Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spring Grape Varieties > Complications of Anesthesia > Flashcards

Complications of Anesthesia Flashcards

1
Q

Complications related to delivery of anesthesia:

Evaluate, Manage, Document.
Is it ok to go back later and change your documentation?

A

HELLS NO. It looks incriminating. Document as closely to the time it happened as you can. Be specific, concise, descriptive. Cover you ass!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the American Society of Anesthesiologists Closed Claims Project?

A

They look at closed claims and identify patterns, potential liabilities, and strategies for prevention of claims/complications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the top 3 claims identified by the ASA?

A
  • Death- 22%
  • Nerve injury -18%
  • Brain damage -9%

Emerging areas of claims are in regional anesthesia, Chronic Pain Management, and Acute pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Drawn-up drugs in a syringe need to have the following items labeled:

A
  • Drug name
  • concentration (%) and/or mg/mL
  • Date drawn up
  • Expiration date/time
  • initials of who drew up the drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is anesthesia awareness?

A

It’s not like breast cancer awareness.

Bad news: It’s being able to recall events while under anesthesia signifying that either the person was not “deeply” enough sedated or may have a physiologically resistance to anesthetics.

Good news: incidence rate of 0.2%-0.4% of people.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What surgical settings are associated with awareness?

A
  • Major Trauma 43%: no gas, too hypotensive
  • Obstetrics 1.5%: Emergent C-section
  • Cardiac Surgery 0.4% -sternotomy is very stimulating, many nerves in the area.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prevention of intraoperative recall/awareness:

In addition to using volatile anesthetic agents at a MAC level consistent with amnesia, what other drugs can help with amnesia?

A
  • Benzodiazepines- Antegrade amnesia (point of administration forward)
  • Scopolamine- Retrograde Amnesia (when given in IV form, not the patch, rarely given)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Eye injuries:

What is the most common and most serious cause of post operative vision loss? How does it happen?

A

Ischemic Optic Neuropathy (ION)

-optic nerve infarction due to decreased oxygen delivery via one or more arterioles supplying the optic nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ischemic Optic Neuroapthy (ION) is commonly reported after what kind of surgeries? Are there any conditions that contribute to intra/post operative ION?

A
  • cardiopulmonary bypass (hypotension- inadequate profusion to the eyes)
  • radical neck dissection
  • abdominal and hip proceedures
  • spinal surgeries in prone position or any prone surgery.

Contributing conditions: HTN, DM, CAD, Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F: ION onset is immediate or can be delayed through 12th day post op and range from decreased visual acuity to complete blindness.

A

T-R-U-E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can one prevent ION in patient?

A
  • enhance venous outflow by position the patient head up.
  • minimize abdominal constriction.
  • monitor BP carefully with arterial line
  • limit degree and duration of deliberate hypotension
  • avoid anemia in patients at risk for ION
  • consider staging long surgical procedures in patients at risk of ION. (multiple surgeries instead of 1 long surgery.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cardiopulmonary arrest during spinal anesthesia is associated with a block that reaches what dermatome level?

A

T4 or above. T4 is at the nippleline. T7 (Xyphoid process) is the target level for a typical spinal.

-T2, T3, T4 are the cardiac accelerators.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cardiopulmonary arrest during spinal anesthesia:

What are signs and symptoms prior to arrest?

A
  • Gradual decline in HR and BP (20% below baseline values)
  • Bradycardia
  • Hypotension (also typical in a normal spinal)
  • Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cardiopulmonary arrest after spinal anesthesia:

What is the treatment for cardiopulmonary complications?

A
  1. Ventilatory support (bag/mask and O2)
  2. Ephedrine- first choice bradycardia and BP support
  3. Atropine to treat bradycardia
  4. Epinephrine in small doses 5-10mcg for bradycardia that is unresponsive to atropine and ephedrine.
  5. CPR if loss of pulses and use ACLS protocols and doses of Epinephrine (1mg).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the cause and treatment of hearing loss after spinal anesthesia?

A

Due to CSF leak, treated with blood patch.

Often accompanied by spinal headache.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

After general anesthesia, what are causes of hearing loss?

A
  • Surgical manipulation
  • Middle ear barotrauma
  • vascular injury
  • ototoxicity of drugs
  • s/p cardiopulmonary bypass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Allergic reactions:

What is an allergic reaction?

A
  • Exaggerated immunologic responses to antigenic stimulation in a previously sensitized individual.
  • The allergen may be the substance itself, its metabolite or a breakdown product of the substance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Allergic reactions:

T/F: An allergen (ie. latex) may cause more than one type of reaction.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Allergic reactions:

What is a Type I- Immediate reaction?

A

Most serious, includes :

  • atopy (genetic predisposition towards developing allergies)
  • Examples include anaphylaxis and allergic rhinoconjunctivitis.
  • involve immunoglobulin E (IgE)–mediated release of histamine and other mediators from mast cells and basophils.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Allergic reactions:

What is a Type II-Cytotoxic reaction?

A
  • involve immunoglobulin G or immunoglobulin M antibodies bound to cell surface antigens, with subsequent complement fixation.
  • Examples: drug-induced hemolytic anemia, hemolytic transfusion reactions and heparin-induced thrombocytopenia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Allergic reactions:

What is a Type III-Immune Complex reaction?

A
  • involve circulating antigen-antibody immune complexes that deposit in postcapillary venules, with subsequent complement fixation.
  • Example is serum sickness, RA
22
Q

Allergic reactions:

What is a Type IV-Delayed, cell-mediated reaction?

A
  • are mediated by T cells rather than by antibodies.

- An example is contact dermatitis from poison ivy or nickel allergy.

23
Q

What type of reaction is anaphylaxis?

