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Gen Med: Surgery > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

what is the WHO safe surgery checklist?

A

Designed to minimize the most common & avoidable risks endangering the lives & well-being of surgical patients

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2
Q

What are the goals of the WHO safe surgery checklist?

A
  1. Surgical site infection prevention
  2. Safe anesthesia
  3. Safe surgical teams
  4. Measurement of surgical service
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3
Q

What is included in the pre-op clearance evaluation H&P?

A
  1. Focus on CV, lungs, neuro assessment, comorbidities
  2. EKG > 40 yr
  3. CXR > 40 yr (smoker) if GETA
  4. Labs
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4
Q

What is included in the pre-op fasting regime?

A
  1. NPO after midnight

A. Sips of water may be ingested up to 2 hrs before checking in for surgery

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5
Q

What meds need to be held before surgery?

A
  1. Most antihypertensives & beta blockers should be continued in the perioperative period
  2. Hold oral DM meds
  3. ½ insulin dose
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6
Q

Define anesthesia

A
  1. Allows patients to undergo a variety of surgical & nonsurgical procedures w/out pain or distress
  2. Blocking of pain & non-awareness is reversible
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7
Q

What are the types of anesthesia?

A
  1. IV regional anesthesia (IVRA) / Bier Block
    A. Analgesia & lack of motor movement in involved area
  2. Local anesthesia w/ monitored anesthesia care (MAC)
    A. Also called conscious sedation
    B. Advantages: fewer S/E & intubation not necessary
  3. GETA
  4. Regional anesthesia
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8
Q

When is IV regional anesthesia indicated?

A
  1. Indicated for extremity procedure distal to elbow or knee
  2. Use limited to procedures lasting less than 1 hr
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9
Q

What other meds are commonly added to IV regional anesthesia?

A

Benzodiazepine & fentanyl often added to prevent seizures & to improve nerve blockage

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10
Q

What are the effects of anesthesia?

A
  1. Amnesia with or without consciousness
  2. Analgesia
  3. Muscle relaxation
  4. Sedation
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11
Q

What can be used for amnesia with or without consciousness?

A

Benzodiazepines (diazepam/Valium, midazolam/Versed)

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12
Q

What can be used for analgesia?

A

Opioids (Morphine and Fentanyl)

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13
Q

What can be used for muscle relaxation?

A

Neuromuscular drugs (succinylcholine, pancuronium)

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14
Q

What meds can be used for sedation?

A

Sedative/Hypnotics (Propofol)

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15
Q

What is the mneumonic used for the hx for an emergency surgery?

A 
SAMPLE
S: signs and sxs
A: Allergies
M: Medications
P: PMH
L: Last meal
E: Events preceding surgery
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16
Q

What needs to occur before the induction of anesthesia?

A

Pre-oxygenate patient before induction of anesthesia

17
Q

How can induction of anesthesia be achieved?

A
  1. IV opioid (Fentanyl)
  2. IV general anesthetic drugs (Propofol)
  3. IV muscle relaxant (succinylcholine)
18
Q

What needs to occur in general anesthesia after induction?

A

Once anesthesia & muscle relaxation achieved, intubation follows

19
Q

When is regional anesthesia indicated?

A 
1. Usually involves surgeries below waist, on lower abd or on upper ext
A. Allows pt to be conscious
2. Spinal anesthesia
3. Epidural anesthesia
4. Peripheral Nerve Block
20
Q

What is the most common complication of spinal anesthesia?

A

spinal headache

21
Q

What is the advantage of epidural anesthesia?

A

No CSF leak

22
Q

When is a peripheral nerve block used?

A

Extremities

23
Q

What are the risk factors for post-op nausea and vomiting?

A
  1. Female
  2. Non-smoker
  3. Hx motion sickness
24
Q

How can post-op nausea and vomiting be prevented?

A
  1. Treat prophylactically with 5HT receptor antagonist

A. Ondansetron (Zofran)

25
Q

How can post-op acute pain be managed?

A 
1. Oral meds
A. Narcotics, NSAIDs
2. IV Opioids
A. Morphine, Fentanyl
3. IV NSAID
A. Ketorolac (Toradal)
4. Epidural anesthesia
A. Opioids via epidural catheter
26
Q

What are common complications post-operatively?

A
  1. N/V
  2. Pain
  3. Urinary Retention
  4. Malignant Hyperthermia
27
Q

How can urinary retention be managed?

A
  1. Catheterize if Unable To Void by 8 hr post-op

2. Alpha 1 adrenergic receptor blockers used if needed

28
Q

What causes malignant hyperthermia?

A
  1. Rare genetic Dz
  2. Commonly triggered by use of succinylcholine
    A. Causes uncontrolled release of Ca → intracellular calcium in skeletal muscle
29
Q

What is the pathophys of malignant hyperthermia?

A
  1. Characterized by intense muscle contraction
  2. Muscle contraction leads to hypermetabolic state
    A. Hyperthermia, tachycardia, metabolic acidosis, hypercapnia

Gen Med: Surgery (6 decks)

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