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Surgery > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What is ASA 1 classification

A

A normal healthy patient

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2
Q

What is ASA 2 classification

A

A patient with mild systemic disease

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3
Q

What is ASA 3 classification

A

A patient with severe systemic disease

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4
Q

What is ASA 4 classification

A

A patient with severe systemic disease that is a constant threat to life

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5
Q

What is ASA 5 classification

A

A moribund patient who is not expected to survive without the operation

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6
Q

What is ASA 6 classification

A

A declared brain-dead patient whose organs are being removed for donor purposes

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7
Q

What is unconscious (general) anesthesia

A

A drug induced LOC during which the patients are not arousable, even by noxious stimulus, and often require a controlled airway

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8
Q

What are types of conscious anesthesia

A
  1. Regional blockade
  2. MAC (local anesthesia with monitored anesthesia care)
  3. Conscious sedation
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9
Q

List the levels of sedation/anesthesia (least to most)

A
  1. Minimal sedation (anxiolysis)
  2. Moderate sedation/analgesia (conscious sedation)
  3. Deep sedation
  4. General anesthesia
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10
Q

What is minimal sedation

A

Drug induced state
1. Responds normally to commands
2. Cognitive/coordination may be impaired
3. Cardiovascular function not affected

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11
Q

What is moderate sedation/analgesia (conscious sedation)

A

Drug induced depression of consciousness
1. Responds purposefully to commands with verbal or light tactile stimulation
2. Cardiovascular function usually maintained

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12
Q

What is deep sedation

A

Drug induced depression of consciousness
1. Patient does not easily arak use but responds purposefully following repeated or painful stimulation
2. Airway assistance may be required
3. Cardiovascular function is usually maintained

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13
Q

What is general anesthesia

A

Drug induced LOC
1. Patient cannot be roused even by painful stimuli
2. Independent ventilatory function impaired
3. Assistance to maintain open airway
4. Ventilation typically required
5. Cardiovascular function may be impaired

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14
Q

What is the overall risk of anesthesia

A
  1. Remarkably safe
  2. Advanced respiratory monitoring
    *via pulse ox / capo graphs
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15
Q

What are some of the risks revolved around medications that are used in anesthesia

A

Some meds have adverse physiologic consequences
1. Respiratory depression
2. Cardiovascular depression
3. LOC
4. Allergic reactions
5. Malignant hyperthermia

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16
Q

What are the most common problems that arise due to anesthesia

A
  1. Airway compromise
  2. Medication errors
  3. Central venous cannulation
17
Q

What are some other concerns that revolve around anesthesia

A

Most important inadequate preop eval and prep
1. Post-op neurological complication
2. Ischemic optic neuropathy
3. Coronary ischemia
4. Anesthesia in remote locations

18
Q

What happens during the pre-op evaluation for anesthesia

A
  1. Anesthesiologist is reviewing details/records from the provider
  2. Reviewing patient medical record
  3. Reviewing H&P
19
Q

During the pre-op evaluation what is critical to note?

A

Any abnormalities in the cardiac and pulmonary systems
1. Findings from medical tests and consults
2. Any evaluations performed prior to being seen by anesthesia

20
Q

When should the pre-op evaluation be completed? For high, medium, and low invasiveness surgeries

A

High- 1 day prior
Medium- day before or day of surgery
Low- day of surgery

21
Q

What should be well controlled in the pre-op period?

A

Comorbidities
*to avoid post-procedural morbidity and mortality

22
Q

What meds can you continue during the pre-op period

A
  1. Low dose ASA for coronary stents and A-fib
  2. Statins
  3. Beta blockers
  4. Antihypertensives
    *discontinues ARBs and ACEIs
23
Q

What meds should you discontinue

A
  1. ACEI, ARB
  2. Chronic anticoagulants
  3. ASA unless for coronary stent/a-fib
  4. Oral anti hyperglycemias day of surgery
24
Q

What is the most common pre-existing disease pre-operatively

A

HTN
*patient should be medically treated to be as close to normotension pre-op

25
Q

What is the triad of lipid disorders

A
  1. Diabetes
  2. Obesity (classic with HTN)
26
Q

What does a DBP of >110 mean during the pre-op period

A
  1. Results in high incidence of intraoperative hypotension and myocardial ischemia
27
Q

What is the leading cause of morbidity and mortality in the perioperative period

A

Coronary artery disease
1. 25% of pre-op patients have CAD
2. Seek cardiology clearance

28
Q

What are some conditions the need pre-op cardiology clearance

A
  1. Recent MI
  2. AV blocks
  3. Symptomatic vesicular arrhythmias
  4. SVT
  5. A-Fib
  6. Symptomatic Bradycardia
29
Q

What type of lung disease put the patient at risk for pre-p complication

A

Obstructive or restrictive Lung disease

30
Q

What is extreme obesity and if there is a patient with extreme obesity who should they see?

A

BMI>35%
*need to be seen in PAC (Pre-anesthesia clinic)

31
Q

If a patient is on LMWH (Low molecular weight heparin) what should be avoided

A

Spinal/epidural anesthesia
1. Should not be performed unless LMWH has been stopped at least 12 hours
2. Substitute the LMWH for another anticoagulant

32
Q

What causes increased post-op mortality when a patient had normal renal function during surgery

A

Onset of AFR (acute renal failure)
*kidneys do not perfuse well and develop injury
*creatinine clearance increases

33
Q

What are risk factors for peri-operative ARF

A
  1. BMI >32
  2. Age
  3. PVD
  4. Liver disease
  5. COPD
34
Q

What are different types of pre-operative medications

A

Given immediately before anesthesia
*Anxiolytic and Opiate (Versed / Fentanyl)
Preventing aspiration
*H2 blockers (Pepcid) PPI (omeprazole)

35
Q

What are the different types of anesthesia

A
  1. Local
  2. Procedural sedation/analgesia
  3. General
36
Q

What is local anesthesia

A
  1. Administered without IV sedation
  2. No pre-medication
37
Q

What is procedural sedation/analgesia

A
  1. Combo of local and IV sedation, monitoring
  2. May have pre-medication
38
Q

What is general anesthesia

A
  1. Pre-oxygenated by face mask
    *intubation, IV drugs (propofol), thiopental
    *If CV compromise etomidate or ketamine
39
Q

How is balanced maintained in general anesthesia

A
  1. Analgesia
    *opiates
  2. Amnesia
    *benzos, nitrous oxide
  3. Muscle relaxation
    *succinycholine

Surgery (31 decks)

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