General, MAC, Regional Anesthesia (Week 3)

Question 1

Ideal anesthetic technique

Incorporates optimal _____ _____ and satisfaction

Provides excellent _______ conditions for the surgeon

Allows rapid ______ and minimal post operative side effects

Answer 1

Patient Safety

Operating

Recovery

Question 2

Ideal Anesthetic Technique

_____ effective

Allow early _____ or _____ from the PACU

Optimize post operative _____ control

Permit efficieny, including ______ times

Answer 2

Cost

Transfer or Discharge

Pain

Turnover

Question 3

Post Operative N/V (PONV)

May be lessened with placement of a ________ patch. Must be careful with handling and must tell caregivers to be careful with handling.

Answer 3

Scopalamine

Question 4

General Anesthetic

Defined as drug-induced loss of _______, during which patients are not _______, even by painful stimulation

Two types of general anesthesia?

Answer 4

Consciousness, Arousable

IV drugs, Inhalation of Volatile Anesthetic

Question 5

General Anesthesia: IV Induction

Induction with use of agents such as ______ or _______

Ventilation options may include a _____ _____ or _____.

alternatively, a ______ ______ drug may be given IV to facilitate direct laryngoscopy before tracheal intubation

Answer 5

Propofol, Etomidate

Face Mask, LMA

Neuromuscular Blocking

Question 6

GA: IV Induction

_______ is intended to replace nitrogen ( ________) in the patient’s functional residual capacity (FRC). This is especially important for certain patient populations, particularly _____ patients

_____ vital capacity breaths of 100% oxygen over a period of 60 seconds is similar to that achieved by breathing 100% oxygen for 3 minutes at normal tidal volumes

Answer 6

Pre-oxygenation, (denitrogenation)

Obese

Eight

Question 7

GA: IV Induction

Pre-oxygenation provides a crucial ______ of ______ during periods of apnea or _____ airway obstruction that can occur with general anesthesia

Answer 7

Margin of Safety

Upper

Question 8

Rapid Sequence Intubation (Induction)

May be indicated for patients who are at _____ risk for ______ of gastric contents. For example, patient’s with ______, delayed stomach ______, or unknown _____ state

Goal of RSI is to _____ time between onset of _______ and tracheal intubation to reduce the risk of ______ via the mechanism of _____ pressure

Answer 8

Increased, Aspiration

GERD, Emptying, Fasting

Minimize, Unconsciousness, Regurgitation, Cricoid

Question 9

Rapid Sequence Intubation (Induction)

Provide ___-______

Admin ______ agent (such as propofol)

Admin _____ agent

With onset of ________, ______ pressure is applied

Laryngoscopy is intiated only _____ onset of skeletal muscle _____ (may be verfied with peripheral nerve stimulator)

Answer 9

Pre-Oxygenation

Induction

NMB

Unconsciousness, Crocoid

After, Paralysis

Question 10

Rapid Sequence Intubation NMB’s

Succinylcholine

Dose: ___ to ___ mg/kg

Onset is ___ to ___ seconds

Rocuronium

Dose: ___ to ___ mg/kg. Increasing dose of Rocuronium to ___ to ___ mg/kg creates onset time similar to that of Succinycholine

Onset time of Roc with smaller dose is _____ than induction with Succ

Answer 10

1.0 to 1.5 mg/kg

45 to 120 seconds

0.6 to 1.2 mg/kg; 1.0 to 1.2 mg/kg

Slower

Question 11

General Anesthesia: Inhaled Induction

May include inhalation of ______ with or without ____ ____.

What is the preferred inhaled agent to use for children?

_______, another induction gas, produces a rapid onset effect but is not often selected for inhaled induction due to its _____ _____ effects

Inhaled (mask induction) anesthesia is often selected for ______ patients when prior insertion of an ___ is not practical (they will fight this)

Answer 11

Sevoflurane, Nitrous Oxide

Sevoflurane

Desflurane, Airway Irritant

Pediatric, IV

Question 12

General Anesthesia: Inhaled Induction

Inhaled induction may be preferred method for patient anticipated to have a _____ _____ to manage, because _______ respiratory efforts are preserved with an inhaled induction of anesthesia

_____ _____ lacks potency to be used alone as induction agent compared to other volatile anesthetic agents, but may be used in conjunction

Inhaled anesthetics increase the risk of post operative _____ and _____

Answer 12

Difficult Airway, Spontaneous

Nitrous Oxide

Nausea and Vomiting

Question 13

GA: Inhaled Induction

Loss of consciousness usually occurs within __ ______ when breathing 8% Sevo. Insertion of a LMA can usually be achieved within __ ______ of administering 7% Sevo.

“_______” the circuit involes filing the breathing circuit with inhaled agent by emptying _____ bag, opening the ______-______ valve, and using a ____ fresh gas flow of __L/min for ___ seconds prior to applying face mask to patient

Answer 13

1 Minute

2 Minutes

Priming, Resovoir, Presssure-Limiting Valve

High, 8L/min, 60 Seconds

Question 14

Always be ready to convert to a ______ anesthetic

Remember, you cannot use ______ ______ agents with an LMA. The LMA would have to be removed and an ETT would have to be placed in this situation.

