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Peri-Op 101 > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What is ASA I?

A

A normal healthy patient.

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2
Q

What is ASA II?

A

A patient with mild systemic disease.

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3
Q

What is ASA III?

A

A patient with severe systemic disease.

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4
Q

What is ASA IV?

A

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

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5
Q

What is ASA V?

A

A moribund patient who is NOT expected to survive without the operation.

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6
Q

What is ASA VI?

A

Patient declared brain-dead, organs removed for donor purposes.

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7
Q

Main equipment used by anesthesia?

A
  1. Anesthesia machine to deliver O2 and gases.
  2. IV pumps for IV anesthetics and vasoactive meds.
  3. Warming devices for pt and fluids.
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8
Q

What is the bispectral index monitor used for?

A

Assess the depth of anesthesia.

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9
Q

What does cardiovascular monitoring include, for anesthesia?

A
  1. Arterial Line
  2. Central venus pressure line
  3. Pulmonary artery catheter
  4. Transesophageal echocardiography
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10
Q

What does basic monitoring include, for anesthesia?

A
  1. O2
  2. BP
  3. ECG
  4. Temp
  5. End-Tidal CO2 or Capnography
  6. Nerve stimulation to assess depth of muscle relaxation
  7. Urine output
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11
Q

What are the five types of anesthesia?

A

General, MAC, moderate sedation, local, regional

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12
Q

Which types of anesthesia require an anesthesia professional?

A

General and MAC.

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13
Q

What are the phases of anesthesia?

A
  1. Induction
  2. Maintenance
  3. Emergence
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14
Q

What happens during IV Induction?

A

Anesthetic agents injected into patient’s IV:

  1. Propofol
  2. Narcotics (fentanyl)
  3. Sedatives (midazolam/versed)
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15
Q

What happens during inhalational induction?

A

Patient breathes in inhalational anesthetic via face mask. Common in children, sometimes for adults w/o IV access:

  1. Sevofluorane with or without nitrous oxide

***THRASHING upon waking!

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16
Q

What are common muscle relaxants used in anesthesia?

A
  1. Succinylcholine (short-acting)
  2. Rocuronium/vecuronium (intermediate-acting)
  3. Pancuronium (long-acting)
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17
Q

What is the technique used for maintaining anesthesia using short infusions of short acting IV agents without inhalational anesthetics?

A

TIVA. Total IV anesthesia. Propofol and remifentanil are commonly used for TIVA.

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18
Q

What is the reversal agent for rocuronium, vecuronium and pancuronium?

A

Sugammadex

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19
Q

What is the reversal agent for narcotics like fentanyl?

A

Naloxone (narcan)

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20
Q

What is the reversal agent for benzodiazepines, like midazolam?

A

Flumazenil (romazicon)

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21
Q

What is the reversal agent for muscle relaxants like succinylcholine?

A

No reversal agent, other relaxants can be reversed with neostigmine or edrophonium.

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22
Q

What type of airway maintenance requires a muscle relaxant?

A

ET Tube.

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23
Q

NO fatty or fried foods and meat for… how many hours?

A

8 Hours

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24
Q

NO light meal… how many hours?

A

6 Hours

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25
Q

NO clear liquids… how many hours?

A

2 Hours

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26
Q

Cricoid is needed during induction for what reason?

A

Prevent aspiration & occlude esophagus.
Visualize vocal cords
Place ET Tube
Required for a “rapid sequence” induction

27
Q

Where is the cricoid cartilage?

A

First ring below the thyroid cartilage.

28
Q

What does firm pressure on the cricoid cartilage do?

A

Occlude the esophagus.

29
Q

The periop nurse should be at the bedside during…

A

Induction & Emergence

30
Q

Women at risk for hypotension after initiation of regional anesthesia include:

A
  1. Older than 35 years

2. BMI over 29 kg/m2

31
Q

What is regional anesthesia?

A

Local anesthetic next to nerves. Prevents pain and movement.

32
Q

What are examples of regional anesthesia?

A
  1. Epidural block
  2. Spinal Block
  3. Peripheral Block
  4. Eye block
33
Q

Local anesthetics commonly used for regional include:

A

Lido, bupivacaine, ropivacaine

34
Q

What can be used for long-acting spinal anesthesia?

