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Priniclpes Of Anesthesia > Exam 1 Study guide flashcards > Flashcards

Exam 1 Study guide flashcards

(54 cards)

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1
Q

NPO guidelines clear liquids

A

2 hours

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2
Q

NPO guidelines chewing gum/candy

A

after midnight

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3
Q

NPO guidelines breastmilk

A

4 hours

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4
Q

NPO guidlines formula or nonhuman milk

A

6 hours

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5
Q

NPO sips with meds

A

1 hour

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6
Q

Things that place a patient at higher risk for aspiration

A

-Anxiety
-GERD/hernia/any esophageal issue
-Anything that increases abdominal pressure (pregnancy, ascites)
-Didn’t follow NPO
-Nuerologic sequalae
-opiods
-Pain
-Prematurity
-Smoking in acute perioperateive window

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7
Q

METS
-Stands for:
-Means:
-Asses:
-Scoring:

A

Metabolic equivalents

One MET is defined as the amount of O2 consumed while sitting at rest and is equal to 3.5 mL O2/kg/min.

2 METS = 3.5 x 2
3 METS=3.5x3
and so on

ask: are you able to walk four blocks w/o stopping? Are you able to climb 2 flights of stairs?

Less than 4 mets should be further assessed

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8
Q

When can you resume elective surgery after bare metal sent placement?

A

4-6 weeks minimum 30 days

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9
Q

When can you resume elective surgery after drug eluding stent placement

A

6-12 months

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10
Q

When can you resume elective surgery after MI

A

6 months

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11
Q

What 3 things would make a cardiac patient need further workup?

A

Less than 4 METS
Unstable angina
any combo of syncope, fatigue, chest pain or dyspnea

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12
Q

Routine labs: general anesthesia
Age: less than 50

A

F: Pregnancy (F), Hb/Hct
M: ECG

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13
Q

Routine labs: General anesthesia
50-64

A

Hb/Hct
ECK

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14
Q

Routine labs: general anesthesia
65-74

A

Hb/Hct
ECT
BUN/CREAT
GLuc

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15
Q

Routine labs: general anesthesia
75+

A

Hb/Hct
ECT
BUN/Creat
Gluc
chest xray

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16
Q

Need EKG for patients with:

A

Cardiac disease
PVD
DM
SMoking
Pulm disease
HTN
Renal insufficiency

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17
Q

Routine labs for Mac/Regional
50-64

A

Hb/Hct

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18
Q

Routine labs for Mac/Regional
65-74

A

Hb, Hct,
ECG

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19
Q

Routine labs for Mac/Regional
75+

A

Hb, Hct
ECG
BUN/CREAT
Glucose

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20
Q

Routine lab tests for Nerve block
64-75

A

Hb/Hct

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21
Q

Routine labs for Nerve block
75+

A

Hct
ECG

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22
Q

Time-out

Study These Flashcards
A

-Before incision or procedure
-Additional time out if person performing the procedure changes
-All involved in immediate care of pt participate and agree: Name, procedure, site
-documented

23
Q

Goals of pre-op assessment

Study These Flashcards
A

-Procure info
-Physical exam
-History
-Eval and documentation anesthetic risk
-Pre-op testing/consults
-Informed consent
-anxiety ease and education

24
Q

When should you cancel/delay surgery with respiratory disease?

Study These Flashcards
A

-active dyspnea
-wheezing
-Pulmonary congestion
-hypercarbia
-peak expiratory flow <50% of baseline

25
How long should a pt abstain from smoking before anesthesia?
12-48 hours before surgery, but 8 weeks is preferred
26
How long does it take cilia to repair in smokers once they stop?
6 to 8 weeks
27
Difficult DL:
SHORT Short neck Hematoma or abcess Obesity Radiation therapy Tumors/Trauma
28
Difficult Intubation
LEMON Look Evaluate Mallampati Obstruction Neck Mobility
29
Difficult LMA
RODS Restricted Mouth Opening Obstruction in upper airway Distortion of airway anatomy - tough seal Stiff lungs (up resistance, down compliance)
30
Cormack Lehane grades
What you can see in terms of chords
31
N20 Contraindications
d/t diffusion hypoxemia -Pneumo -Air embolism -middle ear surgery -pneumocephalus
32
Stages of anesthesia:
1. Induction 2. Maintenance 3. Emergence
33
Induction stage of anesthesia
*establish oxygen and air exchange -often with propofol -Period of time from administration of potent anesthetic --> development of surgical anesthesia
34
Maintenance stage of anesthesia
Surgical anesthesia
35
Emergence stage of anesthesia
Discontinuation of agents--->regained consciousness and protective reflexes -Recovery -reversal agents administered
36
Depth of anesthesia stages
1. analgesia 2. Excitement 3. Surgical anesthesia 4. Medullary paralysis
37
Depth of anesthesia stage 1 (state of mind, VS/ pupils)
Analgesia -Reduced awareness -pupils and VS unchanged
38
Depth of anesthesia stage 2
Excitement -increases SNS, combative -riskiest for laryngospasm -pupils dilate
39
Depth of anesthesia stage 3
Surgical anesthesia -yes! -relaxation -eventual loss of spontaneous movement -unconsciousness -*lid reflex and gag reflex dissapera
40
Depth of anesthesia stage 4
Medullary paralysis -Too far! Lawsuits, death
41
What can you do to reduce the changes of laryngospasm? (5)
1. avoid airway manipulation 2.CPAP 5-10 cm/H20 during inhalation (induction and immediately post extubation) 3. Remove blood/ secretions B4 extubation 4. Extubate when wide awake or deeply anesthetized 5. IV lidocaine before extubation
42
Signs of laryngospasm (4)
1. inspiratory stridor 2. suprasternal/supraclavicular retractions 3. rocking appearance to chest wall 4. chest flailing
43
Larygospasm treatment steps
1. administer 100% FIo2 2. remove stimuli 3. deepen anesthesia 4. Cpap 15-20 cm H20 and larsen's manuver 5. administer succ
44
Muscles that obstruct airway and what they obstruct
Genneoglossus: tongue (oropharynx) Tensor palatine: nasopharynx
45
Causes of lower airway obstruction in treachea:
Physical blockages
46
Causes of lower airway obstruction bronchial/alveolar
ARDS Aspiration pneumonia asthma bronchospasm COPD pulm edema
47
Causes of airway obstruction extrapulmonary
-morbid obesity -pregnancy -trauma
48
Nasopharynx lies _______ and is superiorly bound by _____. It is innervated by _____
-anterior to C1 -base of skull -trigeminal nerve
49
Oropharynx is at _____. It is innervated by ____
C2-C3 Glossopharyngeal
50
Hypopharynx is ____. It is innervated by
Posterior to the larynx 2 branches of the vagus nerve (SLN and RLN)
51
ASA II
Mild systemic disorder -smoker -Social ETOH -Well controlled disease
52
ASA III
Severe symptomatic disease -ESRD with dialysis -Greater than 3 months post MI, CVA, TIA, CAD/stends
53
ASA IV:
Constant threat to life -ESRD no dialysis -less than 3 months for MI, CVA, TIA, CAD/stents -ICU diagnoses
54
ASA V
Moribund, not expected to survive without operation

Priniclpes Of Anesthesia (19 decks)

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