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

Question 1

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

Answer 1

cricoid cartilage

Question 2

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

Answer 2

Sellick’s maneuver

Question 3

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

Answer 3

regurgitation and aspiration

Question 4

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

Answer 4

endotracheal tube cuff

Question 5

An _____ is performed before the induction of general anesthesia.

Answer 5

awake intubation

Question 6

What are the most common indications for awake intubation?

Answer 6

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

Question 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 _____.

Answer 7

airway obstruction

Question 8

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

Answer 8

fiberoptic or rigid laryngoscope

Question 9

What are the five objectives of general anesthesia?

Answer 9

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

Question 10

Oxygenation (as an objective of general anesthesia):

Answer 10

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

Question 11

Unconsciousness (as an objective of general anesthesia):

Answer 11

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

Question 12

Analgesia (as an objective of general anesthesia):

Answer 12

the patient must be free of pain during the surgical procedure

Question 13

Muscle relaxation (as an objective of general anesthesia):

Answer 13

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

Question 14

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

Answer 14

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

Question 15

All anesthesia machines have the following features:

Answer 15

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

Question 16

Safety devices on an anesthesia machine include the following:

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

face mask

Question 23

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

Answer 23

laryngeal mask airway (LMA)

Question 24

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

Answer 24

inflatable

Question 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 _____.

Answer 25

larynx | trachea

Question 26

Advantages of endotracheal administration of anesthetic vapor or gas are:

Answer 26

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

Question 27

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

Answer 27

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

Question 28

Controlled respirations can be defined as the _____.

Answer 28

completely controlled rate and volume of respirations

Question 29

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

Answer 29

respiratory

Question 30

When is controlled aspiration is initiated?

Answer 30

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

Question 31

Advantages or controlled respiration are:

Answer 31

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

Question 32

Nitrous oxide (N20)--Inhalation agent

Answer 32

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

Question 33

Halothane (Fluothane)--Inhalation agent

Answer 33

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

Question 34

Enflurane (Ethrane)--Inhalation agent

Answer 34

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

Question 35

Isoflurane (Forane)--Inhalation agent

Answer 35

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

Question 36

Desflurane (Suprane)--Inhalation agent

Answer 36

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

Question 37

Sevoflurane (Ultane)--Inhalation agent

Answer 37

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

Question 38

Thiopental (Pentothal)--intravenous agent

Answer 38

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

Question 39

Propofol (Diprivan)--intravenous agent

Answer 39

-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

Question 40

Ketamine (Ketalar, Ketaject)--intravenous agent

Answer 40

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

Question 41

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

Answer 41

analgesia and sedation

Question 42

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

Answer 42

oxygen

Question 43

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

Answer 43

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

Question 44

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

Answer 44

bolus or continuous

Question 45

Narcotics produce a dose-related _____.

Answer 45

respiratory depression

Question 46

The respiratory effects of narcotics are:

Answer 46

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

Question 47

Factors that influence narcotic respiratory actions include:

Answer 47

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

Question 48

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

Answer 48

antagonist (reversal)

Question 49

What are two narcotic antagonists?

Answer 49

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

Question 50

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

Answer 50

neuromuscular blockers (muscle relaxers)

Question 51

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

Answer 51

motor nerves to skeletal muscles

Question 52

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

Answer 52

paralyze | diaphragm

Question 53

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

Answer 53

-lasts 15-20 minutes

Question 54

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

Answer 54

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

Question 55

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

Answer 55

-can cause bradycardia, hypotension, and skin flushing

Question 56

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

Answer 56

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

Question 57

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

Answer 57

-used as pretreatment is succinylcholine is used

Question 58

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

Answer 58

-contraindicated in patients with iodine and sulfide allergies

Question 59

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

Answer 59

-produces less hypotension

Question 60

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

Answer 60

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

Question 61

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

Answer 61

-can cause decreased arterial pressure with moderate histamine release

Question 62

What are depolarizing neuromuscular blockers?

Answer 62

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

Question 63

Succinylcholine (Anectine)

Answer 63

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

Question 64

Decamethonium (Syncurine)

Answer 64

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

Question 65

Neostigmine (Prostigmin)--muscle relaxant reversal agent

Answer 65

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

Question 66

Edophonium (Tensilon)--muscle relaxant reversal agent

Answer 66

-rapid onset but short duration

Question 67

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

Answer 67

anesthesia provider

Question 68

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

Answer 68

Bispectral Index (BIS)

Question 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.

Answer 69

consciousness | eletroencephalogram (EEG)

Question 70

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

Answer 70

as nearly awake as possible

Question 71

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

Answer 71

aspiration and respiratory obstruction

Question 72

Extubation is delayed until _____ is ensured.

Answer 72

spontaneous respiration

Question 73

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

Answer 73

endotracheal tube

Question 74

Patient _____ and _____ may accompany emergence.

Answer 74

vomiting and restlessness

Question 75

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

Answer 75

temporary disturbance of body temperature-regulating mechanisms

Question 76

Balanced anesthesia is a technique used to achieve _____.

Answer 76

physiologic homeostasis, analgesia, amnesia, and muscle relaxation

Question 77

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

Answer 77

neuromuscular blockers

Question 78

A _____ reduces motor activity and anxiety.

Answer 78

neuroleptic

Question 79

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

Answer 79

reversal

Question 80

Functions controlled by homeostatic mechanisms include:

Answer 80

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

Question 81

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

Answer 81

anesthetic | pharmacologic

Question 82

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

Answer 82

induced hypothermia

Question 83

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

Answer 83

hypothermia