Anesthesia Flashcards
Who are the 3 medical professionals that can provide anesthesia services?
- anesthesiologists
- certified registered nurse anesthetists
- anesthesiologist assistants
What are the credentials of an anesthesiologist?
- MD or DO
- 4 years of graduate education
- 4 year residency in anesthesiology
- under the anesthesia care team model, an anesthesiologist supervises the certified registered nurse anesthetist and anesthesiologist assistant
What are the credentials of a certified registered nurse anesthetists ?
- RN with a bachelor’s degree in nursing
- Min of 1 year of experience in critical care
- Master’s or doctoral degree from accredited nurse anesthesia ed program
- passed the national certification exam
What are the credentials of an anesthesiologist assistant?
- Bachelor of Science degree with a pre-med education
- Accredited AA program
- passed the national certification exam
What are the 8 factors that should be considered before choosing an anesthetic?
- patient’s age
- length and type of surgery
- patient and surgeon preferences
- patient’s co-existing diseases
- patient’s mental and psychological status
- patient’s previous experiences with anesthesia
- plans and protocols for post pain management
- position of the patient during surgery
What does the American society of Anesthesiologist’s say as NPO guidelines for…clear liquids?
stop 2 hours before surgery
What does the American society of Anesthesiologist’s say as NPO guidelines for…breast milk?
stop 4 hours before surgery
What does the American society of Anesthesiologist’s say as NPO guidelines for…infant formula?
stop 6 hours before surgery
What does the American society of Anesthesiologist’s say as NPO guidelines for…light meal - toast and a clear liquid ?
stop 6 hours before surgery
What does the American society of Anesthesiologist’s say as NPO guidelines for…fried foods-fatty foods-mean?
stop 8 hours before surgery
According to the ASA’s NPO guidelines, infant formula, nonhuman milk, and a light meal may be consumed 6 hours before surgery? true or false
true
Who should be available to assist the anesthesia provider during induction of anesthesia?
perioperative nurse
In what way can the perioperative nurse help the anesthesia provider?
- cricoid pressure application
- if intubation or ventilation of the patient becomes difficult, the perioperative nurse should retrieve additional equipment and supplies.
When is cricoid pressure released?
not until the ET tube cuff is inflated, tube placement is confirmed, and the anesthesia provider has given a verbal confirmation to the nurse that the cricoid pressure can be released.
If you are unsure if you should release cricoid pressure, what should you do?
ask the provider
What are 6 responsibilities of the perioperative nurse to help anesthesia?
- Help set up monitoring equipment.
- obtaining and checking blood products
- positioning forced-air warming equipment
- locating and retrieving emergency equipment
- monitoring the patient according to the preoperative plan of care and making adjustments as needed
- being at bedside during intubation and emergence
What are 3 commonly used anesthesia pieces of equipment?
- anesthesia machine
- intravenous infusion pumps
- warming devices
What is the anesthesia machine used for?
for delivering oxygen and inhaled anesthetic gases to the patient
What is the IV pump used for?
for administering IV anesthetics and vasoactive meds
What are the warming devices used for?
for the patient and for fluids
What are 3 pieces of airway equipment used by anesthesia?
- Laryngoscope
- oral and nasopharyngeal airways
- endotracheal tubes
What assesses depth of anesthesia?
bispectral index monitor
What is general anesthesia?
a drug-induced reversible state of unconsciousness
What does general anesthesia result in?
Results in amnesia, analgesia, and loss of responsiveness, decreased stress response, and loss of skeletal muscle
reflexes to a varying degree
What is regional anesthesia?
An injection of local anesthetics near nerve fibers that causes reversible loss of sensation over an area of the body
What are examples of regional anesthesia?
- spinal
- epidural
- peripheral nerve block
What is monitored anesthesia care?
An anesthesia provider monitors the patient, administers sedatives and other agents as needed, and provides medical services as required.
What is moderate sedation?
The administration of sedative, analgesic, and/or anxiolytic agents by a physician or by a nurse under physician
supervision
What can an RN do depending on state laws and hospital policies?
may administer moderate sedation
What is local anesthesia?
The infiltration or topical administration of agents to anesthetize a part of the body
What does the RN do with local anesthesia?
provides patient monitoring and supportive care
What two types of anesthesia must be administered by an anesthesia provider?
- general anesthesia
2. monitored anesthesia care
What is phase 1 of general anesthesia?
induction
What happens during phase 1 of general anesthesia?
IV medications and inhalational agents are administered by the anesthesia provider.
What is phase 2 of general anesthesia?
maintenance
What happens during phase 2 of general anesthesia?
