Anesthesia

Question 1

what is the WHO safe surgery checklist?

Answer 1

Designed to minimize the most common & avoidable risks endangering the lives & well-being of surgical patients

Question 2

What are the goals of the WHO safe surgery checklist?

Answer 2

1. Surgical site infection prevention
2. Safe anesthesia
3. Safe surgical teams
4. Measurement of surgical service

Question 3

What is included in the pre-op clearance evaluation H&P?

Answer 3

1. Focus on CV, lungs, neuro assessment, comorbidities
2. EKG > 40 yr
3. CXR > 40 yr (smoker) if GETA
4. Labs

Question 4

What is included in the pre-op fasting regime?

Answer 4

1. NPO after midnight

A. Sips of water may be ingested up to 2 hrs before checking in for surgery

Question 5

What meds need to be held before surgery?

Answer 5

1. Most antihypertensives & beta blockers should be continued in the perioperative period
2. Hold oral DM meds
3. ½ insulin dose

Question 6

Define anesthesia

Answer 6

1. Allows patients to undergo a variety of surgical & nonsurgical procedures w/out pain or distress
2. Blocking of pain & non-awareness is reversible

Question 7

What are the types of anesthesia?

Answer 7

1. IV regional anesthesia (IVRA) / Bier Block
   A. Analgesia & lack of motor movement in involved area
2. Local anesthesia w/ monitored anesthesia care (MAC)
   A. Also called conscious sedation
   B. Advantages: fewer S/E & intubation not necessary
3. GETA
4. Regional anesthesia

Question 8

When is IV regional anesthesia indicated?

Answer 8

1. Indicated for extremity procedure distal to elbow or knee
2. Use limited to procedures lasting less than 1 hr

Question 9

What other meds are commonly added to IV regional anesthesia?

Answer 9

Benzodiazepine & fentanyl often added to prevent seizures & to improve nerve blockage

Question 10

What are the effects of anesthesia?

Answer 10

1. Amnesia with or without consciousness
2. Analgesia
3. Muscle relaxation
4. Sedation

Question 11

What can be used for amnesia with or without consciousness?

Answer 11

Benzodiazepines (diazepam/Valium, midazolam/Versed)

Question 12

What can be used for analgesia?

Answer 12

Opioids (Morphine and Fentanyl)

Question 13

What can be used for muscle relaxation?

Answer 13

Neuromuscular drugs (succinylcholine, pancuronium)

Question 14

What meds can be used for sedation?

Answer 14

Sedative/Hypnotics (Propofol)

Question 15

What is the mneumonic used for the hx for an emergency surgery?

Answer 15

SAMPLE
S: signs and sxs
A: Allergies
M: Medications
P: PMH
L: Last meal
E: Events preceding surgery

Question 16

What needs to occur before the induction of anesthesia?

Answer 16

Pre-oxygenate patient before induction of anesthesia

Question 17

How can induction of anesthesia be achieved?

Answer 17

1. IV opioid (Fentanyl)
2. IV general anesthetic drugs (Propofol)
3. IV muscle relaxant (succinylcholine)

Question 18

What needs to occur in general anesthesia after induction?

Answer 18

Once anesthesia & muscle relaxation achieved, intubation follows

Question 19

When is regional anesthesia indicated?

Answer 19

1. Usually involves surgeries below waist, on lower abd or on upper ext
A. Allows pt to be conscious
2. Spinal anesthesia
3. Epidural anesthesia
4. Peripheral Nerve Block

Question 20

What is the most common complication of spinal anesthesia?

Answer 20

spinal headache

Question 21

What is the advantage of epidural anesthesia?

Answer 21

No CSF leak

Question 22

When is a peripheral nerve block used?

Answer 22

Extremities

Question 23

What are the risk factors for post-op nausea and vomiting?

Answer 23

1. Female
2. Non-smoker
3. Hx motion sickness

Question 24

How can post-op nausea and vomiting be prevented?

Answer 24

1. Treat prophylactically with 5HT receptor antagonist

A. Ondansetron (Zofran)

Question 25

How can post-op acute pain be managed?

Answer 25

``` 1. Oral meds A. Narcotics, NSAIDs 2. IV Opioids A. Morphine, Fentanyl 3. IV NSAID A. Ketorolac (Toradal) 4. Epidural anesthesia A. Opioids via epidural catheter ```

Question 26

What are common complications post-operatively?

Answer 26

1. N/V 2. Pain 3. Urinary Retention 4. Malignant Hyperthermia

Question 27

How can urinary retention be managed?

Answer 27

1. Catheterize if Unable To Void by 8 hr post-op | 2. Alpha 1 adrenergic receptor blockers used if needed

Question 28

What causes malignant hyperthermia?

Answer 28

1. Rare genetic Dz 2. Commonly triggered by use of succinylcholine A. Causes uncontrolled release of Ca → intracellular calcium in skeletal muscle

Question 29

What is the pathophys of malignant hyperthermia?

Answer 29

1. Characterized by intense muscle contraction 2. Muscle contraction leads to hypermetabolic state A. Hyperthermia, tachycardia, metabolic acidosis, hypercapnia