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Special Pop Exam 1 > Barash 31: Ambulatory > Flashcards

Barash 31: Ambulatory Flashcards

31

1
Q

Which ASA status is okay for AMBSU

A

Medically stable III or IV

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2
Q

T/F:
A procedure typically performed as ambulatory procedure with local or regional anesthesia can also be performed as an ambulatory procedure in patients with obstructive sleep apnea.

A

True

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3
Q

Surgery after viral infections

A

adults: Airflow obstruction up to 6 weeks after
surgery should be delayed for 6 weeks

children: questionable

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4
Q

T/F
an appropriate dose of pre-medication’s (Versed) effects can last after discharge, even if it does not prolong recovery.

A

True
Most premedicants do not prolong recovery when given in appropriate doses for appropriate indications, although drug effects may be apparent even after discharge

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5
Q

T/F
Regional and general anesthesia in the ambulatory setting are equally safe.

A

True

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6
Q

T/F:
Nerve blocks decrease PONV and pain.

A

True

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7
Q

Two primary concerns for ambulatory anesthesia

A

speed of wake-up and PONV

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8
Q

T/F:
A faster recovery from Des and N2O (vs. propofol and sevo) accurately predicts faster return of ability to sit up, stand, and tolerate fluids and discharge.

A

False

Patients may emerge from anesthesia with desflurane and nitrous oxide significantly faster than after propofol or sevoflurane and nitrous oxide, though the ability to sit up, stand, and tolerate fluids and the time to fitness for discharge may be no different.

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9
Q

probably the most important factor contributing to a delay in discharge and an increase in unanticipated admissions after ambulatory surgery

A

Nausea, with or without vomiting

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9
Q
A
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10
Q

Patients remain in Phase II Recovery until

A

able to tolerate liquids, walk, and (depending on the operation) void.

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11
Q

Ambulatory anesthesia has been around for

A

over 100 years

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12
Q

What case is appropriate for an ambulatory surgical procedure?

A

postoperative care that is easily managed at home
low rates of postoperative complications
do not require intensive physician or nursing management

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13
Q

Who should be scheduled earlier in the day?

A

Longer procedures

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14
Q
A
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15
Q

T/F:
The need for transfusion is not a contraindication for ambulatory procedures.

A

TRUE

autologous blood possible
Freestanding dialysis facilities commonly receive blood shipped from a blood bank located elsewhere and the same can be set up with freestanding ambulatory surgery facilities.
The key is to have proper procedures established

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16
Q

liposuction performed in conjunction with abdominoplasty under general anesthesia

A

problematic and should be avoided

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17
Q

Which babies need 12 H monitoring?

A

Term: PCA <46 weeks
preterm: PCA <60 weeks

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18
Q

Term babies w/ PCA <46 weeksand preterm babies w/ PCA <60 weeks
are at increased risk for apnea, even if….

A

they have no history of apnea

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19
Q

Table 31-1
Guide to Determine Length of Stay for Infants after Surgery

A
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20
Q

T/F:
advanced age alone may prohibit surgery in an ambulatory setting

A

FALSE

Increased age may increase the likelihood of unanticipated admission, but, by itself, does not contraindicate ambulatory surgery

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21
Q

Which factors do NOT increase periop risk if they have OSA?

A

Superficial surgery, local or peripheral block, no sedation
No Postop opioids

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22
Q

Using CPAP or NIPPV (noninvasive positive pressure ventilation) before surgery & postoperatively will (decrease/increase) complications due to OSA.

(scoring)

A

Decrease!
minus 1 point

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23
Q

Patients for these procedures should live close to the ambulatory facility because postoperative complications may require their prompt return

A

laparoscopic cholecystectomy or TURP

24
Q

Why do we mean by “someone to help you at home”?

A

competent person to stay with them afterward until the next morning to provide care

25
Q

Table 31-3

Fasting Guidelines before Surgery

A
26
Q

Table 31-4
Medications Appropriate to Take Prior to Surgery

A
27
Q

T/F:
every patient needs a drug to reduce anxiety

A

false

28
Q
A
29
Q

In adults, particularly when midazolam is combined with fentanyl, patients can remain sleepy for

A

up to 8 hours

30
Q

\children may be sleepier after oral midazolam, but…

A

discharge times are not affected.

