General, MAC, Regional Anesthesia (Week 3) Flashcards
Ideal anesthetic technique
Incorporates optimal _____ _____ and satisfaction
Provides excellent _______ conditions for the surgeon
Allows rapid ______ and minimal post operative side effects
Patient Safety
Operating
Recovery
Ideal Anesthetic Technique
_____ effective
Allow early _____ or _____ from the PACU
Optimize post operative _____ control
Permit efficieny, including ______ times
Cost
Transfer or Discharge
Pain
Turnover
Post Operative N/V (PONV)
May be lessened with placement of a ________ patch. Must be careful with handling and must tell caregivers to be careful with handling.
Scopalamine
General Anesthetic
Defined as drug-induced loss of _______, during which patients are not _______, even by painful stimulation
Two types of general anesthesia?
Consciousness, Arousable
IV drugs, Inhalation of Volatile Anesthetic
General Anesthesia: IV Induction
Induction with use of agents such as ______ or _______
Ventilation options may include a _____ _____ or _____.
alternatively, a ______ ______ drug may be given IV to facilitate direct laryngoscopy before tracheal intubation
Propofol, Etomidate
Face Mask, LMA
Neuromuscular Blocking
GA: IV Induction
_______ is intended to replace nitrogen ( ________) in the patient’s functional residual capacity (FRC). This is especially important for certain patient populations, particularly _____ patients
_____ vital capacity breaths of 100% oxygen over a period of 60 seconds is similar to that achieved by breathing 100% oxygen for 3 minutes at normal tidal volumes
Pre-oxygenation, (denitrogenation)
Obese
Eight
GA: IV Induction
Pre-oxygenation provides a crucial ______ of ______ during periods of apnea or _____ airway obstruction that can occur with general anesthesia
Margin of Safety
Upper
Rapid Sequence Intubation (Induction)
May be indicated for patients who are at _____ risk for ______ of gastric contents. For example, patient’s with ______, delayed stomach ______, or unknown _____ state
Goal of RSI is to _____ time between onset of _______ and tracheal intubation to reduce the risk of ______ via the mechanism of _____ pressure
Increased, Aspiration
GERD, Emptying, Fasting
Minimize, Unconsciousness, Regurgitation, Cricoid
Rapid Sequence Intubation (Induction)
Provide ___-______
Admin ______ agent (such as propofol)
Admin _____ agent
With onset of ________, ______ pressure is applied
Laryngoscopy is intiated only _____ onset of skeletal muscle _____ (may be verfied with peripheral nerve stimulator)
Pre-Oxygenation
Induction
NMB
Unconsciousness, Crocoid
After, Paralysis
Rapid Sequence Intubation NMB’s
Succinylcholine
Dose: ___ to ___ mg/kg
Onset is ___ to ___ seconds
Rocuronium
Dose: ___ to ___ mg/kg. Increasing dose of Rocuronium to ___ to ___ mg/kg creates onset time similar to that of Succinycholine
Onset time of Roc with smaller dose is _____ than induction with Succ
1.0 to 1.5 mg/kg
45 to 120 seconds
0.6 to 1.2 mg/kg; 1.0 to 1.2 mg/kg
Slower
General Anesthesia: Inhaled Induction
May include inhalation of ______ with or without ____ ____.
What is the preferred inhaled agent to use for children?
_______, another induction gas, produces a rapid onset effect but is not often selected for inhaled induction due to its _____ _____ effects
Inhaled (mask induction) anesthesia is often selected for ______ patients when prior insertion of an ___ is not practical (they will fight this)
Sevoflurane, Nitrous Oxide
Sevoflurane
Desflurane, Airway Irritant
Pediatric, IV
General Anesthesia: Inhaled Induction
Inhaled induction may be preferred method for patient anticipated to have a _____ _____ to manage, because _______ respiratory efforts are preserved with an inhaled induction of anesthesia
_____ _____ lacks potency to be used alone as induction agent compared to other volatile anesthetic agents, but may be used in conjunction
Inhaled anesthetics increase the risk of post operative _____ and _____
Difficult Airway, Spontaneous
Nitrous Oxide
Nausea and Vomiting
GA: Inhaled Induction
Loss of consciousness usually occurs within __ ______ when breathing 8% Sevo. Insertion of a LMA can usually be achieved within __ ______ of administering 7% Sevo.
“_______” the circuit involes filing the breathing circuit with inhaled agent by emptying _____ bag, opening the ______-______ valve, and using a ____ fresh gas flow of __L/min for ___ seconds prior to applying face mask to patient
1 Minute
2 Minutes
Priming, Resovoir, Presssure-Limiting Valve
High, 8L/min, 60 Seconds
Always be ready to convert to a ______ anesthetic
Remember, you cannot use ______ ______ agents with an LMA. The LMA would have to be removed and an ETT would have to be placed in this situation.
General
Neuromuscular Blocking
Pharmacoeconomics
Ultimate goal is to obtain best results (low ______, rapid ______, absence of _____ and _____ at the most practical cost)
A useful method to decrease the cost of volatile anesthetics is the use of low ____ ____ flow (__/min) during ______ of anesthesia
Toxicity, Awakening, Nausea & Vomiting
Fresh Gas, 2L/min, Maintenance
Anesthetist’s Responsibilities
_____ management
____ ____ estimation
______ of fluid and blood loss
______ and _____ of the patient (Bed position, Bed height, Injuries to nerves, eyes, ears)
_______ medications
Fluid
Blood Loss
Replacement
Positioning, Safety
Intraoperative
Preparation
Mnemonic: “MS MAID”
What does this stand for?
Machine
Suction
Monitor
Airway
IV
Drugs
PACU
Post op _____ effects anesthetic choice for maintenance and emergence. Ex: A patient returning to ICU on vent - not as concerned about long acting anesthetics or NMB’s
Must know patient’s _____ and must address pain _____ immediately prior to PACU
Disposition
Vitals, Pain
Monitored Anesthesia Care (MAC)
Goal is to maintain patient ______ and sense of well being
Name three goals of MAC?
Safety
Anxiolysis (Anxiety control)
Analgesia (Pain control)
Amnesia (Induction of temporary memory loss)
MAC: Four Flaws
Failure to consider the ______
Failure to consider the _______
Failure to consider MAC skills of the _______
Failure to consider MAC skills of the ______
*Must _______ with the surgeon (Ex: If planned less invasive procedure suddenly becomes more complex and requires higher level of anesthetic)
Procedure
Patient
Surgeon
Anesthetist
Communicate
MAC
________ depression from sedative use is one of the biggest risk factors with MAC
Must have _____ monitoring on at all times during MAC case. Note, ________ is not reliable, only looking for the ________
Respiratory
ETCO2
Capnography, Waveform
MAC wth No Sedation
Very _____ ICU patient
Emergency ________ : sedation can be deadly
Eye surgery: when surgeon desires a ______, still patient
Critical
Tracheotomy
Cooperative
MAC with Minimal Sedation
______ (1 mg) and ______ (50 mcg), and sometimes even _____
Example: for a renal/cerebral or abdominal _______
______ patients
_______ patients
Versed (Midazolam), Fentanyl (Sublimaze); Less
Aortogram
Elderly
Debilitated
MAC with Deep Sedation
These patients still must be able to take _____ _____
*Never* do MAC with deep sedation on the following (4) patient types?
Deep Breaths
- Patients with GERD
- Patients with sleep apnea
- Patients with sick sinus syndrome
- Patients with mediastinal masses or tumors
