Anesthesia for General Surgery Part 1

Question 1

The preoperative anesthetic evaluation gives you the information you need to

Answer 1

make decisions regarding risk assessment and perioperative management

Question 2

As a provider in the preoperative evaluation, we are responsible for

Answer 2

determining medical status of the patient
developing a plan of anesthesia care
reviewing with the patient the proposed plan of care

Question 3

List the different types of anesthetic techniques:

Answer 3

MAC, general, regional, peripheral nerve block

Question 4

The ideal anesthetic:

Answer 4

promotes patient safety and satisfaction, good operating conditions for the surgeon, rapid recovery, avoidance of postoperative side effects, low in cost, allows early discharge from PACU, optimizes pain control, allows for optimal OR efficiency

Question 5

Advantages of general anesthesia include:

Answer 5

rapid onset of unconsciousness, controlled ventilation, allows for paralysis, lower failure rate, more safely allows for positioning extremes

Question 6

Disadvantages of general anesthesia include:

Answer 6

PONV, postoperative sedation, increased stress response, full stomach-risk for aspiration

Question 7

Monitored anesthesia care may lead

Answer 7

to unplanned general anesthetic (due to loss of ability to respond purposefully)

Question 8

Advantages of peripheral nerve blocks include

Answer 8

good option for superficial operations of extremities
consciousness
protective upper airway reflexes
isolated anesthetic effect (good for patients with pulm/CV disease)

Question 9

Disadvantages of peripheral nerve blocks include

Answer 9

unpredictable sensory and motor anesthesia, success rate related to experience of provider, patient cooperation

Question 10

Advantages of regional anesthesia for general surgery include

Answer 10

maintenance of consciousness, skeletal muscle relaxation, contraction of GI tract, lower insufflation pressure, decreased stress response, faster recovery

Question 11

Benefits to a spinal include:

Answer 11

less time to perform, rapid onset sensory/motor anesthesia, less pain

Question 12

Benefits to an epidural include:

Answer 12

lower risk of post-dural puncture headache, less hypotension, catheter that can provide postop analgesia

Question 13

Disadvantages of regional anesthesia for general surgery include:

Answer 13

occasional failure to produce adequate levels of sensory anesthesia
hypotension d/t SNS blockade (worse with hypovolemia)

Question 14

For the maintenance of anesthesia, drug selection is based on

Answer 14

specific goal that is relevant to the drug’s known pharmacologic effects at therapeutic doses

Question 15

Brain function monitoring (BIS) may help in

Answer 15

titrating dose of inhaled/injected anesthetic drugs to produce desired degree of CNS depression

Question 16

Maintenance of anesthesia is important for providing

Answer 16

amnesia, analgesia, skeletal muscle relaxation, and control of sympathetic nervous system responses

Question 17

WIth monitored anesthesia care, we are

Answer 17

held to the same standard as any other anesthetic technique

Question 18

Goal of positioning is to

Answer 18

ensure patient safety

Question 19

Positioning concerns include

Answer 19

peripheral nerve injuries, hypotension from impaired venous return, oxygen desaturation due to V/Q mismatch

Question 20

The best way to position a patient is

Answer 20

a position in which the patient would tolerate when awake

Question 21

Positioning keys include:

Answer 21

peripheral joint extremities are well padded, support normal lumbar spine curvature, head midline, no pressure on eyes, safety straps/prevent falling

Question 22

CV considerations with positioning include:

Answer 22

central, regional, and local mechanisms can blunt the effects of position changes to maintain perfusion to vital organs

• erect to supine–> increased venous return–> preload, stroke volume and CO augmented
• mechanoreceptors–> decrease sympathetic outflow

Question 23

CV considerations regarding atrial reflexes include

Answer 23

atrial reflexes activated to regulate renal sympathetic activity

Question 24

Increased arterial BP activates

Answer 24

afferent baroreceptors from aorta and within carotid sinuses–> decrease sympathetic outflow/increase parasympathetic impulses to SA node–> decreased HR, stroke volume, and CO

Question 25

When a patient is anesthetized and positive pressure ventilation is being used,

Answer 25

there is abnormal diaphragm shape, decreased V/Q matching, decreased arterial PO2
adequate minute ventilation limits atelectasis

Question 26

Any position that limits movement of diaphragm, chest wall or abdomen

Answer 26

may increase atelectasis or intrapulmonary shunt

Question 27

Pulmonary considerations when using neuraxial anesthesia include

Answer 27

loss of abdominal/thoracic muscle function in dermatomes

retained diaphragmatic function

Question 28

Arterial BP is labile immediately following

Answer 28

immediately following induction and positioning

Question 29

CV considerations- GA, muscle relaxation, PPV, and neuraxial blockade interfere with

