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NA 1 > Chapter 58 NORA > Flashcards

Chapter 58 NORA Flashcards

1
Q

challenges with NORA

A
  • unique locations
  • support staff who are unfamiliar with anesthesia
  • variation of the physical set up of the procedure room
  • equipment may be poorly maintained
  • remote positioning of a patient during a lengthy procedure
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2
Q

an anesthesia machine and portable anesthesia cart with the listed equipment, supplies, and medications should be

A

dedicated strictly for use in remote locations

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3
Q

therapeutic and diagnostic procedures require what kind of anesthesia?

A

minimal, moderate, or deep

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4
Q

what type of anesthesia ensures amnesia as a standard of care?

A

general anesthesia

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5
Q

standards for the delivery of anesthesia in a remote location

A

A. Perform a complete pre-anesthesia assessment
B. Obtained informed consent for the planned anesthetic intervention from the patient or legal guardian
C. Formulate a patient-specific plan for anesthesia care
D. Implement and adjunct the anesthesia care plan based on the patient’s physiologic response
E. Properly prepare, dispense, and label all medications to be used for the patient
F. Adhere to appropriate safety precautions and protocols, as established by the institution, to minimize risks to the patient and ancillary staff
G. Monitor and document the patient’s physiologic condition as appropriate for the type of anesthesia and specific patient needs
H. Precautions shall be taken to minimize the risk of infection to the patient, the operator, and ancillary personnel
I. There must be complete, accurate, and time-oriented documentation of pertinent information on the patient’s anesthesia record
J. After the anesthetic treatment for therapeutic or diagnostic procedures, transfer the responsibility for care of the patient to other qualified personnel in a manner that ensures continuity of care and patient safety

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6
Q

what 4 things make NORA unique?

A
  1. location (not what were used to)
  2. personnel (operator is not a surgeon, staff may not understand anesthesia)
  3. procedures (huge variety)
  4. equipment and set up (you have to bring your own
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7
Q

Standard V: mornitoring for NORA

A
  • same as for all other cases
  • still need to monitor ventilation, oxygenation, cadisovascular status, body temp and neuromuscular function
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8
Q

responsiveness for: minimal, moderate (conscious), deep sedation, and general anesthesia

A

minimal = normal response to verbal stimuli

moderate/conscious = purposeful response to verbal or tatile stimulation

deep = purposeful response to repeated painful stimuli

general anesthesia = unarousable even with painful stimuli

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9
Q

airway for: minimal, moderate (conscious), deep sedation, and general anesthesia

A

minimal = unaffected

moderate/conscious = no intervention required

deep = intervention may be required

general anesthesia = intervention often required

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10
Q

respiratory function for: minimal, moderate (conscious), deep sedation, and general anesthesia

A

minimal = unaffected

moderate/conscious = adequate

deep = may be inadequate

general anesthesia = frequently inadequate

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11
Q

cardiovascular function for: minimal, moderate (conscious), deep sedation, and general anesthesia

A

minimal = unaffected

moderate/conscious = usually maintained

deep = usually maintained

general anesthesia = may be impaired

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12
Q

most common adverse events happen in NORA cases (in peds)

A

RESPIRATORY

  • apnea
  • respiratory depression
  • respiratory obstruction
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13
Q

most adverse events happen with procedures lasting longer than __ hour

A

1

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14
Q

children of what age are at greater risk for adverse events?

A

less than 5

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15
Q

2 populations that are commonly seen in NORA?

A

elderly and children

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16
Q

most adverse anesthesia events are caused when __ anesthetic agents are used

A

mulitple

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17
Q

peds NPO status for NORA procedures

A
  • < 6 month: 4-6 hrs
  • 6-36 months: 6 hr
  • > 36 months: 8 hrs
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18
Q

important things to keep in mind for safety purposes during peds assessment

A
  • recent URIs
  • fever
  • cough
  • snoring
  • sputum production

could result in an airway compromise during sedation

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19
Q

BOX 58.5
most common causes of peds A adverse events for therapeutic or diagnostic procedures

A
  • drug errors
  • NO₂ in combo with any other sedative medication
  • inability to rescue the patient from an adverse anesthetic event
  • unmet monitoring standards - especially respiration and oxygenation
  • resp depression/ hypoventilation/ apnea
  • airway obstruction
  • bradycardia secondary to hypoxia
  • laryngospasm/ stridor
  • vomiting/aspiration/diarrhea
  • hypotension
  • inadequate sedation/paradoxical excitation (sustained irritability or combativeness)
  • prolonged sedation after the procedure
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20
Q

ACID & pacemakers

A

ACID = 2 parts (pulse generator and lead electrode)

pacemaker = (unipolar or bipolar)

most common underlying rhythm is pulseless VT or VF

21
Q

anesthesia for AICD and pacemakers

A
  • usually local and some sedation
  • at end… they will cause pt to go into VF to check if AICD is working… give propofol before this
  • ALWAYS have transcutaneous packing pads available and on patient
22
Q

what types of patients commonly present for AICD placement?

A
  • Supraventricular dysrhythmias (younger and healthier)
  • Ventricular dysrhythmias (older, low EF, CAD)
  • CHF (low EF, left BBB)
23
Q

what happens at the end of AICD placement that is very uncomfortable for patient and tricky for us

A
  • putting patient into vfib
  • have to give patient something (prop) so they can tolerate it
  • might need to place patient into vfib several times of lead placement is sketchy

give 5 mins between vfib episodes

24
Q

how long do pacemakers last?

A

6-10 years

25
Q

joules that are used for synchronized cardioversion

A

50-100J

26
Q

what part of the pacemaker insertion can be uncomfortable for the patient?

A

tunneling of the leads

27
Q

sedation for synchronized cardioversion

A
  • probably prop before shock
  • sometimes etomidate if they are unstable
28
Q

ablation and anesthesia

A
  • radio frequency = short and usually with sedation
  • cryofrequency = used before or instead of RFCA
  • start by ice-mapping heart
  • cryo causes less discomfort and higher success rate
29
Q

with longer ablation cases, what are some anesthesia considerations

A
  • patients can experience angina-like pain
  • may need deeper sedation or GA
  • use esophageal stethoscope to monitor left atrial temp
30
Q

PCI procedures use x-radiation/fluoroscopy doses as

A

keep radiation As Low As Reasonably Achievable

known as the radiation principle: ALARA

31
Q

pediatrics and ablation

A

SVT is most common tachyarrhythmia treated in peds with radiofrequency ablation

32
Q

colonoscopy looks at colon from anus –> __

A

cecum

33
Q

sedation for colonoscopy

A

light to deep

manipulation of colon is painful (splenic and hepatic flexures are rough)

34
Q

watch for what with colonoscopies

A
  • bradycardia (caused by vagal reflex)
  • colon spasms can occur as well
  • have glycopyrrolate ready for both conditions
  • if its really bad tell doc to reduce amount of air in colon
35
Q

spray airway with what in EGD?

A

benzocaine (think metHb) or lidocaine

36
Q

if you are doing EGD for GI bleed, what should be your anesthetic technique

A

probably GA with ETT to protect airway and support hemodynamics better

37
Q

before ERCP: labs

A

liver enzymes

38
Q

what will be used in ERCP that we should ask about allergies to

A

contrast dye

39
Q

position for ERCP

A

prone or left lateral decubitus

40
Q

occupational hazards for CT

A
  • if you’re in the room you have to protect yourself from radiation
  • radiation exposure is cumulative over a lifetime !!
41
Q

anesthetic implications for CT

A
  • patient needs to be motionless
  • contrast media concerns
  • ionizing radiation may be a problem in kids
  • airway management can be difficult
42
Q

2 types of contrast media reaction

A

anaphylactoid = histamine release from basophils or mast cells (NOT ANTIBODY/ANTIGEN MEDIATED)

chemotoxic = directly due to inherent chemical action of specific agent on specific organ (contrast-induced renal failure)

43
Q

anesthetic agents that may cause problems with assisted reproductive technologies (ART)

A

morphine, sevo, desflurane, NSAID’s, & metoclopramide

44
Q

T/F magnitude of chemotoxic reaction to contrast media depends on the amount or concentration of the offending agent

A

TRUE

if you give more, the result will be worse

45
Q

T/F magnitude of anaphylactoid reaction to contrast media depends on the amount or concentration of the offending agent

A

FALSE

can have reaction to 1mL or 100mL

46
Q
A
47
Q
A
48
Q
A

NA 1 (15 decks)

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