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Surgery > Intraoperative Procedures > Flashcards

Intraoperative Procedures Flashcards

1
Q

who is part of the surgery team

A
  • Attendants
  • Central Sterile
  • OR Team
  • PA/NP/Assistant
  • Anesthesia
  • Surgeon
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2
Q

What happens during the Day of Surgery

A
  1. Check in - Vitals, change into gown, any preop labs, IV started, preop meds if needed, H&P if needed
  2. Holding Room - Chart check, vitals, review AM labs
  3. Anesthesiologist confirms surgery and type of anesthesia
  4. Surgeon marks surgery site - Universal Protocol
    - Verification of patient name, DOB, Procedure
    - Operative site marked (not an X), must be signed
    - Time out in OR immediately before procedure
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3
Q

Once in Operating Room, how to prepare for Anesthesia?

A

●Apply monitors (BP, O2 sat, EKG leads, temp strip)
● Anesthesia induction (General Anesthesia) - Amnesia, Analgesia, Muscle relaxation, and Sedation
● O2 mask
● IV Drug Administration
- Opioids - “Pretreatment” Agents
- Fentanyl
● Anesthetic agonist: Decreases HTN response during intubation

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4
Q

Anesthetics - “Induction” Agents

A
  1. Propofol (Diprivan)
  2. Ketamine
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5
Q

effects of propofol

A
  • Rapid Onset of Action (less than 1 minute)
  • Side Effect = Pain at injection site
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6
Q

effect of ketamine

A

CNS effects - hallucinations

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7
Q

Muscle Relaxant/Neuromuscular blocker - “Paralysis” Agents

A

Succinylcholine - M/C

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8
Q

Succinylcholine is CI in pts with a h/o?

A

Malignant Hyperthermia

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9
Q

SE of succinylcholine

A

myalgia

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10
Q

which anesthetic

which anesthetic is MC for children

A

Inhalation anesthetics (isoflurane)

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11
Q

What is Malignant Hyperthermia?

A

A pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases
tachypnea, increased oxygen consumption, cyanosis, cardiac dysrhythmias, metabolic acidosis, respiratory acidosis, muscle rigidity

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12
Q

1st sign of What is Malignant Hyperthermia will most likely noticed by ?

A

anesthesia provider

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13
Q

presentation of malignant hyperthermia

A
  • Unexplained tachycardia
  • Increased end-tidal CO2
  • Increase of body temperature above 38.8 C
  • Masseter rigidity
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14
Q

tx for maignant hyperthermia

A

1) Dantrolene – stops the release of calcium into the muscle
2) Oxygen
3) Body cooling and extra fluids
4) Supportive care

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15
Q

If personal or family hx of malignant hyperthermia, you must notify anesthesia as it requires them to do what?

A

Requires flushing of anesthesia machine prior to case

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16
Q

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
17
Q

what 3 things can help with ET intubation if it is a difficult airway?

A
  • Application of cricoid pressure
  • Fiberoptic laryngoscope
  • GlideScope
18
Q

Once Endotracheal tube is inserted, what are the next steps?

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
19
Q

complications of ET intubation

A
  • Damage to teeth, soft tissue of mouth/pharynx, lips
  • Tachycardia, BP irregularities
  • Laryngospasm on extubating
20
Q

Types of Intraoperative Anesthesia is Dependant on several factors:

A
  1. patient’s medical history,
  2. the surgical procedure that is to be performed,
  3. the preference of the surgeon and anesthesiologist, and
  4. the patient’s first choice.
21
Q

4 Types of Anesthesia

A
  1. General Anesthesia
  2. Conscious Sedation or Monitored Anesthesia Care (MAC)
  3. Regional Blocks
  4. Local anesthesia
22
Q
  • Monitored, without intubation
  • Medications Commonly Used: Propofol, Fentanyl, Versed
  • Common with Endoscopies
    which type of anesthesia
A

Monitored Anesthesia Care (MAC) or Conscious Sedation

23
Q
  • Common with invasive surgeries of the extremities, or below the waist pelvic surgery (C-section, bladder sling)
  • Common Medications - Lidocaine, Bupivacaine
    what type of anesthesia
A

Spinal and Epidural

24
Q

how to inject for Spinal anesthesia

A
  • Lumbar Level (L3-L4)
  • Enter subarachnoid space, inject anesthetic into CSF
25
Q

how to inject for epidural anesthesia

A
  • Any point in vertebral column
  • Inject anesthetic into epidural space
26
Q

Proper Positioning for spinal ansthesia

A
  • Lateral Decubitus
  • Sitting, bending forward
27
Q

SE of spinal anesthesia

A
  • HA
  • Most Serious - Cauda Equina Syndrome
  • Hypotension, Sedation, Respiratory Depression, Infection (Abscess)
28
Q

which has less potential SE, spinal or epidural anesthesia?

A

Epidural - Less potential for side effects
still has Hypotension, Sedation, Respiratory Depression, Infection (Abscess)

29
Q

CI for spinal/epidural anesthesia

A

Back abnormalities and infections

30
Q

agents for local anesthesia

A

Lidocaine (with/without Epinephrine), Bupivacaine

31
Q

Should not use Epinephrine local anesthesia on where of the body

A

distal end points
Penis, nose, fingers and toes

32
Q

how to prepare/inject for local anesthesia

A
  1. Skin cleaned and prepped first
  2. Inject Deep & Superficial around surgical site
  3. Use caution not to inject into vasculature
33
Q

local anesthesia is common for what types of procedures

A
  1. Common for minor skin procedures
  2. Commonly used to control postoperative incisional pain
  3. Digital Blocks
34
Q

How to Prevent injury to patient when positioning a pt

A

Provide padding with towels or gel pads
Heels, elbows, wrists, under knees, neck

35
Q

why avoid malpositioning of arms and legs

A

Can result in nerve injury - ie - brachial plexus or ulnar nerve injury

36
Q

how to position pt for surgery

A
  • Proper positioning for surgical procedure
  • Prevent injury to patient
  • Avoid malpositioning of arms and legs
  • During operation, avoid leaning on patient
  • Cover exposed body parts not in the operative field with warm blankets - May use bear hugger.
  • Apply ground pads to skin out of the operative field
37
Q

what preparation must be performed using sterile technique (Performed by circulating OR-RN)

A

Skin Prep

38
Q

what solutions to use for skin prep

A

Chlorhexidine
Betadine
Hibiclens
Alcohol

Multiple Application Methods: Sponges, Stick Applicator

39
Q

Proper Way to Gown and Glove

A
  1. Remove jewelry (rings, bracelets, dangling earrings)
    - Remember: Fingernails short, nail polish without chips (No acrylic)
  2. Put on protective equipment
    - Haircover and facial hair/sideburn cover
    - Shoe Covers
    - Mask
    - Eyewear
  3. Gather all supplies in OR
    - Gown, Gloves
    - Open using sterile technique
  4. Scrub
  5. Enter OR
  6. Dry off with sterile towel
  7. Don sterile gown + gloves

Surgery (7 decks)

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