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Intro to Anes > Neuro, Ob, ENT, Optho > Flashcards

Neuro, Ob, ENT, Optho Flashcards

1
Q

common neuro procedures

A

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

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2
Q

neuromonitoring purpose

A

prevent and detect neurological injury

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3
Q

what can happen from nerve injury or ischemia

A

disabling weakness
paralysis
loss of sensation

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4
Q

what is monitored during neurosurgery

A

sensory and motor function

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5
Q

most common method of neuromonitoring

A

evoked potentials

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6
Q

evoked potential

A

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

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7
Q

what delivers/receives impulses of evoked potential

A

tiny needles

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8
Q

evoked potential: somatosensory

A

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

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9
Q

SSEPs can cause what

A

artifact readings with SpO2 and BP

hand/feet moving regulary

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10
Q

evoked potentials: motor

A

MEPs
efferent nerve conduction
stimulates muscle movement in brain

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11
Q

MEPs can cause

A

large jolt

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12
Q

what changes to anesthetics during neuromonitoring?

A

no non-depolarizing muscle relaxants
<0.5 MAC of gas

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13
Q

typical anesthetic for neuromonitoring

A

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

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14
Q

caveats to neuromonitoring paralysis

A

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

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15
Q

what must you place during a neuromonitoring case?

A

soft bite block

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16
Q

anterior cervical positioning

A

supine
arms tucked
cervical visualizer/pins/traction

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17
Q

anterior cervical considerations

A

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

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18
Q

posterior lumbar positioning

A

prone
arms in superman

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19
Q

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

A

100% fiO2

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20
Q

what should you be checking frequently during prone cases?

A

eyes/nose are pressure free

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21
Q

posterior thoracic positioning

A

prone
tucked arms

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22
Q

posterior cervical positioning

A

prone
tucked arms
mayfield pins

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23
Q

what is important to consider during mayfield pin placement?

A

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

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24
Q

crani positioning

A

supine or prone
arms tucked
possible mayfield pins

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25
Q

crani bed positioning

A

180 degrees

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26
Q

considerations when bed is turned 90 or 180 degrees

A

circuit extension
IV extension
TOF twitches on ankle

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27
Q

considerations for prone

A

ETT extension

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28
Q

temp probe for spine cases

A

use esophageal

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29
Q

which monitor can you use to monitor during TIVA

A

BIS

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30
Q

propofol spine dosing

A

75-150mcg/kg/min

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31
Q

remi spine dosing

A

0.05-0.2 mcg/kg/min

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32
Q

phenylephrone spine dosing

A

0.1-1 mcg/kg/min

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33
Q

which cranis dont usually need an arterial line for healthy pt

A

burr hole decompression

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34
Q

what meds can help for tight BP control

A

phenylephrine
cleviprex
cardenen
nitroglycerine

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35
Q

what fluids for crani for BP control?

A

mannitol
hypertonic saline

36
Q

what is a common anticonvulsant for cranis?

A

keppra

37
Q

what should you use for crani eye tape?

A

tegaderm

38
Q

what cases should you consider a fluid warmer?

A

crani

39
Q

OB pts are considered a ________ aspiration risk

A

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

40
Q

OB pts are likely a __________ airway

A

difficult

41
Q

what drugs do not cross placenta to baby?

A

Heparine
Insulin
Glyco
Neostigmine
Steroidal paralytics (Roc/Vec)

42
Q

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

A

benzos
narcotics
volatile agents

43
Q

C-section drugs

A

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

44
Q

what is common after spinal or epidural placment?

A

sympathectomy
low BP
vomiting

45
Q

what side is pillow positioned

A

under right side to minimize IVC

46
Q

when do you induce gernal anesthesia for emergent C section

A

surgeon is scrubbed in w/scalpel in hand

47
Q

emergency c section airway

A

use video and small ETT

48
Q

what is administered following delivery of baby

A

pitocin

49
Q

cervical cerclage

A

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

50
Q

cervical cerclage anesthesia

A

done under spinal anesthesia

51
Q

suction d&c anesthesi

A

general w/LMA

52
Q

first trimerster

A

organogenesis
highest risk to feturs

53
Q

third trimester

A

highest risk for inducing pre-term labor

54
Q

bilateral myringotomy and tubes anesthesi

A

mask only

55
Q

laryngospasm with no IV?

A

IM sux or atropine

56
Q

IM sux dosing

A

3-5mg/kg

57
Q

IM atropine dosing

A

20-30mcg/kg

58
Q

what should you prep with BMT cases

A

IM small gauge needle sux
IM small guage needle atropine

59
Q

which procedure is indicated with OSA

A

adenoidectomy

60
Q

what should you keep FiO2 at for T& A surgery

A

<30%

61
Q

coblator has a _______ fire risk

A

minimal

62
Q

what should you do with throat packs

A

chart time placed and removed

63
Q

N2O supports

A

combustion

64
Q

T&A positioning

A

arms tucked
bed 90 degrees

65
Q

T&A pts are a high risk for

A

laryngospasm

66
Q

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

A

soft catheter

67
Q

types of tubes for Diagnostic Laryngoscopy

A

small ETT
microlaryngoscopy tube
oral RAE
jet ventilation

68
Q

anesthetic for diagnostic laryngoscopy

A

TIVA

69
Q

diagnostic laryngoscopy positioning

A

arms tucked
bed 90 degrees

70
Q

what is a mayo stand used for

A

diagnostic laryngoscopy

71
Q

what surgeries require nerve monitoring

A

thyroidectomy
parathyroidectomy

72
Q

NIM tube is used for

A

nerve monitoring of recurrent laryngeal nerve

73
Q

can you paralyze with NIM tube

A

no

74
Q

thyroidectomy/parathyroidectomy positioning

A

supine
arms tucked

75
Q

functional endoscopic sinus (FESS)

A

removal of obstructing tissue for better sinus drainage

76
Q

FESS anesthesia

A

GETA

77
Q

FESS pts are high risk for

A

bleeding
laryngospasm

78
Q

oculocardiac reflex

A

occurs when pressure is applied to extraocular muscles

profound bradycardia or asystole

79
Q

what nerves trigger oculocardiac reflex

A

ophthalmic branch of trigenial nerve and vagus nerve

80
Q

when does oculocardaic reflex occur

A

during injection of local
during operation

81
Q

what should you prep in adv for oculocardiac reflex

A

glyco
atropine
syringe

82
Q

opthomalogical blocks provide

A

akinesia
anesthesia

83
Q

optho block complication

A

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

84
Q

cataract anesthesia

A

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

85
Q

cataract positioning

A

supine

86
Q

virectomy anesthesia

A

GETA w/paralysis
regional block by surgeon

87
Q

what is contraindicated during virectomy

A

nitrous
can expand tamponading bubble

Intro to Anes (12 decks)

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