Medications and inhaled agents are administered to keep the patient anesthetized
What is phase 3 of general anesthesia?
emergence
What happens during phase 3 of general anesthesia?
At the end of the procedure, the anesthetic agents are discontinued or reversed to allow the patient to wake up.
What are the 3 types of induction for general anesthesia?
- IV induction - propofol, etomidate, methohexital, ketamine
- Inhalation induction - sevoflurane
- muscle relaxant - succinylcholine, cisatracinum, atracurium, rocuronium, and vecuronium, pancuronium
What airway maintenance usually requires a muscle relaxant?
endotracheal tube
Can succinylcholine be reversed?
no
Other relaxants can be reversed with what?
- neostigmine
2. edrophonium
What is the reversal agent for rocuronium, vecuronium, and pancuronium?
sugammadex
What can reverse benzodiazepines (midazolam)?
flumazenil
What can reverse narcotics (fentanyl)?
naloxone
What happens at the end of the procedure on the anesthesia end?
inhalantional and IV anesthetics are stopped
What happens with the Et/laryngeal mask airway during emergence?
the ET or LMA is removed when the patient is conscious and able to maintain their airway
What are 4 common local anesthetics used for regional anesthesia?
- lidocaine
- bupivacaine
- ropivacaine
- tetracaine
What are 2 additional meds that might be added to the local anesthetic?
- epinephrine
2. bicarbonate
what is tetracaine used for?
long-acting spinal anesthesia
What is epinephrine used for?
can be added to increase the density and duration of a regional block
What is bicarbonate used for?
sometimes added to reduce the acidity of the local anesthetic and speed the onset of the block
What are the 2 types of neuraxial anesthesia?
- spinal anesthesia
2. epidural anesthesia
Describe a spinal block?
local anesthetic is injected into the subarachnoid space
Who are 4 patients at increased risk for hypothermia?
- older adults
- infants and children
- women
- patients with lower-than-normal body weight
How does LAST occur slowly?
if local anesthetic is absorbed over time
How does LAST occur quickly?
If accidentally injected directly into a blood vessel
How can LAST progress?
progresses to seizures and respiratory or cardiac arrest
What are 4 s/sx of LAST?
- ringing in the ear
- tingling around the lips
- metallic taste in the mouth
- dizziness
What type of anesthesia does not use sedation?
local
What are continuously monitored during a procedure using local anesthesia ?
- blood pressure
- ECG
- Pulse ox
- Heart rate
What is MH triggered by?
inhaled general anesthetic agents and the muscle relaxant succinylocholine
What is the most specific sign of MH?
increased end-tidal carbon dioxide
What are s/sx of MH?
- skeletal muscle rigidity
- ventricular dysrhythmia
- skin mottling
- hyperthermia
What is the protocol for treatment of MH?
- stop the surgery
- Get MH cart and dantrolene
- Call for Help
- Hyperventilate with 100% oxygen at a flow of 10 L/min
- Give dantrolene - 2.5 mg/kg
- obtain blood gases
- cool pt. if core temp is greater than 39 degrees celsius, stop cooling if pt.’s temp goes to less than 38 degrees celsius
- provide appropriate treatment for dysrhythmias and abnormal electrolytes
- For management of suspected or known MH cases, immediately call the MHAUS hotline: 800.644.9737
What are conditions in the OR that put a pt. at risk for hypothermia?
- patients are required to wear thin gowns
- Ors are frequently kept cool
- large amounts of skin are often exposed to the air
- wet prep solutions are applied to the skin
- IV and irrigation fluids are usually cooler than body temp.
- surgery can last hours
- regional and general anesthesia interfere with the body’s ability to regulate temp. vasodilation shifts blood from the body’s core to cooler peripheral tissues
The RN providing moderate sedation should have what?
- no competing responsibilities
- be proficient in airway assessment and ACLS
- understand indications, contraindications, interactions, adverse reactions and nursing considerations of the drugs being administered
- have access and the ability to administer reversal meds for the drugs being given
Why might cricoid pressure be needed?
- to prevent aspiration OR
- to help with visualization of the vocal cords and placement of ET tube OR
- required for a rapid sequence induction
What – assesses depth of anesthesia?
Bispectral index monitor
What is ERAS?
Enhanced Recovery After Surgery
What is an airway that is inserted into the mouth and sits above and around the larynx?
supraglottic airway device
What is an example of supraglottic airway device?
LMA
What is TEE?
Transesophageal echocardiography
What is TIVA?
Total intravenous anesthesia
