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Surgery > Anesthesia LO's > Flashcards

Anesthesia LO's Flashcards

1
Q

Std ASA Monitors (5)

A 
1- pulse ox 
2- capnography 
3- BP cuff q 5 min or invasive monitor 
4- body temp measurement (esophageal or rectal) 
5- visual EKG display
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2
Q

In what situations is pulse ox inaccurate or misleading? (7)

A
  • low blood flow conditions
  • pt movement
  • nail polish
  • ambient light
  • dysfunctional HgB (carboxy absorbs red not infrared so variable SpO2) and methemoglobin (absorbs them equally so SpO2 of 85%)
  • IV dyes (methylene blue has SpO2 of 65%)
  • altered relationship b/n PaO2 and SaO2 (any shift in dissociation curve)
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3
Q

Capnography (importance, ideal meas, 4 parts of wave)

A

CO2 waveform represents CO2 in expired air - so shows that pt is ventilating (AKA pt is able to get rid of CO2)

on display is end tidal CO2 - want about 30-35 mmHg (this represents the alveolar CO2 - pACO2 which is close to but not exactly equal to PaCO2)

A-B - exhalation of anatomic dead space (no CO2)
B-C - exhalation of alveolar gas so inc CO2 in gas coming out (more gradual slope is bad sign - obstruction or lung disease)
D- end tidal CO2
D-E - inspiration begins (drop/descending in CO2)

Capnograph also tells you if the R ventricle / R heart is working - otherwise CO2 would not be getting to lungs to be expired

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4
Q

What increases exhaled CO2? (8)

A
  • hypoventilation
  • exhausted CO2 absorber
  • malfunctioning insp or exp valves
  • malignant hyperthermia (give dantrolene)
  • sepsis
  • rebreathing
  • admin of bicarb
  • insufflation of CO2 from lap surgery
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5
Q

Temp Monitoring in Anesthetized Pt (best locations)

A

Best core temp monitors - pulm artery, tympanic membranes, bladder

axillary / skin - prone to artifact

esophagus good for indicating trends of heat gain or loss

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6
Q

What decreases exhaled CO2?

A
  • hyperventilation
  • hypothermia
  • low CO
  • dec or cessation of pulm blood flow (can be due to systemic hypotension or PE)
  • accidental disconnection or tracheal extubation
  • cardiac arrest
  • esophageal intubation instead (may have CO2 from stomach in first breath then vanishes)
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7
Q

Important Aspects of Pre-Op History

A
  • Confirm planned surgical procedure and reason for undergoing surgery
  • Acute and chronic medical problems
  • Surgical history
  • Anesthetic history– does the patient have a personal or family history of anesthetic complications, e.g. post-op nausea/vomiting (PONV), allergic reactions, difficult airway or malignant hyperthermia or pseudocholinesterase def?
  • Allergies to medications
  • Medication Reconciliation
  • Prior substance use
  • Pertinent labs, imaging and other diagnostic studies as indicated. (stress test, echocardiogram, PFTs, cardiac catheterization, etc.)
  • functional capacity - avg level of exercise
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8
Q

Important Aspects of Pre-Op Physical

A
  • airway (Mallampati)
  • tongue size
  • teeth
  • jaw opening
  • cervical ROM
  • thyromental distance
  • neck thickness
  • beard?
  • listen to heart and lungs
  • peripheral pulses
  • edema?
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9
Q

OSA Screen

A

STOP - BANG

S- snoring loudly
T - tired during day
O - observed apneic episodes
P - pressure (High BP)

B - BMI > 35
A - age > 50
N - neck circumference > 40 cm
G - gender (MALE)

High risk of OSA if > 3

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10
Q

Which meds can be continued v. discontinued prior to surgery?

A

CONTINUE

  • statins, HTN meds, diuretics (maybe not loops)
  • 1/2 basal insulin
  • metformin
  • narcotics - esp for addiction
  • psych meds including MAOIs (dep or anxiety)
  • sz meds
  • estrogen / birth control
  • inhalers for asthma or COPD

DISCONTINUE

  • short-acting insulin
  • sulfonylureas
  • herbs/supplements
  • NSAIDs
  • estrogen for HRT or osteoporosis

ASPIRIN

  • cont if taken for stent or vascular disease (secondary prevention)
  • discont if only for primary prevention, risk of bleeding > risk of thrombosis
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11
Q

ASA Classification

A

ASA1 - healthy, non-smoker

ASA2 - mild systemic disease (no functional limitation)

