Intra OP procedures

Question 1

what department keeps surgeries sterile?

Answer 1

Central sterile

super important

Question 2

who hands the equipment during surgery?

Answer 2

scrub techs

Question 3

why do we ask questions to patient over and over

Answer 3

to ensure

right person
right procedure
right doctor

Question 4

What happens at the day of surgery

Answer 4

Check in (pre-admission testing), vitals, height and weight (need to be assessed every 24 hours) H&P if necessary

Holding room after OR is ready: family not allowed her (unless child), waiting for surgeon to get there,

check chart to make sure right doctor, procedure, name, mark the patient BEFORE the OR (needs to be done by the doctor, not PA)

Then sign anesthesia consent

Then time out in OR again after giving the surgeon a knife

then VerSed to calm the patient typically IV (AFTER signing)

Question 5

Once a patient is out of the operating room, what do you do?

Answer 5

Apply monitors (BP, O2 sat, EKG leads, temp strip)

Anesthesia induction (general anesthesia - amnesia, anaglesia, muscle relaxation, and sedation)

Question 6

What are the anesthetics

Answer 6

Propofol (very rarely make it to five when counting down)
Ketamine

Question 7

SE of propofol

Answer 7

pain at injection site

Question 8

SE of ketamine

Answer 8

CNS effects such as hallucinations

Question 9

What is preferred, ketamine or propofol?

Answer 9

Propofol

Question 10

What is the muscle relaxant used?

Answer 10

Succinylcholine
CI with h/o malignant hyperthermia

Question 11

What does isoflurane do?

Answer 11

inhaled anesthetic used in children b4 the IV

then endotracheal intubation

Question 12

What is malignant hyperthermia

Answer 12

pharmacogenetic response to

hyperthermia
metabolic acidosis
stiff muscles

1st sign of malignant hyperthermia - seen by ansestehsiologist (unexplained tach, increased end-tital CO2, increase of body temp above 38.8, masseter rigidity)

no inhaled anesthesia gases
no depolarizing muscle relaxants

Question 13

treatment of malignant hyperthermia

Answer 13

crash cart of:

dantrolene
oxygen
body cooling and extra fluids
supportive care

Question 14

what is the MC anesthesia?

Answer 14

Endotracheal intubation (what we did for lab)

Question 15

What do you do if endotracheal tube is difficult?

Answer 15

Application of cricoid pressure
Fieroptic laryngoscope
GlideScope

Question 16

After tube in inserted for anesthesia, what do you do?

Answer 16

infalte bulb to secure airway
connect to O2
Confirm placement by auscultation
Tape in place

Question 17

Complication of ET tube

Answer 17

damage to teeth
tachy
laryngospams

Question 18

What does the type of anesthesia depend on?

Answer 18

PMH
Length/difficulty of procedure
preference of surgeon/anesthesiologist
patient’s choice (typically overwritten though)

Question 19

what are the different types of anestehsia

Answer 19

cnosious sedation
regional
general
combined regional and general

Question 20

What is a monitored anesthesia care or conscious sedation?

Answer 20

maintain airway but not be moving around too much

typically for endoscopies (you do not remember anything but you can follow commands)

Question 21

What is spinal/epidural procedures

Answer 21

lidocaine or bupivacaine

for LP

Question 22

where is epidural infected

Answer 22

any point in vertebral column

Question 23

What is a laryngeal mask airway?

Answer 23

LMA

for quick procedures
mask in back of throat essentially
not intubation

Question 24

What are the different positions of spinal anesthesia

Answer 24

Lateral decbitis
sitting and bending forward

Question 25

What has more SE, epidural or spinal?

Answer 25

Spinal

HA or cauda equina

Question 26

What are the agents for local anesthesia

Answer 26

lidocaine w/ or w/out Epi
EPI is NOT on distal end points like penis, nose, fingers, and toes

Question 27

when is local anesthesia done?

Answer 27

Minor skin procedures
post op pain reduction
digital blocks

Question 28

What is a digital block

Answer 28

numbing the digits with lidocaine
NOT with EPI remember?

inject once, but pull back and move to next site without completely removing the needle

Question 29

What is patient positioning during surgery

Answer 29

pads where there is pressure
support back/knees/heels
avoid brachial plexus injury
avoid leaning on the patient
cover body parts that are not on the operative fields to keep patient warm
ground pads to skin out of the operative field to ground the patient

Question 30

Where can a grounding pad not be placed?

Answer 30

Over metal, ask history

Question 31

What is the skin prep of a patient

Answer 31

Sterile gloves
Prep kits
Performed before being draped

Question 32

What solution is used for skin prep

Answer 32

Chlorhexidine
Betadine
Bibiclens
Alcohol (fire hazard)

applied with sponges or stick applicator

Question 33

What is gowning and gloving set up

Answer 33

NO jewelry
nothing on nails
PPE (OR hat, shoe covers, mask, eyewear)
ask where they keep the gown and gloves
Open with sterile technique
Scrub sink to scrub
Enter OR with arms above waste
dry with sterile towel
Don sterile gown + gloves

Question 34

How to open sterile packs

Answer 34

Open away from yourself and make sure the inside does not touch anything

Question 35

How are patients draped

Answer 35

depends on surgery
draped with sterile towels around surgical site and specialized drape placed atop the patient (based on the procedure)