialties: Thoracic Concerns

A

General Anesthesia One-lung ventilation Sternotomy Positioning Invasive Monitoring ICU Transport Chest Tube Placement

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39
Q

Surgical Subspecialties: Neurological Cases

A

Intracranial (tumor, aneurysm/AVM - arteriovenous malformation, trauma/bleeding, craniectomy, VP shunt - ventricular-peritoneal Spinal - decompression/fusion, alteration/straightening Functional - DBS, Infusion pumps, generator changes

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40
Q

Surgical Subspecialties: Neurosurgery Anesthetic Concerns

A

General Anesthesia vs. Local Anesthetic vs. MAC Invasive Monitoring CBF Changes/Diuretics Hyperventilation Positioning Head Fixation (Mayfield) Paralysis Burst Suppression (slowing down all electrical activity in the brain while they operate on it - done with high dose Propofol infusion)

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41
Q

Surgical Subspecialties: Intracranial Hypertension

A

Intracranial Pressure > 15mmHg Increase in tissue or fluid w/in the rigid cranial vault Signs and Symptoms: headache, N/V, altered consciousness Treatments: fix underlying cause, steroids (decadron), fluid restriction, diuretics (mannitol 0.25-0.5 g/kg), hyperventilation (ETCO2 30-35mmHg), Intraventricular drain

42
Q

Surgical Subspecialties: Orthopedic Cases

A

Joint Surgery: hip/knee/shoulder, replace vs. repair, arthroscopy Spine: cervical, lumbarl, thoracic Hand: trauma, reattachment, carpal tunnel

43
Q

Surgical Subspecialties: Orthopedic Anesthetic Concerns

A

GA vs. Regional vs. Nerve Block Positioning: sitting/prone/supine Blood Loss/Fluid Replacement Tourniquets Emboli: blood/fat/glue, polymethylmethacrylate

44
Q

Surgical Subspecialties: Ophthalmology Cases

A

Retina Lens Refractive Tumor Cosmetic Trauma

45
Q

Surgical Subspecialties: Ophthalmology Anesthetic Concerns

A

RBB (Retrobulbar Block) vs. GA vs. MAC Intraocular Pressure Oculocardiac Reflex: (reflex when lateral and medial rectus mm. pull at the same time) Ophthalmic tract trigeminal n., Vagus n. Gas Expansion (no nitrous on when you have a gas bubble)

46
Q

Surgical Subspecialties: Vascular Cases & Anesthetic Concerns

A

Carotid Endarterectomy Aneurysm Revascularization Trauma Concerns: GA vs. Regional vs. Local Invasive Monitors - Location Anticoagulation Neuro-monitoring Length of Case Patient population

47
Q

Surgical Subspecialties: Laparoscopic Cases & Anesthetic Concerns

A

Cholecystectomy Kidney Donor Herniorrhapy Appendectomy Splenectomy Bowel Resection GERD Cessation Adrenalectomy Gastric Bypass Concerns: GA Abdominal Insufflation Increased PIP Positioning ETCO2 issues Pneumo

48
Q

Surgical Subspecialties: Transplant Cases & Anesthetic Concerns

A

Renal - CRT vs. Living Related Heart Liver Lung Pancreas Concerns: GA Electrolyte Imbalance Organ Preservation Coagulation Anomaly Pathophysiology of Patient Volume Status IV Access

49
Q

Surgical Subspecialties: Pediatric Cases & Anesthetic Concerns

A

Young: congenital, hernia, TE Fistula, pyloric stenosis Older: ear tubes, tonsils/adenoids, orthopedic, trauma

50
Q

Surgical Subspecialties: Obstetric Cases & Anesthetic Concerns

A

Labor Delivery (Vaginal, C-Section) Resuscitation Anesthesia for Pregnant Patients Concerns: GA vs. Spinal vs. Epidural Drug Effects on Mother/Fetus Sensory vs. Motor Block Fetal Distress/Monitoring Positioning of Mother - aorto-caval compression APGAR Teratogenic Drugs

51
Q

Surgical Subspecialties: Gynecologic Cases & Anesthetic Concerns

A

EUA Hysteroscopy Hysterectomy Myomectomy D&C Concerns: GA vs. Regional Monitoring Blood Loss Apprehension Age of Patient

