Exam 1: Non-Operating Room Anesthesia (NORA)

Question 1

AANA standards of care I and II

Answer 1

I: pt rights: autonomy, privacy, safety
II: pre-anesthesia assessment (with NORA, there is not a lot of support outside the OR - be prepared)

Question 2

What is 1 MET equal to?

Answer 2

3.5 mL/kg/min of O2

Question 3

What are the AANA standars of care III, IV and V?

Answer 3

III: pt specific plan
IV: informed consent
V: documentation

Question 4

AANA standars of care VI, VII, and VIII

Answer 4

VI: verify functioning equipment
VII: anesthesia plan
VIII: pt positioning

Question 5

AANA standard of care IX

Answer 5

IX: monitoring and alarms
- o2, ventilation, CV status, thermoregulation, neuro response
- all alarms audible

Question 6

AANA standard of care X and XI

Answer 6

X: infection control policy (one syringe, one needle, one pt, one time)
XI: transfer of care

Question 7

Top NORA ASA guidelines

Answer 7

• reliable O2 source including backup supply
• adequate and reliable suction
• adequate and reliable scavenging system if anesthetic gases are used
• self-inflating resuscitation bag
• adequate drugs, supplies and equipment for the procedure
• adequate monitoring devices
• immediate suitability of an emergency cart

Question 8

What is the actual definition of general anesthesia?

Answer 8

• pt has lost consciousness
• and their ability to respond is lost too

per Castillo, it doesn’t matter if they can still breathe, this is a general

Question 9

What type of anesthetic is recommended for cerebral coiling?

Answer 9

GETA w/ arterial line and large bore IV.
- volatiles and prop drip
- a-line

Question 10

What is most important in prevention of radiation damage: time, shielding or distance?

Answer 10

Distance

Question 11

What kind of anesthesia should be used for a cardiac ablation in the cath lab?

Answer 11

• both can be used (MAC or GETA)

Question 12

Careful with what drugs during TEE/cardioversion (pt may not come back)

Answer 12

• Sodium Channel blocker (lidocaine) - heart may not restart

Question 13

What drug(s) is/are direct oral thrombin inhibitors?

Answer 13

Dabigatran (Pradaxa)

Question 14

How do direct thrombin inhibitors work?

Answer 14

Antagonizes thrombin to prevent fibrinogen → fibrin

Question 15

What laboratory test will measure Pradaxa’s (Dabigatran) effects?

Answer 15

dTT

Question 16

What agents could reverse direct thrombin inhibitors?

Answer 16

D/C drug but also
- factor 3, factor 4 or prothrombin

Question 17

What drug(s) is/are oral Factor Xa inhibitors?

Answer 17

• Rivaroxaban (Xarelto)
• Apixaban (Eliquis)
• Edoxaban (Savaysa)

Question 18

What is the MOA of Factor Xa inhibitors?

Answer 18

Prevents cleavage of prothrombin → thrombin

Question 19

What could reverse factor Xa inhibitors?

Answer 19

D/C drug but also
- factor 3, factor 4, and prothrombin complex

Question 20

What drugs can reverse the effects of coumadin?

Answer 20

Vitamin K
FFP

Question 21

What is the effect of CO₂ levels on cerebral blood flow?

Answer 21

Hypercapnia = Increased CBF
hypercapnia = cerebral vasodialation