A
  • Exaggerated response to an allergen that is mediated by a Type I hypersensitivity.
  • Appears within minutes of exposure to a specific antigen in a sensitized individual.
24
Q

What are the common clinical manifestations of anaphylaxis?

A

CV: Hypotension and tachycardia (circulatory shock)

Pulmonary: Bronchospasm, cough, wheezing/stridor dyspnea, pulmonary edema, laryngeal edema, hypoxia

Dermatologic: urticaria, facial edema, pruritus

25
Q

What inflammatory mediators are released during an anaphylactic reaction?

A

Histamine-
Leukotrienes
BK-A
Platelet-activating factor

26
Q

What are anaphylactoid reactions?

A

Resembles anaphylaxis but does ot depend on IgE interaction with antigen.

27
Q

How is treatment for an anaphylactoid reaction different than treatment for an anaphylactic reaction?

A
  • There is no difference in treatment.

- One cannot tell the difference as both have the same general symptoms.

28
Q

What are risk factors associated with hypersensitivity to anesthetics?

A
  • Female
  • Atopic history (genetic predisposition towards developing allergies.
  • preexisting allergies
  • previous anesthetic exposure (Sensitization)
29
Q

What are the treatments for anaphlactoid and anaphylactic reactions?

A
  • Discontinue drug administration
  • administer 100% O2
  • Epinephrine (0.01-0.5mg IV or IM) to treat Hypotension
  • Consider intubation or trach (assess airway)
  • IV fluids (1-2 liters LR)
  • Diphenhydramine (50-75mg IV or IM) antihistamine
  • Ranitidine (150mg IV) H2 blocker
  • Hydrocortisone (up to 200mg IV or methylprednisolone (1-2mg/kg) to depress immune reaction.
30
Q

What anesthetic drug is most commonly responsible for anaphylactic reactions?

A

Muscle relaxants, account for 70% of reactions.

Rocuronium is most common, then succinylcholine and atracurium. Roc and many cosmetics contain the same ingredients. Females may be more sensitized to Roc.

31
Q

T/F: Opioid reactions rarely anaphylactic and most are non-immune related histamine release.

A

True

Also true: patient’s love and are not allergic to that one that starts with a “D”

32
Q

T/F: Volatile inhaled agents only cause anaphylactoid reactions.

A

False. In fact, there are no documented cases on anaphylaxis from the volatile agents.

33
Q

Which family of local anesthetics causes the majority of allergic reactions?

A

The Ester type local anesthetics.

  • Share common antigenicity with PABA, cross reactivity with other ester type anesthetics should be suspected. Use an Amide if patient has an ester allergy.
  • Amide type local anesthetic rarely cause anaphylaxis. If they do, it’s due to paraben or methylparaben.
34
Q

What is the 2nd most common cause of anaphylaxis?

A

Latex allergy

Can have a type I and/or Type IV reaction to latex.

35
Q

Foods that cross react with latex are:

A

Mango, banana, kiwi, avocado, passion fruit and chestnut. Bummer!!

36
Q

What is MH?

A

Malignant hyperthermia is a rare, inherited myopathy, characterized by an acute hypermetabolic state in muscle tissue after induction of general anesthesia.

37
Q

What is the 1st indicator of MH?

A

Unexplained and rapidly increasing EtCO2

38
Q

T/F: If a person has no prior problems with anesthesia, they cannot develop MH.

A

False. It an happen after having prior anesthesia without complications.

39
Q

Hyperthermia is an early sign of MH?

A

No, it is a late sign. Watch the EtCO2 and signs of hypermetabolic activity, acidosis, etc.

40
Q

MH is characterized by an uncontrolled increase in intracellular _______ in skeletal muscle.

A

Calcium.

The sudden release of Ca from the Sarcoplasmic reticulum removes the inhibition of troponin and causes intense muscle contractions.

41
Q

What drugs are known to trigger MH?

A
  • Halogenated general anesthetics

- non-depolarizing muscle relaxants: Succinylcholine

42
Q

What is the dose of dantrolene to be administered?

A

2.5mg/kg q 5 minutes to max dose of 10mg/kg. continuous infusion of dantrolene should be given for 24 hours.

43
Q

How does dantrolene work?

A

Directly interferes with muscle contraction by binding to Ryr1 receptor, calcium channel and hihibiting Ca ion release from sarcoplasmic reticulum.

44
Q

What is a laryngospasm?

A

Complete spasmodic closure of the larynx as a consequence of an outside stimulus. Closure of the glottis as a result of reflex constriction of the laryngeal muscles.

45
Q

What is a common cause of laryngospasm at induction?

A

Inadequate onset of muscle relaxant.

46
Q

how can one break a laryngospasm?

A

Positive pressure ventilation usually breaks a spasm.

47
Q

What is a Bronchospasm?

A

Spasmodic constriction of bronchial smooth muscle creates narrowing of airway passages and increases airway resistance.

48
Q

During a Bronchospasm is a patient difficult or easy to ventilate?

A

Difficult. Tight respirations. will feel resistance to bagging.

49
Q

how does a bronchospasm manifest?

A
  • Prolonged expirations.
  • high inflation pressures
  • expiratory wheezes
  • decreased oxygen saturation
  • difficult to bag-mask. resistance to bagging.
50
Q

what is one way to break a bronchospasm?

A

Deepen anesthesia by increasing the gases.

gases=bronchodilators.

51
Q

Radiation exposure in the OR:

Maximum occupational whole body exposure to to radiation per year is ____rem/year.

A

5.

wear lead aprons and stand back if possible. Exposure at 4 meters will be 1/16th the exposure at 1 meter distance.

Spring Grape Varieties (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions