Anes for Therapeutic/Diagnostic Procedures

Question 1

What is the number one challenge CT anesthesia?

Answer 1

Inaccessibility to the patient

Question 2

Deep sedation/analgesia are NOT advised for MRI–T/F?

Answer 2

True–recommend general with ETT or LMA

Bc it is difficult to access the patient’s airway and patient assessment/communication are limited

Question 3

Interventional radiology–these procedures (i.e.: embolization of cerebral and dural AVMs, coiling of cerebral aneurysms, angioplasty of sclerotic lesions, thrombolysis of acute thromboembolic stroke) often require deliberate ___tension and deliberate ___capnia

Answer 3

often require deliberate hypotension and deliberate hypocapnia

Question 4

Interventional radiology–deliberate ___tension is called for during cerebral ischemia in an attempt to maximize collateral flow

Answer 4

deliberate hypertension

Question 5

ECT is performed ___ times a week for ___-___ treatments

Answer 5

ECT is performed 3 times a week for 6-12 treatments

Followed by weekly or monthly maintenance therapy to prevent relapses

Question 6

MOA of ECT–ECT therapeutic effects are thought to result from the release of ___ during the electrically induced ___

Answer 6

ECT therapeutic effects are thought to result from the release of neurotransmitters during the electrically induced grand-mal seizure

Question 7

Neuroendocrine responses to ECT include ___ (increased/decreased) levels of stress hormones

Answer 7

Increased levels of stress hormones

i.e.: ACTH, cortisol, vasopressin, prolactin, growth hormone

Question 8

ECT–___ and ___ levels increase immediately after; ___ levels decrease more rapidly thereafter

Answer 8

norepi and epi levels increase immediately after; epi levels decrease more rapidly thereafter

Question 9

ECT–___ homeostasis is variably affected by ECT; improvement in control of ___ (insulin/non-insulin) dependent diabetes is generally noted, whereas hyperglycemia may be seen when the diabetes is ___ (insulin/non-insulin) dependent

Answer 9

glucose homeostasis is variably affected by ECT; improvement in control of non-insulin dependent diabetes is generally noted, whereas hyperglycemia may be seen when the diabetes is insulin dependent

Question 10

Physiologic response to ECT–grand mal seizure with ___-___ second ___ phase; ___-___ second ___ phase

Answer 10

grand mal seizure with 10-15 second tonic phase; 30-60 second clonic phase

Question 11

Other physiologic responses to ECT–___ (increased/decreased) CBF and ICP; CV–initial ___cardia followed by ___tension and ___cardia, ___rhythmias, myocardial ___; ___-term memory loss; muscle ___/___/___; status ___; sudden ___

Answer 11

increased CBF and ICP; CV–initial bradycardia followed by hypertension and tachycardia, dysrhythmias, myocardial ischemia; short-term memory loss; muscle aches/fractures/dislocations; status epilepticus; sudden death

Question 12

What is one absolute contraindication to ECT?

Answer 12

Pheochromocytoma

Question 13

Relative contraindications to ECT–increased ___ pressure; recent ___; CV ___ defects; high-risk ___; ___ and ___ aneurysms

Answer 13

Relative contraindications to ECT–increased intracranial pressure; recent CVA; CV conduction defects; high-risk pregnancy; aortic and cerebral aneurysms

Question 14

What muscle relaxant is preferred for ECT to prevent fractures/dislocations during the seizure?

Answer 14

Succs–0.75-1.5 mg/kg

Preferable to the longer acting nondepolarizing agents

Question 15

What medication helps reduce ECT-induced myalgia in younger patients?

Answer 15

Toradol 15-30 mg

Question 16

What (2) medications can prevent the parasympathetic effects of ECT (i.e.: salivation, bradycardia, asystole)?

Answer 16

Robinul and atropine

Question 17

What (2) meds lessen hemodynamic responses to ECT? Which of the two has less of an effect on seizure duration?

Answer 17

• Labetalol (0.3 mg/kg)
• Esmolol (1 mg/kg)

Esmolol has a lesser effect on seizure duration

Question 18

What (2) meds administered before induction of anesthesia for ECT are effective in controlling BP without affecting seizure duration?

Answer 18

• Clonidine (1 mcg/kg over 10 mins)

- Dexmedetomidine (1 mcg/kg over 10 mins)

Question 19

Complications of ECT–seizure activity causes an initial ___ discharge, manifested by ___cardia, occasional ___, premature ___, or a combo of these abnormalities; ___tension and ___ may be noted, and then ___ activity

Answer 19

seizure activity causes an initial parasympathetic discharge, manifested by bradycardia, occasional asystole, premature atrial or ventricular contractions, or a combo of these abnormalities; hypotension and salivation may be noted, and then sympathetic activity

Question 20

What (2) ECG changes may be seen after ECT? Do these changes indication myocardial infarction?

