Non-Operating Room Anesthesia (NORA) Flashcards
(42 cards)
What are AANA standards of care 1, 2, 3?
1: Patient rights: autonomy, privacy, safety
2: Pre-anesthesia assessment
3: Patient specific plan
What are AANA standards of care 4, 5, 6?
4: Informed consent
5: Documentation
6: Functioning equipment
What are AANA standards of care 7, 8 , 9?
7: Plan modification
8: Patient positioning
9: Monitoring/alarms
What are AANA standards of care 10 and 11?
10: Infection control
11: Transfer of care
Functional capacity is measured in METs (metabolic equivalent of task). What is 1 MET equivalent to?
MET is rate of energy consumption at rest
1 MET=3.5 mL/kg/min
<5 MET Poor
5-8 fair
9-11 Good
12 Excellent
What are the MET scores and their equivalent level of exercise?
What does the modified aldrete scoring system PARS?
- Respirations
- O2 saturation (color)
- Consciousness
- Circulation
- Activity (movement)
Review these ASA standards for NORA
Someone who responds to verbal commands, and is provided with anxiolysis would be considered what level of sedation?
Minimal sedation
Someone who responds to verbal/tactile stimulation but has a depressed LOC would be considered what level of sedation?
Moderate sedation
Someone who responds to painful stimulation but with impaired independent ventilation would be considered what level of sedation?
Deep sedation
If a patient loses consciousness and the ability to purposfully respond the anesthetic is considered?
general anesthetic
whether airway support is required or not
What type of anesthetic is recommended for cerebral coiling? Why might ETCO2 need manipulation during this procedure?
GETA w/ arterial line and large bore IV.
May manipulate CO2 for cerebral vasculature response:
- Hypercarbia => vasodilation
- Hypocarbia => vasoconstriction
What complications can accompany an aneurysm repair procedure?
- Rupture, dissection
- contrast sensitivity, anaphylaxis
- groin hematoma
What anesthetic choice would be appropriate for abdominal aneurysm repair?
GETA, a-line, large bore IV
- heparin, ACTs, protamine
- foley
- controlled mild hypotension
What anesthetic would be appropriate for a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure?
- GETA, RSI
- Large bore IV
- A-line
- albumin, PRBCs
What anesthetic considerations should be made with EP ablation?
- sedation vs general
- must have external defibrillation pads
- hold anti-arrhythmic
- xray protection (shield, lead, distance)
Electrophysiology Ablation pros and cons?
Pros:
-minimally invasive
-60-85% curative on first attempt
Cons:
-Lengthy (2-6 hrs)
-uncomfortable
-may induce V tach/V fib (defib pads on @ all times)
What is most important in prevention of radiation damage, shielding or distance?
Distance
Describe the intrinsic pathway of the clotting cascade:
damaged endothelium or exposure to collagen ⇒ 12a ⇒ 11a ⇒ 9a + 8a ⇒ 10a + 5a ⇒ turns prothrombin (2) into thrombin (2a) ⇒ thrombin turns fibrinogen (1) into fibrin (1a) ⇒ fibrin + 13a needed for plt aggregation and clot formation
Describe the extrinsic pathway of the clotting cascade
tissue trauma releases tissue factor ⇒ TF + 7a ⇒ 10a + 5a ⇒ turns prothrombin (2) into thrombin (2a) ⇒ thrombin turns fibrinogen (1) into fibrin (1a) ⇒ fibrin + 13a needed for plt aggregation and clot formation
What drug(s) is/are direct thrombin inhibitors?
Dabigatran (Pradaxa)
How do direct thrombin inhibitors work?
Antagonizes thrombin to prevent fibrinogen → fibrin
What laboratory test will measure Pradaxa’s (Dabigatran) effects?
dTT
