Neuro, Ob, ENT, Optho Flashcards by Kira Harms

common neuro procedures

anterior cervical dicectomy and fusion
posterior lumbar interbody fusion
lumbar laminectomy
craniotomy

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neuromonitoring purpose

prevent and detect neurological injury

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what can happen from nerve injury or ischemia

disabling weakness
paralysis
loss of sensation

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what is monitored during neurosurgery

sensory and motor function

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most common method of neuromonitoring

evoked potentials

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evoked potential

stimulus generated and result is measured at target tissue
- assessed by latency and amplitude of waveforms

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what delivers/receives impulses of evoked potential

tiny needles

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evoked potential: somatosensory

SSEPs
afferent nerve conduction
stimulates proprioception, pressure, vibration at peripehral nerve

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SSEPs can cause what

artifact readings with SpO2 and BP

hand/feet moving regulary

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evoked potentials: motor

MEPs
efferent nerve conduction
stimulates muscle movement in brain

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MEPs can cause

large jolt

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what changes to anesthetics during neuromonitoring?

no non-depolarizing muscle relaxants
<0.5 MAC of gas

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typical anesthetic for neuromonitoring

TIVA
or
<0.5 MAC + IV anesthetics
– propofol + remi
– ketamine/precedex/lido

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caveats to neuromonitoring paralysis

anterior approach lumbar will require paralysis
some surgeons request low dose paralysis

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what must you place during a neuromonitoring case?

soft bite block

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anterior cervical positioning

supine
arms tucked
cervical visualizer/pins/traction

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anterior cervical considerations

IV access/infusions prior to prep/drape
BP might need to move to leg
arterial line

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posterior lumbar positioning

prone
arms in superman

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what is critical to do prior to positionming pt for posterior lumbar?

100% fiO2

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what should you be checking frequently during prone cases?

eyes/nose are pressure free

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posterior thoracic positioning

prone
tucked arms

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posterior cervical positioning

prone
tucked arms
mayfield pins

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what is important to consider during mayfield pin placement?

pt needs to be deep
this is very stimulating
have propofol ready to bolus

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crani positioning

supine or prone
arms tucked
possible mayfield pins

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crani bed positioning

180 degrees

considerations when bed is turned 90 or 180 degrees

circuit extension IV extension TOF twitches on ankle

considerations for prone

ETT extension

temp probe for spine cases

use esophageal

which monitor can you use to monitor during TIVA

BIS

propofol spine dosing

75-150mcg/kg/min

remi spine dosing

0.05-0.2 mcg/kg/min

phenylephrone spine dosing

0.1-1 mcg/kg/min

which cranis dont usually need an arterial line for healthy pt

burr hole decompression

what meds can help for tight BP control

phenylephrine cleviprex cardenen nitroglycerine

what fluids for crani for BP control?

mannitol hypertonic saline

what is a common anticonvulsant for cranis?

keppra

what should you use for crani eye tape?

tegaderm

what cases should you consider a fluid warmer?

crani

OB pts are considered a ________ aspiration risk

Higher aspiration risk RSI, espcially 1st and 3rd trimester

OB pts are likely a __________ airway

difficult

what drugs do not cross placenta to baby?

Heparine Insulin Glyco Neostigmine Steroidal paralytics (Roc/Vec)

what drugs do we try to minimize exposure to for OB pts?

benzos narcotics volatile agents

C-section drugs

fentanyl - 15 mcg for spinal morphine - 150 mcg for epidural

what is common after spinal or epidural placment?

sympathectomy low BP vomiting

what side is pillow positioned

under right side to minimize IVC

when do you induce gernal anesthesia for emergent C section

surgeon is scrubbed in w/scalpel in hand

emergency c section airway

use video and small ETT

what is administered following delivery of baby

pitocin

cervical cerclage

indicated for a weakened or short cervix to help prevent preterm labor suture in cervix

cervical cerclage anesthesia

done under spinal anesthesia

suction d&c anesthesi

general w/LMA

first trimerster

organogenesis highest risk to feturs

third trimester

highest risk for inducing pre-term labor

bilateral myringotomy and tubes anesthesi

mask only

laryngospasm with no IV?

IM sux or atropine

IM sux dosing

3-5mg/kg

IM atropine dosing

20-30mcg/kg

what should you prep with BMT cases

IM small gauge needle sux IM small guage needle atropine

which procedure is indicated with OSA

adenoidectomy

what should you keep FiO2 at for T& A surgery

<30%

coblator has a _______ fire risk

minimal

what should you do with throat packs

chart time placed and removed

N2O supports

combustion

T&A positioning

arms tucked bed 90 degrees

T&A pts are a high risk for

laryngospasm

what type of suction should you use in T&A pts

soft catheter

types of tubes for Diagnostic Laryngoscopy

small ETT microlaryngoscopy tube oral RAE jet ventilation

anesthetic for diagnostic laryngoscopy

TIVA

diagnostic laryngoscopy positioning

arms tucked bed 90 degrees

what is a mayo stand used for

diagnostic laryngoscopy

what surgeries require nerve monitoring

thyroidectomy parathyroidectomy

NIM tube is used for

nerve monitoring of recurrent laryngeal nerve

can you paralyze with NIM tube

thyroidectomy/parathyroidectomy positioning

supine arms tucked

functional endoscopic sinus (FESS)

removal of obstructing tissue for better sinus drainage

FESS anesthesia

GETA

FESS pts are high risk for

bleeding laryngospasm

oculocardiac reflex

occurs when pressure is applied to extraocular muscles profound bradycardia or asystole

what nerves trigger oculocardiac reflex

ophthalmic branch of trigenial nerve and vagus nerve

when does oculocardaic reflex occur

during injection of local during operation

what should you prep in adv for oculocardiac reflex

glyco atropine syringe

opthomalogical blocks provide

akinesia anesthesia

optho block complication

brainstem anesthesia into subarachnoid covering of optic nerve sheath --> complete respiratory arrest

cataract anesthesia

MAC -- fentanyl/versed -- propofol if pt wants a block

cataract positioning

supine

virectomy anesthesia

GETA w/paralysis regional block by surgeon

what is contraindicated during virectomy

nitrous can expand tamponading bubble

Neuro, Ob, ENT, Optho Flashcards

(87 cards)