safe administration of anesthesia part 2 Flashcards
1
Q
How long does it take for lidocaine to be in tissue and not in vasculature for bier blocks?
A
15 minutes
2
Q
Why is 15 minutes for lidocaine important?
A
you can’t have a procedure less than 15 minutes because it needs to get into the tissues
3
Q
How does bier block?
A
- place IV in operative hand
- place 2 tourniquets on arm
- esanguinate limb
- inflate proximal cuff labeled A
- put 60 mL of lidocaine into the arm through the IV
- Inflate distal cuff labeled B
- deflate proximal cuff labeled A
- Take IV out before prep
4
Q
What does a bier block create?
A
a bloodless field
5
Q
Lidocaine has rapid onset less than what?
A
5 minutes
6
Q
Motor function returns rapidly then what when it comes to amides and esthers?
A
motor function returns rapidly then sensation
7
Q
How does motor function and sensation work?
A
- nerve goes numb
- you can’t move
- then you can move
- then you get sensation back
8
Q
What is the order the cuffs go up with tourniquets for bier blocks?
A
- proximal up
- distal up
- proximal down
- distal down
9
Q
If a patient who got a bier block does not get any drugs within moderate sedation what can the patient do?
A
drive themselves home
10
Q
The femoral block is well-suited for what surgery?
A
anterior thigh and knee like quadriceps tendon repair
11
Q
The femoral block is good postoperative pain after what 2 surgeries?
A
femur and knee surgery
12
Q
If you are doing nerve stimulator technique for a femoral block, what muscle would you see twitching?
A
quadricep twitch
13
Q
Neuraxial anesthesia is what?
A
amide or esther in the form of epidural and spinal
14
Q
For spinal anesthesia, where is the medication going to go?
A
goes into cerebrospinal fluid.
15
Q
How does spinal work?
A
- Inject spinal needle
- feel it pop through the dura
- CSF leaks out.
16
Q
Where does an epidural go?
A
tissue space outside of the dura
17
Q
How does epidural work?
A
- advance spinal needle
- feel tough resistance of dura
- pull back a smidge
18
Q
What is important for epidurals? why?
A
aspirate before injection because the epidural vein runs through that tissue space
19
Q
What is the most common accidental injection site for LAST?
A
epidural. Bupiv in the epidural vein can cause LAST
20
Q
What do epidurals and spinals facilitate?
A
motor, sensory and autonomic block of nerve roots and spinal cord
21
Q
How do we want to position patients with neuraxial anesthesia?
A
position and transfer patients with care due to lack of motor/sensory function
22
Q
What 2 things should we pay attention to with neuraxial anesthesia?
A
- body alignment
- too rapid a position change can cause severe hypotension
23
Q
Peridural or epidural/caudal where is the medication injected?
A
into epidural space
24
Q
What can Peridural or epidural/caudal be used for?
A
postoperative pain
25
What is longer with Peridural or epidural/caudal?
longer duration
26
What is larger with Peridural or epidural/caudal?
larger dose
27
Where does Peridural or epidural/caudal go?
thoracic and lumbar region
28
Peridural or epidural/caudal is preferred for?
obstetrics
29
Onset for Peridural or epidural/caudal is how many minutes?
15-30 minutes
30
Subdural or spinal/saddle medication is injected into the?
spinal fluid
31
Subdural or spinal/saddle lasts how long?
2 hours
32
Subdural or spinal/saddle injected below what?
L2
33
Subdural or spinal/saddle is not for what?
postoperative pain
34
Onset of Subdural or spinal/saddle is how many minutes?
5 minutes
35
Is it ok to leave an epidural catheter in the epidural space? spinal catheter in the subdural sapce?
yes; that is why it is good post op pain
36
What commonly do we use for epidurals?
ropivicaine; it is more gentle with motor suppression and it lasts for 12 hourrs
37
What are 4 considerations (NOT contraindications) for neuraxial anesthesia considerations?
1. history of spinal malformation
2. previous spinal surgery
3. psychological status
4. high skill level required in children
38
What are neuraxial anesthesia contraindications?
1. patient is anticoagulated - bleeding disorders, pharmacological
2. increased ICP - do not need to add volume
3. septicemia - meningitis
4. skin infection at the insertion site
5. pre-existing neurologic disorders - MS (accelerates disease)
6. cancer of brain/spinal cord
7. patient refusal
39
What are 2 neuraxial anesthesia complications?
1. respiratory depression
2. bladder distention
40
What is respiratory depression associated with neuraxial anesthesia usually caused by?
sedatives used with regional anesthesia OR high placement effecting phrenic nerve
41
What do we want to treat respiratory depression associated with neuraxial anesthesia?
treat the underlying cause and maintain respirations
42
What are the last to recover in neuraxial anesthesia?
sacral autonomic fibers
43
What does the patient not sense in neuraxial anesthesia because of the sacral autonomic fibers?
patient does not sense a full bladder
44
REMEMBER motor function returns before what?
sensory function
45
With bladder distention offer a what?
offer bedpan or urinal
46
What BP issue is associated with neuraxial anesthesia complications?
hypotension
47
Hypotension associated with neuraxial anesthesia occurs in what?
1/3 of patients
48
What happens during hypotension with neuraxial anesthesia?
decreased venous return and cardiac output GREATLY enhanced by hypovolemia (CHF, dialysis)
49
What are 3 treatment options for hypotensive neuraxial anesthesia complications?
1. IVF
2. vasopressors
3. slight head down positions (5-10 degrees)
50
What kind of headache is associated with neuraxial aanesthesia?
Post Dural Puncture Headache (PDPH)
51
For spinal anesthesias to prevent PDPH, use what?
pencil point needles preferred over beveled
52
PDPH can occur from accidental what?
dural puncture in epidural anesthesia
53
Noninvasive treatments for PDPH with neuraxial anesthesia include what?
HOB flat, fluids, analgesics, caffeine, and sumatriptan (for migraines)
54
Invasive treatment for PDPH?
epidural blood patch (venous blood injected into epidural space)
55
Hypoventilation is the most common what?
postop complication
56
Where does hypoventilation come from with anesthesia? (2 things)
Muscle relaxants not fully reversed, CNS depressants
57
What is consideration for hypoventilation?
maintain respirations
58
Emergence delirium is more common in men or females?
men
59
Emergence delirium often occurs in what age group?
adolescents
60
What are patients in when they are in emergence delirium?
dream state
61
What is the best treatment for emergence delirium?
time and safety
62
Laryngospasm is what kind of reflex?
drowning reflex
63
encourage what with laryngospasm?
coughing!!
64
Give what with laryngospasm?
100% O2
65
If laryngospasm is severe what do we do?
sedate and paralyze
66
If you have difficult intubation what could have?
trauma and swelling
67
What do you give with trauma/swelling?
1. 100% O2
2. vaporized epinephrine
68
What do you give for bronchospasm?
1. 100% O2
2. bronchodilators
69
General anesthesia is a state of what?
being unaware and unresponsive to painful stimuli
70
What are the 4 aspects of general anesthesia?
1. lack of conscious awareness
2. lack of perception of pain
3. lack of movement
4. modification of autonomic responses
71
Lack of conscious awareness means what?
unconsciousness
72
Lack of perception of pain from what?
analgesia
73
Lack of movement from what?
muscle relaxant
74
Modification of autonomic responses still comes with what?
increase in HR and BP
75
When is the excitation phase of induction?
stage 2
76
excitation phase of induction with general anesthsia has quick what with short what?
quick onset, short acting medications
77
What meds are given during stage 2 of induction?
non-barbiturate hypnotics
78
What stage of anesthesia do we do surgery?
stage 3
79
Excitement phase of induction you are going to lose what?
laryngeal reflexes
80
Induction agents DO NOT provide what?
analgesia
81
Inhalation induction occurs often in who?
kids
82
Inhaled induction is also used in patients that lack what?
cooperation and comprehension
83
What are 3 nursing considerations for general anesthesia?
1. support ventilation, maintain open airway
2. at risk for aspiration
3. suction ready
84
Stage I of induction is what?
analgesia
85
What are 3 characteristics of stage I?
analgesia and amnesia; drowsy
86
What are patients in stage I of induction?
conscious, can follow simple commands
87
Stage II of induction is what?
delirium/excitation
88
What are 2 characterstics of stage II - delirium/excitation?
dream, excitement
89
are patients conscious or unconscious in stage II - delirium/excitation?
unconscious
90
there is a risk of what 2 things with stage II - delirium/excitation?
risk of laryngospasm and cardiac arrest
91
Pupils are what in stage II - delirium/excitation?
dilated
92
Stage III is the what of induction?
surgical stage/unable to protect airway
93
the 1st plane of stage III - surgical stage/unable to protect airway is characterized how?
regular respirations
94
the 2nd plane of stage III - surgical stage/unable to protect airway is characterized how?
regular respirations, no longer moving
95
the 3rd plane of stage III - surgical stage/unable to protect airway is characterized how?
diaphragmatic respirations
96
what plane of stage III is optimal for surgeon?
3rd plane
97
the 4th plane of stage III - surgical stage/unable to protect airway is characterized how?
irregular respirations
98
Stage 4 of induction is what?
OVERDOSE
99
What happens to patients in stage 4 of induction?
respiratory paralysis
100
Patients are what than necessary in stage 4 of induction?
deeper
101
What is the aldrete score?
is a scoring system for readiness for discharge
102
What are the 5 parts of the aldrete score?
1. activity
2. breathing
3. circulation
4. consciousness
5. oxygen saturation
103
You can be discharge from PACU with a what on the aldrete score? You can go home from PACU with a what?
PACU with an 8, go home with a 9
104
Is there a regulatory requirement that you have to use the aldrete score?
no as long as you have outlined what your discharge criteria are you may or may not use the scoring system
