exam 1 and only Flashcards
MS. MAID
machine check, suction, monitors, airway, IV, drugs
O2 tank holds___ PSI, and how much should be in there prior to case
2000, at least 500
anesthesia machine flow
fresh gas from common gas outlet–>1 way inspiratory valve–>inspiratory breathing tube–>Y piece to pt–> 1 way expiratory valve–>in and out reservoir bag–>APL to scavenging–>CO2 absorber–>back to fresh gas
Pin index safety system
prevents accidental swapping of oxygen and nitrous. O2 is green and 2,5. Nitrous is blue and 3,5
Diameter safety system
verify piped gas, pressures are >50 psi
negative pressure test on anes machine
verifies no leaks between flow meters and common gas outlet
oxygen analyzer on anes machine
evaluates integrity of low pressure circuit
Volume vs pressure control
volume- machine delivers set volume, set Vt, RR, i:e, variable is PIP.
pressure- machine delivers set pressure. set PIP, RR, i:e. variable is Vt.
Who accredits nurse anesthesia programs
COA council of accreditation of nurse anesthesia educational programs
crna boards is called what and administered by
NCE national certification exam
national board of certification and recertification for nurse anesthetists
purpose of standards for nurse anesthesia practice
evaluate quality of care, provide common base for quality care, help public understand what to expect, support and preserve basic rights of patient
general anesthesia
a reversible state of unconsciousness produced by anesthetic agents.
induction sequence: conventional vs rapid sequence
benzo, o2 5 min, opioid, induction agent, ventilate, no ventilation for RSI, cricoid pressure and paralytic and tube, paralytic, tube, inhalation agent.
advantages/disadvantages of regional anesthesia
advantages: conscious, able to protect airway, pulm/cardiac/renal disease patients
disadvantages: unpredictable, needs a skilled practitioner, pt cooperation
advantage to inhalation induction
no IV access, children
nitrous oxide
increases muscle tone, provides analgesia, increases SVR and pulmonary vascular resistance, decreases breath holding, coughing, secretions and laryngospasm, ok in malignant hyperthermia.
sevoflurane
causes AV disturbances, decreases breath holding, coughing, laryngospasm. compound A. 7 flourine makes it less soluble in blood therefore acts and metabolized quickly.
sevoflurane
causes AV disturbances, decreases breath holding, coughing, laryngospasm. compound A. 7 flourine makes it less soluble in blood therefore acts and metabolized quickly.
Desflurane
least soluble in blood therefore metabolized quickly. respiratory irritant.
What effects potency of inhalation agents
heavier atomic mass, more potent. (ceiling effect)
lipid solubility increases potency
oil/gas partition directly proportional to agents potency
reflected by MAC. lower MAC, more potent.
iso, sevo, des structures
iso- 5 F with a Cl
sevo- 7 F
des- 6 F no Cl
fastest to slowest metabolized volatiles
sevo, des, iso
volatile flammability
adding halogen (flourine, bromine, chlorine, or iodine) DECREASES flammability. sevo is the least flammable.
Barbiturates
GABAa conducts Cl through its pore resulting in hyperpolarization
alkalinity makes them incompatible with opioids and muscle relaxants
do not use in porphyrias
neuroprotection
decrease CO, MV, TV, and RR
Etomidate
minimal hemodynamic changes, minute ventilation decreases, RR increases, adrenocortical hypoperfusion, myoclonia.
ketamine
dissociative, NMDA antagonist analgesia minimal resp depression stimulation of sympathetic nervous system bronchodilation give benzo for psychomimetic effects premedicate with anticholinergic
Propofol
antiemetic effects if continuous infusion
anticonvulsant, neuroprotective
no analgesic properties
redistribution
can be eliminated by lungs (30%)
reduces MV, RR, response to CO2 and upper airway reflexes
Propofol infusion syndrome- children>adults, acidosis, brady, fever, rhabdo
Benzos
anticonvulsant but not neuroprotective anteretrograde amnesia anxiolytic rapid onset antagonized by flumazenil decreases BP, little change in Resp function
Opioids
supraspinal- postsynaptic (mu1)
spinal-presynaptic
g protein receptors, inhibit adenylate cyclase
Morphine and demerol have active metabolites
slow pain/C fibers
EEG and evoked potential monitoring stays intact
truncal rigidity
morphine-histamine release
bradycardia except meperidine
Dexmedatomidine
alpha2 adrenergic agonist, hypnosis from locus coeruleus stimulation
decrease CBF
decrease HR and SVR
decrease TV no change in RR. vent response to CO2 unchanged
upper airway obstruction possible
Redistribution and patient awakening
redistribution from central blood volume to muscles fat and tissues is responsible for patient awakening
depolarizing vs nondepolarizing
nondepolarizing: NMBA competitively bind to Ach receptor, closing the receptor and preventing depolarization, aminosteroids and benzylisoquinalones
depolarizing: NMBA mimics action of Ach, inactivating Na channels. succs.
preferred method of peripheral nerve stimulation
ulnar nerve
TOF
4 responses equal - less than 70% blockade 1 response abolished- 75% 2 responses abolished- 80% 3 response abolished- 90% 4/4 response abolished- 100%
Order of paralysis of muscles
- extraocular
- face, neck, hands, feet
- abdomen, arms, legs
- eyeblink
- respiratory/diaphragm
RECOVER IN REVERSE
atracurium vs cisatracurium
atracurium- histamine release, hoffman elimination, ester hydrolysis
cis- no ester hydrolysis
most common neuropathy associated with supine positioning
ulnar neuropathy
larynx location in adult and infant
adult- C5-C6
infant- C4
larynx composed of
thyroid, cricoid, arytenoid, corniculates, and epiglottis. also muscles and ligaments.
mallampati
1- uvula, pillars, soft and hard palate
2- NO PILLARS, uvula, soft and hard palate
3- NO PILLARS ONLY BASE of uvula
4. only tongue
cormack and lehane
Grade 1- see cords/glottis
Grade 2- see 1/2 of glottis
Grade 3- see epiglottis
Grade 4- no glottis or larynx
atlanto occipital extension
flexion of neck aligns larynx and pharynx
extension of head aligns oral and pharyngeal axis.
thyromental distance
less than 3 fingerbreadths is a poor laryngoscopic view.