Answer 20

• ST-segment depression
• T-wave inversion

Occur without any myocardial enzyme changes consistent with myocardial infarction

Question 21

Arrhythmias associated with ECT, even in patients with preexisting arrhythmias, are self-limited and not in themselves a contraindication to treatment–T/F?

Answer 21

True

Question 22

What are the most common causes of death from ECT?

Answer 22

MI and arrhythmia

Question 23

ECT–goal is a seizure that is ___-___ seconds long

Answer 23

30-60 seconds long

Question 24

Dental surgery for patients with Down syndrome–patients often have CV abnormalities–___ abnormalities and ___ defects; risk of ___ dislocation; airway difficulties–___glossia, ___plastic maxilla, ___ abnormalities, mandibular ___

Answer 24

CV abnormalities–conduction abnormalities and structural defects; risk of atlanto-occipital dislocation; airway difficulties–macroglossia, hypoplastic maxilla, palatal abnormalities, mandibular protrusion

Question 25

What are (3) major post-op complications for dental surgery?

Answer 25

• Bleeding
• Airway obstruction
• Laryngospasm

Question 26

What are the (4) stages of sedation and analgesia?

Answer 26

• Minimal sedation (anxiolysis)
• Moderate sedation/analgesia (“conscious sedation”)
• Deep sedation/analgesia
• General anesthesia

Question 27

Minimal sedation/anxiolysis–drug-induced state during which patients respond normally to ___; although cognitive function and physical coordination may be impaired, ___ reflexes, ___ and ___ functions are unaffected

Answer 27

Minimal sedation/anxiolysis–drug-induced state during which patients respond normally to verbal commands; although cognitive function and physical coordination may be impaired, airway reflexes, ventilatory and cardiovascular functions are unaffected

Question 28

Moderate sedation/analgesia (“conscious sedation”) is a drug-induced depression of consciousness during which patients respond ___ to verbal commands, either ___ or accompanied by ___ stimulation; interventions ___ (are/are not) required to maintain a patent airway, and spontaneous ventilation ___ (is/is not) adequate; ___ function is usually maintained

Answer 28

Moderate sedation/analgesia (“conscious sedation”) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation; interventions are NOT required to maintain a patent airway, and spontaneous ventilation is adequate; CV function is usually maintained

Question 29

Deep sedation/analgesia is a drug-induced depression of consciousness during which patients cannot be easily ___ but respond ___ following ___ or ___ stimulation; the ability to independently maintain ventilatory function may be ___; patients may require assistance in maintaining a ___ airway, and spontaneous ventilation may be ___; CV function is usually ___

Answer 29

Deep sedation/analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation; the ability to independently maintain ventilatory function may be impaired; patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate; CV function is usually maintained

Question 30

General anesthesia is a drug-induced loss of consciousness during which patients ___ (are/are not) arousable, even by ___ stimulation; the ability to independently maintain ventilatory function is often ___; patients often require assistance in maintaining a ___ airway, and ___ ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of ___ function; CV function may be ___

Answer 30

General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation; the ability to independently maintain ventilatory function is often impaired; patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function; CV function may be impaired

Question 31

What stage of sedation/analgesia is this describing?–drug-induced state during which patients respond normally to verbal commands; although cognitive function and physical coordination may be impaired, airway reflexes, ventilatory and cardiovascular functions are unaffected

Answer 31

Minimal sedation/anxiolysis

Question 32

What stage of sedation/analgesia is this describing?–a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation; interventions are NOT required to maintain a patent airway, and spontaneous ventilation is adequate; CV function is usually maintained

Answer 32

Moderate sedation/analgesia (“conscious sedation”)

Question 33

What stage of sedation/analgesia is this describing?–drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation; the ability to independently maintain ventilatory function may be impaired; patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate; CV function is usually maintained

Answer 33

Deep sedation/analgesia

Question 34

What stage of sedation/analgesia is this describing?–drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation; the ability to independently maintain ventilatory function is often impaired; patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function; CV function may be impaired

Answer 34

General anesthesia

Question 35

Fasting protocol for sedation/analgesia for elective procedures–all categories (except for children younger than 6 months) should not have solids and nonclear liquids ___-___ hours before surgery

Answer 35

no solids/nonclear liquids for 6-8 hours before surgery

Question 36

Fasting protocol for sedation/analgesia for elective procedures–children younger than 6 months should not have solids and nonclear liquids ___-___ hours before surgery

Answer 36

children younger than 6 months should not have solids/nonclear liquids 4-6 hours before surgery

Question 37

Fasting protocol for sedation/analgesia for elective procedures–all categories should not have clear liquids ___-___ hours before surgery

Answer 37

no clear liquids 2-4 hours before surgery