Peri-Op 101 > Anesthesia > Flashcards

Anesthesia Flashcards

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1
Q

What is ASA I?

A

A normal healthy patient.

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2
Q

What is ASA II?

A

A patient with mild systemic disease.

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3
Q

What is ASA III?

A

A patient with severe systemic disease.

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4
Q

What is ASA IV?

A

A patient with severe systemic disease that is a constant threat to life.

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5
Q

What is ASA V?

A

A moribund patient who is NOT expected to survive without the operation.

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6
Q

What is ASA VI?

A

Patient declared brain-dead, organs removed for donor purposes.

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7
Q

Main equipment used by anesthesia?

A
  1. Anesthesia machine to deliver O2 and gases.
  2. IV pumps for IV anesthetics and vasoactive meds.
  3. Warming devices for pt and fluids.
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8
Q

What is the bispectral index monitor used for?

A

Assess the depth of anesthesia.

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9
Q

What does cardiovascular monitoring include, for anesthesia?

A
  1. Arterial Line
  2. Central venus pressure line
  3. Pulmonary artery catheter
  4. Transesophageal echocardiography
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10
Q

What does basic monitoring include, for anesthesia?

A
  1. O2
  2. BP
  3. ECG
  4. Temp
  5. End-Tidal CO2 or Capnography
  6. Nerve stimulation to assess depth of muscle relaxation
  7. Urine output
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11
Q

What are the five types of anesthesia?

A

General, MAC, moderate sedation, local, regional

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12
Q

Which types of anesthesia require an anesthesia professional?

A

General and MAC.

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13
Q

What are the phases of anesthesia?

A
  1. Induction
  2. Maintenance
  3. Emergence
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14
Q

What happens during IV Induction?

A

Anesthetic agents injected into patient’s IV:

  1. Propofol
  2. Narcotics (fentanyl)
  3. Sedatives (midazolam/versed)
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15
Q

What happens during inhalational induction?

A

Patient breathes in inhalational anesthetic via face mask. Common in children, sometimes for adults w/o IV access:

  1. Sevofluorane with or without nitrous oxide

***THRASHING upon waking!

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16
Q

What are common muscle relaxants used in anesthesia?

A
  1. Succinylcholine (short-acting)
  2. Rocuronium/vecuronium (intermediate-acting)
  3. Pancuronium (long-acting)
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17
Q

What is the technique used for maintaining anesthesia using short infusions of short acting IV agents without inhalational anesthetics?

A

TIVA. Total IV anesthesia. Propofol and remifentanil are commonly used for TIVA.

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18
Q

What is the reversal agent for rocuronium, vecuronium and pancuronium?

A

Sugammadex

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19
Q

What is the reversal agent for narcotics like fentanyl?

A

Naloxone (narcan)

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20
Q

What is the reversal agent for benzodiazepines, like midazolam?

A

Flumazenil (romazicon)

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21
Q

What is the reversal agent for muscle relaxants like succinylcholine?

A

No reversal agent, other relaxants can be reversed with neostigmine or edrophonium.

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22
Q

What type of airway maintenance requires a muscle relaxant?

A

ET Tube.

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23
Q

NO fatty or fried foods and meat for… how many hours?

A

8 Hours

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24
Q

NO light meal… how many hours?

