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Surgery > Anesthetic monitoring > Flashcards

Anesthetic monitoring Flashcards

1
Q

what should be monitored when a patient is under anesthesia?

A

monitor vital signs, reflexes, tones, and other indicators (life status, anesthetic depth status)

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2
Q

what does prolonged CRT mean?

A

prolonged (> 2 secs) may indicate hypotension, hypovolemia, hypothermia, vasodilation, vasoconstriction, cardiac failure, shock

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3
Q

what are ways to review oxygenation status?

A

mm color, RR, respiratory character, Vt, pulse oximetry, blood gas analysis

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4
Q

mm colors and meanings

A

pale= hypovolemia, hypotension, vasoconstriction, shock
cyanosis= hypoxemia
temp, vascular resistance, gum disease, and certain breeds (Chow Chow) may alter color

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5
Q

respiratory rate

A

can be monitored by watching chest movement, reservoir bag movement, and capnography
monitor respiratory character: effort required, relative length of inhalation and exhalation
gasping or labored breathing may require intervention

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6
Q

Vt or tidal volume

A

total volume inhaled in mL’s during normal breath
usually decreased under anesthesia
10-20 mL/kg

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7
Q

abnormal breathing patterns

A

abdominal breathing= expansion and contraction of abdomen during breathing
stridor= high pitched breathing noise (laryngeal obstruction)
stertor= low/deep pitched breathing noise (snoring)

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8
Q

pulse oximetry

A

estimates saturation of hemoglobin (So2)
expressed as %
gives pulse wave form (quality of pulse) noninvasive, portable, inexpensive
easy to use

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9
Q

how does the pulse oximeter work?

A

red and infrared-wavelength light is emitted by the probe and passes through/reflected off tissue bed
frequency of the light is read by the sensor and analyzed
machine determines oxygen saturation by calculating difference between levels of oxygenated and deoxygenated hemoglobin based on subtle differences in light absorption

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10
Q

what is the normal percentage of pulse oximetry?

A

> 95%

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11
Q

blood gas analysis

A

alternative way to monitor oxygenation, CO2, and acid-base status in blood
arterial sample is diagnostic for oxygenation

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12
Q

what are the ways to evaluate heart rate?

A

auscultation, digital palpation, esophageal stethoscope/doppler (long, thin, flexible catheter attached to an electrical amplifier or to a binaural stethoscope), doppler, EKG (used to detect arrythymias)

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13
Q

P wave

A

first little wave of pulse
SA node triggered causing atria depolarization

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14
Q

QRS complex

A

the spike down, up, down
caused by depolarization of the ventricles, triggers main pumping contractions

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15
Q

PR interval

A

flat line between P wave and QRS complex
caused by a delay of the AV node to allow ventricle filling

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16
Q

ST segment

A

flat line between QRS complex and T wave
caused by beginning of ventricle repolarization

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17
Q

T wave

A

little wave that comes after QRS complex
caused by ventricular repolarization

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18
Q

wave of depolarization traveling toward a positive electrode results in a ____ deflection in EKG trace

A

positive

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19
Q

wave of depolarization traveling away from a positive electrode results in a ____ deflection

A

negative

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20
Q

wave of repolarization traveling toward a positive electrode results in a _____ deflection

A

negative

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21
Q

sinus arrhythmia

A

3 waves close together with a large space between the next group of 3 waves
treat with lidocaine

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22
Q

sinus tachycardia

A

T wave goes down instead of up

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23
Q

VPC/PVC (ventricular premature contraction or premature ventricular contraction)

A

heart waves are more rounded and longer than the usual short waves/spikes up and down

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24
Q

ventricular fibrilation

A

rounded waves going up and down in no particular rhythm
need to shock/do CPR

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25
Q

what are the different types of AV heart blocks?

A

1st degree: longer PR interval
2nd degree: (2:1) skipped some QRS complexes and T waves
3rd degree: skipped QRS complexes/T waves and longer PR interval

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26
Q

BP

A

force exerted by flowing blood on arterial walls
used to monitor perfusion
things that have an effect on BP: HR, stroke volume, vascular resistance, arterial compliance, and blood volume

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27
Q

systolic BP

A

contraction of left ventricle

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28
Q

diastolic BP

A

pressure that remains in arteries when heart is resting between contractions

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29
Q

MAP

A

average pressure through cardiac cycle

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30
Q

common causes of hypotension

A

anesthetic agents, excessive anesthetic depth, vasodilation, blood loss, dehydration, cardiac arrhythmias, preexisting heart disease, PPV, gastric distention

31
Q

how do you prevent hypotension?

A

avoid excess depth, provide adequate analgesia, use pre-med to decrease MAC, avoid drugs that decrease cardiac onset/induce bradycardia/cause vasodilation, administer IV fluids at sufficient rate, give vasopressors

32
Q

pulse strength

A

rough indicator of BP
palpate peripheral arteries (lingual, femoral, dorsal pedal)
normal pulse should be strong and occur shortly after each heartbeat
anesthetics can decrease pulse strength

33
Q

direct BP monitoring

A

arterial catheterization, pressure transducer
doppler or oscillometric BP
central venous pressure

34
Q

capnography

A

measures CO2 in the gas that is breathed in and out by the patient and provides graph

35
Q

what is CO2?

A

a heavy odorless colorless gas formed during respiration and by decomposition of organic substances

36
Q

expired CO2

A

EtCO2

37
Q

inspired CO2

A

InCO2

38
Q

normal EtCO2

A

35-45 mmHg

39
Q

normal InCO2

A

0 mmHg

40
Q

why are capnographs helpful to use?

A

they are noninvasive, continuous, and practical
don’t need arterial catheterization
useful during anesthesia and CPR because it can be 1st indicator of death and also of good quality chest compressions

41
Q

what does a capnograph monitor consist of?

A

a sensor and computerized monitor with a digital readout
sensor measures infrared light absorption which is directly proportional to CO2 level

42
Q

what are the types of capnographs?

A

mainstream: sensor chamber is between ETT and breathing circuit = instant results
side-stream: sensor is in the monitor, air sample is pulled between the ETT and the breathing circuit = less dead space with delayed results

43
Q

capnograph(y)

A

monitoring of the concentration of partial pressure of CO2 in respiratory gases

44
Q

capnogram

A

waveform tracing produced by capnograph

45
Q

hypercapnia/hypercarbia

A

excessive CO2 in the bloodstream

46
Q

hypocapnia/hypocarbia

A

deficiency of CO2 in the bloodstream

47
Q

respiratory acidosis

A

increased levels of CO2 in the blood due to not breathing enough

48
Q

respiratory alkalosis

A

decreased levels of CO2 in the bloodstream due to breathing excessively

49
Q

ventilation

A

ability for lungs to exchange gases

50
Q

what does EtCO2 indicate?

A

ventilation and perfusion

51
Q

perfusion

A

ability for blood to flow throughout the CV system

52
Q

what is affected by abnormal ventilation or perfusion?

A

the EtCO2 value and waveform

53
Q

what happens when a patient is hypoventilating/apneic?

A

will retain CO2 in the blood and makes them acidotic

54
Q

what happens when a patient is hyperventilating?

A

will expel too much CO2 and makes them alkalotic

55
Q

capnography phase 1

A

expiratory baseline
beginning of exhalation and corresponds to exhalation of CO2-free dead space gas from the larger conducting airways, CO2 value during this phase should be 0

56
Q

capnography phase 2

A

expiratory upstroke
involves exhalation of mixed alveolar and decreased dead space gas which rapidly increases CO2 concentration

57
Q

capnography phase 3

A

expiratory plateau
occurs when all the dead space gas has been exhaled resulting in exhalation of completely alveolar air
highest point of phase 3 corresponds with the actual EtCO2 value
the plateau has a slight positive slope because of the continuous diffusion of CO2 from the capillaries into the alveolar space

58
Q

capnography phase 0

A

inspiratory downstroke
because of inhalation of CO2-free gas the CO2 concentration rapidly declines

59
Q

what are the angles that are made between phase II/phase III and phase III/phase 0 on a capnograph called?

A

angle made by plane II and plane III is called alpha
angle made by plane III and plane 0 is called beta
the beta angle is the EtCO2 measurement

60
Q

what is the “elephant” capnography abnormality?

A

characterized by a gradual increase. in baseline and EtCO2 that looks like a herd of elephants
caused by rebreathing of exhaled gases which makes the inspiratory phase not return to baseline

61
Q

capnograph with little hump wave after at inspiration after phase 0 instead of a flat line

A

seen in a nonrebreathing system
during inspiration a small rebreathing wave can result from inhalation of CO2, the extent of rebreathing depends on fresh gas flow, Vt, and RR

62
Q

capnograph with more visible upward sloping plateau instead of slight upward plateau

A

caused by a bronchospasm or another expiratory obstructive process that prevents complete alveolar emptying

63
Q

capnograph with a small wave downwards in the middle of phase III
(like a hole in the ground)

A

capnogram of a patient emerging from neuromuscular blockade and demonstrating a curare cleft

64
Q

capnograph with normal shape but decreased plateau height each time

A

can result from hypovolemia, hyperventilation, hypothermia, and increased dead space ventilation

65
Q

capnograph hole in phase 0

A

dilution of EtCO2 by fresh gas flow which produces a terminal dip in plateau

66
Q

capnograph with squiggles going downwards during phase 0

A

oscillations during inspiratory phase
results from cardiac pulsations or fluttering of the inspiratory valve in a rebreathing circuit

67
Q

capnograph with curved plateau

A

abnormal plateau and inspiratory downstroke
caused by ETT cuff leakage

68
Q

how is body temperature regulated?

A

regulated by a physiological process called thermoregulation
regulated by hypothalmus

69
Q

how can body temperature be taken during anesthesia?

A

esophageal or rectal

70
Q

when is body temperature loss the greatest?

A

during the first 20 minutes of the surgery
because of clipping, prepping, starting room temp fluids, starting cold O2

71
Q

what is hypothermia caused by?

A

evaporation, conduction, vasodilation, decreased metabolic rate, lack of body fat, room temperature fluids, respiration

72
Q

what effects does hypothermia have on the body?

A

increases risk of infection and slows metabolism

73
Q

when can hyperthermia occur?

A

if patient has head trauma, excessive heat, or if patient is allergic to anesthetic agents

74
Q

what devices can be used to maintain body temperature?

A

bear hugger, warm water blankets, warmies, fluid warmers, warm blankets, heated tables, heating lamps

Surgery (35 decks)

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