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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
Antispasmodics (glucagon) may decrease spasms but may cause what?
-tachycardia
26
What drugs should be avoided with sphincter of Oddi manometry and why?
- Opioids, Robinol, glucagon | - Alteration in sphincter tone
27
What is Transjugular Intrahepatic Portosystemic Shunt (TIPS) and when is it used?
- Connection of portal vein to hepatic vein to decompress portal circulation - Portal HTN
28
Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure tidbits?
- Minimally stimulating - 2-3 hours - Sedation or GA
29
How often ti ECT performed?
-3X weekly for 6-12 treatments
30
ECT therapeutic effects come from what?
-Release of neuro transmitters during induced grandmal seizure
31
What releases immediately after ECT?
- Epi and Norepi | - Stress hormones (ACTH, cortisol etc.)
32
What are the 2 phases of ECT induced grandmal seizure?
- Tonic = 10-15 sec | - Conic = 30-60 sec
33
What are the CV responses to ECT?
- Increased CBF and ICP - Brady followed by HTN & Tachy - Dysrhythmias - Myocardial Ischemia
34
What other effects can ECT have?
- Memory loss - Muscle aches or fractures - Death - Status elipticus
35
What is the absolute contraindication to ECT
-Pheochromocytoma
36
Relative contraindications to ECT
- ↑ ICP - Recent CVA - CV defects - Pregnancy - Aneurysms
37
What drugs equipment is used for ECT anesthesia?
- Propofol - Short acting opioids - Succs (prevent injury) - Bite guard - Toradol (myalgias) - Robinol (prevent parasympathetic) - Labetalol/Esmolol (decrease sympathetic response) - Clonidine / Precedex
38
What are the initial effects of ECT/seizure? What happens after?
- Parasympathetic (Brady,salivation, PAC/PVC, occ. asystole) | - Sympathetic response (HTN/Tachy)
39
What is the most common cause of death w/ ECT?
-Mi and Arrhythmias
40
Dental surgeries are common with what segment of the population? What abnormalities are common among this group?
- Down syndrome | - Cardiac abnormalities (conduction & structural), Atlanto-occipital dislocation, difficult airways
41
How are dental surgeries managed?
- Ketamine - Oral Versed - Nasal intubation
42
Post op complications of dental surgery?
- Bleeding - Airway obstruction - Laryngospasm
43
Describe minimal sedation
- Responsiveness = Normal - Airway = Unaffected - Spont. Ventilation = Unaffected - CV function = Unaffected
44
Describe moderate sedation (conscious sedation)
- Responsiveness = Verbal/Tactile stimulation - Airway = No intervention required - Spont. Ventilation = Adequate - CV function = Maintained
45
Describe deep sedation
- Responsiveness = Repeated / Painful stimulation - Airway = May need intervention - Spont. Ventilation = Possibly inadequate - CV function = Usually maintained
46
Describe GA
- Responsiveness = Unarousable - Airway = Intervention required - Spont. Ventilation = Inadequate - CV function = may be Impaired
47
What patients may be difficult to sedate?
- Anxious - Psych - Chronic opioid use - Mental status changes - Dementia
48
What are the fasting guidelines for sedation?
- Adults 6-8hrs (none after 00:00) - Children over 3 = 6-8hrs - 6-36 mo = 6 hrs - >6mo = 4-6hrs (2hrs clears)
49
What must be done for sedation recovery?
- Aldrete score - Observed at least 30 mins (1hr if resuscitated) - Vitals Q10minx3 then qhours x2
50
When can a sedation patient be discharged?
- fully away with aldrete of 9 - Walk unassisted - Adequate hydration - Adult escort - Discharge instruction

AAN2 (11 decks)

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