Choice of Anesthesia

Question 1

4 types of anesthesia

Answer 1

1. ) General
2. ) Regional
3. ) peripheral nerve block
4. ) Monitored Anesthesia Care

Question 2

How do you choose?

Answer 2

1. ) preference of the patient, anesthesiologist, and surgeon
2. )coexisting diseases
3. ) site of surgery
4. ) body position of the patient during surgery
5. )- elective or emergency surgery
6. ) increased amounts of gastric contents
7. ) suspected difficult airway
8. ) duration of surgery or procedure
9. ) patient age
10. ) anticipated recovery time
11. ) PACU discharge criteria

Question 3

General anesthesia involves:

Answer 3

1. ) pre-anesthetic assessment
2. ) administration of GA drugs
3. ) airway management
4. ) cardio-respiratory monitoring
5. ) fluid management
6. ) analgesia (intra-& post operative pain relief)

Question 4

3 ways of general anesthesia administration

Answer 4

1.) intravenous 2.) inhalational 3.) combination

Question 5

1st step prior to intubation

Answer 5

pre-oxygenation; 3 minutes CPAP

Question 6

which patients are more likely to have a decreased functional capacity?

Answer 6

infants, obese, pregnant

Question 7

what medications would you use during an IV induction?

Answer 7

Versed- both sedative and amnesic properties
induction- propofol
Faster onset than inhalation

Question 8

What would you use for mask induction?

Answer 8

sevoflurane

Question 9

When can you start an IV after administering sevoflurane?

Answer 9

1-2 minutes

Question 10

how do you maintain an open airway and regulate breathing?

Answer 10

ETT is used or LMA

Question 11

Why do you do an endotracheal intubation?

Answer 11

1. ) need to deliver positive pressure ventilation
2. ) protect the respiratory tract from aspiration of gastric contents
3. ) surgical procedures involving head and neck or non-supine positions
4. ) all procedures involving neuromuscular paralysis
5. ) surgical procedures involving the cranium, thorax, or abdomen
6. ) “Presence of a trachea”

Question 12

How can you tell you have proper placement of the ETT tube?

Answer 12

capnography reveals cyclic waveforms
the upper part of chest expands
the reservoir bag partially empties during inspiration
bilateral breath sounds are present
pulse oximeter continues to read >95% after 2 minutes

Question 13

When would you do a rapid sequence intubation?

Answer 13

anyone not NPO (6 hr solids , 2-4 hr clear liquid) 
trauma victims 
anyone with a unknown NPO status 
pts with longstanding diabetes 
pregnant pts after 9-12 weeks 
GERD pts 
morbidly obese pts

Question 14

Steps in rapid sequence intubation?

Answer 14

1.) preoxygenation
2.) medications (induction agents/narcotics)
~rocuronium (90seconds, NO fasciculations)
~succinlycholine (45-90 seconds, fasciculations)
3.) cricoid pressure
~applied after induction agents
~ maintained until proof of intubation

Question 15

how long is the duration action of IV induction agents?

Answer 15

5-10 minutes

Question 16

Stage I of general anesthesia

Answer 16

The period between the initial administration of the induction medications and loss of consciousness

Question 17

Stage 2 of general anesthesia

Answer 17

excitement or delirium stage; the period following loss of consciousness and marked by excited and delirious activity

Question 18

stage 3 of general anesthesia

Answer 18

marked by the return of regular respirations

Question 19

stage 4 of general anesthesia

Answer 19

overdose or bulbar paralysis

Question 20

drug induced state where patient responds to verbal commands

Answer 20

minimal sedation

Question 21

responds to verbal commands with little stimulation. maintain patent airway

Answer 21

moderate or conscious sedation

Question 22

general w/o airway protection; does not respond to verbal commands may or may not maintain airway OAW or NAW

Answer 22

deep sedation

Question 23

what meds are used during a MAC case? (4)

Answer 23

Versed, propofol, fentanyl, precedex

Question 24

how are meds during a MAC case administered?

Answer 24

continuous infusion, and multiple bolus technique

Question 25

types of regional anesthesia

Answer 25

caudal, epidural, and spinal

Question 26

Advantages of spinal anesthesia (4)

Answer 26

less time to perform, rapid onset, better quality motor and sensory block, and less pain during surgery

Question 27

Advantages of epidural anesthesia (4)

Answer 27

1. ) lower risk of PDPH 2. ) slower onset of hypotension 3. ) controlled, prolonged analgesia with indwelling catheters 4. ) postoperative nausea

Question 28

Disadvantages of spinal/epidural (4)

Answer 28

1. ) PDPH 2. ) failure of block 3. ) decrease in systemic blood pressure 4. ) patient awake +/ -

Question 29

Contraindications for spinal/epidural (7)

Answer 29

1. ) hypovolemia 2. ) increased intracranial pressure 3. ) Coagulopathy (thrombocytopenia) 4. ) Sepsis 5. ) infection at cutaneous puncture site 6. ) pre-exisiting neurologic disease (MS?) 7. ) patient refusal--absolute!

Question 30

Indications for caudal anesthesia (3)

Answer 30

perineum, lower dermatomes, postoperative analgesia

Question 31

Methods for locating peripheral nerves (3)

Answer 31

1. ) ultrasound 2. ) nerve stimulation 3. ) paresthesia

Question 32

Examples of brachial plexus peripheral nerve blocks

Answer 32

1. ) Interscalene 2. ) Supraclavicular 3. ) Infraclavicular 4. ) axillary

Question 33

Examples of wrist block

Answer 33

1. ) median 2. ) ulnar 3. ) radial

Question 34

Ester local anesthetics (4)

Answer 34

1. ) Procaine 2. ) Chloroprocaine 3. ) tetracaine 4. ) cocaine

Question 35

Amides local anesthetics (6)

Answer 35

1. ) lidocaine 2. ) Mepivacaine 3. ) Bupivacaine 4. ) etidocaine 5. ) prilocaine 6. ) Ropivacaine