Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

001 Respiratory Therapy > Induction > Flashcards

Induction Flashcards

1
Q

Local Anesthesia

A

A local anesthetic agent is used in order to prevent the sensation of pain

Will only prevent pain in a small area for a minor procedure to be done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What Makes a Good Local Anesthetic

A

Does not irritate the tissue

Does not cause permanent damage

Is not toxic to any tissue after it is absorbed into the blood

Has a predictable duration and action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common Local Anesthetics

A
  • Bupivacaine (Marcaine)
  • Lidocaine (Xylocaine)
    • A commonly used combination is (0.5%) Lidocaine with epinephrine (reduce bleeding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do Local Anestheic works

A

How these agents work is that they will block the transmission of nerve impulses by acting on the cell membrane

They will generate an action potential but then block any further action

Pain will not be felt during this duration of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where are local anesthetic commonly used

A

Commonly used in out-patient wards and clinics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Regional Anesthesia

A

Regional anesthesia numbs a larger (but still limited) part of the body compared to local anesthesia and does not make the person unconscious. Sometimes medicine is added to help the person relax or fall asleep

Can be a regional nerve block or a regional spinal block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is an important advantage of regional anesthetsia

A

Can be very helpful in many surgical procedures, as the patient will remain awake and can maintain their own airway and ventilation

It is important to remember when using these that they require an anti-anxiety agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Interscalene Block

A

Type of nerve block

Will numb the shoulder and parts of the upper arm

The injection may be done through ultrasound guidance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Intravenous Regional Block

A

A peripheral vein is cannulated so that an agent can be introduced

You want this area to have as little blood flow as possible which is why you want to use elevation, tourniquets, etc

Lidocaine or marcaine is then infused into the vein (area) until anesthesia is obtained.

After the procedure, blood is allowed into the area again, agent will be diluted and function will return.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Spinal Block-Definition

A

At the level of the cauda equina (L2 - S2), an agent (typically tetracaine) can be injected directly into the CSF (sub-arachnoid space) with relatively little risk.

Depending on the amount of agent infused, anesthesia can be obtained much further up the cord.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Spinal Block-Uses

A

This can be very useful for lower extremity or even abdominal organ surgery.

Procedures up to 3 hours are possible—the clinician could use lidocaine for shorter procedures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Spinal Block-Common Side Effects

A

Hypotension.

Severe headache.

Auditory and / or visual disturbances.

PDPH —post ductal puncture headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Spinal Block-Rare Side Effects

A

Cardiac arrest.

Focal neurological defects.

Hematomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Epidural Block

A

Agents are not needed to be placed directly in the CSF for action to occur.

‘Epidural’ suggests the space next to the dura but outside the actual cord

If enough agent is placed next to the dura, some will diffuse across and give the same action.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Epidural Block Uses

A

Caesarian section

Lower abdominal surgery

Procedures involving the legs etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Epidural Block Side Effects

A

Hypotension (* Systemic toxicity)

Accidental total spinal anesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Systemic Toxicity

A

Systemic toxicity is the result of too much agent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Systemic Toxicity Path

A
  1. Eupohoria
  2. Apprehension
  3. Restlessness
  4. Nausea
  5. Vomitting
  6. Tremors
  7. Convulsions
  8. Postictal (post convulsion) coma
  9. Respiratory arrest
  10. Circulatory collapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

General Anesthesia

A

General anesthesia affects the entire body and makes the person unconscious.

The unconscious person is completely unaware of what is going on and does not feel pain from the surgery or procedure.

General anesthesia medicines can be injected into a vein or inhaled.

Modern approaches to general anesthesia involve administration of a combination of medications, such as hypnotic drugs, neuromuscular blocking drugs, and analgesic drugs

If general anesthesia is chosen, the anesthesia provider must then determine a plan for airway management, induction of anesthesia, maintenance of anesthesia, and immediate postoperative care

The anesthesia provider must be prepared to convert to general anesthesia if it becomes apparent that appropriate analgesia and immobility cannot be achieved by other means

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Induction Definition

A

Induction is the phase of anesthesia and will begin with the first application of an agent, which is often IV drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When Does Induction End

A

Induction ends when surgical anesthesia is obtained

The procedure will dictate what level of anesthesia is desired.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most popular IV induction agents used

A

Propofol (Diprivian)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can the clinician decide if the cannula is in the wrong place

A

Thiopental given in a very small dose (2 mg)at this point can help the clinician decide if the cannula has gone interstitial or even possibly intra-arterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What will happen to the patient during induction

A

The patient will probably undergo profound muscle weakness / relaxation during this phase.

