Surg 102 Chapter 24 (B&K)--Part 1

Question 1

Anesthesia is a specialty that requires knowledge of _____, _____, _____, and _____.

Answer 1

biochemistry, clinical pharmacology, cardiology, and respiratory physiology

Question 2

The American Society of Anesthesiologists (ASA) was founded in _____.

Answer 2

1905

Question 3

Selection of anesthesia in made by the _____ in consultation with the _____ and the _____.

Answer 3

anesthesia provider, surgeon, patient

Question 4

Choosing the safest anesthesia agent and technique is a decision predicated on thorough _____, _____, and _____.

Answer 4

knowledge, sound judgement, and evaluation of each individual situation

Question 5

Selection of anesthesia should be based on the following characteristics:

Answer 5

1. provide maximum safety for the patient
2. provide optimal operating conditions for the surgeon
3. provide patient comfort
4. have a low index of toxicity
5. provide potent, predictable analgesia extending into the postoperative period
6. produce adequate muscle relaxation
7. provide amnesia
8. have a rapid onset and easy reversibility
9. produce minimum side effects

Question 6

The patient’s ability to tolerate stress and adverse effects of anesthesia and the surgical procedure depends on _____; _____; and function of the _____, _____, _____, and _____.

Answer 6

respiration; circulation; and function of the liver, kidneys, endocrine system, and central nervous system (CNS)

Question 7

The following factors are important to the patient’s ability to tolerate stress and adverse effects of anesthesia:

Answer 7

1. age, size, and weight
2. physical, mental, and emotional status
3. presence of complicating systemic disease or concurrent drug therapy
4. presence of infection at the site of the surgical procedure
5. anticipated procedure
6. position required for the procedure
7. type and expected length of procedure
8. local or systemic toxicity of the agent
9. expertise of the anesthesia provider
10. preference of the surgeon and patient

Question 8

Both the _____ and _____ play essential roles in clinical anesthesia.

Answer 8

central and autonomic nervous systems

Question 9

The effect of anesthetic drugs is one of _____.

Answer 9

progressive depression of the CNS

Question 10

The anesthesia state involves control of _____, _____, _____, and _____.

Answer 10

motor, sensory, mental, and reflex functions

Question 11

Specific drugs are used to achieve the desired results: _____, _____, and _____.

Answer 11

amnesia, analgesia, and muscle relaxation

Question 12

ASA developed the taxonomy for classifying patients by physical status from class I, the _____, to class VI, the _____.

Answer 12

lowest risk, highest risk

Question 13

ASA Class I includes:

Answer 13

relatively healthy patients with localized pathologic processes

Question 14

ASA Class II includes:

Answer 14

mild systemic diseases (diabetes mellitus)

Question 15

ASA Class III includes:

Answer 15

severe systemic disease that limits activity but is not totally incapacitating (COPD or hypertension)

Question 16

ASA Class IV includes:

Answer 16

an incapacitating disease that is a constant threat to life (cardiovascular and renal disease)

Question 17

ASA Class V includes:

Answer 17

moribund patients who are not expected to survive 24 hours with or without the surgical procedure. Operation is intended to save their life or a resuscitative measure

Question 18

ASA Class VI includes:

Answer 18

declared brain dead but whose organs will be removed for donor purposes.

Question 19

Minimal or light sedation (anxiolysis):

Answer 19

1. patients respond normally to verbal command
2. cognitive function and coordination may be impaired
3. ventilatory and cardiovascular functions are unaffected

Question 20

Moderate sedation/analgesia:

Answer 20

1. a drug-induced depression of consciousness
2. can respond purposefully to verbal commands
3. no interventions are required to maintain a patent airway
4. spontaneous ventilation is adequate

Question 21

Deep sedation/analgesia:

Answer 21

1. a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully after repeated or painful stimulation
2. ability to independently maintain ventilatory function may be impaired
3. may require assistance to maintain a patent airway
4. spontaneous ventilation may be inadequate

Question 22

Full anesthesia:

Answer 22

1. drug-induced loss of consciousness during which patients cannot be roused, even by painful stimulation
2. ability to independently maintain ventilatory function is often impaired
3. often require assistance to maintain patent airway
4. cardiovascular function may be impaired

Question 23

Anesthesia may be produced in several ways, these include _____, _____, _____, and _____

Answer 23

general anesthesia, balanced anesthesia, local or regional block anesthesia, and spinal or epidural anesthesia

Question 24

During general anesthesia, pain is controlled by _____.

