Induc & Emergence

Question 1

Anesthetic plan = 8

Answer 1

Chart review. H&P. Interpret lab tests. ASA status. Anesthetic plan development: comorbidities, preop labs/dx, surgical consid

Question 2

Anesthetic plan includes details on which things: 8

Answer 2

Preop consid, monitoring, induction, a/w management, maintenance technique, fluid plan, emergence. Alternative anesthetic plan

Question 3

MSMAIDP

Answer 3

M (monitors on, alarms set), S (suction on and near), M (PPV/machine check), A (ett and lma), I (IV&fluids), D (drugs, emergency and basic), P (pt position)

Question 4

Airway set up: 11

Answer 4

Appropriate sized face mask, PPV (ambu, jet vent, vent checked), suction on and near, tongue depressor, appropriate sized oral/nasal airways, LMA, laryngoscope handle, 2 blades, 2 ETT, stylet, syringe, tape

Question 5

ETT sizes male and female

Answer 5

Male 7.5-8, female 6.5-7

Question 6

Blade sizes male and female

Answer 6

Male Mac 4 miller 3-4. Female Mac 3 miller 2

Question 7

Standard induction: positioning to pre-oxygenation

Answer 7

Pt supine and in sniffing position. Place monitors and get pre-induction vitals. Pre 02: 5 min 100% fio2 @ 6 LPM flow, 10 safe min. 4 VC breaths in 30 sec= 5 min safe time

Question 8

Induction: med considerations, sequence

Answer 8

Antianxiety meds (benzos), narcotic (sns response), lidocaine, induction agent

Question 9

What to do after induction meds given

Answer 9

Confirm LOC w eyelash reflex. Test ventilate: reposition, use oral a/w, 2 hands on mask, difficult a/w alg, plan b a/w

Question 10

Steps after induction for NMB and intubation

Answer 10

Apply PNS, check baseline twitch. Give NMB, monitor effective ness w PNS. Ventilate while NMB kicks in, tape eyes. Then attempt laryngoscopy and confirm ett placement, tape

Question 11

What to do after ETT secured

Answer 11

Ventilate w machine or by hand. Adjust flows. Add air/n20. Start propofol, add volatile anesthetic

Question 12

Effects of tracheal intubation: 5

Answer 12

Htn, tachycardia, laryngospasm, bronchospasm, MI risk

Question 13

How to prevent effects of tracheal intubation

Answer 13

Deepen plane of anesthesia, use lidocaine/narcotics/additional induction agent. Consider bronchodilator prophylactically

Question 14

Standard induction review 21

Answer 14

1. Pt supine, sniffing pos. 2. Turn on 02 flow 3. Pre-oxygenate 4. Monitors on and vs taken 5. Suction on and ready at HOB 6. Pre-induction meds 7. Lidocaine +/- induction agent 8. Lash reflex 9. Test vent 10. Check PNS 11. Ventilate by mask 12. NMB 13. Vent w mask 14. Tape eyes 15. Vent until twitches lost 16. Intubate 17. Inflate cuff 18. Confirm ett 19. Tape 20. Vent w bag/machine 21. Maintenance anesthetic

Question 15

How RSI different from standard induction

Answer 15

Add sellicks maneuver, removes ventilation

Question 16

RSI sequence 19

Answer 16

ID need for RSI 2. Pre-op aspir prophylaxis 3. Anxiolytic 4. Narcotic 5. Monitors on 6. Suction at hOB 7. Sniffing position and supine 8. Pre-o2 9. Sellicks maneuver 10. Induction agent 11. Sux or roc, wait 60 sec 12. Intubate 13. Confirm placement 14. Have assistant release cric pressure 15. Secure ett 16. Vent 17. Tape eyes 18. Adjust flows 19. Maintenance anesthetic

Question 17

Choices for maintenance anesthesia

Answer 17

IA, TIVA, short or long acting narcotic, intubating NMB or continued paralysis

Question 18

Extubation criteria 6

Answer 18

TV >6ml/kg, VC >10 ml/kg, RR <30 on own, Sao2 >90 on <60% fio2, etco2 <50, no fade on pns

Question 19

Nearly fully awake extubation

Answer 19

Muscle relaxant reversed, confirm w pns. Extubation criteria met. Anesthetic meds and volatiles off. Suction. Pt responsive. 5 sec head lift. Pt can protect own a/w. ETT removed while PPV given

Question 20

Deep extubation steps

Answer 20

NMB reversed and confirmed w pns. Suctioned. Oral or nasal a/w placed. ETT removed while PPV given. Agents and infusions off. Mask a/w while spontaneously venting. Vigilance until pt responsive.

Question 21

Laryngospasm: what it is, signs

Answer 21

Prolonged glottic closure. High pitch squeak to total silence. Supra sternal and Supra clavicular in-drawing, inc diaphragmatic excursions, flailing of lower ribs (rocking horse)

Question 22

Laryngospasm: what its caused by, when its often seen

Answer 22

Contraction of LCA, thyroarytenoids, and cricothyroid from stim of vagus. Induction and emergence

Question 23

Laryngospasm triggers: 6

Answer 23

Secretions, foreign body, pain, pelvic/abd visceral stim, stim glottis in light plane of anesthesia, reactive a/w disease

Question 24

Laryngospasm prevention 4

Answer 24

Deep plane of anesthesia reached before surgical stim, either fully awake or deep before extubation, suction oropharynx before extubation, remove ett w PP breath

Question 25

Laryngospasm tx 6

Answer 25

Remove offending stim, Larson maneuver (retro mandibular notch pressure 3-5 sec), 100% fio2 and cont pos pressure, deepen w propofol, 20-40 mg sux