52
Q

Surgical Subspecialties: Genitourinary Cases & Anesthetic Concerns

A

Cystoscopy TURP Stone Extraction Nephrectomy Prostatectomy Cystectomy w/ Neobladder Concerns: GA vs. Regional vs. MAC GU Suite Location Positioning Obturator Reflex - bx or lateral wall of bladder, TURBT TURP Syndrome - water, electrolytes, sorbitol, mannitol

53
Q

Surgical Subspecialties: Otorhinolaryngology Cases & Anesthetic Concerns

A

Endoscopy - laryngoscopy, esophagoscopy, bronchoscopy Nasal/Sinus Head/Neck Cancer Cranio-facial Reconstruction Concerns: GA Fire Protection - airway fire, laser Field Avoidance Tracheostomy Nasal Intubation Difficult Airway No airway! Muscle Relaxants

54
Q

Emergence duration is proportionate to what factors?

A

Agent Solubility (directly) Agent Concentration (directly) Duration of Anesthesia (directly)

55
Q

Emergence of inhalational anesthesia depends chiefly on what?

A

Pulmonary Elimination Most frequent delay from inhalational GA Sometimes balance b/t building up CO2 and breathing gas off

56
Q

Blood-Gas Partition Coefficients of: Des N2O Sevo Iso

A

Des: 0.45 N2O: 0.47 Sevo: 0.65 Iso: 1.4 Ex: There has to be 1.4x as much Iso in the blood as in the gas to equilibrate

57
Q

Half-Life & Clearance of: Droperidol Etomidate Ketamine Midazolam Propofol

A

Droperidol: 1.7-2.2 / 14 Etomidate: 2.9-5.3 / 18-25 Ketamine: 2.5-2.8 / 12-17 Midazolam: 1.7-2.6 / 6.4-11 Propofol: 4-7 / 20-30

58
Q

Minimum FiO2 during hypoventilation

A

0.85, except severe COPD patients

59
Q

Effects of Hypercarbia

A

Stimulates sympathoadrenal system (increase HR, CO, PP, BP, SV, etc.) Vasodilator, except pulmonary arteries (constricts) Hypercarbic narcosis Dysrrhythmias

60
Q

Action of Neuromuscular Blockade

A

NMBD interrupt transmission of nerve impulses at NMJ of skeletal muscle Categories: Depolarizing Nondepolarizing Long >60 mins. Intermediate 15-45 mins. Short

61
Q

Action of Succinylcholine

A

Bind to ACh and depolarizes the end-plate nicotinic receptor Short duration due to pseudocholinesterase metabolism –> depolarizes the motor end plate then diffuses away and is metabolized Side Effects: Fasciculations, myocyte rupture, hyperkalemia, myalgias Sinus bradycardia - muscarinic receptor Malignant hyperthermia Dose 1-2 mg/kg Laryngospasm (0.1 mg/kg)

62
Q

Action of Non-Depolarizing NMBD

A

Competitively inhibit end plate nicotinic cholinergic receptors Do NOT bind to ACh receptors They bind ACh receptor sites, then as ACh continues to be released, it pushes the non-depolarizing drug off the site so it can bind again. Non-depolarizers are then metabolized, redistributed, diffusion, or excreted from the body

63
Q

Peripheral Nerve Stimulator Monitoring Location

A

Ulnar n. Adductor Pollicis Facial n. Orbicularis Oculi Most closely reflects block at diaphragm Posterior Tibial n. Medial malleolus - flexion of big toe External Peroneal n. Dorsiflexion

64
Q

Which PNS monitoring site is better for induction? Which is better for emergence?

A

Induction: Orbicularis Oculli Emergence: Adductor Pollicis

65
Q

Which muscle is most sensitive and which is most resistant to neuromuscular blockade?

