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733 > Intraop Monitoring > Flashcards

Intraop Monitoring Flashcards

1
Q

What type of monitoring are you required to use when propofol is administered during endoscopic procedures?

A

ETCO2

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2
Q

Crisis management algorithm
COVERABCD

A

Circulation
Oxygen
Ventilation
Endotracheal Tube
Review monitors/equipment
Airway
Breathing
Circulation
Drugs

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3
Q

Late stage of hypoxia

A

Cyanosis

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4
Q

Capnometry

A

Encompasses all means of measuring carbon dioxide

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5
Q

Capnography

A

The RECORDING of the measurement

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6
Q

Capnogram

A

The continuous display of CO2 during ventilation

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7
Q

Advantages/ disadvantages of non-diverting monitoring of ETCO2

A

Minimal sampling time delays, fewer disposable items and don’t require scavenging

Only read CO2 and N2O, increase dead space, greater risk of condensation, added weight can cause disconnect

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8
Q

Diverting CO2 monitoring advantages/disadvantages

A

Monitor multiple gases, can be used to monitor awake patients, no increase in dead space

Need for scavenging

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9
Q

Point on capnogram with no CO2

A

End inspiration and very beginning of expiration- comes from anatomic dead space and contains no CO2

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10
Q

2nd phase in capnogram

A

Upstroke of expiration

Rapid passing of expired gas through upper airways

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11
Q

3rd phase capnogram

A

Plateau

Records alveoli emptying of CO2

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12
Q

Fourth phase in capnogram

A

Rapid decrease in CO2 concentration as result of inspired Air

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13
Q

Impact of a large ventilation-perfusion ratio

A

Means large amount of deadspace=low concentration of ETCO2

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14
Q

V/Q mismatch with small tidal volumes

A

Also-small tidal volumes (inadequate ventilation) may produce ETCO2 recordings that significantly underestimate arterial CO2

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15
Q

Causes of failure to return to baseline in ETCO2

A

Inadequate FGF

Depleted CO2 absorber

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16
Q

Causes of increased ETCO2

A

Increased CO2 production- MH, fever, sepsis

Hypoventilation- COPD, paralysis, CNS depression

Equipment- Absorbent, rebreathing

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17
Q

Causes of Decreased ETCO2

A

Decreased production- hypotension/volemia, hypometabolism

Hyperventilation- pain/awareness

Equipment- disconnect, esophageal intubation

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18
Q

Defining intraop hyper and hypothermia

A

Above 38 or below 36

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19
Q

Risk factors for perioperative hypothermia

A

High ASA
Lengthy surgery
eMobile’s epidural/general
Elderly
Lean body mass

FAILURE TO MONITOR TEMP

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20
Q

Locations considered core temp monitoring

A

Tympanic membrane
Distal esophagus
Nasopharynx
Pulmonary artery

Maybe bladder

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21
Q

Bladder temp monitoring

A

Reflects core temp

Invasive/UTI

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22
Q

Pulmonary artery temp monitoring

A

Reflects core temp

Invasive/PA line
Not reliable if chest is open

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23
Q

Esophageal temp monitoring

A

Most consider it core

Slight risk of trauma
Inaccurate if too close to stomach
Can’t use in awake patients

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24
Q

Nasopharynx temp monitoring

A

Probably core
Easy to insert

Trauma/bleeding
Inaccurate if breathing through nares

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25
Q

Tympanic temp monitoring

A

Most consider it core
Accurate if contact probe used
Easy

Slight trauma risk of the membrane
Ear wax pusher

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26
Q

Axillary

A

Reasonably core
Easy

Not direct core
Influenced by IV fluids
Easily dislodged

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27
Q

What does an EEG measure?

A

The brain does NOT emit electrical waves

eeg measures the differences in electrical potentials in groups of neurons between brain regions

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28
Q

Basic components of an eeg

A

Frequency- duration btwn impulses

Amplitude- mV peak to peak measurement in a vertical plane

Morphology- this seems tricky as waves can be broken down into alpha, beta, delta and theta

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29
Q

2 main reasons eeg is difficult to correlate with patient outcomes

A

Anesthetic dose related cerebral inhibition

Environmental factors-artifact (manipulation of the brain adds to interpretation complexity)

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30
Q

NIRS

A

Cerebral oximetry via Near-infrared Spectrometry

Similar to pulse ox-utilized Beer-lambert

Can be impacted by BP, paCO2, blood volume

This is meant to be used as a trend and cannot fully reflect cerebral oxygenation-so no true values for cerebral ischemia

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31
Q

Nervous system structures that protect against retraction

Elastic limit of nerves

A

Epineurium and perineurium

20%

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32
Q

Indications of cerebral ischemia in EP monitoring

A

50% decrease in amplitude

10% increase in latency

33
Q

Is the combination of IA and IV agents additive or synergistic in depressing SSEP waveforms

