Anesthesia for therapeutic and diagnostic procedures

Question 1

JCAHO definition of anesthesia care

Answer 1

• administration of IV or IM medications that may result in the loss of protective reflexes

Question 2

maximal permissible dose of radiation

Answer 2

50 millisieverts annually

Question 3

predisposing factors for adverse reactions to contrast media

Answer 3

• bronchospasm
• allergy
• cardiac disease
• hypovolemia
• hematologic disease
• renal dysfunction
• extreme age
  -anxiety
• beta-blockers, ASA, NSAIDs

Question 4

pretreatment of contrast allergy

Answer 4

• prednisone 50mg 12 hours before
• diphenhydramine 50 mg immediately before procedure

Question 5

treatment of contrast allergic reaction

Answer 5

• o2
• bronchodilators
• epi
• corticosteroids
• antihistamines

Question 6

medication that reduces contrast nephrotoxicity

Answer 6

• acetylcysteine

Question 7

metformin and contrast dye

Answer 7

• patient can develop lactic acidosis

Question 8

interventional radiology anesthesia considerations

Answer 8

• often need deliberate hypotension and hypocapnia
• smooth emergence, avoid coughing and vomiting

Question 9

percentage of stenosis for CAD considered significant

Answer 9

• 50-70%
• arrythmias may occur when vessels are dilated

Question 10

target ACT for cath procedure

Answer 10

• > 300 seconds

Question 11

drugs to avoid during sphincter of Oddi manometry

Answer 11

• opioids
• glycopyrrolate
• atropine
• glucagon (dilates sphincter/ decreases spasms, may cause tachycardia)

Question 12

Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure

Answer 12

• connects the right and left portal vein to one of the 3 hepatic veins to decompress portal circulation in pts with portal HTN

Question 13

what does electroconvulsive therapy do to the brain

Answer 13

• causes a release of neurotransmitters during the electrically induced grand mal seizure
• increases stress hormones, epi, norepi

Question 14

cardiovascular response to ECT therapy

Answer 14

• initial bradycardia followed by HTN and tachycardia
• dysrhythmias
• myocardial ischemia

Question 15

absolute contraindications to ECT therapy

Answer 15

• pheochromocytoma

Question 16

relative contraindications to ECT therapy

Answer 16

• increased ICP
• recent CVA
• cardiac conduction defects
• high-risk pregnancy
• aortic and cerebral aneurysm

Question 17

sedation medications for ECT therapy

Answer 17

• propofol of short acting opioids (alfentanil, remifentanil)
• anectine is preferred to prevent musculoskeletal complications

Question 18

other medications for ECT therapy

Answer 18

• toradol (15-30 mg) prevent myalgia
• robinul & atropine
• lebetalol and esmolol
• clonidine and precedex (control BP without effecting seizure)

Question 19

airway difficulties associated with down syndrome

Answer 19

• macroglossia
• hypoplastic maxilla
• palatal abnormalities
• mandibular protrusion

Question 20

moderate sedation/ analgesia “conscious sedation” definition

Answer 20

• drug induced depression of consciousness during which patients respond to verbal commands
• pt maintains spontaneously breathing
• CV function is maintained

Question 21

deep sedation/ analgesia

Answer 21

• drug induced depression of consciousness during which patients can not be easily aroused but respond to painful stimuli
• may require assistance with airway

Question 22

general anesthesia

Answer 22

• LOC, pt not does not respond to even painful stimuli