18. Misc Monitors Flashcards
1
Q
febrile
A
> 38C
2
Q
hypothermia
A
<36C
3
Q
room temp
A
23C
4
Q
OR recommended temp
A
20-24C
5
Q
temp monitoring sites
A
blood from PAC
esophageal
rectal
nasal
bladder
skin/axillary
6
Q
most accurate estimate of core temp
A
blood from PAC
7
Q
most consistently reliable estimate of core temp
A
esophageal
8
Q
nasal temp is ______ than esophageal
A
less accurate
9
Q
when is bladder temp reliable
A
with adequate urine output
10
Q
not accurate reflections of core temp
A
skin
axillary
11
Q
reasons for temp loss
A
redistribution (vasodilation)
IV fluids
blood products
VA
radiation/evap/convection/conduction
12
Q
1 reason a pt gets cold in GA/Spinal/Epidural
A
vasodilation causes temp redistribution
13
Q
how much heat do you lose in the first 60 mins of anesthesia?
A
1.6C
14
Q
radiation heat loss
A
60%
15
Q
evaporation heat loss
A
20%
16
Q
convection heat loss
A
15%
17
Q
conduction heat loss
A
5%
18
Q
hypothermia CV effects
A
bleeding
decr SV
bradycardia
arrythmia
incr blood viscosity
19
Q
hypothermia metabolic effects
A
decr drug metabolism
delayed emergence
decr wound healing
shivering
20
Q
hypothermia resp effects
A
respiratory depression
left shift
21
Q
hypothermia neurologic effects
A
decr CBF
incr cerebral vascular resistance
22
Q
hypthothermia renal effect
A
decr GFR
impaired renal function
23
Q
for every _____ drop in temp, CBF decreases _____
A
for ever 1 C drop in temp, CBF decreases 5-7%
24
Q
how much does shivering incr O2 consumption
A
5X
25
when is shivering more likely
lower intraop temp
longer sx
higher [VA]
26
shivering treatment
warm pt
demerol (25mg)
27
esophageal stethoscope purposes
measure temp
listen to heart/lung sounds
28
precordial stethoscope
popular in peds
constant lung sounds
29
goal for urine output
0.5-1 mL/kg/hr
30
TEE estimates
EF
CO
heart valve patency
pulmonary artery pressure
31
which monitor is the best for diagnosisng venous air embolism
TEE
32
BIS sedation
65-85
33
BIS GA
40-65
34
BIS oversedation
<40
35
clinical uses for BIS
TIVA
"sick" pts who do not tolerate normal dosing
prevent anesthetic overdose
36
is BIS useful to prevent awareness?
no
37
high BIS during emergence
faster emergence
38
lower BIS during emergence
slower emergence
39
BIS monitoring is shown to
decr time to extubation
decr PACU/hospital stay length
decr PONV
decr porpofol use
40
does nitrous affect the BIS
no
41
does ketamine affect the BIS
can increase
42
rainbow SpHb probe pulse wavefortm
SVV
43
SVV represented by
PVi
44
PVi value that indicates hypovolemia
>14
45
rainbow SpHb measures
SVV
[hb]
SpO2 / pulse rate
SpOC (CaO2)
Pi (perfusion index)
46
weak perfusion index (weak pulse)
Pi = 0.02%
47
strong pulse perfusion index
Pi = 20%
48
Pi can be affected by
temp
tighness of sensor
49
when is SpO2 unreliable
Pi < 0.4%
50
sedline give us
brain wave spectrogram (DSA)
spectral edge frequency (SEFL and SEFR)
patient state index (PSI)
51
brain wave spectrgram frequency bands
alpha
beta
delta
theta
52
alpha
8-12 hz
green
53
beta
13-30hz
blue
54
delta
0.5-4hz
55
theta
4-8hz
56
beta waves are produced
middle of deep thinking
57
alpha waves relate to
creativity
daydreaming
58
when are delta/theta waves found
deep sleep
59
specral edge frequency monitor indication
white line in spectrogram
60
what does the SEF tell us
95% of pts brain wave activity is BELOW that frequency
61
goal SEF for GA
mid-teens and LOWER
62
which monitor is the PSI similar to?
