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Intraoperative Care Flashcards

1
Q

What should you be making sure prior to the procedure?

A
  • Right person
  • Right procedure
  • Right doctor
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2
Q

What happens on the day of surgery?

A
  • Check in and get vitals, change into gown, preop labs, IV started, preop meds, and H&P if needed
  • Holding room: chart check, vitals, review AM labs
  • Anesthesiologist confirms surgery and type of anesthesia
  • Surgeon marks surgery site
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3
Q

What is universal protocol?

A
  • Verification of patient name, DOB, procedure
  • Operative site marked must be signed
  • Time out in OR immediately before procedure
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4
Q

What happens once in the operating room?

A
  • Apply monitors (BP, O2 sat, EKG leads, temp strip)
  • Anesthesia induction: amnesia, analgesia, muscle relaxation, and sedation
  • O2 mask
  • IV drug administration with opioids “pretreatment” or anesthetic agonist
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5
Q

What are anesthesia induction agents?

A

Propofol and ketamine

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6
Q

What is the onset time of propofol?

A

Less than 1 minute

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7
Q

What is the side effect of propofol?

A

pain at injection site

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8
Q

What are side effects of ketamine?

A

CNS effects-hallucinations

Usually given in bigger patients with mental incapacity

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9
Q

What muscle relaxant/neuromuscular blocker is often given in surgery?

`

A

Succinylcholine

“paralysis agent”

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10
Q

When is succinylcholine contraindicated?

A

Malignant hyperthermia

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11
Q

What is a side effect of succinylcholine?

A

Myalgia

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12
Q

What anesthetic is more commonly used for children and often used to put them to sleep prior to starting IV?

A

Inhalation anesthetics (isoflurane)

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13
Q

After a patient is anesthetized, what is done?

A

ET intubation

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14
Q

If a patient has malignant hyperthermia, what should you not do?

`

A

Give inhaled anesthesia gases or depolarizing muscle relaxants

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15
Q

What is malignant hyperthermia?

A
  • Hypermetabolic response to anesthetic gases
    Characterized by:
  • hyperthermia
  • tachycardia
  • tachypnea
  • increased oxygen consumption
  • cyanosis
  • cardiac dysrhythmias
  • metabolic acidosis
  • respiratory acidosis
  • muscle rigidity
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16
Q

What is the treatment for malignant hyperthermia?

A
  • Dantrolene to stop calcium release into muscle
  • Oxygen
  • Body cooling and extra fluids
  • Supportive care
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17
Q

What are signs of malignant hyperthermia?

A
  • Unexplained tachycardia
  • Increased end-tidal CO2
  • Increase of body temperature above 38.8
  • Masseter rigidity
18
Q

What needs to be done if there is personal or family history of malignant hyperthermia?

A
  • Notify anesthesia!
  • Anesthesia machine must to flushed prior to case
19
Q

What happens during anesthesia induction?

A
  • Preparation 10 mins before
  • Preoxygenation 5 mins before intubation
  • Pretreatment 3 mins before induction
  • Paralysis with agent
  • Protection 30 seconds after induction
  • Placement of ET tube 45 seconds after induction
  • Post-intubation management 60 seconds after intubation
20
Q

What do you do if it is a difficult airway when trying to do an ET intubation?

A
  • Application of cricoid pressure
  • Fiberoptic laryngoscope
  • GlideScope
21
Q

What happens once ET tube is inserted?

A
  • Inflate bulb on tube to secure airway
  • Connect to O2
  • Confirm placement of tube by auscultation of lungs/condensation in the tube
  • Tape in place
22
Q

What are complications of endotracheal intubation?

A
  • Damage to teeth, soft tissue of mouth/pharynx, lipds
  • Tachycardia, BP irregularities
  • Laryngospasm on extubating
23
Q

What does type of anesthesia depend on?

A
  • Patients medical history
  • Surgical procedure to be performed
  • Preference of surgeon and anesthesiologist
  • Patient’s first choice

GOAL to provide safest anesthetic with best outcome possible

24
Q

What are types of anesthesia?

A
  • Conscious sedation or MAC
  • Regional
  • General
  • Combined regional and general
25
What types of anesthesia fall under regional?
Neuroaxial and peripheral nerve blocks
26
What can be used for general anesthesia?
* Inhalation (isoflurane, sevoflurane) * Total IV (ex propofol plus opioid) * Balanced- combo of inhaled and IV
27
How is MAC or conscious sedation performed? When is this often used?
* Propofol, fentanyl, versed can be used * Patient monitored without intubation * Often used with endoscopies
28
When is spinal and epidural anesthesia used? What medication is used?
* Invasive surgeries of the extremities or below the waist pelvic surgery * Common meds: lidocaine, bupivacaine
29
Where is spinal anesthesia injected?
* Lumbar level (L3-L4) * Enter subarachnoid space, inject anesthetic into CSF
30
How is epidural performed?
Anesthetic injected into epidural space at any point in vertebral column
31
How should a patient be positioned for spinal anesthesia?
Lateral decubitus or sitting, bending forward
32
What are side effects of both spinal and epidural anesthesia?
Hypotension, sedation, respiratory depression, infection (abscess)
33
What are side effects of spinal anesthesia?
* Headache * Most serious: Cauda equina syndrome
34
Between spinal and epidural anesthesia, which one is more likely to have side effects?
Spinal
35
What are contraindications to spinal anesthesia?
Back abnormalities and infections
36
What are agents for local anesthesia?
* Lidocaine * Bupivacaine
37
What should you keep in mind when performing local anesthesia?
* Skin should be cleaned and prepped first * Inject deep and superficial around surgical site * Use caution not to inject into vasculature
38
When is local anesthesia frequently used?
* Minor skin procedures * Postoperative incisional pain * Digital blocks
39
What are considerations for patient positioning during surgery?
* Proper positioning for surgical procedure * Prevent injury to patient via padding with towels or gel pads under heels, elbows, wrists, knees, neck * Avoid malpositioning of arms and legs: can result in nerve injury * Avoid leaning on patient during surgery * Cover exposed body parts not in operative field with warm blankets (may use bear hugger) * Apply ground pads to skin out of the operative field
40
How is the skin prepared for surgery?
* Sterile technique via circulating OR-RN * Cleaned with chlorhexidine, betadine, hibiclens, or alcohol * Applied with sponge or stick applicator
41
What is the proper way to gown and glove?
* Remove jewelry (rings, bracelets, dangling earrings) * Fingernails short, nail polish without chips and no acrylic * Put on protective equipment: haircover and facial hair/sideburn cover, shoe covers, mask, eyewear * Gather all supplies in OR: gown, gloves, and open with sterile technique * Scrub * Enter OR * Dry off with sterile towel * Don sterile gown and gloves
42

Surgery (7 decks)

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