3 - Non OR Anesthesia

Question 1

What age of children are at greatest risk for complications with anesthesia?

Answer 1

under 5, even with no underlying disease

Question 2

When using nitrous oxide in peds, what should be avoided?

Answer 2

Giving it with other sedative medications

associated with adverse events

Question 3

When sedating a child for RFCA, what type of anesthetic is optimal?

Answer 3

Total IV

Procedure blocks 25% of CO, and often causes hemodynamic instability (briefly)

Question 4

Dysrhythmias must be monitored for closely during RFCA.

Why?

Answer 4

Patients have to d/c their antiarrhythmics before the procedure

Question 5

What is one extremely rare but often fatal complication of RFCA?

Answer 5

esophageal ulceration or atrioesophageal fistula

Should always use esophagel temp probe

Question 6

What medication is not used in ART?

Answer 6

morphine

may allow more than one sperm to fertilize an egg

Question 7

What is periodontics?

Answer 7

Deals with structures surrounding and supporting teeth (gums)

Question 8

What is endodontics?

Answer 8

diseases and injuries of the pulp and root

Question 9

In dental cases, which nerves will primarily transmit pain?

Answer 9

maxillary and mandibular branches of trigeminal

Question 10

What medication regimen is preferred for periodontal and endodontal procedures?

Answer 10

versed and prop drip

Question 11

What happens to cerebral blood flow and ICP during ECT?

Answer 11

increases 100-400% above baseline

ICP is increased

Question 12

What are absolute contraindications to ECT?

Answer 12

Pheochromocytoma

Recent MI, CVA or intracranial surgery

intracranial mass lesion

unstable C Spine

Question 13

Which anethesia related drugs are proconvulsants?

Answer 13

etomidate

ketamine

Question 14

What respiratory alteration is proconvulsant?

Answer 14

Hypocarbia/Hyperventilation

Question 15

Medications that shorten seizure duration:

Answer 15

versed/ativan/diazepam

Dilt

Fentanyl

Lidocaine

Prop

Sevo

Question 16

What effect do clonidine and precedex have on seizure activity?

Answer 16

None

Question 17

The most common pacu complication of ECT is

Answer 17

postictal agitation

for about 30 min after seizure

Short term memory loss for 2-3 days

Question 18

How are the sympathetic and parasympathetic nervous systems stimulated?

Answer 18

Sequentially

May have increased bp followed by bradycardia or asystole

Question 19

How can transient cardiac changes be attenuated prior to ECT?

Answer 19

Anticholinergics

IV lidocaine

IV narcotics (like remifentanil)

Question 20

What are two new therapies for MDD?

Answer 20

repetitive Transcranial Magnetic Stimulation (rTMS)

Vagus Nerve Stimulation (VNS)

Question 21

Studies suggest patients with MDD have dysfunction where?

Answer 21

frontal cortical-subcortical-brainstem neural network

specifically the dorsolateral prefontal cortices

Question 22

What are the drawback to using ECT and antidepressants for MDD?

Answer 22

they don’t act in the descrete dysfunctional areas of the brain suspected to cause MDD

Question 23

What is rTMS?

Answer 23

Using magnetic fields to pass current along an electromagnetic coil and create pulses (train of stimuli)

Has few cognitive side effects than ECT

Much faster recovery

Question 24

Of all the injuries occuring during monitored anesthesia care, how many are fatal?

Answer 24

34%!

Question 25

What are the two major advantages of office-based procedures?

Answer 25

Cost containment

patient convenience

Question 26

Injuries that occur in offices tend to be _________

Answer 26

of greater severity than in ambulatory centers

Question 27

What are the three big causes of injury in office based settings?

Answer 27

Inadequate periop monitoring

Oversedation

Thromboembolic events

Question 28

What percent of office based injuries were fatal or debilitating?

Ambulatory based?

Answer 28

65%!!!!!

21%

Question 29

What percent of anesthesia procedures are performed in offices?

Answer 29

17-24%

Question 30

During what phase of care do most office based injuries occur?

Answer 30

Intraop (64%)

Question 31

Patents presenting for NOR procedures tend to have an ASA status ________ that patients presenting to standard ORs

Answer 31

HIGHER

Especially in gastro, cardiac and radiologic procedures

Question 32

If sphincter of Oddi manometry is desired during ERCP, which drugs should be avoided?

Answer 32

Anticholinergics

Some Opiods