Module 6- Emergence Flashcards by Shay Edgeston

What Liter of O2 is required to facilitate wash out

10L

Use 100% O2

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What is MAC awake

At which 50% of people respond to commands

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MAC Bar is

The MAC necessary to block SNS response to skin incision, which is about 1.6-2x MAC

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What is useful to analyzing anesthetic depth

BIS

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Lidocaine as an adjunct can cause

Delayed emergence due to excess plasma concentrations (infusion)

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When should Ketamine be stopped

15-30 min prior

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When should Sufentanil be stopped

30-60min prior

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When should remifentanil be stopped?

10-15 min prior

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When should Precedex be stopped

30 min before due to its long half life

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When should propofol be stopped?

Until the end

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What is helpful with breakthrough pain

Short acting opioids like fentanyl

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What is beneficial for post-op pain

long-acting opioids, but don’t give them at end of the case

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What should be considered for a patient taking chronic pain meds?

Add home dose plus what is needed for surgery

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What is the dose of Ketorolac?

10-30mg IV (check with surgeon)

Post-op bleeding risk

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What percentage of patients will develop PONV

One third

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Anticholinergic that acts as an antiemetic

Scopolamine

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What is a NK-1 receptor antagonist

Aprepitant

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Corticosteroid that acts as an antiemetic

Dexamethasone

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Antihistamines given for N/V

Hydroxyzine
Benadryl

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What Phenothiazine is given for N/V

Promethazine
Prochlorperazine

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What Butyrophenones are given for N/V

Droperidol
Haloperidol

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What Prokinetic is given for N/V

Reglan

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What Serotonin receptor antagonist is given for N/V

Ondansetron

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What vasopressor helps with N/V

Ephedrine

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A patient with no risk factors has what % of PONV risk

10%

A patient with 1 risk factor has what % of PONV risk

20%

A patient with 2 risk factors has what % of PONV risk

40%

A patient with 3 risk factors has what % of PONV risk

60%

A patient with 4 risk factors has what % of PONV risk

80%

Sufficient recovery of a NMB is confirmed by

An adductor pollicis ToF ratio of at least 0.90

What is the only method of assessing whether a safe level of recovery of muscular function has occurred

Quantitative

About what percent of patients can have TOF ratios less than 0.90 following surgery

30-50%, which is a real risk

Incomplete reversal is associated with an increased risk for

Hypoxemic events Airway obstruction Postop pulmonary complications Prolonged PACU times

A profound count of <3 can receive how much Sugammadex (posttetanic)

4-16mg/kg

A deep block with 0 twitches can receive how much Sugammadex (postttetanic)

4-16mg/kg

TOF count 1-4 can receive how much sugammadex

2-4mg/kg

With fade, what is the dose of Sugammadex

2mg/kg

With no fade, what is the dose of Sugammadex

1mg/kg

TOF ratio of 0-0.8 should receive how much Sugammadex

2mg/kg

TOF ratio of >0.9 should receive how much Sugammadex

No reversal

What is required (vent settings) prior to extubation?

PSV 5/5

What are the characteristics of stage 2

Disinhibition Delirium Uncontrolled movements HTN Tachycardia

Are airway reflexes intact during stage 2

Yes & are hypersensitive to stimulation Avoid airway manipulation during this stage

There is a high risk of what during stage 2

Laryngospasm

What can compromise the patient's airway

Spastic movements Vomiting Rapid & irregular respirations

What can help reduce the time in stage 2

Fast acting agents

The brain wakes up in what order

Reverse order of evolution

Which reflexes come back first

Deep, which is why you see swallowing, gagging & coughing

What reflex comes back last

Purposeful movement, which is following commands

Why is awake extubation preferred?

For those who are at a high risk for aspiration & are a difficult intubation Ensures they can protect their airway & breathe spontaneously

What are the disadvantages of an awake extubation

CV stimulation Discomfort More coughing & Straining

What is deep extubation?

When patient is in the 3rd stage of anesthesia Minimizes the complications of laryngospasm

What is the MAC of deep anesthesia/extubation

Over 1 MAC (1-1.3 MAC)

What are the advantages of deep extubation

Reduced risk of gagging, coughing & discomfort

What are the disadvantages of deep extubation

Respiratory depression Delayed awakening Difficulty assessing airway reflexes Longer PACU time

Avoiding prolonged intubation can reduce the risk of

Infections such as ventilator-associated PNA

What causes airway obstruction?

Swelling, bleeding

What is a laryngospasm

Reflex contraction of the vocal cords preventing airflow

What are the complications associated with extubation

Respiratory depression Aspiration CV instability

What are the extubating criteria

Confirm adequate reversal Assess Recovery Monitor VS Normothermia Pain management

What are things that can be performed to help with adequate emergence/extubating the patient

Pre-oxygenate the patient Recruitment maneuvers Suctioning Remove throat packs Use bite block

What can happen if the patient bites on the tube?

Negative Pressure Pulmonary edema

Recruitment maneuvers are essential for what patient population

Asthmatics COPD Procedures where insufflation was used

If high pressures with mask ventilation were used, what can you do?

Place OG to suction to decrease risk of aspiration & improve ventilation

What position is best for Obese patients when extubating

Head up position (good for those at risk for hypoventilation

What is the lateral decubitus position good for?

Those at high risk for pulmonary aspiration

Weak pharyngeal muscles can cause

A compromise in airway patency

Why do we inspect the balloon cuff?

To avoid cord injury or arytenoid dislocation

Applying positive pressure right before cuff deflation will

Help expel secretions that have collected above the vocal cords

Reduced muscle strength can

impair adequate ventilation & risk of aspiration

The ability to respond to low oxygen levels

Is diminished

How do we objectively assess degree of NMB

tof

What are the complications of a laryngospasm

Bradycardia due to vagal response Pulmonary edema Pulmonary aspiration Desat/Hypoxemia

What causes a laryngospasm

Sensory stimulation of the vagus nerve- the internal branch of SLN, leading to reflexive spasms

What muscle contracts during laryngospasm?

cricothyroid muscle 9stimulated by SLN) tense the vocal cords, while the thyoarytenoid & lateral cricoarytenoid muscles (stimulated by the RLN) cause adduction of the cords

What type of pressure can you apply to break laryngospasm

Positive pressure

What airway maneuvers break laryngospasm

Jaw thrust Chin lift Lawson maneuver

What medications can be given t obreak a laryngospasm?

Lidocainie Muscle relaxant

Module 6- Emergence Flashcards

(80 cards)