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Basic Principles > 3 - Outpatient Anesthesia > Flashcards

3 - Outpatient Anesthesia Flashcards

1
Q

An infant with a history of apnea and bradycardia must be asymptomatic for ________ before being considered a candidate for outpatient surgery

A

6 months

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2
Q

The greatest at risk age for developing SIDS is:

A

1 month to 1 year

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3
Q

Infants whose siblings died of SIDS are ________

A

5x more likely to die than the general population

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4
Q

If an infant is at risk for SIDS, when can they be considered for outpatient procedures?

A

6 months to 1 year old

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5
Q

Premature infants are NEVER candidates for outpatient anesthesia because (4)

A
  1. Anemic
  2. Lack fully developed gag reflex
  3. Immature temp control
  4. Immatue brainstem function, may develop resp compromise
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6
Q

Why is a Hct less than 30% concerning in a newborn?

A

May increase incidence of apnea

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7
Q

Postoperative apnea in infants may last as long as:

A

12 hours after surgery

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8
Q

Healthy former premature infants whose postgestational age is less than ________ should be admitted for monitoring

A

50-60 weeks

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9
Q

When are full term healthy infants not candidates for outpatient surgery? (3)

A

apneic episodes

FTT

feeding difficulties

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10
Q

Patient age exceeding ____ is predictive of hospital admission after outpatient surgery

A

80

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11
Q

When should surgeries be scheduled for patients with convulsive disorders?

A

early in the day

will need to be monitored for 4-8 hours post op

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12
Q

Patients with cystic fibrosis are at an increased risk for _____ and _____

A

GERD

pulm aspiration

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13
Q

Malignant hyperthermia susceptible patients have at least one of these 5 conditions:

A
  1. Previous episode of MH
  2. Masseter muscle rigidity with previous sx
  3. 1° relative with PMH of MH
  4. Mutations on chromosome 19
  5. Heat induced rhabdomyolysis
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14
Q

List 4 diseases caused by chromosome 19 mutation

A

central core myopathy

King-Denborough syndrome

Native American Myopathy

HypoPP

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15
Q

How many vials of dantrolene should an outpatient facility have?

A

36 required

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16
Q

Which patients with OSA or suspected OSA are candidates for ambulatory surgery?

A

Comorbid conditions optimized

able to use CPAP after discharge

OR

postop pain can be managed with nonopioid analgesics

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17
Q

Sickle cell patients must meet what criteria to be a candidate for ambulatory anesthesia? (5)

A
  1. no major organ disease 2/2 SCD
  2. no crisis in past year
  3. compliant with care
  4. live within 15 minutes of the facility
  5. close follow up care possible
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18
Q

Patients with sickle cell disease are likely to develop sickle crisis if ________ occur (3)

A

acidosis

hypoxia

hypovolemia

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19
Q

When should a patient with sickle cell be scheduled for surgery?

A

Early in the day

Needs preop hydration and prolonged postop monitoring

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20
Q

Which morbidly obese patients are not candidates for outpatient anesthesia?

A

those with significant comorbid conditions like

angina

asthma

uncontrolled OSA

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21
Q

A patient with an ASA > ____ is not a candidate for outpatient anesthesia

A

3-4

22
Q

Patient evaluation should be within ______ hours for stable and ______ hours for high risk patients.

A

30

72

23
Q

When should serum potassium levels be obtained?

For which patients?

A

within 7 days of surgery for patients receiving dig or diuretics

24
Q

Who should have a preop BG?

A

patients with diabetes controlled with meds

25
Q

How do nasal mucosa appear with an infectious URI?

Allergic Rhinitis?

A

Red and inflamed

ashen and boggy

26
Q

After a Lower Respiratory Infection, bronchial reactivity may persist up to

A

6-8 weeks

27
Q

List three H2 receptor antagonists

A

cimetidine

famotidine

ranitidine

28
Q

List three gastric PPIs

A

Omeprazole

Pantoprozole

29
Q

Which has a longer duration of action: omeprazole or ranitidine?

A

Omeprazole

30
Q

Which inhalants are optimal for outpatient anesthesia?

A

desflurane and sevo

rapid on rapid off

31
Q

When should IV fluids be used?

A
  1. Procedure > 30 min
  2. Increased risk of PONV
  3. Post op discomfort likely
  4. Prolonged fasting
  5. risk for bleeding
  6. antibiotics required
32
Q

What are the most commons causes of hospitalization after outpatient surgery?

A

PONV and pain

33
Q

When should oral intake be required prior to discharge?

A

when it’s crucial to convalescence at home

diabeteic patients

patients requiring post op PO meds

34
Q

When is voiding mandatory before discharge?

A

history of postop retention

pelvic or urologic surgery

periop catheterization

35
Q

Which is common in children: direct or indirect inguinal hernia?

A

99% are indirect

more common in premature infants, especially boys

36
Q

60% of inguinal hernias occur on the ______ side

A

Right

37
Q

An elective surgery on a child with a URI is acceptable if:

A
  1. no fever
  2. no lower respiratory symptoms
  3. No purulent discharge
  4. No altered behavior (loss of apettite, disinterested in play)
38
Q

Which drug should be held preop: beta blocker or ace inhibitor?

A

Ace inhibitor. Most antihypertensives EXCEPT ACE/ARBs should be taken

39
Q

Four drugs that can help with shivering

A

demerol

ketamine

clonidine

tramadol

40
Q

In children, when are NSAIDs most effective?

A

When combined with pre-op rectal tylenol

41
Q

For anxious patients, what anxiolytic regimen is recommended preop?

A

2-5mg versed per 70kg

Taken the night before and at 6AM on the morning of the surgery (regardless of when their surgery is)

42
Q

For an anxious child in the preop holding area, what is the dose of oral versed?

A

0.25 mg/kg

43
Q

Which local anesthetic can be problematic in ambulatory care thanks to its long duration?

A

Bupivicaine

44
Q

Does bedrest reduce the likelihood of developing PDPH?

A

No

In fact early ambulation may help reduce risk

45
Q

When are caudal blocks most frequently used?

A

Children with infraumbilical operations

used as a supplement for anesthesia and to reduce postop pain

46
Q

What is the preferred induction agent for children?

A

Sevo

Smooth induction

fast on fast off

47
Q

Six ways to reduce incidence of PONV

A
  1. Use regional alone if possible
  2. If general, use prop instead of gas
  3. Avoid nitrous
  4. minimize opioids
  5. Avoid paralytics
  6. Consider adequate hydration
48
Q

Four predictors for PDNV

A

History of motion sickness

Previous PONV

Hx migraines

Pain upon discharge

49
Q

What is the CTZ

A

chemotactic trigger zone

in medulla

50
Q

How do versed and propofol affect PONV?

A

their antiemetic effects are longer lasting than their sedative effects

Basic Principles (15 decks)

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