3 - Non OR Anesthesia Flashcards
What age of children are at greatest risk for complications with anesthesia?
under 5, even with no underlying disease
When using nitrous oxide in peds, what should be avoided?
Giving it with other sedative medications
associated with adverse events
When sedating a child for RFCA, what type of anesthetic is optimal?
Total IV
Procedure blocks 25% of CO, and often causes hemodynamic instability (briefly)
Dysrhythmias must be monitored for closely during RFCA.
Why?
Patients have to d/c their antiarrhythmics before the procedure
What is one extremely rare but often fatal complication of RFCA?
esophageal ulceration or atrioesophageal fistula
Should always use esophagel temp probe
What medication is not used in ART?
morphine
may allow more than one sperm to fertilize an egg
What is periodontics?
Deals with structures surrounding and supporting teeth (gums)
What is endodontics?
diseases and injuries of the pulp and root
In dental cases, which nerves will primarily transmit pain?
maxillary and mandibular branches of trigeminal
What medication regimen is preferred for periodontal and endodontal procedures?
versed and prop drip
What happens to cerebral blood flow and ICP during ECT?
increases 100-400% above baseline
ICP is increased
What are absolute contraindications to ECT?
Pheochromocytoma
Recent MI, CVA or intracranial surgery
intracranial mass lesion
unstable C Spine
Which anethesia related drugs are proconvulsants?
etomidate
ketamine
What respiratory alteration is proconvulsant?
Hypocarbia/Hyperventilation
Medications that shorten seizure duration:
versed/ativan/diazepam
Dilt
Fentanyl
Lidocaine
Prop
Sevo
What effect do clonidine and precedex have on seizure activity?
None
The most common pacu complication of ECT is
postictal agitation
for about 30 min after seizure
Short term memory loss for 2-3 days
How are the sympathetic and parasympathetic nervous systems stimulated?
Sequentially
May have increased bp followed by bradycardia or asystole
How can transient cardiac changes be attenuated prior to ECT?
Anticholinergics
IV lidocaine
IV narcotics (like remifentanil)
What are two new therapies for MDD?
repetitive Transcranial Magnetic Stimulation (rTMS)
Vagus Nerve Stimulation (VNS)
Studies suggest patients with MDD have dysfunction where?
frontal cortical-subcortical-brainstem neural network
specifically the dorsolateral prefontal cortices
What are the drawback to using ECT and antidepressants for MDD?
they don’t act in the descrete dysfunctional areas of the brain suspected to cause MDD
What is rTMS?
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
Of all the injuries occuring during monitored anesthesia care, how many are fatal?
34%!
What are the two major advantages of office-based procedures?
Cost containment
patient convenience
Injuries that occur in offices tend to be _________
of greater severity than in ambulatory centers
What are the three big causes of injury in office based settings?
Inadequate periop monitoring
Oversedation
Thromboembolic events
What percent of office based injuries were fatal or debilitating?
Ambulatory based?
65%!!!!!
21%
What percent of anesthesia procedures are performed in offices?
17-24%
During what phase of care do most office based injuries occur?
Intraop (64%)
Patents presenting for NOR procedures tend to have an ASA status ________ that patients presenting to standard ORs
HIGHER
Especially in gastro, cardiac and radiologic procedures
If sphincter of Oddi manometry is desired during ERCP, which drugs should be avoided?
Anticholinergics
Some Opiods
