Non-Operating Room Anesthesia (NORA)

Question 1

What type of anesthetic is recommended for cerebral coiling?

Answer 1

GETA w/ arterial line and large bore IV.

Question 2

What is most important in prevention of radiation damage:
shielding, time or distance?

Answer 2

Distance

Question 3

What drug(s) is/are direct thrombin inhibitors?

Answer 3

Dabigatran (Pradaxa)

Question 4

How do direct thrombin inhibitors work?

Answer 4

Antagonizes thrombin to prevent fibrinogen → fibrin

Question 5

What laboratory test will measure Pradaxa’s (Dabigatran) effects?

Answer 5

dTT

Question 6

What drug(s) is/are Factor Xa inhibitors?

Answer 6

• Rivaroxaban (Xarelto)
• Apixaban (Eliquis)
• Edoxaban (Savaysa)

Question 7

What is the MOA of Factor Xa inhibitors?

Answer 7

Prevents cleavage of prothrombin → thrombin

Question 8

What drugs can reverse the effects of coumadin?

Answer 8

Vitamin K
FFP

Question 9

What drugs reverse the effects of direct thrombin inhibitors and factor Xa inhibitors?

Answer 9

• Factor concentrates (2, 7, 9, 10)
• PCC

Question 10

What is the effect of CO₂ levels on cerebral blood flow?

Answer 10

Hypercapnia = Increased CBF (vasodilation)

Question 11

Standard 1:

Answer 11

Patient’s Rights
- Autonomy
- Privacy
- Safety

Question 12

Standard 2:

Answer 12

Pre-Anesthesia assessment/eval

Labs, METs

Question 13

Standard 3:

Answer 13

Patient Specific Plan
- Legal rep
- healthcare team

Question 14

Standard 4:

Answer 14

Informed Consent

Question 15

Standard 5:

Answer 15

Documentation

Question 16

Standard 6:

Answer 16

Equipment

Question 17

Standard 7:

Answer 17

Plan/modification of plan

Accepting responsibility until another anesthesia personnel member takes over

Question 18

Standard 8:

Answer 18

Positioning

Question 19

Standard 9:

Answer 19

Monitoring/alarms

• Must be audible

Question 20

Standard 10:

Answer 20

Infection control

Question 21

Standard 11:

Answer 21

Transfer of care

Question 22

What are the components of the Modified Aldrete Scoring System for the PAR score:

Answer 22

1. Respirations
2. O2 Saturation
3. Consciousness
4. Circulation
5. Activity

needs 9 or 10

Question 23

What are the components of the Postanesthesia Discharge scoring system for the PAR score?

Answer 23

1. Vital Signs
2. Surgical Bleeding
3. Activity and mental status
4. Intake and Output
5. Pain/Nausea/Vomiting

Question 24

T/F:

If a patient loses consciousness and the ability to respond purposefully, the anesthesia care is a general anesthetic, irrespective of whether airway instrumentation is required?

Answer 24

True

Question 25

Common procedures in IR:

Answer 25

- Endovascular treatments - Radiofrequency ablations - TIPS: Transjugular Intrahepatic Portosystemic Shunt - Angiograms - MRI - CT Scan Guided Biopsies

Question 26

When doing a GETA for Cerebral aneurysms, what is recommended?

Answer 26

- Large bore IV - Volatiles - Propofol and Precedex

Question 27

Complications that can arise from a Cerebral Aneurysm?

Answer 27

- Rupture/dissection - contrast hypersensitivity (anaphylaxis) - Groin hematoma

Question 28

Recommendations for Abdominal Aneurysms?

Answer 28

- Large bore IV, Art line - Heparin (ACT's, protamine) - Foley cath - controlled, mild hypotension

Question 29

What is the normal dose of protamine as a reversal agent for Heparin?

Answer 29

1-1.5 mg/ 100u of Heparin

Question 30

Describe the patho of a TIPS procedure

Answer 30

Decompression of portal circulation in patients with portal hypertension and recurrent GI bleeds who have failed medical therapy.

Question 31

Can a TIPS procedure correct the patient's chronic liver damage? Where are the catheter and stent inserted through?

Answer 31

NO Through the Internal Jugular Vein

Question 32

Comorbidities for TIPS

Answer 32

Recent GI bleed Hepatic encephalopathy Ascites Pleural effusion Alcoholic cardiomyopathy Coagulopathy Decreased protein binding

Question 33

Anesthesia Implications for TIPS:

Answer 33

- GETA w/ RSI - IV/Art - Replace volume (Albumin, PRBC's) - Radiation Protection

Question 34

Pros and Cons for EP Ablation:

Answer 34

Pros: - Minimally invasive - 60-85% success on 1st attempt Cons: - Long (2-6 hrs) - Uncomfortable - Could cause V-Tach/fib

Question 35

When is cardioversion most successful in treating a-fib? What medication should we avoid before performing a CV?

Answer 35

Within 7 days from a-fib onset Lidocaine (Na+ Channel blocker)

Question 36

Anesthesia considerations for an ERCP:

Answer 36

1. These patients have extreme comorbidities 2. Prone position w/ head to side 3. Anti-spasmodic necessary (Glucagon) 4. Narcotics not recommended 5. GETA

Question 37

What are some physiologic responses we expect to see during an ECT?

Answer 37

- Incontinence - Myalgia (2-7 days) - Headache - Emergence agitation/confusion

Question 38

Which comes first during an ECT: Parasympathetic response or sympathetic response?

Answer 38

Parasympathetic response followed by a 10-20 min sympathetic response.

Question 39

What are the anesthesia implications for ECTs?

Answer 39

- Hyperventilation - Ativan/Haldol on standby - Short acting B-Blockers for HTN - Caffiene for HA