Proper positioning of the patient to avoid injury is mandatory.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the most reliable sign of loss of consciousness

A

The most reliable sign of loss of consciousness is loss of eyelash reflex. (Blinking at the stroking of the eyelashes.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What Do You Do after you confirm loss of consiousness

A

Anectine can be used now.

Hyper-oxygenation of the patient will allow sufficient time for intubation.

Tracheal intubation can now be preformed with little chance of laryngospasm.

Nitrous oxide and inhaled anesthetics can now be administered to maintain surgical anesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Semiconscious

A

An imprecise term for a state of drowsiness and inaction in which more than normal stimulation may be needed to evoke a response and the response will likely be delayed and incomplete.

28
Q

Unconscious

A

An imprecise term for severely impaired awareness of self and surroundings. Synonyms include comatose and unresponsive.

29
Q

Inhalation Induction

A

Induction via inhaled agent can be both rapid and pleasant for the patient.

Halothane in 0.5% increments (four to five breaths) via face mask until 3 to 4 % concentration is achieved will induce anesthesia.

Sevoflurane is also popular for inhalation induction because of its pleasant odor and low solubility. Enflurane is a potent resp depressant.

30
Q

Rapid Sequence Induction

A

This technique is useful if there is worry that the patient may aspirate gastric contents.

Obesity, pregnancy, an acute abdominal catastrophe, hiatus hernia or Class ‘E’ surgeries are all situations where aspiration must be a concern.

The presence of an assistant is mandatory during rapid sequence induction.

31
Q

RSI Procedure

A
  1. Check and Prepare Equitment
  2. Pre-oxygenate the patient with 100% O2via face mask for 3 to 5 minutes. (4 to 5 VCs minimum.)
  3. Position the patients’ head in the ‘sniffing’ (intubation) position
  4. Administer a carefully calculated dose of thiopental according to the pts size. 3 to 5 mg/Kg
  5. Immediately give the Anectine; (paralyzing dose 1 mg/Kg)
  6. Pre-curarization will reduce intra-gastric pressure and therefore reduce the chance of aspiration but it will also reduce the potency of Anectine and delay its action
  7. Reconfirm positioning of the head and intubate the trachea at the onset of paralysis
  8. Inflate the cuff of the ET Tube (and confirm position) beforereleasing pressure on the cricoid cartilage.
  9. Record the position of the ETT and secure it.
32
Q

Maintenance

A

Maintenance refers to the phase that starts with the achieving of surgical anesthesia and ends with the beginning of emergence.

The surgical procedure should logically happen during this phase.

One or more agents (usually an inhaled anesthetic) are used to maintain unconsciousness and muscle relaxation (if desired).

33
Q

Controlled Ventilation Should Be Used During Maintence When

A
  • Profound muscle relaxation is required.
  • Balanced anesthesia is being used;
    • Nitrous oxide * Volatile agents.
    • Narcotics * Muscle Relaxants.
  • There is pre-existing cardio-pulmonary disease.
  • Hyperventilation is desired.
34
Q

Emergence Phase

A

Discontinuing all anesthetic agents and the patient begins to wake up

If no paralysis or muscle relaxants where used then extubation can be allowed even when the patient is still unconscious, as long as protective reflexes have returned but do not do this is they are semi-consious

When minute ventilation is adequate and airway guarding has returned he can be extubated.

Pt should be positioned laterally to prevent aspiration

If the patient was paralyzed or has a large amount of narcotics onboard then they must be reversed

DO NOTallow a a paralyzed patient to regain consciousness. He’ll be very unhappy with you.

35
Q

Reversing Paralysis

A

To reverse paralysis you can use neostigmine, edrophonium (Tensilon)

36
Q

To Reverse Narcotics

A

To reverse narcotic use Narcan

37
Q

Emergence Complications

A

Diffusion Hypoxia; If nitrous oxide was used during the procedure and suddenly discontinued, large amounts of it will diffuse back out of all areas of compartment 3 into the alveoli.