Answer 24

general insensibility

Question 25

Basic elements of general anesthesia include _____, _____, _____, and _____.

Answer 25

loss of consciousness, analgesia, interference with undesirable reflexes, and muscle relaxation

Question 26

During balanced anesthesia, the properties of general anesthesia are produced, in varying degrees, by a _____.

Answer 26

combination of drugs

Question 27

During local (or regional block) anesthesia, pain is controlled without loss of _____.

Answer 27

consciousness

Question 28

During local (or regional block) anesthesia, the _____ in one area or region of the body are anesthetized.

Answer 28

sensory nerves

Question 29

During spinal (or epidural) anesthesia, sensation is blocked at a level below the _____ without loss of consciousness.

Answer 29

diaphragm

Question 30

During spinal (or epidural) anesthesia, the agent is injected into the _____.

Answer 30

spinal canal

Question 31

In general anesthesia, association neurons are broken in the _____ to produce more or less complete lack of sensory perception and motor discharge.

Answer 31

cerebral cortex

Question 32

In general anesthesia, unconsciousness is produced when _____ contains an adequate amount of the anesthetic agent.

Answer 32

blood circulation to the brain

Question 33

During general anesthesia, the anesthesia provider must constantly observe the body's reflex to stimuli and other guides to determine the degree of _____, _____, and _____ during induction and the surgical procedure.

Answer 33

CNS, respiratory, and circulatory depression

Question 34

The three methods of administering general anesthetic are _____, _____, and _____.

Answer 34

inhalation, IV injection, and rectal instillation

Question 35

Induction involves putting the patient safely into a state of _____.

Answer 35

unconsciousness

Question 36

During induction, a _____ and _____ must be ensured.

Answer 36

patent airway and adequate ventilation

Question 37

During induction, a _____ may be inserted to decompress the gastrointestinal tract and evacuate stomach contents.

Answer 37

nasogastric tube

Question 38

During _____, the anesthesia provider may have the patient breathe pure (100%) oxygen by face-mask for a few minutes.

Answer 38

preoxygenation

Question 39

The process of _____ provides a margin of safety in the event of airway obstruction or apnea during induction.

Answer 39

preoxygenation

Question 40

During induction, _____ is induced by IV administration of a drug or by inhalation of an agent mixed with oxygen. (technique is rapid)

Answer 40

unconsciousness

Question 41

During induction, a patent airway must be established to provide _____ and _____ of the unconscious patient.

Answer 41

adequate oxygenation and control breathing

Question 42

The anesthesia provider evaluates the airway for the risk of difficult intubation using the _____.

Answer 42

Mallampati classification chart

Question 43

While monitoring a patient for a possible difficult intubation, the anesthesia provider also checks _____, _____, and _____.

Answer 43

thyromental distance, neck flexion/extension range, and the ability to prognath (protrude the mandible)

Question 44

During intubation an _____, _____, _____, or _____ may be inserted.

Answer 44

oropharyngeal airway, nasopharyngeal airway, laryngeal mask, or endobronchial tube

Question 45

Physiologic indicators of a difficult airway include the following:

Answer 45

1. inability to open the mouth (previous jaw surgery) 2. immobility of the cervical spine (vertebral disease or injury) 3. chin or jaw deformities 4. dentition can be an issue if the patient has loose teeth or periodontal disease 5. short neck or morbid obesity 6. pathology of the head and neck (tumors, enlarged tongue) 7. previous tracheostomy scar 8. trauma

Question 46

Intubation is insertion of an _____ between vocal cords.

Answer 46

endotracheal tube

Question 47

Tubes may be made of _____, _____, _____, or _____

Answer 47

metal, plastic, silicone, or rubber

Question 48

Most styles of tubes for adult sizes have a built-in cuff that is _____ with a measured amount of _____, _____, or _____ after insertion.

Answer 48

inflated | air, water, or saline

Question 49

The anesthesia provider will be informed is a _____ will be used so that a laser-resistant endotracheal tube can be used.

Answer 49

laser

Question 50

Neuromuscular blocking agents are given before intubation to _____ and _____.

Answer 50

relax the jaw and larynx

Question 51

An _____ during induction and _____ during emergence from anesthesia are precarious times for the patient

Answer 51

intubation | extubation

Question 52

Another hazard is _____, especially in a patient with a full stomach or with increased intraabdominal or intracranial pressure.

Answer 52

aspiration