Surg 102 Chapter 24 (B&K)--Part 2 Flashcards Preview

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Flashcards in Surg 102 Chapter 24 (B&K)--Part 2 Deck (83):
1

Apply pressure to the _____ to occlude the esophagus and immobilize the trachea.

cricoid cartilage

2

Applying pressure to the cricoid cartilage is also called the _____.

Sellick's maneuver

3

The Sellick's maneuver prevents _____ and _____ of stomach contents.

regurgitation and aspiration

4

Compression of the cricoid cartilage must continue until the _____ is inflated and the anesthesia provider states that it is safe to release pressure.

endotracheal tube cuff

5

An _____ is performed before the induction of general anesthesia.

awake intubation

6

What are the most common indications for awake intubation?

acromegaly, anterior larynx, an enlarged tongue, a limited oral cavity, jaw fixation, a short neck, and limited cervical range of motion

7

The conditions that lead to an awake intubation may inhibit visualization of the vocal cords by direct laryngoscopy and thus increase the potential risk of _____.

airway obstruction

8

Awake intubation can be performed with a _____ or _____ for direct visualization of vocal cords.

fiberoptic or rigid laryngoscope

9

What are the five objectives of general anesthesia?

1. oxygenation
2. unconsciousness
3. analgesia
4. muscle relaxation
5. control of autonomic reflexes

10

Oxygenation (as an objective of general anesthesia):

tissues, especially the brain, must be continuously perfused with oxygenated blood

11

Unconsciousness (as an objective of general anesthesia):

the patient remains asleep and unaware of the environment during the surgical procedure

12

Analgesia (as an objective of general anesthesia):

the patient must be free of pain during the surgical procedure

13

Muscle relaxation (as an objective of general anesthesia):

must be constantly assessed to provide necessary amounts of drugs that cause skeletal muscles to relax

14

Control of autonomic reflexes (as an objective of general anesthesia):

anesthetic agents affect cardiovascular and respiratory systems; tissue manipulations and systemic reactions to them may be altered by drugs that control the autonomic nervous system

15

All anesthesia machines have the following features:

1. sources of oxygen and compressed gases
2. means for measuring (flowmeters) and controlling (reservoir bag) delivery of gases
3. means to volatilize liquid (vaporizer) and deliver (breathing tubes) anesthetic vapor or gas
4. device for disposal of carbon dioxide
5. safety devices

16

Safety devices on an anesthesia machine include the following:

1. oxygen analyzers
2. oxygen pressure interlock system (to shut off the flow)
3. end-tidal carbon dioxide monitor
4. pressure and disconnect alarms
5. gas scavenger system

17

The method for administration of inhalation anesthetics through the anesthesia machine can be classified as _____, _____, _____, or _____.

semi-closed, closed, semi-open, or open

18

As it pertains to administration of inhalation anesthesia, describe a semi-closed system.

1. most widely used
2. permits exhaled gases to pass into the atmosphere so that they will not mix with fresh gasses and be re-breathed
3. induction is slower but with less loss of heat ans water vapor that with open methods

19

As it pertains to administration of inhalation anesthesia, describe a closed system.

1. allows complete re-breathing of expired gas
2. exhaled CO2 is absorbed by soda lime or a mixture of barium and calcium hydroxide (Baralyme) in the absorber of the machine
3. provides maximal conservation of heat
4. reduces the amount and therefore cost of agents
5. reduces environmental contamination

20

As it pertains to administration of inhalation anesthesia, describe a semi-open system.

1. some exhaled gas can pass into surrounding air but some returns to the inspiratory part of the circuit for re-breathing
2. degree of re-breathing is determined by the volume of flow of fresh gas

21

As it pertains to administration of inhalation anesthesia, describe an open system.

1. valves direct expired gases into the lower portion of the canister, where they are removed by vacuum
2. patient inhales only the anesthetic mixture delivered by the anesthesia machine

22

Anesthetic gas or vapor of a volatile liquid is inhaled through a _____ attached to the anesthesia machine by breathing tubes.

face mask

23

An airway can be maintained by inserting a _____ into the larynx.

laryngeal mask airway (LMA)

24

A laryngeal mask airway is a flexible tube that has an _____ silicone ring and cuff.

inflatable

25

When the cuff of the laryngeal mask airway (LMA) is inflated, the mask fills the space around and behind the _____ to form a seal between the tube and the _____.

larynx
trachea

26

Advantages of endotracheal administration of anesthetic vapor or gas are:

