Intro to NA

Question 1

Triad of Anesthesia

Answer 1

1. Hypnosis
2. Analgesia
3. Muscle relaxation (dependent on the surgery/ what the surgeon is doing)

Question 2

Dyad of Regional Anesthesia

Answer 2

1. Analgesia

2. Muscle Relaxation

Question 3

Analgesia

Answer 3

Main component of what we do NO PAIN

Question 4

Sedative- hypnotics

Answer 4

• propofol (doesn’t help with pain)
• etomidate
• ketamine** (helps with pain and sedation)
• benzodiazepines (not used as frequent, longer 1/2 life)
• barbiturates
• anesthetic gases (desflurane, sevoflurane, isofluarne)

Question 5

Prerequisites

Answer 5

• oxygen (any time you give an anesthetic)
• suction
• OR
• bed/ stretcher (drugs affect gait/ mobility)
• resuscitation bags
• monitors (EKG, BP, end tidal)
• Anesthesia provider
• drugs
• machine
• airway equipment

Question 6

Recovery

Answer 6

• turn off agents
• reverse relaxants
• extubate/ remove LMA
• ensure return of motor/ sensory blockade (ex train of 4)
• monitor in pacu/ icu

Question 7

Disadvantages of Anesthesia

Answer 7

• effects various systems
• allergic reaction
• recovery time varies
• post op N/V
• pain
• awareness

Question 8

Local Anesthesia

Answer 8

**No anesthesia provider needed

-anesthetic drug usually injected into the tissue to numb the specific location requiring minor surgery

Question 9

Regional Anesthesia

Answer 9

**Anesthesia Provider needed

-injection near a cluster of nerves will numb (larger) area that requires surgery; pt can be awake or given a sedative

ex; epidural, spinal, peripheral nerve blocks

Question 10

Minimal sedation (anxiolysis)

Answer 10

**May or may not need Anesthesia provider

• responds normally to verbal commands, can follow instructions, pt feels relaxed, can be awake
• cognitive function and coordination may be impaired
• ventilation and cardiovascular functions are unaffected

Question 11

Moderate sedation (conscious sedation)

Answer 11

• pt drowsy, may sleep through procedure, can wake them up with voice/ touch, can respond purposefully
• minimal memory
• no interventions required to maintain a patent airway, spontaneous ventilation is adequate
• cardiovascular function usually maintained

Question 12

Deep sedation

Answer 12

• pt sleeps through procedure (not easily aroused, can respond purposefully to repeated/ painful stim)
• no memory
• breathing can slow, ability to maintain ventilation and airway can be impaired, supplemental oxygen given
• cardiovascular function usually maintained

Question 13

General Anesthesia

Answer 13

**unconscious/ Not Arouseable/ No sensation

• ability to independently breath is impaired, requires assistance maintaining patent airway, + pressure ventilation may be required
• gases or vapor are inhaled through a breathing mask or tube and other drugs often given IV
• cardiovascular function may be impaired
• if risk of malignant hypothermia present, total IV propofol can achieve general (200-300 mcg/kg/min)

Question 14

Monitored Anesthesia Care

(MAC)

Answer 14

MAC is a billing term

• uses sedatives and other agents
• dose low enough pt remains responsive and breaths without assistance

**simple procedures and minor surgery

Question 15

Combination Technique

Answer 15

• MAC/ sedation and local/ regional anesthesia

- regional and general anesthesia

Question 16

Pre-op medications

Answer 16

• patient comfort
• reduce anxiety
• prevent aspiration
• abx per surgeons request

Question 17

Induction drugs

Answer 17

-can be IV or inhaled to induce anesthesia

Question 18

Neuromuscular blockade

Answer 18

• facilitate intubation

- optimize surgical conditons

Question 19

Inhalation Drug

Answer 19

• to maintain general anesthesia (can also be IV)

ex. propofol, etomidate, ketamine

Question 20

Opioid

Answer 20

-minimize physiological effects of pain and promote comfort

Question 21

Antiemetic

Answer 21

-prevent nausea likely with opioids/ inhalation agents

Question 22

Neuromuscular Blockade Reversal Agent

Answer 22

-reverse the paralyzing effects

Question 23

Alice Magaw

Answer 23

-published her work (ether and chloroform with open gtt; 14,000 anesthetics with no complications)

