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Basics TL > Week 10 Handout In And Out OR > Flashcards

Week 10 Handout In And Out OR Flashcards

1
Q

What is the importance of preoperative setup and readiness?

A

It includes prepping drugs, equipment checks, verifying case details, and ensuring patient optimization.

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2
Q

What does the Revised Cardiac Risk Index (RCRI) predict?

A

It helps predict the risk of cardiac complications in noncardiac surgeries.

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3
Q

What are the factors included in the RCRI?

A

High-risk surgery, history of ischemic heart disease, congestive heart failure, stroke or TIA, diabetes on insulin, creatinine >2.0 mg/dL.

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4
Q

What do Metabolic Equivalent Tasks (METS) measure?

A

They measure functional capacity.

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5
Q

What does a METS score of < 4 indicate?

A

< 4 METs (e.g., can’t walk 2 flights of stairs) = poor functional status and higher perioperative risk.

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6
Q

What should be asked about stents in relation to perioperative risk?

A

BMS (Bare Metal Stent) = delay elective surgery ≥30 days; DES (Drug-Eluting Stent) = wait ≥6 months (preferably 12 months); surgery within 3 months is high-risk for thrombosis.

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7
Q

What are the essentials of infection control in the OR?

A

Hand hygiene, sterile technique, proper OR attire and PPE, minimize OR traffic and contamination risk, use N95 or higher respirators if indicated.

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8
Q

What are some safe practices in the perioperative setting?

A

Single dose vials = single patient, never reuse needles, disinfect ports, vials, monitors, know precautions, master PPE, surgical time-out, equipment checklists, patient identity and procedure confirmation, fire risk assessment.

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9
Q

What is a good time to give anxiolysis en route to the OR?

A

It is a good time to give versed.

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10
Q

What should be documented regarding airway exam and dental integrity?

A

Document verbal consent regarding risks such as dental injury from intubation.

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11
Q

What are common predictors of difficult intubation?

A

Obesity, large tongue, limited jaw opening, short thyromental distance, cervical immobility, facial or neck trauma.

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12
Q

What is the goal of induction of anesthesia?

A

Smooth and safe transition from consciousness to unconsciousness.

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13
Q

What must be ensured during induction of anesthesia?

A

Adequate pre-oxygenation, appropriate induction agent, proficient airway management.

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14
Q

What is the concept of chair flying?

A

Mental rehearsal before a case, visualizing each step builds confidence and prevents errors.

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15
Q

What is the first step in Dr. Watson’s anesthesia preparation?

A

Preoxygenate with 100% O₂, check EtCO₂ waveform, suction, circuit integrity.

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16
Q

Why is pulse oximetry important before giving anesthetics?

A

It provides early detection of hypoxia and cardiovascular changes.

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17
Q

What are the induction drugs that may be used?

A

Opioid (Fentanyl, morphine, dilaudid), lidocaine, sedative hypnotic (Propofol, thiopental, etomidate), optional defasciculating dose of NMB (Rocuronium).

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18
Q

What should be done after intubation?

A

Inflate cuff, hook up circuit to tube, note depth, adjust APL valve, administer breaths while auscultating placement.

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19
Q

What is a tip for reducing discomfort during induction?

A

Priming receptors: giving lidocaine/fentanyl before propofol reduces burn and blunts sympathetic response.

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20
Q

What is a methodical scan in anesthesia?

A

Patient, Anesthesia, Train of four, IV, EtCO2, Narcotics, Temperature

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21
Q

What causes bradycardia with induction?

A

More common with high vagal tone, opioids, propofol

Treat with glycopyrrolate or atropine.

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22
Q

What is a common cause of hypotension during induction?

A

Propofol = ↓ SVR

Prevent with fluid bolus, slow propofol push, vasopressor ready, reduced anesthetic depth, or positioning.

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23
Q

How do you manage hypoxemia during induction?

A

Ensure O2 is on, effective bag mask ventilation, secure airway, check equipment.

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24
Q

What are the steps to manage bronchospasm?

A

Deepen anesthesia, administer beta-2 agonists, consider epinephrine, use steroids, and anticholinergics.