1. ensures a patent airway and control of respiration
2. secretions are easily removed from the trachea by suctioning
3. protects the lungs from aspiration of blood, vomitus of gastric contents, or foreign material
4. preserves the airway regardless of the patient's position during the surgical procedure
5. interferes minimally with the surgical fields during head and neck procedures
6. helps minimize the escape of vapors or gases into the room atmosphere

27

Potential complications of endotracheal administration of anesthetic vapor or gas are:

1. trauma to teeth, pharynx, vocal cords, or trachea
2. cardiac dysrhythmias
3. hypoxia and hypoxemia
4. accidental esophageal or endobronchial intubation
5. aspiration of gastrointestinal contents

28

Controlled respirations can be defined as the _____.

completely controlled rate and volume of respirations

29

Assisted respiration implies that the patient's own _____ effort initiates the cycle.

respiratory

30

When is controlled aspiration is initiated?

after the anesthesia provider has produced apnea by hyperventilation or administration of respiratory depressant drugs or a neuromuscular blocker

31

Advantages or controlled respiration are:

1. provides for optimal ventilation
2. allows for selective lung deflation for thoracic procedures
3. provides access to deep regions of the thorax and upper abdomen
4. permits deliberate production of apnea to facilitate surgical manipulation below the diaphragm, ligation of deep vessels, or obtaining radiographic films

32

Nitrous oxide (N20)--Inhalation agent

Advantages
1. nonvolatile
2. rapid induction
3. pleasant, fruit-like odor
4. incidence of nausea and vomiting minimal
Disadvantages
1. can cause bowel distension and increased volume in other air pockets
2. can cause displacement of tympanoplasty grafts or increased intercranial pressure

33

Halothane (Fluothane)--Inhalation agent

Advantages
1. rapid with smooth induction
Disadvantages
1. potentially toxic to the liver
2. has profound effect on body temperature control (may cause hypothermia)

34

Enflurane (Ethrane)--Inhalation agent

halogenated ether
Advantages
1. rapid induction and recovery with minimal aftereffects

35

Isoflurane (Forane)--Inhalation agent

-most commonly used
-nonflammable
-more potent muscle relaxant
-protects the heart against catecholamine-induced dysrhythmias

36

Desflurane (Suprane)--Inhalation agent

-nonflammable,volatile liquid
Advantages
--rapid emergence and recovery
Disadvantages
1. pungent odor
2. may lower blood pressure
3. elevated heart rate

37

Sevoflurane (Ultane)--Inhalation agent

-volatile liquid, nonflammable
Advantages
--rapidly eliminated by lungs
Disadvantages
--may cause glycosuria

38

Thiopental (Pentothal)--intravenous agent

Advantages
--onset of action within 30 seconds
--short acting duration is 5 to 30 minutes depending on body mass
--can be used as anticonvulsant

39

Propofol (Diprivan)--intravenous agent

-used for rapid induction
-can be used in combination with inhalation agents or opioids for prolonged anesthesia
Advantages
--rapidly distributed, metabolized, and eliminated
--emergence is very rapid, with few postoperative side effects
--can be used for postoperative nausea and vomiting
Disadvantages
--produces dose-related cardio-respiratory depression
--decreases blood pressure

40

Ketamine (Ketalar, Ketaject)--intravenous agent

Advantages
--rapid induction
--respirations not depressed unless drug is administered too rapidly or in too large a dose
Disadvantages
--psychological manifestations (delirium, vivid imagery, hallucinations, unpleasant dreams) may occur during emergence; these can be reduced by giving preanesthetic diazepam and allowing patient to lie quietly and undisturbed

41

Natural opiates and synthetic opioids have been given to produce _____ and _____ preoperatively and postoperatively.

analgesia and sedation

42

Narcotics are used in combination with _____ for complete anesthesia for short procedures.

oxygen

43

The most popular narcotics for general anesthesia are the opioids...

1. fentanyl (Sublimaze)
2. sufentanil (Sufenta)
3. altentanil (Alfenta)
3. meperidine (Demerol)
4. morphine sulfate (opiate)

44

Narcotics may be given in _____ or _____ via IV infusion.

bolus or continuous

45

Narcotics produce a dose-related _____.

respiratory depression

46

The respiratory effects of narcotics are:

1. reduction of responsiveness of CNS respiratory centers to CO2
2. impairment of respiratory reflexes and alteration of rythmicity (prolonged aspiration, delayed expiration)
3. reduction in the respiratory rate before reduction in the tidal volume
4. production of bronchoconstriction or rigidity of chest wall
5. impairment of ciliary motion

47

Factors that influence narcotic respiratory actions include:

1. age
2. pain
3. sleep
4. urinary output
5. other drugs
6. intestinal resorption
7. disease

48

A narcotic _____ neutralizes or impedes the action of another drug.

antagonist (reversal)

49

What are two narcotic antagonists?

1. Naloxone (Narcan)
2. Flumazenil (Romazicon)

50

What facilitates muscle relaxation for smoother endotracheal intubation and working conditions during the medical procedure?

neuromuscular blockers (muscle relaxers)

51

Neuromuscular blockers are administered via IV in small amounts at intervals, they interfere with the passage of impulses from _____ to _____.

motor nerves to skeletal muscles

52

Neuromuscular blockers _____ all skeletal muscles including the _____ and accessory muscles of respiration

paralyze
diaphragm

53

Mivacurium (mivacron)--short-acting neuromuscular blocking agent

-lasts 15-20 minutes

54

Atracurium (Tracrium)--intermediate-acting neuromuscular blocking agent

-lasts about 30 min
-metabolizes more quickly that other blockers (may be an advantage in patients with liver or renal disease)

55

Cisatracurium (Nimbex)--intermediate-acting neuromuscular blocking agent

-can cause bradycardia, hypotension, and skin flushing

56

(**)Rocuronium (Zemuron)--intermediate-acting neuromuscular blocking agent

-rapid onset
-lasts about 30 min
-can be reversed with neostigmine (**)

57

Tobocurarine (Curare)--long-acting neuromuscular blocking agent

-used as pretreatment is succinylcholine is used

58

Gallamine (Flaxedil)--long-acting neuromuscular blocking agent

-contraindicated in patients with iodine and sulfide allergies

59

Metocurine (Metubine)--long-acting neuromuscular blocking agent

-produces less hypotension

60

Pancuronium (Pavulon)--long-acting neuromuscular blocking agent

-has a vagolytic action that may raise the blood pressure, pulse rate, and heart rate

61

Pipecuronium (Arduan)--long-acting neuromuscular blocking agent

-can cause decreased arterial pressure with moderate histamine release

62

What are depolarizing neuromuscular blockers?

they stimulate autonomic receptors; they cause muscular fasciculation (involuntary muscle contractions)

63

Succinylcholine (Anectine)

-onset of action in seconds
-produces paralysis for up to 20 minutes

64

Decamethonium (Syncurine)

-rapid onest
-short duration
-used for deep relaxation of a short duration, such as endoscopy

65

Neostigmine (Prostigmin)--muscle relaxant reversal agent

-used to reverse nondepolarizing neuromuscular blocking agents
-not for use in patients with peritonitis or bowel or urinary obstruction

66

Edophonium (Tensilon)--muscle relaxant reversal agent

-rapid onset but short duration

67

The _____ monitors the level of anesthesia, balancing doses of medications, throughout the surgical procedure.

anesthesia provider

68

The _____ is a compact system for monitoring the effects of anesthesia on the brain.

Bispectral Index (BIS)

69

The BIS monitor allows the anesthesia provider to accurately track the patient's level of _____ by using an electrode applied to the patient's forehead that sends _____-like signals to a small monitor.

consciousness
eletroencephalogram (EEG)

70

The anesthesia provider attempts to have the patient _____ at the end of a surgical procedure.

as nearly awake as possible

71

Pharyngeal and laryngeal reflexes must be recovered to prevent _____ and _____.

aspiration and respiratory obstruction

72

Extubation is delayed until _____ is ensured.

spontaneous respiration

73

When extubation is deemed safe, the _____ is carefully removed.

endotracheal tube

74

Patient _____ and _____ may accompany emergence.

vomiting and restlessness

75

Slight cyanosis, stertorous respiration, rigidity, and shivering are not uncommon as a result of a _____, thus altering circulation to the skin and muscles.

temporary disturbance of body temperature-regulating mechanisms

76

Balanced anesthesia is a technique used to achieve _____.

physiologic homeostasis, analgesia, amnesia, and muscle relaxation

77

A _____ permits control of ventilation while providing muscle relaxation during intubation.

neuromuscular blockers

78

A _____ reduces motor activity and anxiety.

neuroleptic

79

Residual effects of narcotics or muscle relaxants my require _____ by antagonists during and/or at the conclusion of the surgical procedure.

reversal

80

Functions controlled by homeostatic mechanisms include:

1. body temperature
2. heartbeat
3. blood pressure
4. electrolyte balance
5. respiration

81

The parameters of homeostasis may be altered by _____ and other _____ agents.

anesthetic
pharmacologic

82

_____ is an artificial, deliberate lowering of body temperature below the normal limits.

induced hypothermia

83

_____ reduces the metabolic rate and oxygen needs of the tissues in conditions causing hypoxia or during a decrease or interruption of circulation.

hypothermia