31
Q

T/F:
Benzodiazepines cause retrograde amnesia

A

False
Anterograde but probably not retrograde amnesia

32
Q

controlling shivering

A

Meperidine

also: clonidine, tramadol, and ketamine

33
Q

T/F:
Opioid premedication prevents increases in systolic pressure in a dose-dependent fashion

A

true

34
Q

how Propofol affects discharge

A

half-life is 1 to 3 hours
induction dose causes impairment is apparent for 1 hour

35
Q

T/F:
Sevoflurane’s speed of induction is only slightly slower than propofol.

A

True

relatively low blood–gas partition coefficient

36
Q

How to make Sevo induction faster

A
  1. breathe out to residual volume
  2. take a vital capacity breath through a primed circuit
  3. hold the breath
37
Q

T/F:
paralysis is not needed to insert an endotracheal tube

A

True
can use combinations such as propofol, alfentanil, or remifentanil, with or without lidocaine

38
Q

ideal for maintenance of anesthesia for ambulatory surgery

A

Propofol, desflurane, and sevoflurane

39
Q

T/F:
Propofol has a short half-life and results in rapid recovery and few side effects.

A

True

40
Q

Table 31-7
Techniques to Decrease Postoperative Nausea and Vomiting Risk

A
  • regional alone
  • If general: propofol gtt instead of an inhalational
  • Avoid nitrous oxide for maintenance, particularly for procedures longer than 1 hour
  • Minimize opioids
  • avoid paralysis
  • adequate hydration
41
Q

more likely to have PDNV

A
  • history of motion sickness
  • previous PONV
  • migraine headaches
  • pain on activity postdischarge
42
Q

T/F:
Nitrous increases risk of PDNV.

A

False!

43
Q

T/F:
Nonsteroidal analgesics are not effective as supplements during general anesthesia.

A

True!

44
Q

Best use for NSAIDs

A

controlling postoperative pain, particularly when given before skin incision

45
Q

T/F:
LMAs reduce anesthetic requirements.

A

True
coughing is less than with tracheal intubation. Anesthetic requirements, hoarseness, and sore throat are all reduced

46
Q

T/F:
N/V may be greater with an LMA.

A

True
Because of gastric insufflation

47
Q

The three most common reasons for delay in patient discharge from the PACU

A

drowsiness, N/V, pain

48
Q

T/F:
Flumazenil will comletely reverse the psychomotor impairment of benzodiazepines.

A

FALSE
incomplete psychomotor impairment
subjective experience of sedation is not necessarily attenuated

49
Q

T/F:
Midazolam has antiemetic effects.

A

True!
Midazolam and propofol, although more commonly used for sedation, have antiemetic effects that are longer in duration than their effects on sedation

50
Q

A pt received zofran in preop for N/V prophylaxis. They’re now nauseous in PACU. Should you give another dose?

A

might not be effective

If patients have already received ondansetron prophylaxis in the OR, and then are nauseous in the PACU, another dose might not be effective

51
Q

T/F:
treatment of pain frequently decreases nausea

A

True

pain may be associated with nausea

52
Q

T/F
IV Tylenol is safer for the liver than PO Tylenol.

A

True
if IV, first-pass hepatic exposure is limited

53
Q

When should we give Tylenol so it can reduce opioid requirements?

A

before incision or postoperatively

54
Q

Total daily dose of acetaminophen

A

should not exceed 4 g/day
2 g/day or less if impaired liver or kidney function

55
Q

Fentanyl dosing
per pain scale

A

3-5 out of 10: 25 μg/70 kg
6-10 out of 10: 50 μg/70 kg

Q5-minutes intervals until pain is controlled

56
Q

ketorolac dosing

A

30 to 60 mg/70 kg

57
Q

Who can be transferred directly to Phase II Recovery from the OR?

A

9 or 10 according to the modified Aldrete scoring system

58
Q

When can patients drive?

A

advised against driving for at least 24 hours after a procedure.

Special Pop Exam 1 (16 decks)

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