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Priniclpes Of Anesthesia > Exam 1 Study guide flashcards > Flashcards

Exam 1 Study guide flashcards

1
Q

NPO guidelines clear liquids

A

2 hours

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2
Q

NPO guidelines chewing gum/candy

A

after midnight

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3
Q

NPO guidelines breastmilk

A

4 hours

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4
Q

NPO guidlines formula or nonhuman milk

A

6 hours

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5
Q

NPO sips with meds

A

1 hour

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6
Q

Things that place a patient at higher risk for aspiration

A

-Anxiety
-GERD/hernia/any esophageal issue
-Anything that increases abdominal pressure (pregnancy, ascites)
-Didn’t follow NPO
-Nuerologic sequalae
-opiods
-Pain
-Prematurity
-Smoking in acute perioperateive window

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7
Q

METS
-Stands for:
-Means:
-Asses:
-Scoring:

A

Metabolic equivalents

One MET is defined as the amount of O2 consumed while sitting at rest and is equal to 3.5 mL O2/kg/min.

2 METS = 3.5 x 2
3 METS=3.5x3
and so on

ask: are you able to walk four blocks w/o stopping? Are you able to climb 2 flights of stairs?

Less than 4 mets should be further assessed

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8
Q

When can you resume elective surgery after bare metal sent placement?

A

4-6 weeks minimum 30 days

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9
Q

When can you resume elective surgery after drug eluding stent placement

A

6-12 months

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10
Q

When can you resume elective surgery after MI

A

6 months

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11
Q

What 3 things would make a cardiac patient need further workup?

A

Less than 4 METS
Unstable angina
any combo of syncope, fatigue, chest pain or dyspnea

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12
Q

Routine labs: general anesthesia
Age: less than 50

A

F: Pregnancy (F), Hb/Hct
M: ECG

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13
Q

Routine labs: General anesthesia
50-64

A

Hb/Hct
ECK

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14
Q

Routine labs: general anesthesia
65-74

A

Hb/Hct
ECT
BUN/CREAT
GLuc

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15
Q

Routine labs: general anesthesia
75+

A

Hb/Hct
ECT
BUN/Creat
Gluc
chest xray

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16
Q

Need EKG for patients with:

A

Cardiac disease
PVD
DM
SMoking
Pulm disease
HTN
Renal insufficiency

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17
Q

Routine labs for Mac/Regional
50-64

A

Hb/Hct

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18
Q

Routine labs for Mac/Regional
65-74

A

Hb, Hct,
ECG

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19
Q

Routine labs for Mac/Regional
75+

A

Hb, Hct
ECG
BUN/CREAT
Glucose

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20
Q

Routine lab tests for Nerve block
64-75

A

Hb/Hct

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21
Q

Routine labs for Nerve block
75+

A

Hct
ECG

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22
Q

Time-out

A

-Before incision or procedure
-Additional time out if person performing the procedure changes
-All involved in immediate care of pt participate and agree: Name, procedure, site
-documented

23
Q

Goals of pre-op assessment

A

-Procure info
-Physical exam
-History
-Eval and documentation anesthetic risk
-Pre-op testing/consults
-Informed consent
-anxiety ease and education

24
Q

When should you cancel/delay surgery with respiratory disease?

A

-active dyspnea
-wheezing
-Pulmonary congestion
-hypercarbia
-peak expiratory flow <50% of baseline

25
Q

How long should a pt abstain from smoking before anesthesia?

A

12-48 hours before surgery, but 8 weeks is preferred

26
Q

How long does it take cilia to repair in smokers once they stop?