A

Most Sensitive: Extraocular Most Resistant: Vocal cords *Diaphragm is 2nd most resistant

66
Q

Characteristics of Depolarizing and Non-depolarizing Blocks for: TOF Tetany Double Burst Stimulation Postetanic Potentiation

A

TOF, Tetany & Double Burst Stimulation Depolarizing: Phase 1: constant but diminished, Phase 2: Fade Non-Depol: Fade Postetanic Potentiation Depolarizing: Phase 1: absent; Phase 2: Present Non-Depol: Present

67
Q

Train of Four (TOF)

A

4 Stimulations at 2 Hz (0.5 sec) 4 of 4 can have 75% block 3 of 4 = 85% block 2 of 4 = 90% block 1 of 4 = 95% block 0 of 4 = 99% block Must have 1 twitch prior to reversal or post tetanic count >10

68
Q

Post Tetanic Count

A

Profound NMB with no response to single twitch Apply 50 Hz tetany 5 seconds Wait 3-5 seconds Single twitch response 1/sec. Count total twitches >10 twitches indicates sufficient receptors for reversal Post –Tetanic Potentiation: do tetany at 50-100 Hz for 5-10 seconds. This will flood the junction with ACh. Follow with TOF. If you have a response from TOF, this will indicate that the muscle relaxant is being metabolized and you will be able to reverse soon. If no response, this means you have a lot of NMB left that needs to metabolize

69
Q

Double Burst Stimulation (DBS)

A

3 stimulus at 50 Hz, 750ms pause, 2 stimulus at 50 Hz

70
Q

Head lift greater than 5 sec = TOF ratio of what?

A

> 0.7

71
Q

What is the action of Neostigmine?

A

It is an anticholinesterase, inhibits acetylcholinesterase Causes muscarinic stimulation (PNS) Dose: Max 0.07 mg/kg or 70 mcg/kg NOT 5 mg! Peak onset: 5-10 mins

72
Q

How do you assess the adequacy of ventilation?

A

Arterial Blood-Gas PaO2 > 65 on FiO2 > 0.40 PaCO2 < 50 torr ETCO2 SpO2 > 90% Tidal Volume (better than 250 cc/min but subjective)

73
Q

NAW vs. OAW

A

Nasal airway primarily used for sleep Consider establishing airway prior to extubation for patients believed to have obstructive issues (obesity, OSA, snoring)

74
Q

Snoring

A

Indication of obstructed upper airway Vibration of soft palate responsible for noise Incidence greatest in 1st, 5th, and 6th decades of life More prominent in males Obesity is a factor

75
Q

Obstructive Sleep Apnea

A

Pathophysiology: Sleep fragmentation in adults affects neuropsychological and cognitive performance Usually results in arousal, followed by clearance of the pharyngeal airway. Hypoxia is the major factor in arousal SaO2 = 85% Arousal results in massive sympathetic discharge. Hypercapnia = increased PAP and afterload = right ventricular hypertrophy

77
Q

What is the most common reason for readmittance into the hospital after surgery?

A
78
Q

Surgical Sites with the Greatest Risk of PONV

A

Intra-abdominal Laparoscopic Orthopedic Gynecological ENT Breast Plastic Neurosurgical

79
Q

Anti-Emetics: Serotonin 5-HT3 Receptor Antagonists

A

End in -tron Zofran (Ondansetron) Anzemet (Dolasetron) Kytril (Granisetron)

80
Q

Anti-Emetics: Dopamine Antagonists

A

Droperidol Don’t use for Parkinsons patients

81
Q

Anti-emetics: Antihistamines

A

Diphenhydramine Promethazine (Phenergan)

82
Q

Post-op Pain Management

A

Epidural Placement Bolus 6-8 cc agent in divided doses prior to extubation Verify normovolemia prior to bolus Be prepared for hypotension Parenteral Narcotics NSAIDs (Toradol 30mg) 30mg Toradol = 10mg Morphine Contraindications: GI Ulcers/bleeding, coagulopathies, renal impairment, bone graft

83
Q

Equivalent of Toradol to Morphine

A

30mg Toradol = 10mg Morphine

84
Q

Potency of Hydromorphone relative to Morphine? Dosage and Duration of Hydromorphone?

A

8x as potent as morphine Dosage: 1-4 mg Duration: 4-8 hrs

85
Q

Dosage, duration and contraindications of Morphine?

A

Dosage: 2-10 mg Duration: 4 hrs Contraindications: Renal Failure

86
Q

Potency and duration of Fentanyl

A

100x as potent as morphine Duration: 0.5-1 hr

87
Q

Narcotics should be titrated to a respiratory rate of _______ breaths per minute

A

10-16 BPM

88
Q

When is it appropriate to extubate a patient?

