Choice of Anesthesia Flashcards
Stage 2
Excitement or delerium phase
- Uncontrolled movements
- Pupillary dialation
- Irregular respirations, HR
- Breath holding
- Vomiting
- Delerium
- Stimulation
Types of regional anesthesia (3)
Spinal, epidural, caudal
Preoxygenation?
- 100% O2 10L/min flow
- 3 min or 8VC/min
Four types of anesthesia?
- General
- Regional
- Monitored anesthesia care (MAC)
- Peripheral
CPAP
Continuous Positive Airway Pressure (CPAP)
- Decreased functional residual capacity
- Mask held tightly 5-25 cmH20 for 3 min
Stage 4
Overdose or bulbar paralysis
- Impending death
- Dialated and nonreactive pupils
- Hypotension
- Bradycardia
- Cardiac arrest
Epidural space
Potential space between Ligamentum flavum and dura
- Widest at L2 (5-6mm)
- Narrowest at C5 (1-1.2mm)
Quicker onset, spinal or epidural?
Spinal (5-10sec) compared to epidural (15-20min)
Indications for ETT intubation
- Need of positive airway pressure
- Protection from aspiration
- Head or neck procedures or in non-supine procedures
- Neuromuscular paralysis
- Surgery involving cranium, thorax, or abdomen
- “Presence of trachea??”
Spinal/epidural contraindications
- Hypovolemia
- Increased intracranial pressure
- Coagulopathy (thrombocytopenia)
- Sepsis
- Infection at the cutaneous puncture site
- Pre-existing neurological disease (Multiple sclerosis?)
- PATIENT REFUSAL
(MAC) Ramsay Scale
- Anxious, agitated, restless
- Cooperative, oriented and tranquil
- Drowsy, but responds to commands
- Asleep, brisk response to stimuli
- Asleep, sluggish response to stimuli
- Asleep, no response
Anesthesia check for all types
- Anesthesia machine check
- Ensure breathing system is functional, attach a properly sized facemask
- Check CO2 absorbent for color change
- Liquid level of vaporizers
- Proper functioning of mechanical ventilator
- Suction working and available
- Final position of all flowmeters, vaporizers, and monitors
- Monitors (blood pressure, pulse ox, ECG, capnography, temperature)
90% of cases are?
Balanced anesthesia, combination of IV and inhalation techniques
Three most important factors?
- Type of surgical procedure
- Patients coexisting disease
- Patient preferences
Why do a RSI?
- Prevention of aspiration
- Anyone not NPO, trauma victims, unknown NPO, longstanding diabetics, pregnant patients after 9-12 weeks, GERD, morbidly obese patients
Stage 3
Surgical or operative phase
Two types of induction?
- Mask induction (usually pediatric patients)
2. IV induction (faster 10-20 seconds)
How to do an RSI?
- Pre-oxygenate
- Induction agent/Narcotics
- Succinylcholine (60sec)
- Hold cricoid pressure and don’t let go until proof of intubation unless you want to get showered and compromise the airway
Drug check for all types
-Local anesthetic, induction drug, opioid, benzos, anticholinergics, sympathomimetic, succinylcholine, nondepolarizing muscle relaxant, anticholinesterase, catecholamines, anti-hypertensives
Once a patient cannot protect their airway, what type of anesthesia are they in?
General
Equipment check for all types
-IV solution and connective tubing, IV catheter, suction catheter, OAW/NAW, LMA, ETT/laryngoscope
How to confirm proper placement of the ETT?
- > 20mmHg during exhalation at peak
- Upper chest expansion
- Emptying of reservoir bag during inspiration
- Bilateral breaths
- > 95% O2 saturation after 2 min
- Humidity in tube
Stage 1
Analgesia or induction phase
- Conscious
- Voluntary movements
- Sense of reality
- Increased sense of hearing
