What are the AANA stardards of care?
1: patient rights to autonomy, privacy, safety
2: pre-anesthesia eval completed
3: patient specific care plan
4: consent for anesthesia
5: accurate documentation
6: equipement check completed
7: patient must always be monitored by an anesthesia provider
8: patient is properly positioned (minimize injuries) surgical team responsibility
9: monitoring and alarms on and audible
10: infection control policy
11: transfer of care to appropriate recovery personale
What are the 5 items scored in the modified Aldrete scoring system?
- respirations
- oxygen saturation
- consciousness
- circulation
- activity
*Must have a score of 9 or 10 to be ready to DC
What are the 5 items scored in the postanesthesia discharge scoring system?
- vitals
- surgical bleeding
- activity and mental status
- intact and output
- pain, nausea and vomiting
What are some ASA guidelines for Non-OR anesthesia (NORA) patients?
- reliable oxygen source and backup supply
- adequate and reliable suction
- adequate and reliable scavenging system
- self inflating resuscitation bag capable of delivering an FiO2 of 0.90
- adequate drugs, supplies, and equipment
- adequate monitoring equipment
- immediate suitability of an emergency cart with defibrilator and E drugs
What are some key distictions between monitored anesthesia care (MAC) versus GA?
MAC: arousable, airway is not needed (should have backup), spontaneous ventilation and cardiovascular function is usually maintained
What are the three levels of sedation?
minimal: responds to verbal commands, anxiolysis
moderate: responds to verbal/tactile stimulation c depressed LOV
deep: responds to pain, impaired ventilation (may need jaw thrust, support breaths)
List some common procedures performed by radiology?
endovascular treatments, radiofrequency ablations, TIPS procedure, angiograms, MRI, CT
What are some anesthesia considerations when taking care of patients undergoing cerebral aneurysm coiling?
- need a large bore IV
- volatiles and or propofol drip
- dexmedetomidine
- may need an A line
- ETCO2
What are some complications assoicated with cerebral aneurysm coiling?
rupture, dissection, contrast hypersensitivity,
anaphylaxis, groin hematoma
What is involved in a TIPS procedure?
transjugular intrahepatic portosystemic shunt to treat poratl hypertension in patients with recurrent GI bleeds who have failed medical therapy
catheter and stent are placed in internal jugular vein
What are some anesthesia considerations associated with patients undergoing a TIPS procedure?
- RSI (full stomachs)
- large bore IV
- A line
- type and cross (blood needs to be ready)
- liver is impaired (consider medications that are metabolized by the liver)
- provider needs lead
What are some common procedures performed in cath lab?
- electrophysiology procedures (EP)
- cardioversion
- TEE
- TAVR
- ablations
What patients typically need cardioversion?
a flutter or symptomatic a fib
What induction medication should we AVOID in patients undergoing cardioversion?
No Lidocaine (Na channel blocker). Cardioversion stops to restart the heart, if you give Lidocaine the heart may not restart causing asystole
List the parenteral anticoagulants that target thrombin…
Bivalurudin
Argatroban
Hirudin
List the parenteral anticoagulants that target just factor Xa…
Fondaparinux
List the parenteral anticoagulants that target thrombin and factor Xa…
Heparin and LMWH
What are some anesthesia considerations for patients undergoing TEE and cardioversion?
- nasal cannula
- bite block in place
- propofol until loss of lash reflex, but patient is still spontaneously breathing
- can use versed and ketamine
- NO lidocaine!!
- may need multiple cardioversions
What does TAVR stand for? What does it treat?
transcatheter aortic valve replacement
treats aortic stenosis
What are some anesthesia concerns for TAVR patients?
- large bore IV
- A line
- defibrillator
- type and crossed blood
- heparin/ ACTs and protamine reversal
What are ERCP’s and what do they treat?
Endoscopic retrograde cholangiopancreatography
Used to treat biliary stenosis and common bile duct stones
What are some anesthetic considerations for patients undergoing ERCPs?
- these patients typically have extreme comorbidities
- patient in prone position
- GETA recommended
- glucagon is given as an antispasmodic
- narcotics and anti-emetics are given
What are ECTs used to treat?
- bipolar disease
- schizophrenia
- extreme depression
- suicidal behavior
What does the treatment regimine look like for patients prescribed ECT?
3x per week for 12 total treatments