A

Synergistic

34
Q

Anesthetic rec for SSEP monitoring

A

Narcotic based

TIVA

<0.5 MAC

Paralytics should not affect SSEP

35
Q

Term for inequality of pupil diameter

A

Anisocoria

36
Q

Neuromonitoring that is very resistant to interference

A

BAEP

Brain stem-auditory

37
Q

BIS

A

Bispectral index
Analysis and processing of EEG signals with proprietary algorithm
Numeric between 0-100
40-60 suggests general anesthesia

38
Q

BIS less than 40 for more than 5 minutes

A

Increases postoperative mortality

39
Q

Anesthetic concentrations on evoked potentials

A

Increased latency

Decreased amplitude

40
Q

Methemoglobinemia and SaO2

A

May cause falsely low reading when SaO2 is greater than 85%

May cause falsely high reading if SaO2 is actually less than 85%

41
Q

Failure of ETCO2 to return to zero

A

Incompetent expiratory valve

(Or exhausted absorbent)

42
Q

What does NIRS monitor?

A

Largely absorption of venous hemoglobin as it does not have ability to identify pulsatilla arterial component

Saturations less than 40% or changes of 25% from baseline are problematic

43
Q

Why is temperature management becoming a quality indicator for anesthesia? (What does hypothermia cause)

A

Hypothermia- delayed drug metabolism, hyperglycemia, vasoconstriction, impaired coagulation, increased risk of surgical site infections

Hyperthermia- tachycardia, neurological injury, and vasodilation

44
Q

Only time you might not use ETCO2

A

elective C section…

45
Q

How often are you documenting HR and blood pressure?

A

Q5

46
Q

Standard VIII as it applies to ventilators

A

Audible alarm with disconnect

Low concentration alarm turned on and in use

47
Q

What does SpO2 analyze?

A

PULSATILE flow

48
Q

Pulse oximetry and wavelengths

A

660- absorbed by deoxyhemoglobin

940- absorbed by oxyhemoglobin

49
Q

Plethysmographic function of SpO2

A

Differentiates arterial vs venous flow and gives us heart rate

Variability can indicate fluid status

50
Q

Spectrophotometric function of SpO2

A

Allows us to calculate SpO2 from pulsatile flow

51
Q

ET vs FI

A

Expired vs Inspired concentration of gas…

52
Q

Is ETCO2 typically higher or lower than PaCO2

A

Usually 2-5mmHg lower

53
Q

What could cause a sudden increase in CO2

A

Administration of NaHCO3

Release of tourniquet

Increase in pulmonary blood flow

54
Q

Sudden decrease in ETCO2

A

Hypotension!

Leakage

Hyperventilation

55
Q
A

Curare cleft

Diaphragm, kicking back in

56
Q
A

Rebreathing, think absorbent

57
Q
A

Cardiac oscillations

58
Q
A

COPD
Asthma

Other obstructions

59
Q

Discuss dipole

A

Pair of charges moving together….

Positive before negative

Movement toward positive=upward deflection

60
Q

Isoelectric

A

Extinguishment of dipole, or a dipole at right angles to the positive electrode

61
Q

Pathway of cardiac conduction

A

SA

AV

Bundle of HIS

Bundle branches

Purkinje Fibers

62
Q

What leads do we commonly monitor and why?

A

II and V5

90% specific in detecting ischemia

63
Q

What does lead II give us a view of?

A

Atria

64
Q

Korotkoff sounds

A

Result from turbulent flow in an artery

65
Q

Oscillometry

A

Basis of automatic BP cuffs

66
Q

Sizing NIBP cuff

A

Bladder width 40% of extremity circumference

Bladder length encircles > or = to 80% of extremity

67
Q

False low readings of BP come from:

A

Large cuff

Positioned above heart

68
Q

False high readings of NIBP come from

A

Small cuff or loose cuff

Extrinsic compression

69
Q

2,3 DPG

A

Facilitates O2 transport via stabilization of deoxyhemoglobin, making it easier to release O2

70
Q

Bigggg reimbursement measure in PACU

A

Temp>36

71
Q

Most significant mechanism of heat loss in the OR

A

Radiation
-transfer of heat to the environment

72
Q

Best practice to prevent hypothermia

A

PRE- warming

73
Q

When should we warm the OR?

A

Probably all the time

Mainly in burn, pediatrics and elderly

74
Q

Most common misuse of BIS monitoring

A

Need a baseline before you induce anesthesia

75
Q

BIS awake

A

80-100

76
Q

BIS moderate sedation

A

60-80

77
Q

BIS general anesthesia

A

40-60

78
Q

When will depth of anesthesia monitors not work?

A

Hypothermia

Hypoglycemia

Acid/base balance abnormalities

Comorbid brain pathology

79
Q

How much CO2 do we produce

A

200ml/min

12L/hr

733 (10 decks)

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