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Clin Med - II (Surgery) > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Pre-op Evaluation

A 
Type of sx or reason for sx
Allergies to meds/drug intolerances
Medical problems / comorbidities
Meds (Prescription and OTC), other drugs, including alcohol
Sx hx
Anesthesia hx
POS
Height / Weight
NPO status
Mallampati classification
Smoking (pack/years)
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2
Q

Pre-op eval - Anesthesia hx

A 
N/V
Intubation
Anesthetic type
Reactions
Bleeding
Prolonged paralysis
Awareness
FHx
- Malignant hyperthermia
- Dantrolene
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3
Q

Pre-op eval - ROS

A 
General
Respiratory
CV (CHF, CAD, valve dz)
Renal
GI
Hematologic
Neurologic (CVA)
Endocrine (DM, thyroid)
Psychiatric
Orthopedic
Dematologic
Recent infections (URI, UTI, sepsis)
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4
Q

American Society of Anesthesiologists Physical Status Classification

A 
ASA 1 (PS1) - A normal healthy pt
ASA 2 (PS2) - A pt with mild systemic dz
ASA 3 (PS3) - A pt with severe systemic dz
ASA 4 (PS4) - A pt with severe systemic dz that is a constant threat to life
ASA 5 (PS5) - A moribund pt who is not expected to survive w/o the operation
ASA 6 (PS6) - A declared brain-dead pt whose organs are being removed for donor purposes
E - Emergency
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5
Q

Physical Exam - in general

A 
Airway
Cardiac
Respiratory
IV Sites
ROM of extremities
Neurologic
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6
Q

Physical Exam - Airway

A 
Cervical ROM
Thyroid cartilage to mentum distance
Mouth opening
Dentition
Jaw Protrusion
Beard
Mallampati score
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7
Q

Mallampati score

A

Class 1 - wide open (Grade 1)
Class 2 - uvula can be partially visualized (Grades 1-4)
Class 3 - soft palate can be visualized (Grades 1-4)
Class 4 - No visualization of the soft palate (Grade 4)

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8
Q

Grading portion of the Mallampati score

A

Grade 1 - complete visualization of the vocal cords
Grade 2 - partial visualization of the vocal cords
Grade 3 - partial visualization of the trachea
Grade 4 - no visualization of the trachea

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9
Q

NPO status Guidelines

A

No solid food eaten after evening meal or 8h prior to nonemergent sx
Formula 6h / breast milk 4h
NPO after midnight, except sips of clear liquids to take oral meds
Clear liquids up to 2h before checking in for sx
Important in DM (keep BG ~120)

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10
Q

Drug continued Pre-op

A 
Anti-HTN / Cardiac meds
BB
Steroids
Antacids / reflux meds
Insulin
Pain med
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11
Q

What is a concern with giving antihypertensives pre-op?

A

Watch for hypotension with general anesthesia and ACE-I / ARBs

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12
Q

Drugs d/c pre-op

A

Anticoagulants
Herbs / OTC
Oral diabetic meds morning of sx

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13
Q

Anticoagulants - Pre-op

A

Stop asa, coumadin, plavix

Some exceptions (Bleeding vs. peri-operative MI)

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14
Q

Herbs / OTC

A

Garlic / gingko / ginseng = platelets
Ephedra = increased BP / HR / Stroke
Vitamin E = bleeding

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15
Q

Smoking and sx

A

The earlier the pt quits the greater the chance they have of avoiding post-op complications

Calculate pack years

If possible no smoking 12-24h prior to sx

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16
Q

Pack years

A

Packs/day * years smoked

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17
Q

Pre-op labs / tests

A 
EKG
CBC
CMP
Coagulopathy studies
Type and Screen / hold
FSBS - morning of sx
PG test
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18
Q

CBS as a pre-op lab

A

WBC
PLTs
HBG
HCT

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19
Q

CMP as a pre-op lab

A 
Creatinine
BUN
K
Na
Ca
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20
Q

Coagulopathy studiesas a pre-op lab

A

PT
PTT
INR

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21
Q

Who should get a PG test prior to sx?

A

Any female of childbearing age unless postmenopausal or previous hysterectomy

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22
Q

Goals of anesthesia

A

Amnesia
Analgesia
Hypnosis
Muscle relaxation

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23
Q

Succinylchoine

A

Depolarizing med
Lasts 1-2 minutes
K goes up (Don’t give in trauma or burns)

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24
Q

Pre-op Meds

A 
Benzodiazepines (Anxiety in adults/peds)
Post -op N/V Prophylaxis
Opioid
Anti-reflux meds
Breathing tx
Stress dose steroids
Anticholinergics
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25
Q

Anesthetic choice

A 
Extent of sx procedure
Site of sx procedure
Pt positioning during sx procedure
NPO status
Elective vs, Emergent
Pt's age and comorbidities
Anticipated recovery time
Pt preference
Surgeon preference
Anesthesiologist preference
26
Q

Types of Anesthesia - in general

A

General
Regional
MAC

27
Q

General anesthesia - IV induction

A

Anesthetic agents through the IV to render them unconscious
Analgesia (opiates and inhalational agents)
Amnesia (benzos, NO, inhalation agents)
Muscle relaxation (neuromuscular-blocking drugs, inhaled agents or local anesthetics)

28
Q

General anesthesia - Inhalational Induction

A

Pt breathes in anesthetic gases to render them unconscious

Children or airway reflexes need to be preserved throughout case

29
Q

Regional anesthesia

A

Spinal
Epidural
Peripheral nerve block

30
Q

MAC - in general

A

Monitored anesthesia Care
IV sedation / local anesthetic to surgical site
Pt given oxygen

31
Q

Most common complications of anesthesia

A

Post-Op N/V
Sore throat
Dental damage (most common legal complaint)

32
Q

Common complications of anesthesia

A 
Anesthesia awareness (0.1%)
Drug errors
Peripheral nerve injury
Obstetric complications
Pediatric complications
Malignant hyperthermia (Hypermetabolic state)
Post-op visual loss
Burns
Equipment errors
Pain management
IV/arterial catheterization
33
Q

Examples of complications of anesthesia involving peripheral nerve injury

A

Positioning - Ulnar N. most commonly injured
Nerve blocks
Eye injury in prone position

34
Q

Examples of complications of anesthesia involving pediatric pts

A

Respiratory

In peds, cases change QUICKLY!!!

35
Q

Indications for General anesthesia

A

Sx including the head/neck, airway, CV, thoracic abdominal, laparoscopic
Pt refusal of regional anesthesia (spinal/epidural)
Long length of sx
Emergency sx - NPO status followed
Individual pt circumstances / sx circumstances

36
Q

Contraindications for General anesthesia

A 
Severe CV dz
Severe respiratory dz
NPO status not followed
Pt refusal
Difficult airway
37
Q

Types pf airways during General anesthesia

A

Endotracheal intubation

LMA (laryngeal mask airway)

38
Q

Indications for Regional anesthesia

A

Sole anesthetic for lower abdominal and lower extremity procedures
In combination with general anesthetic
Post-op pain relief
Anesthesia when general is contraindicated or not best choice
Pain relief, motor blockade and sympathetic blockade
Allows pt to be alert w/o pain

39
Q

Example of a sole anesthetic for lower abdominal and lower extremity procedures

A

Spinal or

Epidural

40
Q

Example of a combination with general anesthetic

A

Epidural with general

41
Q

Example of post-op pain relief that are given as regional anesthesia

A

Post-op epidural

Peripheral nerve block

42
Q

Example of a pt in which Anesthesia when general is contraindicated or not best choice

A

Patient with COPD

43
Q

Example of a procedure where the pt is alert w/o pain

A

C-section

44
Q

What at the types of regional anesthesia

A

Spinal

Epidural

45
Q

Advantages of regional anesthesia

A 
Reduced risk of bleeding
Difficult airway
Respiratory depression / pneumonia / COPD
Post-op N/V
Less post-op cognitive defects
Superior pain control
Pt satisfaction
Decreased immunosuppression
Less alterations of hemodynamics
Alternative to General anesthesia (example - malignant hyperthermia)
46
Q

Absolute contraindications of Regional anesthesia

A 
Pt refusal
Infection at site of insertion
Severe aortic or mitral stenosis
Increased ICP
Severe hypovolemia
True allergy of local anesthetics
Coagulopathy
47
Q

What is the number one reason for nerve damage during sx?

A

Hematoma

48
Q

Relative contraindications of Regional anesthesia

A

Pre-existing neurologic deficit
Specific dz states (CV dz, respiratory failure)
Lack of pt cooperation
Lack of consciousness
Demyelinating dz
Existing back problems / previous back sx
Sepsis

49
Q

Complications of regional anesthesia

A 
Spinal ha
Hemodynamic changes
Bleeding
Infection
Nerve damage
Prolonged parasympathetic blockage (urinary retention)
Back pain
Inadequate or "patchy" block
High spinal (respiratory compromise)
50
Q

How are spinal ha tx?

A

Laying flat
Lots of caffeine
Blood patch

51
Q

What is high spinal in regional anesthesia?

A

The pt’s block has move up and they will begin to have arm/finger numbness, which will progress up their arms.
As it continues to progress, it will stop the pts respirations.
Tx by intubation and allowing the regional to wear off.

52
Q

MAC - indications

A

ERCP
Cartaracts
Some carpal tunnel releases
AV fistulas

53
Q

MAC - monitoring

A

BP
EKG
Pulse Ox
Temperature

54
Q

Conscious Sedation / local - in general

A

Local anesthetic to surgical site
Versed
Doesn’t involve anesthesia team
Pt given oxygen

55
Q

Conscious Sedation / local - indications

A

Minor sx

56
Q

Conscious Sedation / local - monitor

A

BP
EKG
Pulse Ox
Temperature

57
Q

PACU

A

Postanesthesia Recovery Room
Equipped with essentially the same monitors as the OR
Specialized, short-stay ICU

58
Q

D/c from PACU

A 
After ~1h or 
When pt meets criteria
- Monitoring of oxygenation, ventilation, circulation, level of consciousness and temperature
Pain
Post-op N/V
59
Q

Common post-op problems

A 
Hypothermia
N/V
Pain control
Hypotension / HTN
Hypoxemia
Hypoventilation
Agitation
Arrhythmias
60
Q

What do your pts need to know?

A

Make sure they are NPO for the appropriate time
Make sure that they have had a complete H and P and f/u with any major complications
Be aware of the different options your pt might have regarding anesthesia for different procedures
Know what meds to stop or continue prior to sx

Clin Med - II (Surgery) (10 decks)

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