Anesthesia for therapeutic and diagnostic procedures Flashcards
JCAHO definition of anesthesia care
- administration of IV or IM medications that may result in the loss of protective reflexes
maximal permissible dose of radiation
50 millisieverts annually
predisposing factors for adverse reactions to contrast media
- bronchospasm
- allergy
- cardiac disease
- hypovolemia
- hematologic disease
- renal dysfunction
- extreme age
-anxiety - beta-blockers, ASA, NSAIDs
pretreatment of contrast allergy
- prednisone 50mg 12 hours before
- diphenhydramine 50 mg immediately before procedure
treatment of contrast allergic reaction
- o2
- bronchodilators
- epi
- corticosteroids
- antihistamines
medication that reduces contrast nephrotoxicity
- acetylcysteine
metformin and contrast dye
- patient can develop lactic acidosis
interventional radiology anesthesia considerations
- often need deliberate hypotension and hypocapnia
- smooth emergence, avoid coughing and vomiting
percentage of stenosis for CAD considered significant
- 50-70%
- arrythmias may occur when vessels are dilated
target ACT for cath procedure
- > 300 seconds
drugs to avoid during sphincter of Oddi manometry
- opioids
- glycopyrrolate
- atropine
- glucagon (dilates sphincter/ decreases spasms, may cause tachycardia)
Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure
- connects the right and left portal vein to one of the 3 hepatic veins to decompress portal circulation in pts with portal HTN
what does electroconvulsive therapy do to the brain
- causes a release of neurotransmitters during the electrically induced grand mal seizure
- increases stress hormones, epi, norepi
cardiovascular response to ECT therapy
- initial bradycardia followed by HTN and tachycardia
- dysrhythmias
- myocardial ischemia
absolute contraindications to ECT therapy
- pheochromocytoma
relative contraindications to ECT therapy
- increased ICP
- recent CVA
- cardiac conduction defects
- high-risk pregnancy
- aortic and cerebral aneurysm
sedation medications for ECT therapy
- propofol of short acting opioids (alfentanil, remifentanil)
- anectine is preferred to prevent musculoskeletal complications
other medications for ECT therapy
- toradol (15-30 mg) prevent myalgia
- robinul & atropine
- lebetalol and esmolol
- clonidine and precedex (control BP without effecting seizure)
airway difficulties associated with down syndrome
- macroglossia
- hypoplastic maxilla
- palatal abnormalities
- mandibular protrusion
moderate sedation/ analgesia “conscious sedation” definition
- drug induced depression of consciousness during which patients respond to verbal commands
- pt maintains spontaneously breathing
- CV function is maintained
deep sedation/ analgesia
- drug induced depression of consciousness during which patients can not be easily aroused but respond to painful stimuli
- may require assistance with airway
general anesthesia
- LOC, pt not does not respond to even painful stimuli