A

A/w protective reflexes in tact Clinical stability Intact neurological function Adequate pulmonary function Normal body temp (35-37 C) Normal neuromuscular function Normal coagulation Head lift, grip, TOF 4/4 ST (5 sec) RR 5-30 TV > 5 cc/kg PaO2 > 65 on FiO2 < 0.40 PaCO2 < 50 torr Resting MV < 10 L/min. Level of Consciousness Muscle Relaxant Reversed

89
Q

What is the Purpose, Contraindications & Criteria for Deep Extubation?

A

Purpose Minimize tracheal stimulation Minimize coughing/bucking - Increase IOP, ICP, BP, Dehiscence Contraindications Difficult mask airway Difficult Intubation Aspiration Risk Airway Edema Criteria MAC 1.3 NMB completely reversed Spontaneous rhythm at regular rate/rhythm No a/w reflex 100% O2 Lidocaine (0.5 mg/kg)

90
Q

What should you never deep extubate a patient without?

A

An oral a/w in place

91
Q

What are the steps after extubating a patient?

A

Suction again Place mask on patient Keep right hand on the bag Test for a/w patency Help them breathe for a while if they are not doing an adequate job on their own

92
Q

ASA Standards for PACU

A

Standard I: all patients who have received general, regional or MAC shall receive appropriate post-anesthesia management Standard II:A patient transported to the PACU shall be accompanied by a member of the anesthesia care team who is knowledgeable about the patient’s condition. The patient shall be continually evaluated and treated during transport with monitoring and support appropriate to the patient’s condition.

93
Q

ICU Transport Equipment & Monitoring

A

Equipment Cardiac Monitor or defibrillator a/w managment equipment - breathing bag, reintubation equip. O2 source w/ 30 min reserve Standard resuscitation drugs - epi, lidocaine, atropine, IV fluids Medication Monitoring EKG & spO2 = continuous BP, RR, Pulse Rate = intermittent Capnography, PA and/or IC pressure

94
Q

PACU Admission Monitoring Reqmts

A

Every pt: HR & rhythm, BP, airway patency, spO2, RR and pain Every pt continuous: pulse ox, ECG Capnography only necessary for ventilated pts.

95
Q

PACU Report

A

Pt name, Allergies, preop vitals ASA class, Medical Hx Procedure, Surgeon, Anesthesia Type Anesthesia Pre-meds, narcotics, paralytics, Rx Fluids, lines Orders

96
Q

MAC Anesthesia: ASA Guidelines

A

Oxygenation: Inspired gas (insufflation) - 100% O2 from auxillary O2 flowmeter O2 mask, nasal cannula, breathing circuit tubing Never use N2O or inhalational agents - no scavenging, potential loss of a/w Blood oxygenation - pulse ox, nail beds, etc. Ventilation: Chest excursion, thoracic impedance plethysmography, capnography (via nasal cannula) Circulation: ECG & HR, BP, Pulse Pleth., Auscultation of heart sounds, palpation of pulse

97
Q

Neuraxial Anesthesia Contraindications

A

Absolute:

  • PATIENT REFUSAL!!
  • Infection at site of injection
  • Coagulopathy
  • Severe hypovolemia
  • Increaseed ICP
  • Severe aortic stenosis
  • Severe mitral stenosis Relative:
  • Sepsis
  • Uncooperative Patient
  • Neurologic deficit
  • Severe Spinal deformity Controversial:
  • Prior back surgery
  • Inability to communicate
  • Complicated surgery
98
Q

Coagulopathy and Neuroaxial Anesthesia

A

Oral Anticoagulants: Coumadin (warfarin) Must be stopped to normal PT and INR Antiplatelet Drugs: NSAIDs Plavix (clopidogril) - stopped 7 days prior!!! Heparin: Subcutaneous, Intraoperative, Therapeutic Cardiopulmonary bypass Low Molecular Weight Heparin Lovenox Lot of pts on this post-op

99
Q

Principle Landmarks for Spinal Anesthesia

A

Superior aspect of iliac crest crosses body of L4 (Tuffier’s Line)

100
Q

Principle Landmark for Thoracic Epidural

A

T7-T8 interspace at scapula (inferior aspect of scapula)

101
Q

Ligaments of the Spinal Column

A

Ligamentum flavum - tough one right outside epidural space Supraspinous ligament Interspinous ligament

102
Q

Where does the spinal cord end in adults and infants?

A

Adults: L1-L2 Infants: L3-L4

103
Q
A

Anesthesia Practice 1 (2 decks)

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