Intra-Operative

Question 1

Team role- Surgeon

Answer 1

o Performs procedure and heads team

Question 2

Team role- • RN First assistant

Answer 2

o Relatively new role
o Handles tissue in operative field
o Suturing
o Maintains homeostasis

Question 3

Team role- • Anesthesiologist (or anesthetist)

Answer 3

o admin of anesthetic agent
o monitor physical status
o Monitor vitals, ECG, ventilation

Question 4

Team role- Scrub role (scrub nurse or surgical technologist)

Answer 4

o Provides sterile instruments to surgeon

Question 5

Team role- • Circulating nurse

Answer 5

nurse coordinates care of patient in the OR
o	Pt positioning
o	Skin prep
o	Managing surgical specimens
o	anticipating team needs
o	documenting

Question 6

Difference between Anesthesiologist and Anesthetist

Answer 6

1) Anesthesiologist
o	physician trained in anesthesiology
o	admin of anesthetic med
o	intubation
o	does assessment of pt

2) Anesthetist
o specially trained health care professional
o can admin anesthetic meds
o Mostly RN trained in anesthesia

Question 7

Why is an E added to ASA physical classification system?

i.e ps2 E

Answer 7

An E added Like (p2E) means it is an emergency surgery

Question 8

Describe the environment of the OR room and the 3 zones

Answer 8

• Kept Cold
• Sterile (as possible)
• Environmental controls like air flow are closely monitored to reduce air born bacteria.

• 3 zones
o unrestricted- street clothes
o semi restricted- scrubs on
o restricted- fully outfitted (many cothing restrictions to maintain sterility)

Question 9

What are Adjunctive anaesthetic drugs

Answer 9

drugs used in combination with anesthetic drugs to control adverse effects of anaesthetics or to help maintain the anaesthetic state.

Question 10

Define anesthesia

Answer 10

loss of the ability to feel pain, resulting from administration of drug or other medical interventions

Question 11

What is a general anesthetic?

General anesthesia?

Answer 11

drug that induces a state of anaesthesia. Effects are global involving the whole body.

drug-induced state, CNS is altered to produce degrees of pain relief throughout the body, depression of consciousness, muscle relations, absent reflexes.

Question 12

What is Local Anaesthetic (regional)?

Answer 12

Local Anaesthetic (regional)- drugs that render a specific portion of the body insensitive to pain at the level of the peripheral nervous system, normally without affecting consciousness.

Question 13

What is malignant hyperthermia

Answer 13

major adverse reaction to general anaesthesia; genetically linked. Rapid rise in body temp, tachycardia, tachypenea, sweating.

Question 14

What s the Overton-Meyer Theory

Answer 14

the relationship between lipid solubility of a anaesthetic drug and its potency. The greater the solubility, the greater the effect.

Question 15

What is the Mechanism of Action of General Anaesthetics

Answer 15

o Anaesthetic drug cross the blood-brain barrier and concentrate in nerve cell membranes. This produces a loss of the senses; sight, touch, taste, smell, and hearing. It also produces a loss of awareness and usually the patient becomes unconscious.
o The vital organs (heart and lungs) are typically spared, because they are controlled by the medulla. The medulla is the last thing to be depressed during anaesthetic procedure. (Why anaesthetics is such a complicated profession, need to balance drugs properly?)

Question 16

General Anaesthietic are typically administered two ways:

Answer 16

o Inhaled – volatile liquids or gases vaporized in oxygen

o Injected – Parenteral/IV administered.

Question 17

What are Local Anaesthetics

Belong to two major groups of organic compounds:

Answer 17

• Also known as regional anaesthetics. They render a specific portion of the body insensitive to pain without major reduction of the CNS function and level of consciousness.
• Most commonly used when LOC, whole body relaxation, loss or responsiveness are undesirable or unnecessary (ex. Childbirth).
• Belong to two major groups of organic compounds: Esters or Amides.

Question 18

Three types of local anesthetics

Answer 18

• Topical anaesthetics – applied directly to skin and membranes. Solutions, gels, creams, powders.
• Parenteral anaesthetics – administered intravenously or by spinal injection. Depending on site, the drug may anaesthetize all or parts of the CNS and/or PNS.
• Spinal anaesthetics is considered local anaesthetics, because it does not depress the CNS to cause a loss of consciousness. (Large scale local anaesthetics).

Question 19

Mechanism of Action for Local Anaesthetics?

Answer 19

o Works by rendering a portion of the body insensitive to pain by interfering with nerve transmission in that area. Nerve conduction is blocked on in the area with the anaesthetic is applies. No loss of consciousness. Blocks conduction of impulses in all nerve fibre types (sensory, motor, and autonomic by blocking movement of ions; Na, K, Ca).
o Autonomic activity affected first, then pain. Motor function is last to be affected. When anaesthetics wear off, the recovery is in the opposite order: Motor activity returns first, then sensory functions, finally autonomic activity returns.

Question 20

Neuromuscular Blocking Drugs (NMBAs)

Answer 20

• NMBAs prevent nerve transmission in certain muscles, leading to paralysis of the muscles.
• Often used with anaesthetics for surgical procedures.
• Require mechanical ventilation because they paralyze the respiratory and skeletal muscles. Pt. is rendered unable to breath.
• Divided into depolarizing and non-depolarizing drugs

Question 21

Mechanism of action NMBA’s

Answer 21

o Non-depolarizing – prevent ACh (acetocholine) from acting at neuromuscular junctions. Classified as –short, -intermediate, -long acting.
o Depolarizing – acts similarly to ACh, but metabolizes slower. Succinylcholine is the major synthetic drug example. Thus, blocks the receptors at the endplate of muscle nerves to produce ongoing depolarization and muscle contractions. As long as sufficient succinylcholine concentration are present, muscle contraction is inhibited, and muscle paralysis results

Question 22

What is moderate sedation

Answer 22

• Also known as conscious sedation and procedural sedation. Anaesthesia that does not lead to loss of consciousness. Uses the combinations of several drugs that may be classified differently.
• The goal is to anaesthetize that allows the patient to remain conscious, respond verbally to commands, relax, and maintain an open airway.
• Mild amnesia may occur.
• Moderate sedation have a more rapid recovery time than that of general anaesthesia and a better safety profile because of lower cardiorespiratory risks.
• Children – moderate sedation can be achieved using oral syrup form with/without concurrent use of injected meds such as opiates.

Question 23

Discuss Nitrous Oxide

Answer 23

Nitrous Oxide: General anesthetic. Inhaled. (semi closed method) Induction and recovery are both rapid. Most useful in conjunction to another medication. May produce hypoxia.

Question 24

Discuss Isoflurane

Answer 24

Isoflurane: inhalation anesthetic agent. Rapid induction and recovery. Monitor respirations d/t respiratory depressant

Question 25

Discuss propofol

Answer 25

Propofol: IV anesthetic sedative. Inhibition of nerve transmission and CNS depression. Rapid onset (awake in 4-8 minutes). May cause pain when injected. Assess for decrease in CO and respirations. Hypotension, nausea, vomiting.

Question 26

Discuss Lidocaine

Answer 26

Lidocaine: Local anesthetic. Blocks the generation and conduction of action potentials in sensory nerves. Urinary retention, headaches, and hypotension d/t sympathetic block.

Question 27

Discuss Succinylcholine

Answer 27

Succinylcholine: skeletal muscle relaxant. Used in adjacent to general surgeries to assist in intubating patients. No known affect on pain threshold. Short duration and rapid onset. *requires refrigeration