basics exam 3 rvw for final Flashcards
Although this medication may be given to prevent anesthesia awareness, little scientific evidence exists that supports such treatment
Benzo’s
Preop patient is anxious, what dose of diazepam will you give them?
2-5mg of diazepam PO
Type One OR fire is located?
In or on the patient
What does a BIS monitor assess?
Monitors anesthetic depth
What is implicit memory?
Patient can follow commands but has no memory
What medication has alpha, minimal beta- used for phentolamine reversal?
Phenylephrine
Regional Anesthesia for Ophthalmic Surgery, what would you assume if someone is having seizures? (page 523, table 31.2)
That an intravascular injection has occurred.
Regional Anesthesia for Ophthalmic Surgery, what has occurred if you see contralateral mydriasis and contralateral eye block?
Brainstem Anesthesia
If all you see occuring during Regional anesthesia during ophthalmic surgery is loss of consciousness, apnea, and cardiac instability, what may be going on?
Most likely you have oversedated the patient, but brainstem anesthesia or intravascular injection is still possible, typically with the latter two you will see other more ominous signs but they have all the same signs as oversedation and then some more s/s.
Do you have seizures with brainstem anesthesia?
No, brainstem anesthesia does not have seizures that is only intravascular injection.
Most common cause of post op eye pain?
corneal abrasion
maint. fluid for 100lb grandma?
85cc/hr
LMA for 49kg male
size 3
what are some of the risks associated with strabismus surgery?
OCR
MH
PONV
Positional considerations for a patient having laminectomy with thoracic outlet?
prone with hands down by side
how is the laryngospasm reflex mediated?
vagal stimulation of the SLN.
OCR is afferent and efferent, tell me about it?
afferent is trigeminal nerve and efferent is vagal nerve.
Afferent is to the CNS, Efferent is from the CNS. (think A before E, has to go to the CNS before it can come from it)
Epiglottitis most likely is caused by which pathogen?
Acute haemophilus influenzae type B
What are some things you want to do for a patient who has epiglottitis before intubation actually occurs?
Do NOT attempt to directly visualize the glottis
Have surgeon called to assist with intubation
Do not administer anesthesia until equipment is opened and ready
02 levels should be at what percent to avoid OR fire?
LESS than 30%
High CO2, Increased inspiratory pressure, decreased O2 may indicate?
ETT dislodgement
Concentration of O2 that causes OR fire in less than 1 second?
95%
A patient that would benefit from prolonged post op monitoring? (this is bc they are susceptible to airway obstruction as late as 24 hours post op)
Patient less than four years old
How long should you wait to have a surgery on someone who had an MI, if the surgery is not an emergency?
6 months
Typically in an out patient setting for surgery you will do no lab testing, except for three possible reasons?
UNSTABLE CHRONIC DISEASE
POTENTIAL HIGH BLOOD LOSS (A GOOD REASON NOT TO DO PROCEDURE IN ASC/OBA)
EXPECTED USE OF CONTRAST DYE (BUN/Cr)
Do not perform surgery on the day of surgery if 3 or more of the following are present? (6 possible, you only need 3 to stop)
ISCHEMIC HEART DISEASE
HISTORY OF CHF
INSULIN-DEPENDENT DIABETES
CHRONIC RENAL INSUFFICIENCY (Cr > 2.0 mg/dl)
A TRNASIENT ISCHEMIC ATTACK
CVA
If a patient is wheezing really bad and you fix their wheezing before surgery (no longer symptomatic) can you proceed with the surgery or should it be cancelled?
you may proceed with the surgery, the only reason you would stop the surgery is if you could not stop their wheezing and they were symptomatic.
AV fistulas and outpatient surgery…. tell me what you know?
ARTERIOVENOUS FISTULAS (CREATION OR REVISION) AND UNSTABLE RENAL FAILURE ARE EACH ASSOCIATED WITH A HIGH MORBIDITY RATE AND ARE NOT GOOD CANDIDATES FOR SURGERY IN A FREE STANDING OUTPATIENT FACILITY
Biguanides such as metformin needs to be D/C how long before surgery and why?
48 hours preoperative and this is because of possible fatal lactic acidosis.
55 year old man with CHF, insulin dependent diabetes and a TIA 1 year ago… is he a good candidate for outpatient surgery?
He is NOT a good candidate for a stand alone clinic surgery.
How do propofol and remifentanil benefit hypotension intraoperatively?
Decreased PONV
Normal range for IOP?
10-22 mm HG
Tell me some things that can increase IOP (not medications)?
Face mask, coughing, laryngoscopy, tracheal intubation, hypoxemia and hypoventilation.
Afferent and Efferent…. which one carries stimulus from the CNS and which one carries stimulus to CNS?
A before E
afferent carries stimulus to the CNS
efferent carries stimulus from the CNS
What medication can be given to decrease incidence of oculocardiac reflex?
parasympatholytics
Oculocardiac reflex can be abated by what?
Parasympatholytic (atropine/glycopyrrolate)
What drug administered during ophthalmic surgery profoundly interferes with metabolism of sux?
echothiophate
An Adult with URI is scheduled for surgery. How long would you delay the surgery?
