Choice of Anesthesia Flashcards
4 Types of Anesthesia to choose from
- General Anesthesia
- MAC (Monitor Anesthesia Care)
- Peripheral Nerve Block
- Regional Anesthesia
11 items to consider when choosing which anesthesia type to provide
- preference of patient, surgeon, anesthesiologist
- coexisting diseases
- site of surgery
- body position of patient
- elective or emergency surgery?
- increased amount of gastric contents
- suspected difficult airway
- duration of surgery
- patient age
- anticipated recovery time
- post anesthesia care unit discharge criteria
What anesthesia type would be best for a COPD patient on oxygen?
Spinal (regional anesthesia) instead of general due to risk with suppressing their airway. Should try to convince patient if they decline regional.
What is Anesthesia? (6 Modes of Action)
- analgesia
- amnesia
- immobility –loss of motor reflexes
- unconsciousness
- skeletal muscle relaxation
- block autonomic responses
MAC (meaning and how it is administered)
- monitored anesthesia care
* administered through IV –continuous or boluses
What 3 drugs are used for MAC?
fentanyl, midazolam, propofol
_______ should always be given with succinylcholine in children because pronounced bradycardia may occur.
atropine
general anesthesia checklist (6 items)
- pre-anesthetic assessment
- administration of GA drugs
- airway management
- cardio-respiratory monitoring
- fluid management
- analgesia (during and post op pain relief)
When pre-oxygenating patients, how much O2 do you give and for how long?
100% at 10L/min flow for 3 minutes or 8VC/1min
When should you use a CPAP during pre-oxygenation?
When there is a decreased functional residual capacity.
*esp. in infants, obese, pregnant women
What value are you looking for with CPAP use?
____ cmH2O for ___ min
+5 to +25 cmH2O for 3 min
Which induction has a faster onset…inhalational or IV?
IV due to onset being 10-20 secs
(inhalational induction takes 30+ secs
3 advantages to IV induction
- faster onset than inhalational
- induces total unconsciousness
- avoidance of the excitatory phase of anesthesia
3 ways to administer General Anesthesia
- IV
- inhalational
- combination
Loss of consciousness causes?
- loss of protective airway reflexes
- loss of airway patency (ex. soft tissue obstruction)
- irregular breathing pattern due to meds
Standard steps in sevoflurane mask induction
- 70% N2O with 30% O2 for 30 secs
- sevoflurane to 8%
- can start IV after 1-2 min of breathing sevoflurane mix
7 Indications for intubation
- A need to deliver positive pressure ventilation
- To protect respiratory tract from aspiration of gastric contents
- head, neck, thorax, or abdomen surgery
- non-supine positions that preclude airway support
- profound disturbance in consciousness with inability to protect airway
- cannot control secretions in throat (tracheobrochial toilet)
- severe pulmonary or multisystem injury associated with respiratory failure. (ie. sepsis, airway obstruction, hypoxemia, hypercarbia)
- *hypercarbia is too much CO2 in bloodstream)
When to Mask ventilate
- short, supine case
- low or no risk of aspiration
- does NOT protect airway
When to use LMA for ventilation
- need to free up both hands
- low or no risk of aspiration
- -does NOT protect airway
5 ways to confirm you have placed ETT properly
- capnography reads 35-45 mmHg
- bilateral breath sounds
- -evidence ETT is not advanced too far and only in one lung
- upper part of chest expands
- reservoir bag partially empties during inspiration
- pulse oximeter continues to read >95% after 2 min
Main reason for RSI
to prevent aspiration
Who gets RSI
- not NPO for 6 hours solids and 2-4 hours liquids
- trauma victims
- unknown NPO status
- longstanding diabetes (risk of gastroparesis)
- pregnant > 9-12 weeks
- GERD
- morbidly obese
RSI steps
- preoxygenate
- Administer Meds: Induction agent/narcotic
Rocuronium (90 secs and no
fasciculations)
**Succinylcholine (45-90 secs with
fasciculations) - Cricoid Pressure after induction agent given and held until ETT is confirmed in
(research shows succinylcholine is preferred for RSI due to faster onset than Roc)