Anesthesia Flashcards
What is ASA 1 classification
A normal healthy patient
What is ASA 2 classification
A patient with mild systemic disease
What is ASA 3 classification
A patient with severe systemic disease
What is ASA 4 classification
A patient with severe systemic disease that is a constant threat to life
What is ASA 5 classification
A moribund patient who is not expected to survive without the operation
What is ASA 6 classification
A declared brain-dead patient whose organs are being removed for donor purposes
What is unconscious (general) anesthesia
A drug induced LOC during which the patients are not arousable, even by noxious stimulus, and often require a controlled airway
What are types of conscious anesthesia
- Regional blockade
- MAC (local anesthesia with monitored anesthesia care)
- Conscious sedation
List the levels of sedation/anesthesia (least to most)
- Minimal sedation (anxiolysis)
- Moderate sedation/analgesia (conscious sedation)
- Deep sedation
- General anesthesia
What is minimal sedation
Drug induced state
1. Responds normally to commands
2. Cognitive/coordination may be impaired
3. Cardiovascular function not affected
What is moderate sedation/analgesia (conscious sedation)
Drug induced depression of consciousness
1. Responds purposefully to commands with verbal or light tactile stimulation
2. Cardiovascular function usually maintained
What is deep sedation
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
What is general anesthesia
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
What is the overall risk of anesthesia
- Remarkably safe
- Advanced respiratory monitoring
*via pulse ox / capo graphs
What are some of the risks revolved around medications that are used in anesthesia
Some meds have adverse physiologic consequences
1. Respiratory depression
2. Cardiovascular depression
3. LOC
4. Allergic reactions
5. Malignant hyperthermia
What are the most common problems that arise due to anesthesia
- Airway compromise
- Medication errors
- Central venous cannulation
What are some other concerns that revolve around anesthesia
Most important inadequate preop eval and prep
1. Post-op neurological complication
2. Ischemic optic neuropathy
3. Coronary ischemia
4. Anesthesia in remote locations
What happens during the pre-op evaluation for anesthesia
- Anesthesiologist is reviewing details/records from the provider
- Reviewing patient medical record
- Reviewing H&P
During the pre-op evaluation what is critical to note?
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
When should the pre-op evaluation be completed? For high, medium, and low invasiveness surgeries
High- 1 day prior
Medium- day before or day of surgery
Low- day of surgery
What should be well controlled in the pre-op period?
Comorbidities
*to avoid post-procedural morbidity and mortality
What meds can you continue during the pre-op period
- Low dose ASA for coronary stents and A-fib
- Statins
- Beta blockers
- Antihypertensives
*discontinues ARBs and ACEIs
What meds should you discontinue
- ACEI, ARB
- Chronic anticoagulants
- ASA unless for coronary stent/a-fib
- Oral anti hyperglycemias day of surgery
What is the most common pre-existing disease pre-operatively
HTN
*patient should be medically treated to be as close to normotension pre-op
What is the triad of lipid disorders
- Diabetes
- Obesity (classic with HTN)
What does a DBP of >110 mean during the pre-op period
- Results in high incidence of intraoperative hypotension and myocardial ischemia
What is the leading cause of morbidity and mortality in the perioperative period
Coronary artery disease
1. 25% of pre-op patients have CAD
2. Seek cardiology clearance
What are some conditions the need pre-op cardiology clearance
- Recent MI
- AV blocks
- Symptomatic vesicular arrhythmias
- SVT
- A-Fib
- Symptomatic Bradycardia
What type of lung disease put the patient at risk for pre-p complication
Obstructive or restrictive Lung disease
What is extreme obesity and if there is a patient with extreme obesity who should they see?
BMI>35%
*need to be seen in PAC (Pre-anesthesia clinic)
If a patient is on LMWH (Low molecular weight heparin) what should be avoided
Spinal/epidural anesthesia
1. Should not be performed unless LMWH has been stopped at least 12 hours
2. Substitute the LMWH for another anticoagulant
What causes increased post-op mortality when a patient had normal renal function during surgery
Onset of AFR (acute renal failure)
*kidneys do not perfuse well and develop injury
*creatinine clearance increases
What are risk factors for peri-operative ARF
- BMI >32
- Age
- PVD
- Liver disease
- COPD
What are different types of pre-operative medications
Given immediately before anesthesia
*Anxiolytic and Opiate (Versed / Fentanyl)
Preventing aspiration
*H2 blockers (Pepcid) PPI (omeprazole)
What are the different types of anesthesia
- Local
- Procedural sedation/analgesia
- General
What is local anesthesia
- Administered without IV sedation
- No pre-medication
What is procedural sedation/analgesia
- Combo of local and IV sedation, monitoring
- May have pre-medication
What is general anesthesia
- Pre-oxygenated by face mask
*intubation, IV drugs (propofol), thiopental
*If CV compromise etomidate or ketamine
How is balanced maintained in general anesthesia
- Analgesia
*opiates - Amnesia
*benzos, nitrous oxide - Muscle relaxation
*succinycholine
