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Basic Principles > 3 - Complications and PACU > Flashcards

3 - Complications and PACU Flashcards

1
Q

Estimated mortality related to anesthesia

A

1:10,000

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2
Q

Incidence of Awareness during general anesthesia

A

20:10,000

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3
Q

Incidence of Damage to Teeth

A

2-5:10,000

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4
Q

Percentage of Elderly Patients with Post-Op cognitive dysfunction

A

16%

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5
Q

Key Factors in prevention of patient injury

A

Vigilance Adequate Monitoring Up-To-Date Knowledge

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6
Q

What are critical incidents?

A

Near misses

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7
Q

What are sentinel events?

A

single, isolated events that may indicate a systemic problem

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8
Q

To be successful in a malpractice suit, the plaintiff must prove: (4)

A

Duty: That the anesthesiologist owed the patient a duty

Breach of duty: That the anesthesiologist failed to fulfill his or her duty

Causation: That a reasonably close causal relation exists between the anesthesiologist’s acts and the resultant injury

Damages: That actual damage resulted because of a breach of the standard of care.

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9
Q

doctrine of res ipsa loquitor

A

“The thing speaks for itself”

Burden of proof is on the physician instead of the patient if:

typically would not occur in the absence of negligence.

caused by something under the exclusive control of the anesthesiologist.

not attributable to any contribution on the part of the patient.

evidence for the explanation of events is more accessible to the anesthesiologist than to the patient.

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10
Q

What are the three types of damages?

A

General: damages for pain and suffering

Special: actual damages from bills, lost income etc

Punitive: intended as punishment

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11
Q

Proof in a malpractice case only means:

A

more likely than not

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12
Q

What is a Type I hypersensitivity reaction?

A

immediate hypersensitivity

occurs with 15-30 min

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13
Q

What is the most important moderator of type 1 hypersensitivity reactions?

A

Histamine

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14
Q

What are the two triggers of Type 1 hypersensitivity reactions?

A

IgE (requires prior exposure to substance)

Non-IgE (anaphylactoid, can occur on first exposure to substance)

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15
Q

What is the treatment for Type 1 hypersensitivity reactions?

A

Anithistamines

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16
Q

Most anesthesia related hypersensitivity reactions are _________

A

Type I IgE mediated Type 1 reactions

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17
Q

Which anesthetic drugs account for 50-70% of hypersensitivity reactions?

A

NMBAs

Believed to be caused by the ammonium structure

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18
Q

What is a Type II hypersensitivity reaction?

A

Cytotoxic hypersensitivity

Mediated by IgM or IgG

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19
Q

What are some examples of Type II hypersensitivity?

A

Type I DM

Myasthenia Gravis

Thrombocytopenia

Transfusion Reactions

Goodpasture’s nephritis

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20
Q

What is the treatment for a Type II hypersensitivity reaction?

A

Anti-inflammatory and immunosuppressive agents

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21
Q

What is a Type III hypersensitivity reaction?

A

Immune complex hypersensitivity

Failure of the immune system to get rid of antibody-antigen complexes

These complexes lodge in joints and tissues where they activate complement and stimulate mediators

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22
Q

What are some examples of Type III hypersensitivity reactions?

A

SLE

RA

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23
Q

What is a Type IV hypersensitivity reaction?

A

cell mediated or delayed type hypersensitivity

takes 24 hours to 14 days

NO ANTIBODIES INVOLVED

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24
Q

What are some examples of Type IV hypersensitivity reactions?

A

Contact hypersensitivity (like poison ivy)

granulomatous sensitivity (TB or leprosy)

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25
Q

What is a Type V Hypersensitivity Reaction?

A

results from auto-antibodies that bind and stimulate specific cell targets

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26
Q

What is an example of a Type V Hypersensitivity Reaction?

A

Graves Disease

antibodies stimulate the TSH receptor on the thyroid gland, leading to excessive secretion of thyroid hormone

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27
Q

What is alloimmunity?

A

response of the immune system towards the tissues of other members of the same species

blood transfusions, GVHD, organ transplants

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28
Q

What is transient neonatal disease?

A

Alloimmunity

Rhogam

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29
Q

What is autoimmunity?

A

Abnormal response to self antigens resulting in production of self-antibodies and damage to self tissues

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30
Q

The highest incidence of MH is in ________

A

children under 15

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31
Q

How is MH susceptibility inherited?

A

autosomal dominant

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32
Q

What drug should never be administered with dantrolene?

A

Ca Channel Blockers

Leads to life threatening myocardial depression and hyperkalemia

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33
Q

What does dantrolene do?

A

Binds to the ryanodine calcium channel and reduces calcium efflux from SR

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34
Q

Which patients should have core temperature monitoring?

A

Any patient under GA for more than 30 minutes

35
Q

Why is mild respiratory acidemia expected in PACU patients?

A

atelectasis and decreased MV

36
Q

A laryngospasm can be overcome by:

A
  1. Continuous positive pressure of 10-20mmHg
  2. Small dose of succ (not an induction dose) or propofol
37
Q

A severe laryngospasm can be caused by excision of the _______

A

parathyroid d/t acute hypocalcemia

38
Q

What effect does histamine have on bronchial smooth muscle tone?

A

Vasoconstricts

39
Q

Patients who have increased airway pressure preop are at risk for _________ post op

A

bronchospasm

40
Q

Increased airway resistance is manifested by:

A

wheezing

41
Q

Which has more cardiovascular effects: albuterol or racemic epi?

