OB, Remote, Elderly

Question 1

Remote anesthesia check list

Answer 1

O2 with backup, Suction, ASA monitor, scavange, crash cart/meds, ambu, 2 way communication, a way to get pt out in code, skilled provider,

Question 2

EGD

Answer 2

scope that assess esophagus, pylorus, and stomach
may involved biopsy, dilation
benzo + opioid vs GA with Propofol
Big dose propofol blunts scope
Fent- unpredictable apnea
Presedex: maintain RR but dec HR and BP
high risk populations: GERD, OSA, obesity: more likely to intubate

Question 3

EGD big risk

Answer 3

aspiration and laryngospasm

Question 4

Sigmoidoscopy and colonoscopy

Answer 4

Benzo + opioids vx GA and Propofol
insuflate air + external pressure = vagal response
GI track has no pain receptors, pain meds should be needed

Question 5

ERCP

Answer 5

fluro exam of biliary and pancreatic ducts
often Prone
needs to be immobile
GA with ETT
Glucogon 0.3mg SE: Inc HR and nausea

Question 6

Rigid bronch

Answer 6

Often have CV or pulm problems
Sharing an airway
TIVA preferred: Propofol and Remi

Question 7

Bronch complications

Answer 7

airway fire, bronchospasm

Question 8

Radiology suite

Answer 8

limited space, bulky equipment
pt needs to immobile for long periods of time
occupational hazard: ALARA
lead apron, thyroid shield etc

Question 9

Contrast die hypersensitivity

Answer 9

O2, bronchdilation, hydration, Epi,

pretx: H1 and H2 blocker, corticosteroids

Question 10

Contrast nephro, what happens and risk

Answer 10

direct tubular injury due to release of free O2 radicals and microvascular obstruction
Inc risk: renal insufficiency DM, Hypovolemia, CHF, HTN, gout

Question 11

Azotemia

Answer 11

starts within 24-48hrs last 3-5day
increased creatinine 0.5mg/dl within 24hrs
NO surg during this time

Question 12

Minimize contrast effects by

Answer 12

Hydration 1ml/kg 4hrs prior and 12hrs after
Bicarb: to promote renal elimitation
NAC: contarversal
Monitor creatinine for 72hrs

Question 13

Angio

Answer 13

Min pain, long duration
Local at puncture site
when inject contrast dec HR and BP
Sedation Vs GA: if ETT make sure no coils are in xray

Question 14

CT

Answer 14

usually tolerated

considers aspiration risk if PO contrast was used

Question 15

MRI CI

Answer 15

SCARY!!!
pacemakers, aneurysm clips, insulin pumps, shrapnel, cardiac stents, IV wires, cochlear implants, 1st trimester, pumps/nerve stimulators

Question 16

MRI anesthesia

Answer 16

induce outside
Protect airway, won’t be able to hold still with out GA
GA with VA or TIVA
everything needs to be MRI compatible- monitoring problematic
limited access
emerge outside

Question 17

Radation therapy

Answer 17

Cant be in the room
usually peds
Propofol
CNS involvement Inc ICP
Immobilization devices can restrict airway
Immunosuppressive: cytotoxic therapies

Question 18

IR Neuro, for what5, how, may require (and how)

Answer 18

radiologically guided endovascular approach to CNS lesions
Embolizations of AVMs
coiling aneurysms
Angioplasty of lesions
Thrombolysis of acute stoke
Carotid stent
May need HoTN: prevent bleeding, Labetolol, Esomolol, Hydrazine, NTP
HTN: unblock something that shouldn’t have been occluded. 30-40% above normal Phenyl
Dec CO2: constrict
Inc CO2: dilate

Question 19

IR neuro anesthesia/procedure

Answer 19

6-7 french cath- femoral
Preop: hx of contrast reaction? asmt of BP (thats what your going to manipulate)
WADA: barb into carotid anesthetize 1/2 brain eval speech to see which is dominate
SAFE: occlude carotid to see which is dominate
Intraop: Heparin 70unit/kg (3000-5000) goal ACT 2-2.5x normal)
Emergence: control, no coughing/bucking

Question 20

IR neuro complications

Answer 20

hemorrhage: aneurysm rupture, hematoma at puncture site
Occlusion: emoli migration, vasospasm

Question 21

Cardiac cath suite coronary angio

Answer 21

passing a cath retrograde through aortic root and injecting contrast die
Site: femoral, brachial, radial
Risk: ischemia, infx, coronary dissection, thrombolitic event, hemorrhage, contrast reaction
meds used: SL and IV NTG
Heparin/protamine
Ergonovine maleate, methylergonoviene: produce vasoconstriction

Question 22

Cardiac suite Peds

Answer 22

Usually require GA
versed 0.5mg/kg for induction or Inhaled
do not tolerate blood loss well
monitor HCT and tx anemia
brady--> atropine 
air bubbles very dangerous with intercadiac shunting

Question 23

Cardiac suite EP studies: ablate, pacemaker, cardioversion

Answer 23

stop antiarrhy drug, stimulate dysrhythmia and ablate
long procedure must stay still–> GA
no NMB, need to monitor phrenic nerve
Pacemaker insertion: internal–>GA Aline EF

Question 24

ECT for what 4

Answer 24

major depression
parkinsons
schizo
mania

Question 25

what is ECT

Answer 25

electrical stimulation of CNS to initiate sz
2-3times per week
Sz causes PSNS response: brady HoTN then SNS follow tachy and HTN
want high quality sz at least 25sec
muscle relaxant
pretax with glycol 0.2mg

Question 26

CI for ECT

Answer 26

high risk preg
Pheo
Inc ICP
Aortic and cerebral aneurysm

Question 27

ECT anesthesia

Answer 27

GA
Induction:
Methohexital 0.75-1.5mg/kg
Etomidate 0.15-0.3mg/kg
Propofol 0.75mg/kg-- low dose bc of sz prevent at induction dose
loss of lid reflex
insert bite block 
ensure adequate masking Hypervent!!!!!! ETCO2 >22
BP cuff inflate on extremity 
Succ 0.75-1.5mg/kg
Stimulus
Sz
support vent 
other drugs: esmolol, labetolol, CCB, toradol, Presedex