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25
What should you do for laryngospasm?
Use positive pressure ventilation, deepen anesthesia, neuromuscular blocker, secure airway, monitor for NPPE.
26
What is the protocol for esophageal intubation?
Immediate recognition, reoxygenate, use intubation aids, alternative airway if needed.
27
What to do in case of difficult or failed intubation?
Call for help, use 'Cannot Intubate' algorithm, insert supraglottic airway, consider cricothyrotomy/tracheostomy.
28
How to manage an allergic reaction during anesthesia?
Stop the trigger, administer epinephrine, manage airway, use medications, and provide fluid bolus.
29
What are the steps for cardiac arrhythmias management?
Call for help, identify cause, treat specifically, replace electrolytes, consult cardiology.
30
What to do in case of dental or oral injury?
Immediate assessment, pain treatment, consult dentistry, preventive measures.
31
How to handle awareness under anesthesia?
Check IV, increase anesthetic depth, reassure patient, provide postop support, review technique.
32
What are the goals of maintenance of anesthesia?
Maintain amnesia, analgesia, akinesia, and autonomic stability. ## Footnote Amnesia: volatile agents, IV hypnotics; Analgesia: opioids, adjuncts; Akinesia: NMB; Autonomic stability: titrate drugs.
33
What factors should be adjusted during maintenance of anesthesia?
Surgical stimulus/procedure, patient comorbidities, vitals (HR, BP, EtCO₂, SpO₂, temp), and electrolytes.
34
What is Dr. Watson's tip regarding blood pressure and heart rate?
Avoid wide swings in BP/HR.
35
What should you ask to prepare for potential complications?
Ask what the worst thing that can happen is, then prepare for it.
36
How can you prevent awareness during anesthesia?
Explain to the patient about light sedation and ensure MAC ≥0.7–1.3. ## Footnote Use BIS if available for TIVA.
37
What is the focus of emergence from anesthesia?
Safely and gradually returning the patient to consciousness and ensuring a well recovery with minimal side effects.
38
What are the goals of emergence from anesthesia?
Reversal of anesthetic depth, pain management, return of spontaneous breathing, responsiveness, and safe extubation.
39
What are the extubation criteria?
Must have sustained head lift >5 sec or hand grasp, following commands, TOF ratio ≥0.9, spontaneous ventilation with good TV, hemodynamic stability, and protective airway reflexes.
40
What are some complications of extubation?
Laryngospasm, airway obstruction, aspiration, and negative pressure pulmonary edema.
41
What is the prevention strategy for extubation complications?
Gentle suction, avoid extubation in Stage 2, and make a deep vs awake extubation decision.
42
What does the PACU handoff mnemonic PATIENT stand for?
Procedure, anesthetic agents, timeline of events, intraop complications, estimated blood loss, next plan.
43
What is PONV?
Leading cause of hospital admissions from office-based anesthesia.
44
What is controlled hypotension used for?
To improve surgical field in ENT, neuro cases, extensive dissection, long operative times > 12 hrs, and potential significant blood loss.
45
What is the target MAP for controlled hypotension?
MAP 50-60 mmHg or no more than 20% below baseline.
46
What are the advantages and disadvantages of Nitroprusside?
Advantage: Fast on/off; Disadvantage: Cyanide toxicity, rebound hypertension.
47
What are the advantages and disadvantages of Dexmedetomidine?
Advantage: Analgesia, sedation; Disadvantage: Bradycardia, AV block.
48
What are the advantages and disadvantages of Esmolol?
Advantage: ↓HR, easy titration; Disadvantage: Cardiac depression.
49
What are the advantages and disadvantages of Nitroglycerin?
Advantage: Preserves oxygenation preload; Disadvantage: ↑ ICP, variable dosing.
50
What are the advantages and disadvantages of Nicardipine?
Advantage: Ca 2+ blocker, maintains cerebral flow; Disadvantage: Reflex tachycardia.
51
What are the advantages and disadvantages of Remifentanil + Propofol?
Advantage: Bloodless field, ↓ PONV; Disadvantage: Rebound pain, hypoalgesia.
52
What is CO₂ insufflation in laparoscopic surgery?
CO₂ insufflation increases EtCO₂, requiring increased minute ventilation (MV). It stimulates the vagal nerve, and Robinul or atropine may be given if bradycardic. Pneumoperitoneum causes increased MAP and SVR, decreased SV and venous return, and increased PaCO2 and EtCO₂, leading to respiratory acidosis.
53
What are the effects of pneumoperitoneum?
Pneumoperitoneum leads to decreased FRC, FVC, and FEV1. CO₂ absorption can cause hypercarbia and acidosis.
54
What are the entry methods for laparoscopic surgery?
Entry methods include closed (Veress/trocar) and open (Hasson) approaches.
55
What is the prophylaxis for PONV?
Prophylaxis for PONV includes dexamethasone and ondansetron, with or without scopolamine.
56
What are the ventilation considerations during laparoscopic surgery?
Ventilation may show decreased compliance and increased peak pressures. Adjust tidal volume (TV) and respiratory rate (RR), and consider pressure control.
57
What are the complications of steep Trendelenburg positioning?
Steep Trendelenburg can increase intraocular pressure (IOP), intracranial pressure (ICP), and decrease FRC.
58
What should be monitored for during positioning?
Watch for subcutaneous emphysema, gas embolism, and visceral/vascular injury.
59
What is the preferred anesthesia for laparoscopic surgery?
General anesthesia is preferred to ensure patient comfort and ventilatory control.
60
What are the common hemodynamic challenges during laparoscopic surgery?
Hemodynamic fluctuations are common; agents should be titrated carefully.
61
What is the trend in anesthesia management during laparoscopic surgery?
The trend is to use short-acting opioids like remifentanil and multimodal analgesia.
62
What are common postoperative issues in laparoscopic surgery?
Common issues include PONV, shoulder pain, and visceral discomfort. Management includes opioids, NSAIDs, dexamethasone, locals, and antiemetics like Zofran.
63
What are the benefits of robotic surgery?
Robotic surgery offers better instrument control, decreased length of stay, pain, and bleeding.
64
What are common surgical fields for robotic cases?
Robotic surgery is common in prostate, gynecologic, thoracic, and cardiac procedures.
65
What are the hemodynamic and respiratory effects of steep Trendelenburg and pneumoperitoneum?
Steep Trendelenburg with pneumoperitoneum increases MAP, CVP, and PCWP, decreases lung volumes and compliance, and increases peak airway pressures and risk of atelectasis.
66
What are the risks associated with extreme positioning in robotic surgery?
Extreme positioning can lead to complications such as POVL (postoperative visual loss).
67
What are the risk factors for POVL?
Risk factors for POVL include hypotension, anemia, venous congestion, and direct pressure on the eyes.
68
How can POVL be prevented?
Prevent POVL by protecting the eyes from pressure and contact, maintaining euvolemia, minimizing blood loss, and shortening the duration in Trendelenburg.
69
What is ERAS?
ERAS (Enhanced Recovery After Surgery) protocols are widely used in robotic cases.

Basics TL (56 decks)

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