This can dilute the oxygen in the alveoli if inspired oxygen concentration were only 21%.

Use 100% oxygen during emergence to ensure something more than 21% at all times.

38
Q

Neuroleptic Anesthesia

A

Innovar; a combination of droperidol (Inapsine ®) (tranquilizer) and Fentanyl (powerful opioid) can produce a dopy, who cares, what-ever attitude in subjects.

There is some amnesia and high analgesia along with a calm lack of movement in subjects.

Nitrous Oxide could be used as an adjunct.

Seldom used.

39
Q

Dissociative Anesthesia Definition

A

Ketamine produces a situation where the patient appears to be awake but will have no recollection of events after emergence from the drug.

40
Q

Dissociative Anesthesia is Composed Of

A

Catalepsy.

Sedation.

Amnesia.

Analgesia

41
Q

Low Flow Anesthesia

A
  • Extremely low flows can be used to maintain anesthesia in a controlled situation.
  • Oxygen flows of 500mL/min and N2O flows of 700 mL/min are enough to adequately;
    • Carry the inhaled agent (eg. Sevoflurane).
    • Supply oxygen for metabolism.
    • Provide enough flow so that CO2 being scrubbed will be replaced.
  • Economy, less pollution, quick titration to effect, little chance of negative side effects and safety can be the result.
42
Q

What are the most important factors to consider when choosing which anesthetic technique to use

A

Type of surgical procedure

Coexisting disease

Patient preference

43
Q

Continuum of Depth of Sedation

Mild Sedation

A

Anxiolysis

Response (Stimulation Type): Normal (verbal stimuli)

Ability to Maintain Airway: Not Affected

Cardiovascular Funtion: Not Affected

44
Q

Continuum of Depth of Sedation

Moderate Sedation

A

Consious Sedation

Response (Stimulation Type): Purposeful (verbal or tactile stimuli)

Ability to Maintain Airway: Airway maintained without intervention, ventilation adequate

Cardiovascular Funtion: Usually maintained

45
Q

Continuum of Depth of Sedation

General Anesthesia

A

Response (Stimulation Type): None

Ability to Maintain Airway: Airway intervention often required;ventilation frequently inadequate

Cardiovascular Funtion: May be impaired

46
Q

Continuum of Depth of Sedation

Deep Sedation

A

Response (Stimulation Type): Purposeful (repeated or painful stimulus)

Ability to Maintain Airway: Airway maintained without intervention, ventilation may be inadequate

Cardiovascular Funtion: Usually maintained

47
Q

neuraxial Anesthesia

A

spinal, epidural, caudal

48
Q

Clinical Settings Where Regional Anesthesia May Not Be Appropriate

A
  • Preference and experience of patient, anesthesia provider, and surgeon
  • The need for an immediate post-operative neurological examination in he anatomic area impacted by the regional anesthetic
  • Coagulopathy
  • Pre-existing neurological diseases
    • Ex. Multiple sclerosis, Neurofibromatosis
  • Infected or abnormal skin at the planned cutaneous puncture site
49
Q

Specific Consideration for Neuraxial Anesthesia

A

Hypovolemia increase the risk for hypotension

Coagulopathy, including anticoagulants and antiplatlets medication therapy, which will increase risk of epidural hematoma

Increase ICP which may result in cerebral herniation with intentional or inadvertent dural puncture

50
Q

Clinical Settings Appropriate for General Anesthesia

A
  • A requirement for systemic neuromuscular blockade
  • A requirement for establishment of a secure airway
    • Due to surgical procedure that may compromise native airway integrity, oxygenation, or ventilation
    • Due to the level of consciousness required to provide immobility, analgesia, or anxiolysis
  • Patient or procedural characteristics that are not appropriate for monitored anesthesia care
    • Uncooperative patient or patient refusal
    • Surgical pain not emendable to local or tropical anesthesia
  • Patent or procedural characteristic that are not suitable for regional anesthetic
  • Preference of patient, anesthesia provider, and/or surgeon
51
Q

