NORA

Question 1

ASA NORA guidelines

Answer 1

1. Oxygen and backup
2. Suction
3. Scavenging System
4. Resus Bag (90% fio2)
5. Drugs, Supplies for Proc
6. Monitoring
7. Electrical Outlets
8. Space
9. Crash Cart
10. Communication, 2 way
11. Observation of Codes
12. PACU

Question 2

When to consider GA…

Answer 2

longer procedures

Question 3

JCAHO anesthesia definition

Answer 3

admin of IV, IM or inhalation agents that may result in loss of protective reflexes

Question 4

Should pts expect same standard of care outside of OR when receiving sedation/anesthesia?

Answer 4

yea, duh

Question 5

Needed for transport to recovery area…

Answer 5

oxygen and monitoring

emergency meds

Question 6

Office based anesthesia: general

Answer 6

• pt needs full preop workup
• difficult airway not ideal
• prop, des, nitrous, sevo

Question 7

Office based anesthesia: JCAHO and ASA guidelines

Answer 7

• trained, credentialed personnel
• maintained anes equip
• documentation tool
• monitors and emerg equip
• PACU and trained nursing
• protocols

Question 8

Radiation exposure can cause

Answer 8

• leukemia & fetal abnormalities
• dosimeters required (max 50 mSv annually
• lead

Question 9

Iodinated contrast media

Answer 9

old= hyperosmolar and toxic
new = lower osmolality & improved s/e

Question 10

Predisposing factors for rxn to contrast media…

Answer 10

hx of bronschospasm, allergy, cardiac disease, hypovolemia, hematologic disease, renal dysfunction, extremes of age, enxiety, meds (betablockers, aspirin, NSAIDs)

Question 11

Pre-treatment for contrast media…

Answer 11

• prednisone 50 mg, 12 hrs before

- benedryl 50 mg immediately before

Question 12

Mild rxn to contrast media

Answer 12

nausea, perception of warmth, headache, itchy, rash, hives

Question 13

severe rxn to contrast media

Answer 13

vomiting, rigors, feel faint, chest pain, severe hives, bronchospasm, dyspnea, arrythmias, renal failure

Question 14

life-threatening rxn to contrast media

Answer 14

glottic edema/bronchospasm, pulmonary edema, arrythmias, cardiac arrest, seizures

Question 15

Treatment of contrast reaction

Answer 15

oxygen
bronchodilators
epi
corticosteroids
antihistamines

Question 16

Metformin & contrast media

Answer 16

-pts can develop life-threatening lactic acidosis (NIDDM)

Question 17

Which med has been shown to decrease nephrotoxicity with admin of contrast media?

Answer 17

acetylcysteine

Question 18

CT

Answer 18

• need immobility

- inaccessibility to pt

Question 19

MRI

Answer 19

• good soft tissue contrast
• no ionizing radiation
• movement = artifact
• thermal injury potential
• magnet is always on

Question 20

Is hearing protection mandatory for MRI?

Answer 20

yes, > 90 dB

Question 21

MRI contraindications

Answer 21

schrapnel, vascular clips, shunts, spiral ETT, pacemaker, some tattoo ink

Question 22

Is deep sedation advisable for MRI?

Answer 22

No, you don’t have good access to the pt

Question 23

Which procedures often require deliberate hypotension and deliberate hypocapnia?

Answer 23

cerebral and dural AVM’s, coiling, etv.

Question 24

When may deliberate HTN be called for?

Answer 24

cerebral ischemia - want to maximize collateral blood flow

Question 25

Cerebral coiling

Answer 25

- deep sedation --> GA spectrum - always 2 IV, art-line - fluid warmer, upper bair - ACT's - goal 2-2.5x normal

Question 26

Why is smooth emergence so important in IR?

Answer 26

-prone to device migration or intracranial hemorrhage

Question 27

Stenosis of coronary artery >50-70% the normal diameter indicates...

Answer 27

- pt considered hemodynamically significant | - after dilation of stenotic coronary artery, ventricular arrhythmias may develop

Question 28

Glucagon

Answer 28

-decreases spasm at sphincter of oddi, but can cause sinus tachycardia

Question 29

If sphincter of oddi manometry is being performed, which meds should be avoided?

Answer 29

glucagon, opioids, glycopyrrolate & atropine

Question 30

TIPS procedure

Answer 30

- transjugular intrahepatic prtosystemic shunt - decompresses portal circulation - minimal stim, 2-3 hrs

Question 31

TIPS considerations

Answer 31

- airway - aspiration - decreased FRC d/t ascites - esophageal varices - coagulopathy - hepatic encephalopathy

Question 32

ECT therapy response

Answer 32

- grand mal (10-15 second tonic phase, 30-60 second clonic phase) - increased CBF & ICP - bradycardia --> HTN and tachy - muscle aches, fractures - sudden death

Question 33

Contraindications to ECT

Answer 33

absolute: pheochromocytoma relative: increased ICP recent CVA, CV conduction defects, high risk pregnancy, aneurysms

Question 34

ECT anesthesia considerations

Answer 34

-bite block -maybe paralytic to prevent injury -toradol 15-30 mg -hyperventilate w/ 100% goal = seizure lasting 30-60 seconds

Question 35

Preferred NMB for ECT

Answer 35

anectine (0.75-1.5 mg/kg)

Question 36

ECT: robinul & atropine

Answer 36

can prevent parasympathetic effects of ECT (salivation, bradycardia, asystole)

Question 37

ECT: labetolol & esmolol

Answer 37

labetolol 0.3 mg/kg esmolol 1 mg/kg aid in hemodynamic response, esmolol has lesser effect on seizure duration

Question 38

ECT: clonidine & precedex

Answer 38

control BP without effecting seizure duration

Question 39

Seizure activity causes...

Answer 39

initial parasympathetic discharge --> bradycardia.

Question 40

Are arrythmias a contraindication to ECT therapy?

Answer 40

not in themselves...need other reasons

Question 41

Most common cause of death with ECT

Answer 41

MI & arrythmias

Question 42

Dental surgery: ketamine

Answer 42

``` IV = 1-2 mg/kg IM= 2-4 mg/kg oral = 5-10 mg/kg ```

Question 43

Minimal sedation (anxiolysis)

Answer 43

-respond normally, just chill

Question 44

Moderate sedation/analgesia | "conscious sedation"

Answer 44

-still follow commands either alone or with light tactile stim

Question 45

Deep sedation/analgesia

Answer 45

- not easily aroused, but respond to noxious stim | - may need some airway support

Question 46

General anesthesia

Answer 46

- not arousable | - cannot protect airway

Question 47

Ramsay scale

Answer 47

1-6 1- anxious 2- normal 6- no response

Question 48

Modified Aldrete

Answer 48

adds up used in PACU need 9 or better to get out of pacu

Question 49

NPO guidelines

Answer 49

meal - 8 hrs | clears 2-4 hrs

Question 50

PACU guidelines

Answer 50

VS q10 mins x 3 then q1hr x2, or until fully recovered using aldrete score if pt was resus, then need an hour