A

6 Hours

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25
NO clear liquids... how many hours?
2 Hours
26
Cricoid is needed during induction for what reason?
Prevent aspiration & occlude esophagus. Visualize vocal cords Place ET Tube Required for a "rapid sequence" induction
27
Where is the cricoid cartilage?
First ring below the thyroid cartilage.
28
What does firm pressure on the cricoid cartilage do?
Occlude the esophagus.
29
The periop nurse should be at the bedside during...
Induction & Emergence
30
Women at risk for hypotension after initiation of regional anesthesia include:
1. Older than 35 years | 2. BMI over 29 kg/m2
31
What is regional anesthesia?
Local anesthetic next to nerves. Prevents pain and movement.
32
What are examples of regional anesthesia?
1. Epidural block 2. Spinal Block 3. Peripheral Block 4. Eye block
33
Local anesthetics commonly used for regional include:
Lido, bupivacaine, ropivacaine
34
What can be used for long-acting spinal anesthesia?
Tetracaine
35
Additional drugs can be added to local anesthetic. What does epi and bicarb do?
Epi: increase the density and duration of a regional block Bicarb: reduces acidity of local and speeds the onset of the block
36
What is neuraxial anesthesia?
Placement of local near the spinal cord.
37
Two types of neuraxial anesthesia?
Spinal and Epidural.
38
During spinal, where is the local injected?
The subarachnoid space is entered and local is injected into the spinal canal.
39
Potential complications of spinal?
Hypotension, decreased RR, headache post-op.
40
Where is the needle advanced during epidural anesthesia?
Find the space between the ligamentum flavum and dura. The space is identified by a loss of resistance as the needle is advanced.
41
Complications of an epidural:
Dural puncture Subarachnoid injection Intravascular injection.
42
Intravenous Regional Anesthesia is also called...
Bier Block
43
The Bier Block can be used for procedures on the _____?
Hand, wrist, forearm.
44
The Bier Block is performed as follows:
1. IV in operative arm 2. Tourniquet applied on upper arm. 3. Arm raised. 4. Cuff inflated. 5. Local injected into IV. Anesthetic lasts until tourniquet is deflated.
45
Three examples of local:
1. Amino esters (procaine, tetracaine) 2. Amino amides (lido, prilo, bupivacaine) 3. Ropivacaine
46
Describe Local Anesthetic Systemic Toxicity (LAST)
Unsafe amounts of local enter the bloodstream.
47
Sings of LAST?
Ringing in the ears Tingling around the lips Dizziness Metallic taste in the mouth
48
LAST can progress to....
Seizures, respiratory arrest, cardiac arrest.
49
What is malignant hyperthermia triggered by?
Inhaled general anesthetic agents and muscle relaxant, succinylcholine.
50
MH can lead to... ?
cardiac arrest, brain damage, organ failure, and death
51
Common initial signs of MH?
Tachycardia and HTN. Tachypnea and increased minute ventilation are more specific to MH but may be masked if given muscle relaxants and ventilation is controlled.
52
The MOST SPECIFIC sign of MH?
Increased end-tidal carbon dioxide, and is seen on the capnography monitor.
53
What is the drug to treat MH?
Dantrolene.
54
How do you prepare Dantrolene?
Dilute with sterile water for injection, USP (without bacteriostatic agent)
55
How much dantrolene do you administer for MH?
2.5 mg/kg IV
56
How does AORN define hypothermia?
Body temperature <36C or <96.8F
57
These patients are at an increased risk for hypothermia:
Old pts (decreased effectiveness of natural responses) Infants (larger surface area relative to their wt) Women Low body wt
58
Core body temperature definition:
The temperature of blood and internal organs. Correlates with the temp measured in the bladder, oral cavity, axilla.
59
Passive warming devices:
1. Blankets 2. Drapes 3. "Space blankets" and Plastic sheeting
60
Active warming devices:
1. Circulating water garments 2. Radient Warming 3. Forced Air 4. Room temp 5. Warmed IV fluids and gases
61
When is it appropriate for the periop nurse to release cricoid pressure?
After ET tube is inflated and position is confirmed. Cricoid pressure occludes esophagus, prevents aspiration, helps for visualization of vocal chords.
62
When is the ET or LMA removed?
When the patient is conscious and able to maintain the airway.
63
A nurse performing conscious sedation needs to be competent in what?
Monitoring pts undergoing sedation, airway assessment, resuscitative equipment and drugs, ACLS.
64
During IV regional anesthesia (Bier Block), the tourniquet should be deflated slowly to prevent what from entering the circulation?
to prevent a bolus of local anesthetic from entering the systemic circulation
Peri-Op 101
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