Anesthesia for Therapeutic & Diagnostic Procedures - Quiz 3 Flashcards
How does JACAHO define Anesthesia?
IV, IM, or Inhaled Meds that cause loss of Protective Reflexes
What are the Drugs of Choice for Anesthesia at the Office (ENT or Dental)
Propofol
Sevo
Des
N2O
What is required by the ASA & JCAHO for Office Anesthesia?
Maintained Anesthesia Equipment
Documentation
Monitoring & Emergency Equipment
Staffed PACU
Plan for Emergency Transport
How should patients who are at risk for adverse reactions to Contrast be pretreated?
Prednisone 50mg 12 Hours Before
&
Benadryl 50mg right before
What can be given to reduce the risk of Nephrotoxicity from Contrast?
Acetylcysteine
What can develop in Type 2 Diabetic Renal Patients on Metformin who receives Contrast?
Severe Lactic Acidosis
Why is Deliberate HYPERtension needed for Cerebral Ischemia?
Maximizes Collateral Flow
Why should Emergence be Smooth for Interventional Radiology Procedures?
To avoid Device Migration & Intracranial Hemorrhage
What should the ACTs be for Cerebral Coiling?
2 - 2.5X above normal
What degree of Coronary Stenosis is considered hemodynamically significant?
50 - 70%
What can happen after a Stenotic Coronary Artery is Dilated?
Ventricular Arrhythmias
What are the adverse effects of Protamine?
Vasodilation
Anaphylaxis
Pulmonary Vasoconstriction
What is an important side effect of Abciximab?
Increased ACT without Heparin
Which drugs are Platelet Aggregation Inhibitors?
Abciximab
Ticlopidine
Clopidogrel
What can the use of Glucagon cause when used during an ERCP?
Tachycardia
What meds should be avoided during Sphincter of Oddi Manometry due to their effect on sphincter tone?
Opioids
Glycopyrrolate
Atropine
Glucagon
What is the purpose of a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure?
Decompresses Portal Circulation by connecting the right or left portal vein to one of three hepatic veins
TIPS procedure is normally performed under _______
TIPS procedure is normally performed under GENERAL ANESTHESIA
What is Electroconvulsive Therapy used for?
Depression
Mania
Schizophrenia
How often is Electroconvulsive Therapy performed to treat mental disorders?
3x per week for for 6-12 treatments
then weekly or monthly treatments
How does Electroconvulsive Therapy work?
Release Neurotransmitters during Grand Mal Seizure
↑Stress Hormones
↑NorEpi & Epi
Improved Glucose Control for DM2
Hyperglycemia for DM1
Which hormones are increased following Electroconvulsive Therapy?
ACTH
Cortisol
Vasopressin
Prolactin
Growth Hormone
Electroconvulsive Therapy _______ Cerebral Blood Flow & Intracranial Pressure
Electroconvulsive Therapy INCREASES Cerebral Blood Flow & Intracranial Pressure
How is the Heart affected by Electroconvulsive Therapy?
Bradycardia, then HTN & Tachycardia
Dysrhythmias
Myocardial Ischemia
What are the physical effects of Electroconvulsive Therapy?
Short Term Memory Loss
Muscle Aches
Fractures
Seizures
Sudden Death
What is an absolute contradication to Electroconvulsive Therapy?
Pheochromocytoma
What are some relative contraindications to Electroconvulsive Therapy?
↑ICP
Recent CVA
Heart Conduction Problems
High Risk Preggos
Aortic/Cerebral Aneurysms
Which muscle relaxant is preferred for Electroconvulsive Therapy?
Succinylcholine 0.75 - 1.5 mg/kg
What are some EKG changes related to Electroconvulsive Therapy?
PACs
PVCs
ST Depression
T-Wave Inversion
What are the most common cause of death related to Electroconvulsive Therapy?
MI & Arrhythmia
The goal of Electroconvulsive Therapy is a seizure that lasts _______
The goal of Electroconvulsive Therapy is a seizure that lasts 30-60 SECONDS
During Electroconvulsive Therapy, there will be Bradycardia, then HTN & Tachycardia. How should this be treated?
Esmolol
What are the anesthetic considerations for patients with Down Syndrome?
Abnormal Cardiac Conduction
A-O Dislocation
Macroglossia
Hypoplastic Maxilla
Abnormal Palate
Mandibular Protrusion
What are the Ketamine doses for Dental Procedures?
Ketamine
1-2 mg/kg IV
5-10 mg/kg Oral
2-4 mg/kg IM
What anesthetics are usually used for Dental Procedures?
Ketamine
Oral Versed
EMLA Cream for IV
What are the Airway Consideration for Dental Procedures?
Nasal Tracheal Intubation
LMA
Post-Op Bleeding, Obstruction, and Larygospasm
What is considered Minimal Sedation or Anxiolysis?
Patient can respond to Verbal Commands
&
Preserved Airway, Ventilatory, and CV Reflexes
What is considered Moderate or Conscious Sedation?
Patient responds to Verbal Commands WITH Light Tactile Stimulation
Patent Airway
Preserved Spont. Ventilation & CV Function
What is considered Deep Sedation?
Patient responds to repeated PAINFUL stimuli
Impaired Ventilation & Airway
Preserved CV Function
What is considered General Anesthesia?
Patient NOT arousable
Impaired Ventilation, Airway, and CV Function
What is a Ramsay Scale of 1?
Patient Anxious, Agitated, or Restless
What is a Ramsay Scale of 2?
Patient Cooperative, Oriented, and Calm
What is a Ramsay Scale of 3?
Patient responds to commands only
What is a Ramsay Scale of 4?
BRISK response to Light Glabellar Tap or Auditory Stimuli
What is a Ramsay Scale of 5?
SLOW response to Glabellar Tap or Auditory Stimuli
What is a Ramsay Score of 6?
No Response Glabellar Tap or Auditory Stimuli
What is the Adult Fasting Protocol for Solids & Non-Clear Liquids?
6-8 Hrs
or
NPO after Midnight
What is the >3 y.o Child Fasting Protocol for Solids & Non-Clear Liquids?
6 - 8 Hours
What is the Fasting Protocol for Solids & Non-Clear Liquids for Kids 6-36 months?
6 Hours
What is the Fasting Protocol for Solids & Non-Clear Liquids for Kids < 6 months?
4 - 6 hrs
What is the Fasting Protocol for Clear Liquids?
2 Hours for Kids < 6 months
&
2-4 Hours for everyone else
For Recovery, the patient must have V/S every 10 minutes x 3, then every hour x two
OR
until they have an Aldrete score of at least ______
For Recovery, the patient must have V/S every 10 minutes x 3, then every hour x two
OR
until they have an Aldrete score of at least 9
What’s the minimum time a patient is to be observed post procedure?
30 min
&
1 Hour if Resuscitive measures were needed
