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Surgery > Intraoperative Care > Flashcards

Intraoperative Care Flashcards

1
Q

What should you be making sure prior to the procedure?

A
  • Right person
  • Right procedure
  • Right doctor
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2
Q

What happens on the day of surgery?

A
  • Check in and get vitals, change into gown, preop labs, IV started, preop meds, and H&P if needed
  • Holding room: chart check, vitals, review AM labs
  • Anesthesiologist confirms surgery and type of anesthesia
  • Surgeon marks surgery site
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3
Q

What is universal protocol?

A
  • Verification of patient name, DOB, procedure
  • Operative site marked must be signed
  • Time out in OR immediately before procedure
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4
Q

What happens once in the operating room?

A
  • Apply monitors (BP, O2 sat, EKG leads, temp strip)
  • Anesthesia induction: amnesia, analgesia, muscle relaxation, and sedation
  • O2 mask
  • IV drug administration with opioids “pretreatment” or anesthetic agonist
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5
Q

What are anesthesia induction agents?

A

Propofol and ketamine

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6
Q

What is the onset time of propofol?

A

Less than 1 minute

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7
Q

What is the side effect of propofol?

A

pain at injection site

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8
Q

What are side effects of ketamine?

A

CNS effects-hallucinations

Usually given in bigger patients with mental incapacity

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9
Q

What muscle relaxant/neuromuscular blocker is often given in surgery?

`

A

Succinylcholine

“paralysis agent”

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10
Q

When is succinylcholine contraindicated?

A

Malignant hyperthermia

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11
Q

What is a side effect of succinylcholine?

A

Myalgia

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12
Q

What anesthetic is more commonly used for children and often used to put them to sleep prior to starting IV?

A

Inhalation anesthetics (isoflurane)

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13
Q

After a patient is anesthetized, what is done?

A

ET intubation

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14
Q

If a patient has malignant hyperthermia, what should you not do?

`

A

Give inhaled anesthesia gases or depolarizing muscle relaxants

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15
Q

What is malignant hyperthermia?

A
  • Hypermetabolic response to anesthetic gases
    Characterized by:
  • hyperthermia
  • tachycardia
  • tachypnea
  • increased oxygen consumption
  • cyanosis
  • cardiac dysrhythmias
  • metabolic acidosis
  • respiratory acidosis
  • muscle rigidity
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16
Q

What is the treatment for malignant hyperthermia?

A
  • Dantrolene to stop calcium release into muscle
  • Oxygen
  • Body cooling and extra fluids
  • Supportive care
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17
Q

What are signs of malignant hyperthermia?

A
  • Unexplained tachycardia
  • Increased end-tidal CO2
  • Increase of body temperature above 38.8
  • Masseter rigidity
18
Q

What needs to be done if there is personal or family history of malignant hyperthermia?

A
  • Notify anesthesia!
  • Anesthesia machine must to flushed prior to case
19
Q

What happens during anesthesia induction?

A
  • Preparation 10 mins before
  • Preoxygenation 5 mins before intubation
  • Pretreatment 3 mins before induction
  • Paralysis with agent
  • Protection 30 seconds after induction
  • Placement of ET tube 45 seconds after induction
  • Post-intubation management 60 seconds after intubation
20
Q

What do you do if it is a difficult airway when trying to do an ET intubation?

A
  • Application of cricoid pressure
  • Fiberoptic laryngoscope
  • GlideScope
21
Q

What happens once ET tube is inserted?

A
  • Inflate bulb on tube to secure airway
  • Connect to O2
  • Confirm placement of tube by auscultation of lungs/condensation in the tube
  • Tape in place
22
Q

What are complications of endotracheal intubation?

A
  • Damage to teeth, soft tissue of mouth/pharynx, lipds
  • Tachycardia, BP irregularities
  • Laryngospasm on extubating
23
Q

What does type of anesthesia depend on?

A
  • Patients medical history
  • Surgical procedure to be performed
  • Preference of surgeon and anesthesiologist
  • Patient’s first choice

GOAL to provide safest anesthetic with best outcome possible

24
Q

What are types of anesthesia?

A
  • Conscious sedation or MAC
  • Regional
  • General
  • Combined regional and general
25
Q

What types of anesthesia fall under regional?

A

Neuroaxial and peripheral nerve blocks

26
Q

What can be used for general anesthesia?

A
  • Inhalation (isoflurane, sevoflurane)
  • Total IV (ex propofol plus opioid)
  • Balanced- combo of inhaled and IV
27
Q

How is MAC or conscious sedation performed? When is this often used?

A
  • Propofol, fentanyl, versed can be used
  • Patient monitored without intubation
  • Often used with endoscopies
28
Q

When is spinal and epidural anesthesia used? What medication is used?

A
  • Invasive surgeries of the extremities or below the waist pelvic surgery
  • Common meds: lidocaine, bupivacaine
29
Q

Where is spinal anesthesia injected?

A
  • Lumbar level (L3-L4)
  • Enter subarachnoid space, inject anesthetic into CSF
30
Q

How is epidural performed?

A

Anesthetic injected into epidural space at any point in vertebral column

31
Q

How should a patient be positioned for spinal anesthesia?

A

Lateral decubitus or sitting, bending forward

32
Q

What are side effects of both spinal and epidural anesthesia?

A

Hypotension, sedation, respiratory depression, infection (abscess)

33
Q

What are side effects of spinal anesthesia?

A
  • Headache
  • Most serious: Cauda equina syndrome
34
Q

Between spinal and epidural anesthesia, which one is more likely to have side effects?

A

Spinal

35
Q

What are contraindications to spinal anesthesia?

A

Back abnormalities and infections

36
Q

What are agents for local anesthesia?

A
  • Lidocaine
  • Bupivacaine
37
Q

What should you keep in mind when performing local anesthesia?

A
  • Skin should be cleaned and prepped first
  • Inject deep and superficial around surgical site
  • Use caution not to inject into vasculature
38
Q

When is local anesthesia frequently used?

A
  • Minor skin procedures
  • Postoperative incisional pain
  • Digital blocks
39
Q

What are considerations for patient positioning during surgery?

A
  • Proper positioning for surgical procedure
  • Prevent injury to patient via padding with towels or gel pads under heels, elbows, wrists, knees, neck
  • Avoid malpositioning of arms and legs: can result in nerve injury
  • Avoid leaning on patient during surgery
  • Cover exposed body parts not in operative field with warm blankets (may use bear hugger)
  • Apply ground pads to skin out of the operative field
40
Q

How is the skin prepared for surgery?

A
  • Sterile technique via circulating OR-RN
  • Cleaned with chlorhexidine, betadine, hibiclens, or alcohol
  • Applied with sponge or stick applicator
41
Q

What is the proper way to gown and glove?

A
  • Remove jewelry (rings, bracelets, dangling earrings)
  • Fingernails short, nail polish without chips and no acrylic
  • Put on protective equipment: haircover and facial hair/sideburn cover, shoe covers, mask, eyewear
  • Gather all supplies in OR: gown, gloves, and open with sterile technique
  • Scrub
  • Enter OR
  • Dry off with sterile towel
  • Don sterile gown and gloves
42
Q
A

Surgery (7 decks)

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