Answer 14

General

Neuromuscular Blocking

Question 15

Pharmacoeconomics

Ultimate goal is to obtain best results (low ______, rapid ______, absence of _____ and _____ at the most practical cost)

A useful method to decrease the cost of volatile anesthetics is the use of low ____ ____ flow (__/min) during ______ of anesthesia

Answer 15

Toxicity, Awakening, Nausea & Vomiting

Fresh Gas, 2L/min, Maintenance

Question 16

Anesthetist’s Responsibilities

_____ management

____ ____ estimation

______ of fluid and blood loss

______ and _____ of the patient (Bed position, Bed height, Injuries to nerves, eyes, ears)

_______ medications

Answer 16

Fluid

Blood Loss

Replacement

Positioning, Safety

Intraoperative

Question 17

Preparation

Mnemonic: “MS MAID”

What does this stand for?

Answer 17

Machine

Suction

Monitor

Airway

IV

Drugs

Question 18

PACU

Post op _____ effects anesthetic choice for maintenance and emergence. Ex: A patient returning to ICU on vent - not as concerned about long acting anesthetics or NMB’s

Must know patient’s _____ and must address pain _____ immediately prior to PACU

Answer 18

Disposition

Vitals, Pain

Question 19

Monitored Anesthesia Care (MAC)

Goal is to maintain patient ______ and sense of well being

Name three goals of MAC?

Answer 19

Safety

Anxiolysis (Anxiety control)

Analgesia (Pain control)

Amnesia (Induction of temporary memory loss)

Question 20

MAC: Four Flaws

Failure to consider the ______

Failure to consider the _______

Failure to consider MAC skills of the _______

Failure to consider MAC skills of the ______

*Must _______ with the surgeon (Ex: If planned less invasive procedure suddenly becomes more complex and requires higher level of anesthetic)

Answer 20

Procedure

Patient

Surgeon

Anesthetist

Communicate

Question 21

MAC

________ depression from sedative use is one of the biggest risk factors with MAC

Must have _____ monitoring on at all times during MAC case. Note, ________ is not reliable, only looking for the ________

Answer 21

Respiratory

ETCO2

Capnography, Waveform

Question 22

MAC wth No Sedation

Very _____ ICU patient

Emergency ________ : sedation can be deadly

Eye surgery: when surgeon desires a ______, still patient

Answer 22

Critical

Tracheotomy

Cooperative

Question 23

MAC with Minimal Sedation

______ (1 mg) and ______ (50 mcg), and sometimes even _____

Example: for a renal/cerebral or abdominal _______

______ patients

_______ patients

Answer 23

Versed (Midazolam), Fentanyl (Sublimaze); Less

Aortogram

Elderly

Debilitated

Question 24

MAC with Deep Sedation

These patients still must be able to take _____ _____

*Never* do MAC with deep sedation on the following (4) patient types?

Answer 24

Deep Breaths

1. Patients with GERD
2. Patients with sleep apnea
3. Patients with sick sinus syndrome
4. Patients with mediastinal masses or tumors

Question 25

MAC: Not Good Candidates

Page 20 (Power Point)

Answer 25

Children

Confused

Uncooperative

Retarded

Patients with tremors

Patients unable to lie flat (Obese, COPD)

Unmanageable Anxiety (Previous poor anesthesia outcome)

PTSD

Question 26

Regional Anesthesia

A neuraxial (spinal, epidural, caudal) is selected when maintenance of _______ during surgery is desirable

Regional anesthesia allows complete preservation of _____ _____ reflexes (this is important with patients at risk for ______ of ______ ______)

Answer 26

Consciousness

Upper Airway

Aspiration, Gastric Contents

Question 27

Spinal VS Epidural

Spinal

Takes _____ time to perform

More _____ onset of better quality _____ and ____ anesthetic

Associated with less ____ during surgery

**Continuous spinal technique rarely used due to concern of post spinal _____ and concern about proper ______ of catheter in the ______ space

**Increased _____ is a con with a spinal approach

Answer 27

Less

Rapid, Sensory, Motor

Pain

Headache, Maintenance, Subarachnoid

Headaches

Question 28

Spinal VS Epidural

Epidural

_____ risk for post-dural puncture _____

Less chance of ______ ______ if epinephrine is added to the local anesthetic solution

Ability to ____ or _____ anesthesia through indwelling catheter

Answer 28

Lower, Headache

Systemic Hypotension

Prolong, Extend

Question 29

Regional Anesthesia

Only absolute contraindication for regional anesthesia is?

Name conditions that may increase risk associated with spinal or epidural anesthesia? (6)

Answer 29

When patient requests another form on anesthesia

**Also, if there is an abcess at or around area where needle insertion site would be

• Hypovolemia
• Increased ICP
• Coagulopathy (Thrombocytopenia)
• Sepsis
• Infection at cutaneous puncture site
• Pre-existing neurologic disease (Multiple Sclerosis)

Question 30

Regional Anesthesia

Most often selected for surgery that involves the _____ part of the ______ or the lower ______

Often preferable for procedures lasting ____ to ____ minutes

Bier-Block Concept (Page 24 on PP)

Answer 30

Lower, Abdomen

Extremities

20-90 Minutes

Question 31

Peripheral Nerve Block

Advantages are maintenance of ______ and presence of protective _____ _____ reflexes (Ex: Insertion of HD catheter in upper extremity in patient who may have pulmonary and cardiac contraindications to NMB drugs

Disadvantage to peripheral nerve block is the _______ attainment of adequate sensory and motor anesthesia for duration of surgery (may not be a sufficient block)

Success depends on what two things?

Answer 31

Consciousness, Upper Airway

Unpredictable

Provider Skill and Cooperative Patient

Question 32

Spinal Anesthesia

Question 33

Spinal Anesthesia