A

6 to 8 weeks

27
Q

Difficult DL:

A

SHORT
Short neck
Hematoma or abcess
Obesity
Radiation therapy
Tumors/Trauma

28
Q

Difficult Intubation

A

LEMON
Look
Evaluate
Mallampati
Obstruction
Neck Mobility

29
Q

Difficult LMA

A

RODS
Restricted Mouth Opening
Obstruction in upper airway
Distortion of airway anatomy - tough seal
Stiff lungs (up resistance, down compliance)

30
Q

Cormack Lehane grades

A

What you can see in terms of chords

31
Q

N20 Contraindications

A

d/t diffusion hypoxemia
-Pneumo
-Air embolism
-middle ear surgery
-pneumocephalus

32
Q

Stages of anesthesia:

A
  1. Induction
  2. Maintenance
  3. Emergence
33
Q

Induction stage of anesthesia

A

*establish oxygen and air exchange
-often with propofol
-Period of time from administration of potent anesthetic –> development of surgical anesthesia

34
Q

Maintenance stage of anesthesia

A

Surgical anesthesia

35
Q

Emergence stage of anesthesia

A

Discontinuation of agents—>regained consciousness and protective reflexes
-Recovery
-reversal agents administered

36
Q

Depth of anesthesia stages

A
  1. analgesia
  2. Excitement
  3. Surgical anesthesia
  4. Medullary paralysis
37
Q

Depth of anesthesia stage 1
(state of mind, VS/ pupils)

A

Analgesia
-Reduced awareness
-pupils and VS unchanged

38
Q

Depth of anesthesia stage 2

A

Excitement
-increases SNS, combative
-riskiest for laryngospasm
-pupils dilate

39
Q

Depth of anesthesia stage 3

A

Surgical anesthesia
-yes!
-relaxation
-eventual loss of spontaneous movement
-unconsciousness
-*lid reflex and gag reflex dissapera

40
Q

Depth of anesthesia stage 4

A

Medullary paralysis
-Too far! Lawsuits, death

41
Q

What can you do to reduce the changes of laryngospasm? (5)

A
  1. avoid airway manipulation
    2.CPAP 5-10 cm/H20 during inhalation (induction and immediately post extubation)
  2. Remove blood/ secretions B4 extubation
  3. Extubate when wide awake or deeply anesthetized
  4. IV lidocaine before extubation
42
Q

Signs of laryngospasm (4)

A
  1. inspiratory stridor
  2. suprasternal/supraclavicular retractions
  3. rocking appearance to chest wall
  4. chest flailing
43
Q

Larygospasm treatment steps

A
  1. administer 100% FIo2
  2. remove stimuli
  3. deepen anesthesia
  4. Cpap 15-20 cm H20 and larsen’s manuver
  5. administer succ
44
Q

Muscles that obstruct airway and what they obstruct

A

Genneoglossus: tongue (oropharynx)
Tensor palatine: nasopharynx

45
Q

Causes of lower airway obstruction in treachea:

A

Physical blockages

46
Q

Causes of lower airway obstruction bronchial/alveolar

A

ARDS
Aspiration pneumonia
asthma
bronchospasm
COPD
pulm edema

47
Q

Causes of airway obstruction extrapulmonary

A

-morbid obesity
-pregnancy
-trauma

48
Q

Nasopharynx lies _______ and is superiorly bound by _____.

It is innervated by _____

A

-anterior to C1
-base of skull
-trigeminal nerve

49
Q

Oropharynx is at _____. It is innervated by ____

A

C2-C3
Glossopharyngeal

50
Q

Hypopharynx is ____. It is innervated by

A

Posterior to the larynx
2 branches of the vagus nerve (SLN and RLN)

51
Q

ASA II

A

Mild systemic disorder
-smoker
-Social ETOH
-Well controlled disease

52
Q

ASA III

A

Severe symptomatic disease
-ESRD with dialysis
-Greater than 3 months post MI, CVA, TIA, CAD/stends

53
Q

ASA IV:

A

Constant threat to life
-ESRD no dialysis
-less than 3 months for MI, CVA, TIA, CAD/stents
-ICU diagnoses

54
Q

ASA V

A

Moribund, not expected to survive without operation

Priniclpes Of Anesthesia (19 decks)

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