ASA3 - severe disease (some functional limitation) ex - on dialysis, class II CHF

ASA4- severe disease at constant threat to life (functionally incapacitated) es - acute MI, resp failure w/ vent

ASA5- moribund - likely to die in 24 hrs +/- surgery

ASA6 - brain dead organ donor

**E on any above means emergency operation

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12
Q

Indications for Intubation

A
  • every pt receiving general anesthesia can be intubated but does not HAVE to be intubated

SPECIFIC …

  • if need patent airway
  • prevent aspiration (only form w/ “protected” airway)
  • if need frequent suction
  • for pos press vent of lungs
  • if operative position other than supine
  • operative site near upper airway
  • if airway maintenance by mask is difficult

**Mandatory if recently consumed food or SBO undergoing operation

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13
Q

Hypoxia (definition, differential, tx)

A

PaO2 < 60 or sat < 90%

  • atelectasis (shunt)
  • dec FRC –> V/Q mismatch
  • dec CO
  • alveolar hypoventilation (may be due to anesthetic)
  • aspiration (airway closes reflexively, dec surfactant, cap leak)
  • PE
  • pneumothorax (shunt)
  • advanced age
  • obesity (hypovent)
  • inc oxygen consumption (ex - shivering)
  • post-hyperventilation hypoxia (compensate afterwards to replenish CO2 stores)

Tx -

Can do chest tube for pneumothorax

If relative shunt (some alveoli working) then give high inspired O2

If absolute shunt (no alveoli open - no gas exchange) then give PEEP and CPAP to re-inflate

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14
Q

Hypercarbia (definition, differential and tx)

A

PaCO2 > 45 mmHg

Hypoventilation

  • residual effect of anesthesia meds / inadequate CNS stim
  • may be due to inadequate antagonists, potentiation by hypothermia, Mg or aminoglycosides, renal disease so dec excretion, delayed-phases effects of opioids

** Tx - naloxone, anti-cholinesterase, ventilate for them

Reduced ability to take deep breath

  • obesity, positioning affecting muscles
  • incision site pain

**Tx - incentive spirometry, chest PT, deep breathing exercises

COPD

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15
Q

What med can be taken pre-operatively if hx severe post-op nausea?

A

Scopalamine patch 2-4 hrs before

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16
Q

What meds can be taken pre-operatively to dec chance of aspiration?

A

H2 antagonists

PPIs

Metoclopramide

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17
Q

What meds can be taken pre-operatively if sig hx allergic rxn?

A

Diphenhydramine and cimetidine - totally block histamine receptors

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18
Q

What are the major differences b/n pediatric and adult airway?

A

In kids …

  • larynx higher in neck
  • tongue takes up greater proportion
  • epiglottis is larger, stiffer, more posterior so use STRAIGHT blade (miller)
  • larger head compared to body so need pillow or rolled towel under occiput
  • shorter neck
  • narrow nares

In adult narrowest part is vocal cords, in kids narrowest part is cricoid

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19
Q

LMA (what is it? when to use it / when to not use it?)

A

LMA - supraglottic airway (seals in hypopharynx above upper esophageal sphincter)

Indications - difficult intubation, if pt is not undergoing neuromuscular block (so cannot intubate)

Contraindications - full stomach (b/c not protected - risk aspiration)

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20
Q

Complications of Intubation

A

DURING

  • dental injury
  • HTN or tachy (reaction to blade)
  • cardiac dysrhythmia or ischemia
  • aspiration
  • esophageal intubation
  • cuff leak
  • barotrauma
  • tracheal tube obstruction

AFTER

  • laryngospasm
  • pharyngitis, laryngitis, tracheitis (sore throat)
  • tracheal stenosis
  • vocal cord paralysis
  • arytenoid dislocation
  • edema or ulceration
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21
Q

How do you verify endotracheal tube placement?

A
  • Visualize it going thru vocal cords
  • capnography > 30
  • symmetric bilateral chest rise
  • bilateral breath sounds (more so right placement in BOTH lungs not 1)
  • reservoir bag will have feel of normal lung compliance
  • see condensation in mask
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22
Q

Predictors of Difficult Mask Ventilation (5)

A 
Age > 55
BMI > 26
beard
lack of teeth
hx snoring
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23
Q

Predictors of Difficult Intubation (7)

A

Mouth opening - Inter-incisor distance < 3 cm

Uvula not visible (class III or IV)

short thick neck, neck circumference > 27 in

Inability to bring lower teeth in front of upper teeth

thyromental distance < 3 fingerbreadths

limited flexion or extension of neck

submandibular space w/ mass, stiffness or induration

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24
Q

Basic Parts of Anesthesia Machine

A

Pop-off Valve

Flow meter (sep for ea gas)

Vaporizer (for ea volatile anesthetic)

Circle System (gas mix –> pt –> exhale –> CO2 absorber –> fresh gas to pt)

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25
Q

Pop-Off Adjustment

A

Open = no pressure - all gas wasted - pt can exhale freely

Closed = pressure / resistance to exhalation - most gas flows in circle

OPEN WHEN PT EYES OPEN (aka awake) and CLOSE WHEN PT EYES CLOSED

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26
Q

Colors of Flow Meters

A

Blue - N2O

Green - O2

Yellow - air

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27
Q

What are the two most common positioning injuries?

A

Ulnar Claw- elbow hyperflexion

Brachial plexus - b/n clavicle and rib

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28
Q

Absorption

Distribution

Context-sensitive half-time

A

Absorption - from site of admin to bloodstream (solubility, dose, bioavailability, site, first pass)

Distribution - from blood to body (areas of greatest perfusion first - brain, heart, kidneys, liver, glands)

Time required for 50% drug conc dep on duration of infusion (context) not just half-life (ex - fentanyl)

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29
Q

4 Goals of General Anesthesia (drugs used for ea)

A

1- unconsciousness (propofol or etomidate, volatile agents and N2O in kids)

2- analgesia (fentanyl, morphine, ketamine)

3- amnesia (benzo like midazolam)

4- muscle relaxation (sux or rocuronium)

**Volatile agents (sevoflurane) can do all but analegisa

**N2O can do all but muscle relaxation

30
Q

Steps of Induction

A

1- monitors (EKG, pulse ox, BP)

2- pre-oxygenate (valve OPEN)

**may give midalozam and fentanyl here

3- IV sleep drug (propofol or etodmidate)

4- bag mask ventilate (valve CLOSED)

5- paralyze - muscle relax (do not want reflex against intubation)

**may give phenylephrine here for inc BP

6- intubate then check

31
Q

Pre-oxygenation

A

Goal = replace nitrogen w/ 100% oxygen for safety margin b/n mask vent and intubation

8 vital capacity breaths of 100% oxygen over 1 min

OR 3 min tidal volume breaths of 100% oxygen

32
Q

What is MAC?

A

min alveolar conc

min conc of inhaled anesthetic at 1 atm needed to prevent skeletal muscle movement in response to noxious stimuli in 50% people

Reflect partial pressure at site of action

33
Q

How do inhaled anesthetics affect ventilation?

A

Inc RR but dec tidal volume so minute vent stable

This leads to inc PaCO2 (not as much CO2 expired) / less efficient gas exchange

Less ventilatory response to hypoxemia or hypercarbia

34
Q

How do inhaled anesthetics affect cardio?

A

Small artery vasodilation –> less systemic vasc resistance

Inc HR

Prolong QT

35
Q

4 Main Effects of Nitrous Oxide

A

1- expands air-filled cavities (blood-gas partition coef 34X nitrogen so leaves blood 34X faster) –> inc pressure in non-compliant areas and inc volume in compliant areas

2- cerebral vasodilation / inc cerebral flow

3- inc symp tone (diaphoresis, inc body temp, inc catecholamines in plasma, inc R atrial pressure)

4- inactivates methionine synthase to worsen B12 def

36
Q

Factors that Inc MAC

A
  • acute amphetamine use (cocaine or ephedrine)
  • chronic alcohol use
  • age
  • hypernatremia, hyperthermia
  • high cardiac output
37
Q

Major Effects of Propofol

A

CNS - sedation, dec cerebral blood flow, dec ICP

Cardio - dec SVR, dec BP, small inc HR

Resp - dec RR, really dec tidal volume, dec ventilatory response to hypoxemia or hypercappnia, dec upper airway reflexes

38
Q

Uses and Side Effects of Benzos

A

Uses - pre-op (dec anxiety, amnesia, sedation, synergistic w/ propofol or opioids), IV sedation, suppress sz, induction of anesthesia

Side Effects - dec cerebral flow, peripheral vasodilation - dec BP, minimal resp depression (may cause transient apnea if combined w/ other induction drugs)