6 weeks
A child has an URI: How long would you delay?
2 weeks
what combination of anesthesia techniques would improve patient satisfaction?
Combined regional and general anesthesia
What medication should be stopped 10 hours before surgery?
ACE inhibitor
Lisinopril
A patient with a BMI of 44 is supine for surgery. He has hypoxemia, etc. What would you expect to be a contributing factor?
Decreased FRC
Regarding HgbA1C, erythrocytes have a life span of?
120 Days
Lidocaine 0.75% is equal to what in mg?
7.5mg
What should you do regarding a fire in the OR (in or on the patient)?
Simultaneously stop gases and remove ETT, disconnect circuit.
(book states it does not matter which one you do first as long as they are done at the same time, but it would make sense that you would turn the gas off before you pull out the tube bc that creates a blow torch lol)
Type 1 OR fire consists of? (EXAM question)
Can include drapes and surgical towels
Usually in or on patient
What is true regarding O2 rich atmospheres in the OR (Choose 2)
Decreases temperature at which a fuel will ignite
Fire will burn more vigorously
What can you make sure happens to help decrease fires in the OR?
Make sure the prep dries completely before placing drape
What anesthetic gas would you consider NOT using in a patient that experience PONV?
Nitrous (N20)
A patient with a past experience of PONV that usually requires pain medications 3-7 days post op, what can you consider using for them?
triple medication therapy
this is bc they have PONV history, and requires pain medication post op for multiple days
What will sevoflurane combine with to form an exothermic reaction in the OR(choose 2)
soda lime
baralyme
what three things do you need in order to start a fire?
fuel
ignition source
oxidizer
which type of memory is explicit and which is implicit?
explicit is conscious
implicit is unconscious
what two patient groups are at greater risk for operative awareness?
OB (crash C section)
Cardiac
What MAC or above prevents conscious recall?
0.7 MAC
give me examples of the three components to start a fire?
IGNITION SOURCE
(SURGEON/BOIVE)
FUEL (NURSE/PREP)
ANESTHESIA (OXIDIZER/O2)
Patient just drank 16 oz of water, how long will you need to delay surgery?
2 hours
Patient said he had a steak dinner 3 hours ago, how long must you wait to perform surgery?
5 more hours to total 8 hours NPO
What medication would you avoid to prevent IOP. (Induction medication)
SUX
What medication needs to be d/c 48 hours before surgery bc of a risk for fatal lactic acidosis?
metformin
what system takes over during spinal anesthesia (you are blocking out either SNS or PNS and the other takes over)?
PNS takes over and you can thus have a parasympathetic response during spinal anesthesia.
What is true of spinal anesthesia in relation to BP?
hypotension can and often does occur.
When performing Sellick maneuver what weight should you apply (in kg and newtons) and where should you push the esophagus?
5kg or 30 newtons and you will push the esophagus posteriorly.
Nerves in the anterior 2/3 of the tongue?
Lingual
Nerves in the posterior 1/3 of the tongue?
glossopharyngeal
what medication can you give to dry up secretions and help visualize the airway?
ANTICHOLINERGICS
atropine
scopolamine
glycopyrolate
EXAM QUESTION
Something about cocaine pledgets for nasal/sinus surgery?
Trigeminal → ophthalmic → anterior ethmoidal
order of structures you will pass through while doing a spinal?
Skin, subq, supraspinous, interspinous, ligamentum flavum, dura mater, arachnoid space
which block has a slower onset and thus considered a disadvantage, retrobulbar block or peribulbar block?
peribulbar block
Remifentanil and Propofol combination benefit in relation to ear surgery?
Remifentanil reduces middle ear blood flow, creating a dry surgical field for tympanoplasty.
Propofol may help reduce PONV
What type of anesthesia has a decreased risk for PONV?
REGIONAL
How to identify an ester from an amide?
“one “i” ester”
Medication you can give to decrease edema and PONV?
DEXamethasone
An inhaled induction and maintenance of anesthesia with ventilation via a face mask is preferred for this brief procedure?
Myringotomy and tube insertion.
If a patient had an uncomplicated airway during intubation are they a candidate for deep extubation?
Yes
A child presents and the mother states that he has been having fever and very tired acting, he is drooling and leaning forward, what do you suspect is going on?
Epiglottitis
If a patient is having eye surgery and all of a sudden their HR falls greatly what has likely occurred and what will you do next?
OCR has likely occurred, you will tell the surgeon to let up on the eye nerve, to let up traction and the HR should come back up. If the HR does not recover in a few short min (may also have dysrhythmia’s) then you will want to give atropine or glycopyrrolate.
Tell me what OCR is? When is it most often encountered?
oculocardiac reflex, sudden profound decrease in HR in response to traction on the extraocular muscles or external pressure on the globe.
Typically occurs during strabismus surgery.
Peribulbar block, tell me what you know about it good and bad.
placed more shallow and minimally angled, thus more protection to the internal nerves and structures. larger volumes and more time for diffusion of LA needed.
