HEENT part II Flashcards
moderate rxn to contrast media
- edema 2. bronchospasm 3. hypotension 4. seizure
severe reaction to contrast media
- dyspnea 2. hypotension –> cardiac arrest 3. loss of consciousness
CXR puts out __________ mREM
8
Head CT emits ________mrem
170
Abdominal CT emits __________ mrem
680
fluroscopy emits ____________ mrem
> 75,000
what should you be aware of for self and pt before doing anesthetic procedure in MRI suite
- no metal on you or patient 2. c/i for pts with implants, pacer, aneurysm clips, ocular implants 3. large tattoos with ferromagnetic ink –> burns/thermal injury 4. all monitors and anesthesia equipment must be MRI compatible
what airway device is commonly used for MRI procedures
LMA
anesthetic technique for rigid bronchoscopy
GA + ETT + NMB
anesthetic management of interventional neuroradiology procedures
- art line (freq draws) + femoral sheath 2. heparinized saline for art line 3. separate heparin gtt during procedure and 24 hours after 4. General anesthesia/MAC 5. hyperventilation 6. tight blood pressure control
what meds should anesthesia have readily available for interventional neuroradiology procedure
- neo 2. ephedrine 3. labatolol 4. metoprolol 5. hydralazine 6. esmolol 7. mannitol 8. calcium
what position will a pt be in for ERCP
prone with head turned
what meds should be readily available by anesthesia during ERCP
- glucagon 2. morphine 3. fentanyl
anesthetic technique for ERCP
MAC vs GETA
what cardiac procedures are done NORA
- cath lab - dx procedures 2. balloon angio/stenting 3. ablation 4. pacer/defib wire placement 5. valvular lesion removal 6. cardioversion for dysrhythmia 7. congenital heart defect procedures
what is the goal of ECT
promotes seizures that are at least 25 seconds long
phase 1 ECT
tonic seizure, 10-15 seconds
CV response of 1st phase ECT
acute CV response: 1. increase cerebral blood flow 2. increased ICP 3. initial brady or asystole
2nd phase ECT
clonic seizure, 30-60 seconds
CV response of ECT phase 2
- HTN 2. tachycardia
when starting ECT therapy it is usually done _________x/wk for ________ weeks
3; 12
what is ECT used for?
management of psychiatric disorders like: schizophrenia, depression, mania
Anesthesia goals with ECT
- lower seizure threshold/increase duration 2. preoxygenate 3. hyperventilate 4. prevent injury: bite gaurd 5. initiate seizure
what med is the gold standard for induction of anesthesia for ECT procedure
methohexital 1-1.5 mg/kg
what med other than methohexital can be used to induce anesthesia for ECT therapy
etomidate .15-.3 mg/kg
how do you monitor seizure with succinylcholine with ECT therapy
inflate a blood pressure cuff on the ankle, prior to giving succ (will prevent succ from entering that foot.) –> give succ –> watch seizure activity on foot with the cuff
what med can help decrease CV effects with ECT therapy
propofol
what med can be used 10 min prior to seizure induction with ECT therapy
precedex
minimum elements for providing anesthesia outpatient: CRNA checklist
- will BON allow CRNA to work with this type of physician 2. will liability insurance cover office anesthesia 3. does state have specific rules/regulations specific to office anesthesia 4. what class of pts, procedures, and anesthesia will be performed 5. are there est policies and procedures in place
minimum elements for providing anesthesia in outpatient setting: MD checklist
- does MD have liability coverage? 2. current license? 3. current DEA # 4. does MD have hospital priviledges for this procedure 5. does pt have admitting priviledges at nearby hospital?
in outpatient setting, who should be seen day before procedure instead of day of?
- ASA III/IV with severe systemic dz: CAD, CHF, valvular dz, htn, dm, Renal failure + dialysis 2. fraility 3. poor functional status
T/F: routine testing results in better outcomes for patients presenting for ambulatory surgery
FALSE
if pt develops an arrhythmia/cardiac arrest secondary to LAST, what meds should NOT be administered?
- vasopressin 2. CCB 3. BB 4. local anesthetics (lidocaine)
if pt codes secondary to LAST, epi doses should be decreased to?
< 1 mcg/kg
risk of morbidity and mortality in office based setting is ____________ greater than in ambulatory surgery center
10x
what are the 4 broad categories of injury in office based practice?
- Respiratory 2. drug related 3 .CV 4. airway
if doing outpatient cystoscopy procedure, what anesthetic technique should be used and why?
LMA + GA; bc cystoscope uses rigid scope, thus pt cannot cough or move!
if do regional block for urologic procedure, what must you ensure?
that the block is high enough
for lithotripsy, using regional block, at what vertebral level must the block be at or above
T10
considerations with outpatient ortho procedures
- extremely painful - use multimodal technique 2. regional/peripheral block can help with PONV and pain 3. short acting neuraxial blocks can delay discharge home 2ndary to delayed resolution of block 4. impt for pacu rn to be trained on managing blocks 5. instruct patient on: rest, ice, compression, and elevation to manage pain at home.
how can the 4 main causes of injury in office-based practice be prevented?
- better monitoring 2. better equipment 3. better policies/procedures 4. proper credentials of providers (ACLS/BLS) 5. emergency medications
during an electrophysiologic ablation, how are intraoperative arrhythmias terminated?
the electrophysiologist will terminate the arrhythmia, (the purpose of the electrophysiologic ablation is for an arrhythmia to ensue, so the source can be located and terminated)
how would you manage the airway for TIPS?
high risk of aspiration, so RSI would be best choice
would would you induce anesthesia for TIPS procedure?
General anesthetic induction
if patient is claustrophic or anxious going into MRI suite for procedure, you may need to administer ______________________
minimum to moderate sedation
if give minimum to moderate sedation in the MRI suite, what is required?
FULL monitoring
if a patient is recieving radiation therapy, it is important that anesthesia does what?
- ensure pt is deeply sedated 2. ensure they are immobile (NMB) 3. use agents tht give quick onset/recovery 4. anesthesia must leave the room before radiation is administered due to high doses.
during a bronchoscopy or fiberoptic endoscopy what med should you administer to dry up secretions?
glycopyrrolate
___________ surgery is performed to correct misalignment of extraocular muscles and realign the visual axis
stabismus surgery
special considerations with strabisumus surgeries
- high risk of PONV 2. potential increased risk of MH 3. frequent incidences of oculocardiac reflex