the BIS
63
recommended range for PSI for GA
25-50
64
PSI > 50
pt is too light
65
what falsely elevates PSI number
EMG (muscle movement)
artifact (Cautery)
66
PSI high
no artifact
no EMG
pt is light
67
PSI high
artifact or emg present
pt may or may not be light
68
what doe vertical white lines indicate
artifact
69
what do vertical black lines indicate
periods of burst suppression
(pt is very deep)
70
what might you see in a pt with several periods of burst suppression:
several vertical black lines on DSA
suppression ration increase
PSI decrease
71
how much is the PSI delayed
20-40s
72
how much is SEF delayed
it is not delayed
73
is SEF affected by articat/muscle activity?
no
74
cerebral oximeter
give O2 saturation number in cerebral vessels
rSO2
75
cerebral oximeter uses what technology
near-IR spectroscopy (NIRS)
76
cerebral oximetry is an indicator of
cerebral perfusion
77
what indicates low cerebral perfusion
low rSO2 value
78
clinical use for cerebral oximetry
beach chair/sitting
heart surgery
79
when should you be concerned with rSO2 levels?
rSO2 < 50%
20%+ drop from baseline rSO2
>30% difference between L and R hemispheres
80
which rSO2 values are associated with poor neurologic outcomes
<45% absolute
>25% declines
81
what decreases rSO2
decr CBF
hypotension
hyperventilation (low CO2)
hypoxemia (decr SaO2)
anemai
mechanical distrubances
82
michancial distubracnes that decr rSO2
vascular occlution/compression
embolic events
clamping
dissection
83
how to incr cerebral SpO2
incr FiO2
incr cerebral perfusion pressure (incr MAP / decr ICP)
incr EtCO2
incr hematocrit
hypothermia (dec metabolism)
check head/neck positioning
NTG (decr MAP)
84
how to decr ICP
mannitor
lumbar drain
85
masimo cerebral oximeter measures
current rSO2 (blue)
baseline rSO2 (green)
change in rSO2 (red)
86
left oximeter probee slot
1
87
right oximeter probe slot
2
88
when do you set baseline for cerebral oximeter
before preoxygenation
89
evoked potentials alert sx to
nerve ischemia or damage
90
amplitude
wave height
91
latency
time form onset to peak
92
nerve damage/ischemis
decr amplitude
incr latency
93
anesthetics
decr amplitude
incr latency
94
what can the AA do if the evoke potential change intraooperatively not related to nerve damage?
incr BP
95
Evoked potentials: VA
decr amplitdue
incr latency
96
evoke potentials: N2O
decr amplitude
no change latency
97
EP: Propofol
decr amplitude
incr latency
98
EP: versed
decr amplitude
no change latency
99
EP: ketamine
incr amplitude
incr latency
100
EP: etomidate
incr amplitude
incr latency
101
which drugs incr amplitude of EP
ketamine
etomidate
102
whcih drugs incr latency of EP
VA
propofol
ketamine
etomidate
103
which durgs have not change to latency
nitrous
versed
104
types of EP
SSEP
MEP
BAEP
VEP
105
SSEP monitor
sensory nerves
106
SSEPs travel through
dorsal/posterior pathways
107
what can be dosed during SSEPs
muscle relaxants
(no impact to sensory)
108
MEPs stimulate
motor nerve
109
MEPs travel through
anterior/lateral pathways
110
MEPs are ________ sensitive to VA than SSEPs
more sensitve
111
can you use MR with MEPs
no
112
BAEPs measure
vestibulocholear nerve (VIII)
113
which evoked potential are least effected by anesthetics
BAEPs
114
VEPs measure
optic nerve integrity
115
which evoke potential are most affected by anesthetics
VEP
116
EP anesthetic management
<0.5 MAC
constant anesthetic level
avoid MR for MEPs
117
supplement VA w/
propofol
narcotic drips
118
propofol has a _______ effect on EP if it is infused
propofol has a _______ effect of EP if it is bolused
lower effect for infusion
higher effect for bolus