A

Racemic Epi

42
Q

Besides Levalbuterol and Epi nebs, what other meds can reduce elevated airway resistance?

A

isoproterenol neb

IM or sublingual terbutaline

Anticholinergics (atropine)

Epinephrine drip (if severe)

43
Q

What metrics indicate readiness to come off mechanical ventilation?

A

Raise head for 10 seconds

Forced vital capacity of 10-12 ml/kg

Insp > -25

Tactile TOF

44
Q

During anesthesia, how is CO2 production impacted?

A

Decreased by 60%

45
Q

What is the difference between compliance and elasticity?

A

Compliance is the ease with which you can stretch something

Elasticity is the strength of recoil from stretch

46
Q

What are the three factors that influence lung compliance?

A

Elasticity of the lungs

Elasticity of the chest wall

Surface Tension

47
Q

What happens to compliance and elasticity in pulmonary fibrosis?

A

The compliance decreases, because the lungs don’t want to stretch.

BUT the elasticity increases, because as the pressure goes up and volume goes down, elasticity increases

48
Q

What happens to compliance and elasticity in emphysema?

A

The elastic tissue over alveoli and lung tissues is broken down, so elasticity is increased

BUT

compliance is increased (because the lung can easily inflate, but it can’t snap back)

49
Q

What happens to compliance and elasticity of the chest wall in patients with Ankylosing Spondylitis/Kyphosis/Scoliosis?

A

Chest wall compliance is decreased (difficult to expand)

There isn’t a huge change in elasticity, most of the disease process is due to decreased compliance

50
Q

When alveolar surface tension is increased, what happens to compliance?

A

Compliance is decreased and elasticity is increased

Very high work of breathing to get those alveoli to expand

51
Q

What osmolality, pH, and sodium concentration in urine is reassuring that tubules are intact and functional?

A

They should be disparate from serum values

if values closely resemble serum values, it is non-reassuring

52
Q

What is the most common occular complication in general anesthesia?

A

Corneal abrasion

53
Q

Which tooth is number one?

A

Back tooth on right side of upper mandible

54
Q

The front teeth are numbered

A

8 & 9

55
Q

The middle bottom two teeth are numbered

A

24 & 25

56
Q

How long do sensory neuropathies usually last?

A

5 days

57
Q

PACU stay is increased by ________ minutes by hypothermia

A

40-90 min

58
Q

Postop hypothermia causes:

A

Increased SNS

Decreased venous compliance

Increased PVR

59
Q

What diagnostics and labs would you perform on patient who has not emerged from anesthesia after 70 minutes?

A

End-tidal anesthetic concentration

Nerve stimulator

ABG

CT Scan

60
Q

What are some metabolic causes for delayed emergence?

A

Pseudocholinesterase Deficiency

Hypercarbia/hypoxia

Resp and metabolic acidosis

Hyper/hyponatremia

Hypo/hyperthermia

61
Q

What drug crosses the blood brain barrier and is used to reverse the anticholinergic effects of scopolamine and atropine

A

Physostigmine

62
Q

Emergence delirium is prevalent in which age bracket?

A

Children and young adults

63
Q

What should you bear in mind when caring for a postop myringotomy?

A

They are hearing normally for the first time, and may be very sensitive to sound

64
Q

When scopolamine is used in pre-treatment intraop, what can happen post op?

A

disorientation, combativeness, paranoia

can be reversed with physostigmine

65
Q

How long do most emergence reactions last?

A

10-15 minutes

66
Q

Avoiding which drugs reduces the risk of post op delirium?

A

Benzos

Anticholinergics

meperidine

67
Q

Which has a lower instance of PONV: TIVA or Inhalation?

A

TIVA, esp propofol

68
Q

Laryngospasm may be caused by a closure of the glottis by _________

Or a closure of the larynx by __________

A

Glottis = intrinsic muscles

larynx = extrinsic muscles

69
Q

Glottic closure manifests as _______

Larnyx closure manifests as ________

A

intermittent obstruction

complete obstruction

70
Q

If succinylcholine is effective in resolving a laryngospasm, you must still:

A

support breathing for 5-10 min with bag ventilation

71
Q

Negative-pressure pulmonary edema is caused by _________

A

a decrease in interstitial pressure

72
Q

What is the most common cause of postop hypoxemia?

A

atelectasis

73
Q

Virchow’s Triad

A

Venous Stasis

Hypercoaguability

Vessel Damage

74
Q

What is another name for chemical pneumonitis

A

Mendelson Syndrome

75
Q

In an intubated patients, Bronchospasm is caused by increased ______ which manifests as ______

A

airway resistance

increased peak inspiratory pressure

76
Q

Increased _____ (electrolyte) and decreased ____ may prolong anesthesia blockade

A

magnesium

potassium

77
Q

Hypothermia contributes to which two dysrhythmias?

Why?

A

sinus brady, a fib

prolongs the refractory period

78
Q

Name three herbal supplements that can cause delayed awakening

A

Kava kava

St. John’s Wort

Valerian

79
Q

Serotonin Syndrome can look like _________

A

MH or delayed awakening

80
Q

How does zofran work?

A

Blocks serotonin receptors in the vomiting center

81
Q

How does Haldol or Droperidol assist with nausea?

A

blocks dopamine receptor sites in the vomiting center

82
Q

How do compazine and reglan work?

A

Block dopamine receptors

83
Q

How do phenergan and benadryl help with nausea?

A

Block histamine receptors

84
Q

How does a scop patch help with nausea?

A

Blocks muscarinic receptors

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