NORA - Exam 6 Flashcards
(70 cards)
Which kind of anesthesia ensures amnesia?
general
How must your meds be labeled?
- Drug name
- Strength
- Amount (if you can’t tell from the container)
- expiration date (if not using within 24 hours)
- time
- initials
Does mild sedation need etCO2 per AANA?
no
When do you have to monitor temperature? When is it optional?
Standard: GA
Optional: mild, moderate, deep sedation
What age of child is at greatest risk for adverse events of sedation? What are these events?
Less than 5 years of age; respiratory depression, apnea etc
What is the relationship between length of surgery and adverse reactions?
Less than 1 hour, reduced amount of adverse reactions
What is the cause of most adverse anesthetic events?
Multiple anesthetic agents being used
NPO for food/non-clear liquids for:
<6 months
6-36 months
>36 months
< 6 months: 4-6 hours
6-36 months: 6 hours
36< months: 6-8 hours
What is cardioversion?
Synchronized countershock to the R wave of the QRS to convert unstable afib/flutter, stable VT
How does cardioversion work?
Closes an excitable gap in the myocardium, causing currents to re-enter and excite the electrical system of the heart
Do patients need to be NPO for cardioversion?
No if emergent
Yes if non-emergent
Optimal shock conversion for afib/flutter
50-100 J
up to 360 J
Paddle placement for cardioversion
- Parasternally over 2nd to 3rd intercostal space
- Other paddle over apex of the heart
Anesthetic technique for cardioversion
- TIVA
-Versed beforehand
-Propofol/etomidate as anesthetic (IV) - Muscle relaxant NOT necessary
- MUST intubate if patient has not fasted (anesthetic plan is changed to general ETT)
What is radiofrequency catheter ablation?
Catheter with an electrode on the tip guided on fluoroscopy to an area of the heart muscle that demonstrated accessory electrical conductivity
-Usually for SVT, but can treat other arrhythmias
-Catheter guided via femoral artery and vein to the area of accessory electrical pathway or internal jugular
What is cryoablation?
liquid nitrous oxide cause -22 to -75 C
-Safer in AV node region compared to RFCA
What is ice mapping?
Temporary freezing to see if it will fix the arrhythmia, if it does, cool further to permanently destroy tissue
Retrosternal angina pain of mild/moderate intensity for 1-2 minutes. Is this normal during RFCA?
yes
Anesthetic choice for RFCA
-Moderate sedation + local +analgesia
-Kids: use LMA/GETT
Why is TIVA ideal for RFCA?
Because the pulmonary artery is occluded, resulting in a loss of 25% of CO
-Interferes with inhalation of volatile anesthetics
What is important to monitor during RFCA?
ECG
-Patient stops taking all antiarrhythmics before this procedure
Possible injury as a result of RFCA?
1.Thermal injury to esophagus during RFCA of left atrium
-Arterioesophageal fistual can occur!
2. CVA
3. Cardiac tamponade
4. Aortic valve damage
Is it okay if there is space between the esophageal probe and the esophagus? What is the purpose of using an esophageal probe?
No; to monitor the temperature of the left atria – don’t want thermal injury
Most electrophysiology procedures require MAC. Which electrophysiology procedures require GETT
RFCA Atrial fibrillation
V-Tach/V-Fib RFCA WITH epicardial approach
Lead extraction