39
Q

Opioids MAO and Uses

A

MAO - bind opioid receptors –> act G protein –> inhibitory / hyper polarizing

Inhibit substance P release from primary sensory neurons in dorsal horn of SC which dec pain sensation to brain

Change affective response to brain in forebrain & change reward structures in brain

More effective for slow, unmyelinated C fibers than fast, A delta fibers

More effective if given b/f painful stimulus

Uses - pain relief, sleepiness, suppress cough

40
Q

Opioid Side Effects (8)

A
  • resp depression
  • bradycardia, vasodilation
  • nausea and vomiting
  • pupil constriction (pinpoint)
  • urinary retention
  • constipation (delay emptying and sphincter spasm)
  • muscle rigidity including vocal cord rigidity
  • DEC MAC (synergistic w/ volatiles)
41
Q

Amides v. Esters

A

Amides - not metabolized to PABA (metabolized in liver instead) –> so less likely to have allergies

**slow onset, longer duration, less maximum dose

Esthers - metabolized to PABA by local cholinesterases –> PABA cross reacts leading to greater chance allergies

**rapid onset, shorter duration, higher max dose

42
Q

Mechanism and Complications of Local Anesthetic

A

MAO - stabilize nerve Na+ channels in inactivated state which blocks conduction of nerve impulses

Local complications - prolonger/ permanent anesthesia or muscle weakness

Systemic complications - (other Na+ voltage gated channels like in neurons, heart)

  • agitation, tremor
  • drowsy/unconscious
  • sz
  • vertigo
  • tinnitus
  • slurred speech
  • angina
  • SOB
  • dysrhythmia
43
Q

How do you prevent systemic affects of local anesthetic?

A

Co-administer w/ epinephrine to vasoconstrict

** cannot give if unstable angina, dysrhythmia, HTN, placental insufficiency, if nerve block w/o collateral flow

44
Q

What is the max safe dose for lidocaine?

A

4.5 mg/kg w/o epi (do not exceed 300 mg)

7 mg/kg if w/ epi

45
Q

Depolarizing v Non-depolarizing Neuromuscular Block (MAO, onset, metabolism)

A

Depolarizing

  • mimics Ach to depolarize at NMJ (fasiculations)
  • rapid onset (30-60 sec) and short duration (5-10 min)
  • slowly hydrolyzed by AchE
  • rapidly hydrolyzed by plasma pseudo-cholinesterase

Non-depolarizing

  • comp antagonist of Ach at nicotinic receptors; no depolarization (NO fasiculations)
  • onset 1-2 min for roc and 3-5 min for vecuronium/pancuronium
  • duration is 20-35 min for rocuronium/vec and 60-90 min for pancuronium
46
Q

What drugs dec effect rocuronium?

A
  • calcium
  • corticosteroids
  • phenytoin
  • burn injury
47
Q

Adverse Effects of Sux (8)

A
  • cardiac dysrhythmia, bradycardia
  • fasiculations
  • hyperkalemia (released from muscle cells during fasiculations)
  • myalgias (can prevent w/ pretreating w/ roc)
  • myoglobinuria
  • inc intraocular pressure
  • inc intragastric pressure
  • trismus in kids esp
48
Q

Adverse Effects of Non-depolarizers

A

Mainly dysrhythmia, inc HR, inc SVR

49
Q

Contraindications to Sux (6)

A

24 hrs after major burns, trauma, SC injury or denervation (worry about hyperkalemia)

worry about hyperkalemia in boys if undiagnosed Duchenes Muscular Dystrophy

ICU pts or pts immoble for long periods - inc extra-junctional receptors –> inc K+ release

Narrow angle glaucoma (inc pressure)

malignant hyperthermia hx

plasma pseudocholinesterase def

50
Q

How do you reverse a non-depolarizing block? What happens if reversal is incomplete?

A

Anticholinesterase inhibitor like neostigmine - dec metabolism of Ach so more Ach to outcompete rocuronium

QUARTERNARY - no CNS (just peripheral)

Side effects - muscarinic (brady, hypotension, inc GI motility, urination, sweating, laryngospasm, bronchospasm)

Can give w/ glycopyrrolate or atropine to dec muscarinic effects

If incomplete … AIRWAY AT RISK (pharyngeal muscles too weak to prevent aspiration and cough)

51
Q

Train of 4’s Testing

A

4 consecutive 2 Hz stim < 10 sec apart

For non-depolarizing … there is a fade response so meas TOF ratio (height last twitch / height of first twitch)

For depolarizing … there is a uniform response; all twitches same magnitude so meas TOF count (# twitches)

If depolarizing drug if used and it becomes a fade then you know you are in phase II

More drug = less twitches

if 0 twitches DO NOT UNBLOCK/ REVERSE because you do not know where you are in blockade sequence)

52
Q

TOF # and Suppression Correlations

A

0/4 - excessive blockade; difficult to predict; DO NOT REVERSE

1/4 - 90% suppression

2/4 - 80% suppression

3/4 - 75% suppression

4/4 - can then do tetanus test … repetitive stim for 5 sec … if full tetanus then no block … if tetanus fades then there is residual block

53
Q

What nerves are used for TOF monitoring?

A

Ulnar - adductor pollicus

  • similiar to larynx muscles if sux
  • more intense blockade than larynx muscles if roc

Facial - orbicularis oculi
-more similar to larynx muscles than ulnar

54
Q

Phase I and Phase II of Depolarizing Blocks

A

Phase I - depolarization; sux binds Ach receptors to depolarize motor end plate; Ach cannot bind b/c receptors are OCCUPIED

Phase II - desensitization; post-synaptic membrane repolarizes but it de-sensitized so still does not respond to Ach

55
Q

Crystalloids v. Colloid v. Blood

A

Crystalloid - doesn’t stay intravascular; electrolyte content causes 2/3 to become interstitial

Ex) normal saline (.9% NaCl hypertonic), LR (hypotonic), D5W (glucose metabolized)

Colloid - does not easily cross endothelial barrier so stays endovascular; no electrolytes

Ex) albumin, dextran, hydroxyethyl starch

Blood - rarely used as first resort b/c in high demand and risk transfusion reaction; inc oxygen carrying capacity

56
Q

Blood Transfusion Complications (8)

A
  • Hep C or HIV
  • tranfusion reactions (febrile, allergic, hemolytic)
  • ARDS w/in 4 hrs
  • suppression of cell-mediated immunity
  • citrate overload can lead to metabolic alkalosis
  • platelet and leukocyte microaggregation during storage - use 170 micron filter
  • hypothermia leading to inc oxygen demand if blood temp is too low
  • dilution thrombocytopenia
  • DIC
57
Q

Indications for Platelet Transfusion

A

Platelets < 50,000

1 unit –> inc 5000-10,000 in first hr

58
Q

Indications for FFP Transfusion ( + what is it?)

A

**Contains all coagulation factors but no platelets

  • If PT/PTT 1.5X longer than normal
  • reversal of warfarin
  • correction of coag factor deficit
59
Q

Tissue Layers for Spinal v. Epidural

A

Spinal - skin –> superficial fascia –> supraspinous ligament –> interspinous ligament –> ligamentum flavum –> epidural space (POTENTIAL SPACE W/ VENOUS PLEXUS) –> dura mater (hear POP) –> arachnoid –> now in subarachnoid space (CSF)

**Get CSF back in

Epidural - stop b/f popping thru dura (use Tuohy needle that cannot easily pop and shorter catheter)

**Do not get CSF back

60
Q

What is in the epidural space?

A

fat, lymphatics, blood vessels

61
Q

Spinal v. Epidural (adv and disadv)

A

Spinal - easier to do and more comfortable for pt, more intense drugs so less amount of drug

Epidural - less headache, less hypotension, can leave catheter in post-op to inc drug

62
Q

Contraindications and Complications from Neuroaxial Blocks

A

Contraindications

  • infection at planned site of needle puncture
  • inc ICP
  • bleeding diathesis (AKA prone to bleed - hypo coag)

Relative Contraindications

  • general systemic infection - risk abscess or meningitis
  • pre-existing neuro disease
  • Mitral or aortic stenosis / cannot withstand dec SVR
  • abnormal coagulation

Complications

  • neuro
  • hypotension from symp NS block (give ephedrine)
  • bradycardia / asystole (give atropine)
  • headache (COMMON) - loss of CSF in spinal –> downward brain displacement –> stretch on supporting structures @ 12-48 hrs
  • apnea (dec breathing motor) - O2 and CPAP
  • nausea
  • urinary retention
  • back ache / root irritation

Specific Complications for Epidural

  • hematoma or abscess
  • dural puncture
  • systemic absorption into vessels
  • nerve injury
63
Q

