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AAN2 > Class 5 Anesthesia for Theraputics > Flashcards

Class 5 Anesthesia for Theraputics Flashcards

1
Q

What is the maximum radiation exposure one can receive per year?

A

50 mSv

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2
Q

Why older contrast dye harmful? What is better about new IV contrast?

A
  • Hyperosmolar and toxic

- Lower osmolality and less side effects

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3
Q

What are some predisposing factors to reactions to contrast media?

A
  • Bronchospams
  • Allergy
  • Cardiac disease
  • hypovolemia
  • hematologic disease
  • renal disease
  • extremes of age
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4
Q

What medications may react with contrast dye?

A
  • Betablockers
  • NSAIDs
  • ASA
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5
Q

How would you pretreat for potential contrast reactions?

A
  • Prednisone (12 hourrs prior)

- Benadryl (just prior to procedure)

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6
Q

Describe the mild symptoms of contrast dye reaction?

A
  • Nausea
  • Warmth
  • HA
  • Itchy rash
  • Hives
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7
Q

Describe severe symptoms of contrast dye reactions.

A
  • Vomiting
  • CP
  • severe hives
  • bronchospasm
  • dyspnea
  • arrythmias
  • Renal failure
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8
Q

How to treat reaction to contrast dye?

A
  • O2
  • Bronchodilator
  • Epi
  • Corticosteroids
  • Antihstamines
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9
Q

Renal dysfunction is well documented after contrast dye, especially in what type of patients?

A

-Preexisting renal disease r/t diabetes

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10
Q

What medicine helps reduce nephrotoxicity induced by contrast dye?

A

-acetylcysteine (mucomyst)

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11
Q

Why is metformin contraindicated with contrast dye?

A

-Life threatening lactic acidosis

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12
Q

What is the main problem for CT?

A

-inaccessability to the patient

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13
Q

What is the most significant risk of MRI?

A

-effect of magnet on ferrous objects

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14
Q

What is contraindicated in the MRI suite?

A
  • Metal objects

- Tattoos permanent makeup w/ high iron levels

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15
Q

What type of anesthesia is not appropriate for MRI?

A

-Deep sedation

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16
Q

What meds are generally used in MRI?

A
  • Propofol (versed/Fent not needed)

- Sevo w/ LMA < 1 MAC

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17
Q

What is often needed during interventional radiology procedures?

A

-Deliberate hypotension / hypocapnia

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18
Q

deliberate hypertension is used for what?

A

-Maximize collateral flow

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19
Q

Things needed for cerebral coiling?

A
  • 2 large bore IVs
  • A-Line
  • Fluid warmer/Upper Bair
  • Frequent ACTs
  • Smooth emergence, no coughing bucking
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20
Q

When is stenosis considered hemodynamically significant?

A

->50-70%

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21
Q

What may happen in the cath lab after stenosis dilation?

A

-Ventricular arrhythmias

22
Q

What may happen after protamine administration?

A
  • Vasodilation (↓BP)
  • Anaphylactic and anaphylactoid reactions
  • Pulmonary vasoconstriction
23
Q

What med may elevate ACT levels?

A

-abciximab

24
Q

Numerous studies have shown the benefits of _________ in both acute and chronic coronary syndromes.

A

Anti-platelet therapy

25
Q

Antispasmodics (glucagon) may decrease spasms but may cause what?

A

-tachycardia

26
Q

What drugs should be avoided with sphincter of Oddi manometry and why?

A
  • Opioids, Robinol, glucagon

- Alteration in sphincter tone

27
Q

What is Transjugular Intrahepatic Portosystemic Shunt (TIPS) and when is it used?

A
  • Connection of portal vein to hepatic vein to decompress portal circulation
  • Portal HTN
28
Q

Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure tidbits?

A
  • Minimally stimulating
  • 2-3 hours
  • Sedation or GA
29
Q

How often ti ECT performed?

A

-3X weekly for 6-12 treatments

30
Q

ECT therapeutic effects come from what?

A

-Release of neuro transmitters during induced grandmal seizure

31
Q

What releases immediately after ECT?

A
  • Epi and Norepi

- Stress hormones (ACTH, cortisol etc.)

32
Q

What are the 2 phases of ECT induced grandmal seizure?

A
  • Tonic = 10-15 sec

- Conic = 30-60 sec

33
Q

What are the CV responses to ECT?

A
  • Increased CBF and ICP
  • Brady followed by HTN & Tachy
  • Dysrhythmias
  • Myocardial Ischemia
34
Q

What other effects can ECT have?

A
  • Memory loss
  • Muscle aches or fractures
  • Death
  • Status elipticus
35
Q

What is the absolute contraindication to ECT

A

-Pheochromocytoma

36
Q

Relative contraindications to ECT

A
  • ↑ ICP
  • Recent CVA
  • CV defects
  • Pregnancy
  • Aneurysms
37
Q

What drugs equipment is used for ECT anesthesia?

A
  • Propofol
  • Short acting opioids
  • Succs (prevent injury)
  • Bite guard
  • Toradol (myalgias)
  • Robinol (prevent parasympathetic)
  • Labetalol/Esmolol (decrease sympathetic response)
  • Clonidine / Precedex
38
Q

What are the initial effects of ECT/seizure? What happens after?

A
  • Parasympathetic (Brady,salivation, PAC/PVC, occ. asystole)

- Sympathetic response (HTN/Tachy)

39
Q

What is the most common cause of death w/ ECT?

A

-Mi and Arrhythmias

40
Q

Dental surgeries are common with what segment of the population? What abnormalities are common among this group?

A
  • Down syndrome

- Cardiac abnormalities (conduction & structural), Atlanto-occipital dislocation, difficult airways

41
Q

How are dental surgeries managed?

A
  • Ketamine
  • Oral Versed
  • Nasal intubation
42
Q

Post op complications of dental surgery?

A
  • Bleeding
  • Airway obstruction
  • Laryngospasm
43
Q

Describe minimal sedation

A
  • Responsiveness = Normal
  • Airway = Unaffected
  • Spont. Ventilation = Unaffected
  • CV function = Unaffected
44
Q

Describe moderate sedation (conscious sedation)

A
  • Responsiveness = Verbal/Tactile stimulation
  • Airway = No intervention required
  • Spont. Ventilation = Adequate
  • CV function = Maintained
45
Q

Describe deep sedation

A
  • Responsiveness = Repeated / Painful stimulation
  • Airway = May need intervention
  • Spont. Ventilation = Possibly inadequate
  • CV function = Usually maintained
46
Q

Describe GA

A
  • Responsiveness = Unarousable
  • Airway = Intervention required
  • Spont. Ventilation = Inadequate
  • CV function = may be Impaired
47
Q

What patients may be difficult to sedate?

A
  • Anxious
  • Psych
  • Chronic opioid use
  • Mental status changes
  • Dementia
48
Q

What are the fasting guidelines for sedation?

A
  • Adults 6-8hrs (none after 00:00)
  • Children over 3 = 6-8hrs
  • 6-36 mo = 6 hrs
  • > 6mo = 4-6hrs (2hrs clears)
49
Q

What must be done for sedation recovery?

A
  • Aldrete score
  • Observed at least 30 mins (1hr if resuscitated)
  • Vitals Q10minx3 then qhours x2
50
Q

When can a sedation patient be discharged?

A
  • fully away with aldrete of 9
  • Walk unassisted
  • Adequate hydration
  • Adult escort
  • Discharge instruction

AAN2 (11 decks)

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