Question 24

Agatha Hodgins

Answer 24

• taught physicians in Europe on nitrous/ oxygen anesthesia

- began first NA program and founded the AANA

Question 25

Operating Room Areas

Answer 25

Restricted Semi Restricted Unrestricted

Question 26

Unrestricted Area

Answer 26

- Traffic is NOT limited - street clothes - if in OR scrubs put lab coat on ex. break room, administrative space

Question 27

Semi-restricted

Answer 27

traffic IS limited - surgical scrubs - surgical caps ex. storage area for clean medical supplies

Question 28

Restricted

Answer 28

Traffic restricted to necessary personnel -mask up if sterile field/supplies open ex. where procedures are performed.

Question 29

Sterile Team

Answer 29

- surgeon - scrub tech - first assist

Question 30

Non- sterile team

Answer 30

- anesthesia - OR. nurse - other techs (x-ray)

Question 31

OR temperature

Answer 31

68-75 F

Question 32

Humidity

Answer 32

30-55% less than 30% - increased risk for fire - alters sterile indicator strips - increased infection risk greater than 55% - increased risk for infection - mold/mildew - uncomfortable

Question 33

OR Ventilation

Answer 33

- Positive Pressure Room - 80/20 mixture of recycled/ fresh air (from ceiling) - 25 air exchanges per hour - removes 90% of particles in the air

Question 34

OR Noise

Answer 34

- normal operating room levels 75-90dB | * to be heard voices need to be 20dB above background noise

Question 35

Ionizing Radiation

Answer 35

- enough energy to detach electron from atom - nuclear decay (alpha, beta, gamma, neurons) - gamma rays and X-rays - ultraviolet light

Question 36

Radiation Protection

Answer 36

-As little as reasonable practice (ALARP) - Law of inverse squares (amount of radiation changes inversely with distance (1/d2) ex. 16% less at 4m than 1m

Question 37

Types of Shock

Answer 37

Macroshock Microshock

Question 38

Macroshock

Answer 38

- current applied to the body through intact skin - measured in milliamps (mA) - 1000 – 3000 mA Ventricular fibrillation

Question 39

Microshock

Answer 39

- current applied directly to the heart/internal organs - measured in microamps - 30 microamps VF potential in humans - 10 microamps in dogs

Question 40

LASER

Answer 40

Light Amplification by the Stimulated Emission of Radiation (LASER) class 4- medical lasers

Question 41

Laser Safety Precautions

Answer 41

- room lights as bright as possible (pupils are really constricted bc light is on and small pupil less surface area for laser to damage) - restrict access to area - close doors/windows, signs on doors - eye protection you and pt (human eye very vulnerable to laser beams) - cover all skin - n95 mask (smoke plume from cautery/ laser surgery, fine particles can be 0.1-0.8 micrometer)can be deposited into lower airways) - remove all extra shiny things - alarm to indicate when laser in use - keep LASER beam above/below normal line of sight, avoid looking into the primary beam at all times

Question 42

LASER safety with Anesthesia

Answer 42

- oxygen <30% - avoid N20 - don't wrap ETT in foil - double cuff tube to prevent leaking of gas if cuff ruptures - LMAs can be sensitive to Lasers

Question 43

Waste Anesthesia Gas

Answer 43

-if you can smell it you are over the limit threshold for smell 5-300ppm

Question 44

Equipment cleaning

Answer 44

- Critical: sterilization ex. surgical instruments - Semi- critical: highly disinfected ex. anesthesia blades/scopes - Non-critical: wipe down in between cases ex. BP cuff, cables Single use: 1 and done, single pt