Exam 1 Study guide flashcards
NPO guidelines clear liquids
2 hours
NPO guidelines chewing gum/candy
after midnight
NPO guidelines breastmilk
4 hours
NPO guidlines formula or nonhuman milk
6 hours
NPO sips with meds
1 hour
Things that place a patient at higher risk for aspiration
-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
METS
-Stands for:
-Means:
-Asses:
-Scoring:
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
When can you resume elective surgery after bare metal sent placement?
4-6 weeks minimum 30 days
When can you resume elective surgery after drug eluding stent placement
6-12 months
When can you resume elective surgery after MI
6 months
What 3 things would make a cardiac patient need further workup?
Less than 4 METS
Unstable angina
any combo of syncope, fatigue, chest pain or dyspnea
Routine labs: general anesthesia
Age: less than 50
F: Pregnancy (F), Hb/Hct
M: ECG
Routine labs: General anesthesia
50-64
Hb/Hct
ECK
Routine labs: general anesthesia
65-74
Hb/Hct
ECT
BUN/CREAT
GLuc
Routine labs: general anesthesia
75+
Hb/Hct
ECT
BUN/Creat
Gluc
chest xray
Need EKG for patients with:
Cardiac disease
PVD
DM
SMoking
Pulm disease
HTN
Renal insufficiency
Routine labs for Mac/Regional
50-64
Hb/Hct
Routine labs for Mac/Regional
65-74
Hb, Hct,
ECG
Routine labs for Mac/Regional
75+
Hb, Hct
ECG
BUN/CREAT
Glucose
Routine lab tests for Nerve block
64-75
Hb/Hct
Routine labs for Nerve block
75+
Hct
ECG
Time-out
-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
Goals of pre-op assessment
-Procure info
-Physical exam
-History
-Eval and documentation anesthetic risk
-Pre-op testing/consults
-Informed consent
-anxiety ease and education
When should you cancel/delay surgery with respiratory disease?
-active dyspnea
-wheezing
-Pulmonary congestion
-hypercarbia
-peak expiratory flow <50% of baseline
How long should a pt abstain from smoking before anesthesia?
12-48 hours before surgery, but 8 weeks is preferred
How long does it take cilia to repair in smokers once they stop?
6 to 8 weeks
Difficult DL:
SHORT
Short neck
Hematoma or abcess
Obesity
Radiation therapy
Tumors/Trauma
Difficult Intubation
LEMON
Look
Evaluate
Mallampati
Obstruction
Neck Mobility
Difficult LMA
RODS
Restricted Mouth Opening
Obstruction in upper airway
Distortion of airway anatomy - tough seal
Stiff lungs (up resistance, down compliance)
Cormack Lehane grades
What you can see in terms of chords
N20 Contraindications
d/t diffusion hypoxemia
-Pneumo
-Air embolism
-middle ear surgery
-pneumocephalus
Stages of anesthesia:
- Induction
- Maintenance
- Emergence
Induction stage of anesthesia
*establish oxygen and air exchange
-often with propofol
-Period of time from administration of potent anesthetic –> development of surgical anesthesia
Maintenance stage of anesthesia
Surgical anesthesia
Emergence stage of anesthesia
Discontinuation of agents—>regained consciousness and protective reflexes
-Recovery
-reversal agents administered
Depth of anesthesia stages
- analgesia
- Excitement
- Surgical anesthesia
- Medullary paralysis
Depth of anesthesia stage 1
(state of mind, VS/ pupils)
Analgesia
-Reduced awareness
-pupils and VS unchanged
Depth of anesthesia stage 2
Excitement
-increases SNS, combative
-riskiest for laryngospasm
-pupils dilate
Depth of anesthesia stage 3
Surgical anesthesia
-yes!
-relaxation
-eventual loss of spontaneous movement
-unconsciousness
-*lid reflex and gag reflex dissapera
Depth of anesthesia stage 4
Medullary paralysis
-Too far! Lawsuits, death
What can you do to reduce the changes of laryngospasm? (5)
- avoid airway manipulation
2.CPAP 5-10 cm/H20 during inhalation (induction and immediately post extubation) - Remove blood/ secretions B4 extubation
- Extubate when wide awake or deeply anesthetized
- IV lidocaine before extubation
Signs of laryngospasm (4)
- inspiratory stridor
- suprasternal/supraclavicular retractions
- rocking appearance to chest wall
- chest flailing
Larygospasm treatment steps
- administer 100% FIo2
- remove stimuli
- deepen anesthesia
- Cpap 15-20 cm H20 and larsen’s manuver
- administer succ
Muscles that obstruct airway and what they obstruct
Genneoglossus: tongue (oropharynx)
Tensor palatine: nasopharynx
Causes of lower airway obstruction in treachea:
Physical blockages
Causes of lower airway obstruction bronchial/alveolar
ARDS
Aspiration pneumonia
asthma
bronchospasm
COPD
pulm edema
Causes of airway obstruction extrapulmonary
-morbid obesity
-pregnancy
-trauma
Nasopharynx lies _______ and is superiorly bound by _____.
It is innervated by _____
-anterior to C1
-base of skull
-trigeminal nerve
Oropharynx is at _____. It is innervated by ____
C2-C3
Glossopharyngeal
Hypopharynx is ____. It is innervated by
Posterior to the larynx
2 branches of the vagus nerve (SLN and RLN)
ASA II
Mild systemic disorder
-smoker
-Social ETOH
-Well controlled disease
ASA III
Severe symptomatic disease
-ESRD with dialysis
-Greater than 3 months post MI, CVA, TIA, CAD/stends
ASA IV:
Constant threat to life
-ESRD no dialysis
-less than 3 months for MI, CVA, TIA, CAD/stents
-ICU diagnoses
ASA V
Moribund, not expected to survive without operation
