Basics exam 3 Flashcards
5 general principles for improving pt outcomes and experiences (M&P chart):
1. (on exam) Regional -general anesthesia technique to improve pt care 2 3. 4 5
Although a benzodiazepine may be given to prevent anesthesia awareness, little
scientific evidence exists that supports such treatment
M&P
Oculocardiac reflex is :
- pressure on the globe
- pressure on the extraocular muscles
Pre-op patient is anxious. what dose of diazepam do you give?
2-5mg PO
Type 1 OR fire is located:
in or on the patient
BIS monitoring assess:
anesthetic depth
Patient can follow commands but has no memory. what kind of memory is this:
Implicit memory
Potential risk factors with various types of anesthesia from Chart in M&P.
-Regional anesthesia =
seizures is a risk
brainstem anesthesia with regional anesthesia is not associated with:
(chart in m&p)
seizures
What medication has alpha, minimal beta, and phentolamine is used for infiltration
Phenlephrine
Strabismus surgery associated with higher risks of:
- MH
- PONV
- OCR
Maintenance rate for 100lb granny:
85ml/hr
LMA size for 68kg
size 4
EBV for full term infant with weight of 7.7lbs
85x 3.5kg = 297.5ml
Cut length for 4 year old =
16cm
ETT size for a 4 year old =
4.5, 5.0, 5.5
Decreasing pH means:
- increased hydrogen ions
- increasing acidity
Patient getting a laminectomy with thoracic outlet. How do you position?
Prone with hands down by side
Laryngospasm mediated by:
SLN of vagus nerve
OCR afferent and efferent (2 questions on this):
a. afferent trigeminal; efferent vagal
b. afferent is to CNS; efferent is from the CNS
Epiglottis is most likely caused by what pathogen?
Haemophilus influenzae type B
If suspected epiglottitis, what are three things you should do:
- do NOT attempt to directly visualize the glottis
- have surgeon called/in to assist with intubation
- do not administer anesthesia until equipment and team are ready
O2 levels should be what percentage to avoid OR fires?
< 30%
High CO2, increased inspiratory pressure, decreased O2 may indicate:
ETT dislodgement
Concentration of O2 that can cause OR fire in less than 1 sec (cotton huck towel):
95%
A patient that would benefit from prolonged post-op monitoring (T&A??):
3 year old female
< 4 y/o
Pt is 55 yr old with CHF, insulin dependent DM, and a TIA 1 yr ago. Would this pt be appropriate for a stand alone surgical center?
no
How do propofol and remifentanil benefit hypotension intraoperatively?
**need to check wording*
Decrease PONV
What device could potential increase IOP?
face mask
Most common cause of post-op eye pain?
Corneal abrasions
Afferent carries stimulus
to CNS
Efferent carries stimulus
from the CNS
OCR can be abated by:
parasympatholytics (atropine or glycopyrrolate)
Normal IOP pressure is:
10-22mmHg
What would improve pt satisfaction (from chart on m&p):
combined regional and general anesthesia
An adult with URI is scheduled for surgery. How long would you delay the surgery?
6 weeks
A child has a URI. How long would you delay surgery?
2 weeks
What medication should be stopped 10 hours before surgery?
Lisinopril (ACE inhibitors)
A patient with a BMI of 42 is supine for surgery. He has hypoxemia, etc. What would you expect to be a contributing factor?
Decreased FRC
What is true regarding stopping metformin prior to surgery:
- Its controversial
- must be d/c’d 48 hours prior to surgery
HgbA1C — eryhrocytes have a life span of:
120 days
Lidocaine 0.75% is equal to:
7.5mg
What should you do in regards to an ETT fire:
simultaneously stop gases/o2 , remove ETT, and disconnect circuit
Type 1 OR fires consist of (2)
- in or on the pt
2. can include drapes and surgical towels
What is true regarding O2 rich atmospheres in the OR (2):
- decreases temperature at which the fuel will ignite
2. the fire will burn more vigorously
Giving a benzodiazepine
is recommend but not clinically proven to benefit
Ensuring the prep is dry completely before placing drapes will:
help to decrease risk of OR fire
If a pt has hx of PONV, what anesthetic gas would you consider NOT using:
N20
A patient with a past experience with PONV that usually requires pain meds 3-7 days post op…
You may consider:
triple medication therapy on
What will sevoflurane combine with to form an exothermic reaction in the OR? (2)
- soda lime
2. baralyme
An source of ignition is:
bovie
A patient drank water. how long will you delay surgery?
2 hours
Patient had a steak dinner one hour ago. How long will you keep NPO?
7 hours (8 hours total)
in your induction; what medication would you avoid to prevent IOP?
succinylcholine
A patient should d/c metformin 48hrs preop to decrease incidence of:
fatal lactic acidosis
Two major side effects of spinal anesthesia:
- hypotension
2. parasympathetic response
What would you give preop to decrease awareness in the OR?
Benzodiazepine
Unconscious memory =
Implicit memory
Conscious memory =
explicit memory
What pt(type of) would you expect to have a greater likelihood of awareness during anesthesia?
- emergent c-section
- cardiac surgery
*on exam: 35 year old /emergent c-section
Name three elements required to perform Sellick maneuver:
- 5kg
- or 30 newtons
- push esophagus posteriorly
Nerves dealing with anterior 2/3 and posterior 1/3 tongue:
Lingual and glossopharyngeal (in order)
Something about cocaine pledgets for nasal/sinus surgery?
Trigenminal –> opthalmic –> anterior ethmoidal
**need to fix this question?
Disadvantage of the peribulbar technique?
slower onset
*than the intrabulbar block (think of it as the epidural vs spinal)
correct spinal order via midline approach:
Skin, subq, supraspinous, interspinous, ligamentum flavum, dura mater, arachnoid space
Remifentanil and Propofol combination benefit:
a. Remifentanil reduces middle ear blood flow, creating a dry surgical field for tympanoplasty.
b. Propofol may help reduce PONV
Propofol may help reduce
PONV
Remifentanil reduces middle ear blood flow, creating a
dry surgical field for tympanoplasty.
What type of anesthesia has a decreased risk for PONV?
regional