Denitrogenation

A

Pre oxygenation is also known as denitrogenation is the deliberate replacement of nitrogen in the patient functional residual capacity (FRC) with oxygen

52
Q

Preoxygenation is done by

A

8 VC of 100% oxygen over 60 seconds OR

Vt breathing of 100% oxygen for 3 min

Both of the above will replace ~80% of FRC with oxygen

53
Q

Purpose of Pre-Oxygenation

A

The purpose of preoxygenation is to provide a margin of safety during periods of apnea or upper airway obstruction that can result from general anesthesia

It can also delay or eliminate the onset of hypoxemia during the time between intravenous induction and beginning of controlled ventilation

54
Q

What Are Some Reasons an Inhaled Induction May be Used over IV Induction

A

An inhaled induction is often for pediatric patients or patient who are thought to have a difficult airway as spontaneous respirations will be preserved with an inhaled induction

However, inhaled anesthetics ablate protective airway reflexes and pharyngeal muscular tone, so this method will not be suitable for all patients in whom difficulties with airway management are anticipated.

55
Q

What is the most common inhaled induction agent

A

Sevoflurane is the most commonly used anesthetic for inhaled induction of anesthesia because of its low pungency, high potency (permitting delivery of high-inspired oxygen concentration), and rapidity of onset.

56
Q

Priming

A

In order to speed up onset priming may be used

This approach to inhaled induction of anesthesia can produce loss of consciousness within 1 minute.

57
Q

How is Priming Done

A

Priming involves filling the breathing circuit with 8% sevoflurance through emptying the reservoir bag and opening the adjustable pressure limiting valve, and using a high fresh gas flow (e.g., 8 L/min) for 1 minute before applying the face mask to the patient

58
Q

Anectine

A

Succinylcholine Chloride

Skeletal muscle relaxant for intravenous (IV) administration indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

59
Q

Goal of RSI

A

minimize the time between onset of unconsciousness and tracheal intubation and reduce the risk of regurgitation by applying cricoid pressure

60
Q

Airway Management Techniques

A

Airway management techniques (e.g., direct laryngoscopy, supraglottic airway placement) are implemented after the intravenous or inhaled induction of anesthesia

However, if the anesthesia provider anticipates difficulty with ventilation via a mask or tracheal intubation then tracheal intubation should be initiated prior to induction of anesthesia (i.e., awake intubation)

61
Q

Nitric Oxide with General Anesthesia

A

Nitrous Oxide can provide hypnosis and anaglesia, but can not be used as the sole drug for general anesthesia as it lacks the potency of volatile inhaled anesthetics

The minimum alveolar concentration required to prevent movement to surgical stimulation is greater than the concentration that can be delivered at atmospheric pressure, so it cannot be used alone to provide reliable hypnosis

Substitution of nitrous oxide for a portion of the inhaled anesthetic dose can reduce the cardiovascular effects observed with potent inhaled anesthetics while maintaining the same anesthetic depth.

Nitrous oxide also provides analgesia and is rapidly titratable because of its low blood-gas partition coefficient.

62
Q

Post Operatively What Can Inhaled Anesthetic Increase the Risk Of

A

Inhaled anesthetics increase the risk for postoperative nausea and vomiting

Patients undergoing outpatient surgery require special attention to the prevention of postoperative and post-discharge nausea and vomiting

This may involve selection of a less emetogenic anesthetic maintenance drug (e.g., propofol) as well as administration of multiple antiemetic drugs

63
Q

Propofol For Maintenance of Anesthesia

A

Propofol can reduce incidence of posoperative nausea and vomitting as well as have more favorable emgerence (decreased coughing and laryngospasm)

64
Q

How Can the Depth of Hypnosis Be Measured

A

However, depth of hypnosis cannot be reliably measured in the absence of EEG or auditory evoked potential monitoring.

65
Q

What is the most common use of drugs for maintanance of anesthetsia

A

Potent inhaled anesthetics represent the mainstay of drugs used to maintain anesthesia in most clinical situations

They are easily titratable, reduce the autonomic response to noxious stimulation, and at clinically relevant doses can often provide sufficient muscle relaxation to facilitate surgical exposure

001 Respiratory Therapy (53 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions