Intraoperative Procedures - Exam 1

Question 1

_____ marks the surgery site. What is the mark they leave? What is verified with the patient over and over and over?

Answer 1

the SURGEON

must sign it! X is NOT acceptable

patient name, DOB and procedure

Question 2

What is the general flow of anesthesia induction?

Answer 2

Amnesia, Analgesia, Muscle relaxation, and Sedation

Question 3

What is the procedure for sedating a child who currently does NOT have IV access?

Answer 3

If child with no IV - will “breath down” with gas then start IV

Question 4

______ and _____ are used in anesthesia as induction agents

Answer 4

propofol and ketamine

depending on facility preference

Question 5

What is the onset of action for propofol? What is the SE?

Answer 5

less than 1 minute, aka VERY RAPID

SE: pain at injection site

Question 6

What is the SE of ketamine?

Answer 6

hallucinations

Question 7

________ is used as a Muscle Relaxant/Neuromuscular blocker - “Paralysis” Agents in anesthesia. What is the CI? What is the SE?

Answer 7

Succinylcholine - M/C

Succinylcholine contraindicated with h/o Malignant Hyperthermia

Can cause p/o myalgia

Question 8

______ is an inhalation anesthetics that is used more commonly for children for induction

Answer 8

(isoflurane)

Question 9

What is malignant hyperthermia caused by?

Answer 9

A pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases

Question 10

tachycardia, tachypnea, increased oxygen consumption, cyanosis, cardiac dysrhythmias, metabolic acidosis, respiratory acidosis, muscle rigidity

What am I?
What can these pts NOT get?

Answer 10

Malignant Hyperthermia?

**NO INHALED ANESTHESIA GASES
**NO DEPOLARIZING MUSCLE RELAXANTS

Question 11

What is the tx for malignant hyperthermia?

Answer 11

Question 12

Who is the OR is most likely to recognize malignant hyperthermia first? What are some signs they might find?

Answer 12

anesthesia provider

Unexplained tachycardia
Increased end-tidal CO2
Increase of body temperature above 38.8 C
Masseter rigidity

Question 13

If a person has a personal/family hx of malignant hyperthermia, what needs to happen before the pt can have surgery?

Answer 13

If personal or family hx of this must Notify anesthesia

Requires flushing of anesthesia machine prior to case

Question 14

_____ typically starts 5 minutes before intubation. _____ happens 30 seconds after induction. _____ happens 45 seconds after induction. _______ happens after 60 seconds of intubation

Answer 14

preoxygenation

protection of airway : 30 seconds

placement of ET tube: 45 seconds

post-intubation management: 60 seconds after

Question 15

What are your 3 options for anesthesia induction?

Answer 15

Application of cricoid pressure
Fiberoptic laryngoscope
GlideScope

Question 16

What is the 4 step process that you need to do once the ET is inserted?

Answer 16

Inflate bulb on tube to secure airway

Connect to O2

Confirm placement of tube by auscultation of lungs/condensation in the tube, End-tidal carbon dioxide (ETCO2) detector

Tape in place

Question 17

What are some complications of ET intubation?

Answer 17

Damage to teeth, soft tissue of mouth/pharynx, lips

Tachycardia, BP irregularities

Laryngospasm on extubating

Question 18

What are the 3 different types of anesthesia?

Answer 18

conscious sedation/ monitored anesthesia care (MAC)

regional (spinal or epidural)

general

Question 19

_____ is monitored WITHOUT intubation. What 3 medications are commonly used? What setting is this commonly used in?

Answer 19

Monitored Anesthesia Care (MAC) or Conscious Sedation

Propofol, Fentanyl, Versed

Common with Endoscopies

Question 20

_______ are common with invasive surgeries of the extremities, or below the waist pelvic surgery. What are 2 common medications?

Answer 20

Spinal/epidural

Lidocaine, Bupivacaine

Question 21

What level is spinal anesthesia administered? injected into the ______

Answer 21

Lumbar Level (L3-L4)

Enter subarachnoid space, inject anesthetic into CSF

Question 22

What level are epidurals injected into? What space?

Answer 22

any point in vertebral column

inject anesthetic into epidural space

Question 23

What is this?

Answer 23

Laryngeal Mask Airway

Question 24

for the following symptoms are they more common with spinal or epidural?
hypotension
urinary retention
HA

Answer 24

hypotension: common with spinal

urinary retention: common with spinal

HA: 1-5% in spinal and NEVER in epidural unless dural puncture

Question 25

What is the 2 pt positioning options for spinal/epidural anesthesia?

Answer 25

lateral decubitus sitting/bending forward

Question 26

What are 4 SE of spinal/epidural anesthesia? What is common in spinal? What is the most serious?

Answer 26

Hypotension, Sedation, Respiratory Depression, Infection (Abscess) spinal: HA Most Serious - Cauda Equina Syndrome

Question 27

What are 2 CI to spinal/epidural anesthesia?

Answer 27

Back abnormalities and infections

Question 28

What is the difference in term of what the pt feels between spinal anesthesia and epidural anesthesia?

Answer 28

spinal: the pt cannot feel ANYTHING, no sensation will be present epidural: the pt cannot feel PAIN, but CAN still feel pressure

Question 29

What are the local anesthesia medication options?

Answer 29

Lidocaine (with/without Epinephrine), Bupivacaine

Question 30

**_______ should be avoided on any distal end points

Answer 30

epinephrine

Question 31

Patients should be kept at a core temperature of at least _______ because anesthesia impairs ________

Answer 31

35.5°C (95.9 F) thermoregulation

Question 32

What are 5 possible negative things that could happen to a pt if their temp drops below 35.5?

Answer 32

ϲοаgսlοpаthy, infection, prolonged drug action, thermal discomfort / shiveriոg myocardial ischemia

Question 33

________ is done to help manage the body temp in the OR

Answer 33

warming!! can start before the pt even enters the OR

Question 34

Who is responsible for fluid management in the OR?

Answer 34

anesthesia

Question 35

Ηуроvоlеmiа results in reduced _______ and ______. Persistent hурοvοlemiа can lead to _____ and ______

Answer 35

cardiac output tissue perfusion shock multiorgan failure

Question 36

Preoperative _____ may increase the risk of significant decreases in ______ during induction of anesthesia

Answer 36

hуроvοlеmiа blood pressure

Question 37

What would cause hypervolemia in an OR setting?

Answer 37

anesthesia giving excessive fluid administration to treat hypotension during general treatment of surgical bleeding

Question 38

What are some consequences seen after the fact from hypervolemia during surgery?

Answer 38

Impairs oxygen exchange and increases risk for postoperative respiratory failure and pneumonia. GI edema, decreased GI motility and possible ileus dehiscence of anatomosis dilutes clotting factors increased wound healing time

Question 39

What is the fluid management protocol for a minimal/moderately invasive surgery?

Answer 39

1 to 2 L of a balanced electrolyte solution to provide adequate intravascular hуdrаtiоn Lactated Ringers Use caution with known CHF or COPD Typically administered during sսrgery over a period of 30 minutes to two hours.

Question 40

What is the fluid management protocol for an invasive surgery with expected blood loss of less than 500mL? At what rate?

Answer 40

restrictive strategy, zero balance strategy only the fluid that is lost during ѕurgerу is replaced rate of approximately 3 mL/kg per hour during the intraoperative period

Question 41

What is the fluid management protocol for an invasive surgery with expected blood loss of MORE than 500mL? At what rate?

Answer 41

goal directed therapy continuous monitoring of hemodynamic parameters to guide fluid administration, aiming to optimize tissue perfusion by giving only the necessary amount of fluid to achieve specific physiological goals, like maintaining adequate blood pressure and cardiac output.

Question 42

How do you know how much blood has been lost? What level is considered concerning?

Answer 42

surgical sponges/tapes Visualization of suction canister Pt vitals can be clue Hgb levels over 500mL is considered concerning

Question 43

Where should the grounding pad be placed on the patient?

Answer 43

somewhere that is on clean exposed skin out of the operative field aka NOT hairy and cannot be placed over anything metal inside the pt's body

Question 44

Sterile items that are below the ______, or items held below _____ are considered to be non-sterile.

Answer 44

waist level waist level,

Question 45

Sterile fields must always be kept ____ to be considered sterile. What should you NOT do?

Answer 45

in sight NEVER turn your back on the sterile field

Question 46

Once a sterile field is set up, the border of _______ of the sterile drape is considered non-sterile

Answer 46

one inch at the edge

Question 47

What should you do if you have to cough/sneeze in the OR?

Answer 47

DO NOT TURN YOUR HEAD TO COUGH need to sneeze/cough into your mask as to keep the germs contained

Question 48

If needed, when is a catheter placed?

Answer 48

Urinary catheter (if needed) is placed after patient is asleep and prior to final positioning.

Question 49

What are some patient prep solutions used in surgery? How long should you scrub?

Answer 49

Chlorhexidine Betadine Hibiclens Alcohol approx 3 minutes

Question 50

What is the proper way to scrub/gown/glove?

Answer 50

Question 51

How are surgical instruments cleaned and disinfected?

Answer 51