Locations for Brachial Plexus Blocks

A

Interscalene - (C3 to C7) for shoulder / proximal arm surgery

Supraclavicular - (at level of upper, middle, lower trunks) rapid onset and dense block for surgery of distal 2/3 arm

Infraclavicular - (at cords - lateral, medial, posterior) also for surgeries of distal 2/3 of arm and good for catheter stability if needed

Axillary - (at level of individual nerves - radial, median, ulnar, musculocutaneous) - may require mult injections

**May need to separately block intercostobrachial nerve for tourniquet placement - not part of plexus

64
Q

Location for Lower Extremity Blocks

A

Lumbar plexus - usually in addition to GA for pain control; in psoas compartment

Femoral - anterior thigh and knee

Fascia Iliaca - lateral femoral cutaneous block; sensory to lateral thigh

Obturator - medial distal thigh

Saphenous nerve and adductor canal - saphenous is terminal sensory nerve of femoral; for superficial/medial lower leg and ankle

Sciatic - complete anesthesia of leg below knee; can use anterior or posterior approach

Popliteal - can block sciatic from this pt on

Ankle block - must inject to block 5 separate nerves (superficial and deep peroneal, tibial, sural, saphenous nerve) for surgery on foot and toes

65
Q

Differential for Hypotension (11)

A
  • Hypovolemia (inadequate replacement post-op)
  • Hypovolemia secondary to internal bleeding - dec Hct
  • Hypovolemia secondary to inc cap permeability (sepsis, burns, transfusion -related lung injury)
  • Cardiogenic - dec contractility due to residual anesthetic, acute MI, pulmonary edema (give inotropes)
  • Dec SVR - residual anesthesia or sepsis
  • adrenal insufficiency
  • cardiac dysrhythmia
  • PE
  • arterial hypoxemia
  • pneumothorax
  • tamponade
66
Q

Signs on Bronchospasm

A
  • wheezing
  • inc peak inspiratory pressure / dec tidal volume
  • slower upslope of capnogram
  • if severe … no breath sounds and difficult to ventilate
67
Q

Algorithm for Pre-Op Cardiac Eval for Non-Cardiac Surgery

A

1- is it an emergency? is yes - optimize and operate

2-do they have symptomatic valve disease, arrhythmia, recent MI, decomp CHF or unstable angina? do not operate at this time

3- if not … do they have > 4 mets? (flight of steps); if yes –> OR w/o further tests

4 - if not… assess cardiac risk

  • ischemic heart disease
  • heart fail
  • CVA/TIA hx
  • Creat > 2 mg/dL
  • insulin dep DM
  • vascular above inguinal lig, thoracic or intra-peritoneal surgery

if 0-1 factors … low risk (< 1%) –> OR
if 2+ factors … elevated risk –> do echo, CXR, EKG

68
Q

Risk Factors for Post-op N and V (9)

A
  • prior hx
  • hx motion sickness
  • female
  • non smoker
  • use of intra or post operative opioids
  • volatiles and nitrous oxide
  • large dose of neostigmine
  • surgery duration
  • surgery type (gyn, eye muscles, middle ear, chole, laparoscopic)
69
Q

Tx options for post -op nausea and vomiting

A

Ondansetron - serotonin receptor antagonist

Perphenazine - works at hypothalamus

Droperidol (careful QT prolongation)

Metclopromide - inc motility

Scopolamine

Propofal at 1/10 induction dose

Dexamethasone

Aprepitant - NK1 antagonist

70
Q

Complications from Post- Op Pain

A

“PaGE the ICU”

P- pulm (atelectasis and eventually, pneumonia)

G- GI (ileus)

E - endocrine (inc catecholamine release - hyperglycemia, sodium and water retention, protein catabolism)

I- immune function dec

C- cardio /coag ( hypertension, tachycardia, MI, dysrhythmia, DVT)

U- urinary retention

71
Q

Parts of Anesthetic Plan

A

1- Will sedative-hypnotic premedication be useful?

2 - Prophylaxis against PONV (Post-operative nausea and vomiting)

3- What type(s) of anesthesia will be employed?

  • General
  • Regional
  • Sedation/MAC

4- Are there special intraoperative management issues?

  • Non-standard monitors
  • Positions other than supine
  • Relative or absolute contraindications to specific drugs
  • Fluid management
  • Potential need for blood transfusion

5 -How will the patient be managed postoperatively?

  • Management of acute pain
  • Need for mechanical ventilation or hemodynamic monitoring

Surgery (2 decks)

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