Anesthesia Procedures, Methods, Techniques Flashcards
An anesthesiologist is covering two rooms, each with a CRNA. Which of the following actions taken by the anesthesiologist is MOST likely to cause The Centers for Medicare & Medicaid Services to pay at the medically supervised rate instead of the medically directed rate?
**Travelling to the ER to provide guidance for difficult emergency ECMO placement **
To satisfy the requirements for medical direction, the physician must:
perform a pre-anesthetic examination and evaluation;
prescribe the anesthetic plan;
personally participate in the most demanding procedures in the anesthesia plan, including, if applicable, induction and emergence;
ensure that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified individual;
monitor the course of anesthesia administration at frequent intervals;
remain physically present and available for immediate diagnosis and treatment of emergencies; and
provide indicated post-anesthesia care.
A patient files a lawsuit against an anesthesiologist alleging intraoperative awareness. Which of the following is MOST likely to be protected by legal privilege?
Email message using personal account between the anesthesiologist and their malpractice attorney
A patient files a lawsuit against an anesthesiologist alleging intraoperative awareness. Which of the following is MOST likely to be protected by legal privilege?
Which of the following is true regarding renal function in the geriatric population?
There is an impaired ability to both concentrate and dilute urine
Changes to the renal system in the geriatric population include a decreasing renal mass, blood flow, creatinine clearance, and ability to effectively dilute and concentrate urine placing them at risk for prolonged medication effects and dehydration.
A 33-year-old man with cerebral palsy is brought to the preanesthesia testing clinic because he is scheduled for elective contracture release surgery. Medications include diazepam 5 mg as required for anxiety and muscle spasticity and dantrolene 50 mg 4 times daily for spasticity. Which of the following tests should be assessed periodically in this patient?
Liver function tests
Chronic, oral dantrolene use can cause hepatotoxicity. Liver function tests should be assessed periodically in patients who take dantrolene to assess for any potential liver damage.
Which of the following physiologic mechanisms is responsible for increased small airway collapse in the elderly population?
Increased closing capacity
Increased chest wall stiffness, loss of muscle mass, flattening of the diaphragm, and increased compliance of lung parenchyma lead to several physiologic changes in elderly respiration. The volume at which small airways collapse increases with aging, such that by the mid-60s, closing capacity surpasses functional residual capacity and will eventually surpass tidal volume.
Which of the following is recommended by the American Society of Anesthesiologists to monitor oxygen in the breathing system during general anesthesia?
Inspired Gas analyzer
The American Society of Anesthesiologists (ASA) recommends the use of an oxygen analyzer with a low oxygen concentration limit alarm to monitor the oxygen content in the breathing circuit when general anesthesia is performed with an anesthesia machine. Oxygenation of the blood should be measured by pulse oximetry.
A 200kg elderly female presents for anal fistulotomy. Her long-standing history includes hypertension, diabetes, delayed gastric emptying, high cholesterol, and left ventricular hypertrophy. She received neuraxial anesthesia for her procedure, which is performed in the lithotomy position. The day after surgery, the primary service calls you because she is “tripping over her left foot”. She denies back pain. Which of the following is MOST likely?
Neuropathy of the sciatic nerve branch
Common peroneal nerve injury, although rare in occurrence, is the most commonly injured nerve during lithotomy position.
According to a 2019 JAMA review, which of the following physical exam findings is MOST likely to predict for difficult intubation?
Class 3 Upper lip bite test
Multiple airway features should be evaluated prior to planned airway management since no single physical exam finding has a 100% predictive value for difficult intubation. However, a 2019 JAMA review determined that, of the multiple physical exam findings studied, a class 3 upper lip bite test (ULBT) is the most likely to predict a difficult intubation. The presence of this finding is associated with a > 60% incidence of difficult intubation.
After an uneventful topicalized flexible bronchoscopic intubation with confirmed endotracheal tube placement, the SpO2 via pulse oximeter remains at 85%. You obtain an arterial blood gas which reports the following:
pH: 7.35
pCO2: 39 mm Hg
PaO2: 216 mm Hg
HCO3: 18 mEq/L
BE: -4
SaO2: 100%
Which of the following is the first BEST treatment option?
Methylene Blue
Prilocaine and benzocaine are local anesthetics known to induce methemoglobinemia. These agents can be used for upper airway topicalization prior to awake flexible bronchoscopy and intubation. Standard pulse oximetry SpO2 readings of 85-88% are commonly noted in the setting of methemoglobinemia. Methylene blue (1-2 mg/kg) is the primary pharmacologic treatment of methemoglobinemia. Methylene blue is a monoamine oxidase inhibitor. Doses > 5mg/kg in the setting of selective serotonin reuptake inhibitor use may precipitate serotonin crisis. For this reason, indigo carmine may be preferred for use in detecting ureteral injury.
An 8-year-old 25 kg male presents for inguinal hernia repair surgery. The surgery lasts for two hours with minimal blood loss. Which of the following volumes of total perioperative fluid seems MOST appropriate within the first 2-4 hours of the perioperative period?
600ml
20 to 40 mL/kg of balanced salt solution should be administered during the first 2-4 hours of the perioperative period during the course of the anesthetic in children
20 to 40 mL/kg of balanced salt solution should be administered during the first 2-4 hours of the perioperative period during the course of the anesthetic in children
Radiation
Heat loss from the body occurs via one of four ways: radiation, evaporation, conduction, and convection. Radiation is the largest contributor to heat loss accounting for 60%.
Which of the following is the MOST common symptom seen with ondansetron at usual clinical doses?
Headache
Common side effects of ondansetron include QTc prolongation (20%, very rarely clinically significant), headache (11%), transient AST/ALT increases (5%), constipation (4%), rash (1%), flushing/warmth (< 1%), and dizziness (< 1%).
Compared with adult patients who fast from clear liquids for > 4 hours, those who fast between 2-4 hours have:
Equivocal gastric volumes and equivocal gastric pH
A 70-year-old man with a history of tobacco smoking is undergoing an elective laparoscopic colectomy with carbon dioxide insufflation. Which of the following is MOST true regarding inhaled nitrous oxide as part of a balanced anesthetic?
**Nitrous oxide may **