Answer 29

venous return to the heart, arterial tone, and autoregulatory mechanisms

Question 30

CV considerations with spinals & epidurals include

Answer 30

significant sympathectomy (reduced preload/blunted cardiac responses)

Question 31

Positive pressure ventilation leads to

Answer 31

increased mean intrathoracic pressure and decreased venous pressure gradient leading to decreased CO

Question 32

The most common position for surgery is

Answer 32

supine

Question 33

The lawn chair position is

Answer 33

where hips/knees are slightly fixed in supine to take the strain off the lumbar spine

Question 34

The frog-leg position is

Answer 34

where hips/knees flexed and hips externally rotated

Question 35

Describe arm placement in the supine position:

Answer 35

abduction less than 90 degrees to minimize brachial plexus injury by caudad pressure in axilla from head of humerus
supinated hand/forearm or kept neutral (ulnar nerve)
pad elbows, IV lines, stopcocks

Question 36

The most common peripheral nerve injury with supine position includes

Answer 36

ulnar neuropathy

Question 37

Complications of the supine position include

Answer 37

pressure alopecia, backache (padding of spine or flexion hip/knee), soft tissue ischemia (bony prominences), peripheral nerve injury (ulnar neuropathy is most common), operating room table weight limit

Question 38

Considerations with reverse trendelenburg include

Answer 38

supine, head tilted upward
facilitates upper abdominal surgery by shifting abdominal contents caudad
detect hypotension due to decreased venous return
reduced perfusion pressure to brain

Question 39

Considerations with trendelenburg include

Answer 39

tilt head down position
nonsliding mattress
should braces not recommended (brachial plexus injury)

Question 40

CV effects of trendelenburg include:

Answer 40

increased central venous, intracranial, and intraocular pressures, swelling of face, conjunctiva, larynx, and tongue,

Question 41

Resp effects of trendelenburg include:

Answer 41

potential postoperative airway obstruction
decreased FRC and pulmonary compliance, In MV, higher airway pressures needed to ensure ventilation, ETT preferred to protect airway from aspiration and atelectasis

Question 42

The lithotomy position involves

Answer 42

hips flexed 80 to 100 degrees
legs abducted 30 to 45 degrees from midline
legs held by stirrups (candy cane, knee crutch, or calf support style)

Question 43

The most common nerve injury with lithotomy position is

Answer 43

common peroneal nerve injury due to lateral head of fibula that rests against stirrups

Question 44

Complications with lithotomy position include:

Answer 44

crush injuries to fingers, lower extremity compartment syndrome, both legs should be raised together/down together

Question 45

Lithotomy is used for (surgical types)

Answer 45

gynecologic, rectal, and urologic surgeries

Question 46

Resp. and CV concerns with lithotomy position include

Answer 46

increased preload, reduced lung compliance, decreased tidal volume, increased abdominal pressure

Question 47

Considerations for the lateral decubitus position include

Answer 47

prevent lateral rotation of neck and stretch injuries to brachial plexus, check ears, eyes, and all pressure points, balanced with anterior and posterior support, flexed dependent leg, arms positioned in front of patient

Question 48

Lateral decubitus position is used for surgeries of the

Answer 48

thorax, retroperitoneal, and hip

Question 49

To prevent compression injury to the dependent brachial plexus,

Answer 49

an axillary roll is used in the lateral decubitus position

Question 50

Resp & CV concerns with lateral decubitus position:

Answer 50

Kidney rest needs to be under the dependent iliac crest or else it can compress inferior vena cava and prevent venous return
can compromise pulmonary function- favors ventilation of nondependent lung and blood flow to under ventilated, dependent lung (gravity)

Question 51

Considerations for anesthetic managements include

Answer 51

choice of anesthetic, monitoring, foley catheter, evacuation of gastric contents, positioning, emergence/extubation, antiemetics, & pain management

Question 52

For every 15 cm of height that the arterial BP transducer is moved,

Answer 52

there is a 10 mmHg change in BP

Question 53

Factors that affect pulse oximetry include

Answer 53

methylene blue & indocyanide as they will show a decrease in SpO2

Question 54

The anesthesia provider is responsible for coordinating the flip in the prone position except for

Answer 54

when the patient is in Mayfield rigid pins and then the neurologist will stabilize the head

Question 55

Surgeries performed in the prone position include

Answer 55

posterior spine, buttocks, perirectal area, and lower extremities

Question 56

Pulmonary concerns in the prone position include

Answer 56

elevated intraabdominal pressure which increases the risk for decreased FRC and pulmonary compliance