A

Tetracaine

35
Q

Additional drugs can be added to local anesthetic. What does epi and bicarb do?

A

Epi: increase the density and duration of a regional block
Bicarb: reduces acidity of local and speeds the onset of the block

36
Q

What is neuraxial anesthesia?

A

Placement of local near the spinal cord.

37
Q

Two types of neuraxial anesthesia?

A

Spinal and Epidural.

38
Q

During spinal, where is the local injected?

A

The subarachnoid space is entered and local is injected into the spinal canal.

39
Q

Potential complications of spinal?

A

Hypotension, decreased RR, headache post-op.

40
Q

Where is the needle advanced during epidural anesthesia?

A

Find the space between the ligamentum flavum and dura. The space is identified by a loss of resistance as the needle is advanced.

41
Q

Complications of an epidural:

A

Dural puncture
Subarachnoid injection
Intravascular injection.

42
Q

Intravenous Regional Anesthesia is also called…

A

Bier Block

43
Q

The Bier Block can be used for procedures on the _____?

A

Hand, wrist, forearm.

44
Q

The Bier Block is performed as follows:

A
  1. IV in operative arm
  2. Tourniquet applied on upper arm.
  3. Arm raised.
  4. Cuff inflated.
  5. Local injected into IV.

Anesthetic lasts until tourniquet is deflated.

45
Q

Three examples of local:

A
  1. Amino esters (procaine, tetracaine)
  2. Amino amides (lido, prilo, bupivacaine)
  3. Ropivacaine
46
Q

Describe Local Anesthetic Systemic Toxicity (LAST)

A

Unsafe amounts of local enter the bloodstream.

47
Q

Sings of LAST?

A

Ringing in the ears
Tingling around the lips
Dizziness
Metallic taste in the mouth

48
Q

LAST can progress to….

A

Seizures, respiratory arrest, cardiac arrest.

49
Q

What is malignant hyperthermia triggered by?

A

Inhaled general anesthetic agents and muscle relaxant, succinylcholine.

50
Q

MH can lead to… ?

A

cardiac arrest, brain damage, organ failure, and death

51
Q

Common initial signs of MH?

A

Tachycardia and HTN. Tachypnea and increased minute ventilation are more specific to MH but may be masked if given muscle relaxants and ventilation is controlled.

52
Q

The MOST SPECIFIC sign of MH?

A

Increased end-tidal carbon dioxide, and is seen on the capnography monitor.

53
Q

What is the drug to treat MH?

A

Dantrolene.

54
Q

How do you prepare Dantrolene?

A

Dilute with sterile water for injection, USP (without bacteriostatic agent)

55
Q

How much dantrolene do you administer for MH?

A

2.5 mg/kg IV

56
Q

How does AORN define hypothermia?

A

Body temperature <36C or <96.8F

57
Q

These patients are at an increased risk for hypothermia:

A

Old pts (decreased effectiveness of natural responses)
Infants (larger surface area relative to their wt)
Women
Low body wt

58
Q

Core body temperature definition:

A

The temperature of blood and internal organs. Correlates with the temp measured in the bladder, oral cavity, axilla.

59
Q

Passive warming devices:

A
  1. Blankets
  2. Drapes
  3. “Space blankets” and Plastic sheeting
60
Q

Active warming devices:

A
  1. Circulating water garments
  2. Radient Warming
  3. Forced Air
  4. Room temp
  5. Warmed IV fluids and gases
61
Q

When is it appropriate for the periop nurse to release cricoid pressure?

A

After ET tube is inflated and position is confirmed. Cricoid pressure occludes esophagus, prevents aspiration, helps for visualization of vocal chords.

62
Q

When is the ET or LMA removed?

A

When the patient is conscious and able to maintain the airway.

63
Q

A nurse performing conscious sedation needs to be competent in what?

A

Monitoring pts undergoing sedation, airway assessment, resuscitative equipment and drugs, ACLS.

64
Q

During IV regional anesthesia (Bier Block), the tourniquet should be deflated slowly to prevent what from entering the circulation?

A

to prevent a bolus of local anesthetic from entering the systemic circulation

Peri-Op 101 (4 decks)

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