Intraoperative Procedures - Exam 1 Flashcards
_____ marks the surgery site. What is the mark they leave? What is verified with the patient over and over and over?
the SURGEON
must sign it! X is NOT acceptable
patient name, DOB and procedure
What is the general flow of anesthesia induction?
Amnesia, Analgesia, Muscle relaxation, and Sedation
What is the procedure for sedating a child who currently does NOT have IV access?
If child with no IV - will “breath down” with gas then start IV
______ and _____ are used in anesthesia as induction agents
propofol and ketamine
depending on facility preference
What is the onset of action for propofol? What is the SE?
less than 1 minute, aka VERY RAPID
SE: pain at injection site
What is the SE of ketamine?
hallucinations
________ is used as a Muscle Relaxant/Neuromuscular blocker - “Paralysis” Agents in anesthesia. What is the CI? What is the SE?
Succinylcholine - M/C
Succinylcholine contraindicated with h/o Malignant Hyperthermia
Can cause p/o myalgia
______ is an inhalation anesthetics that is used more commonly for children for induction
(isoflurane)
What is malignant hyperthermia caused by?
A pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases
tachycardia, tachypnea, increased oxygen consumption, cyanosis, cardiac dysrhythmias, metabolic acidosis, respiratory acidosis, muscle rigidity
What am I?
What can these pts NOT get?
Malignant Hyperthermia?
**NO INHALED ANESTHESIA GASES
**NO DEPOLARIZING MUSCLE RELAXANTS
What is the tx for malignant hyperthermia?
Who is the OR is most likely to recognize malignant hyperthermia first? What are some signs they might find?
anesthesia provider
Unexplained tachycardia
Increased end-tidal CO2
Increase of body temperature above 38.8 C
Masseter rigidity
If a person has a personal/family hx of malignant hyperthermia, what needs to happen before the pt can have surgery?
If personal or family hx of this must Notify anesthesia
Requires flushing of anesthesia machine prior to case
_____ typically starts 5 minutes before intubation. _____ happens 30 seconds after induction. _____ happens 45 seconds after induction. _______ happens after 60 seconds of intubation
preoxygenation
protection of airway : 30 seconds
placement of ET tube: 45 seconds
post-intubation management: 60 seconds after
What are your 3 options for anesthesia induction?
Application of cricoid pressure
Fiberoptic laryngoscope
GlideScope
What is the 4 step process that you need to do once the ET is inserted?
Inflate bulb on tube to secure airway
Connect to O2
Confirm placement of tube by auscultation of lungs/condensation in the tube, End-tidal carbon dioxide (ETCO2) detector
Tape in place
What are some complications of ET intubation?
Damage to teeth, soft tissue of mouth/pharynx, lips
Tachycardia, BP irregularities
Laryngospasm on extubating
What are the 3 different types of anesthesia?
conscious sedation/ monitored anesthesia care (MAC)
regional (spinal or epidural)
general
_____ is monitored WITHOUT intubation. What 3 medications are commonly used? What setting is this commonly used in?
Monitored Anesthesia Care (MAC) or Conscious Sedation
Propofol, Fentanyl, Versed
Common with Endoscopies
_______ are common with invasive surgeries of the extremities, or below the waist pelvic surgery. What are 2 common medications?
Spinal/epidural
Lidocaine, Bupivacaine
What level is spinal anesthesia administered? injected into the ______
Lumbar Level (L3-L4)
Enter subarachnoid space, inject anesthetic into CSF
What level are epidurals injected into? What space?
any point in vertebral column
inject anesthetic into epidural space
What is this?
Laryngeal Mask Airway
for the following symptoms are they more common with spinal or epidural?
hypotension
urinary retention
HA
hypotension: common with spinal
urinary retention: common with spinal
HA: 1-5% in spinal and NEVER in epidural unless dural puncture
What is the 2 pt positioning options for spinal/epidural anesthesia?
lateral decubitus
sitting/bending forward
What are 4 SE of spinal/epidural anesthesia? What is common in spinal? What is the most serious?
Hypotension, Sedation, Respiratory Depression, Infection (Abscess)
spinal:
HA
Most Serious - Cauda Equina Syndrome
What are 2 CI to spinal/epidural anesthesia?
Back abnormalities and infections
What is the difference in term of what the pt feels between spinal anesthesia and epidural anesthesia?
spinal: the pt cannot feel ANYTHING, no sensation will be present
epidural: the pt cannot feel PAIN, but CAN still feel pressure
What are the local anesthesia medication options?
Lidocaine (with/without Epinephrine), Bupivacaine
**_______ should be avoided on any distal end points
epinephrine
Patients should be kept at a core temperature of at least _______ because anesthesia impairs ________
35.5°C (95.9 F)
thermoregulation
What are 5 possible negative things that could happen to a pt if their temp drops below 35.5?
ϲοаgսlοpаthy,
infection,
prolonged drug action,
thermal discomfort / shiveriոg
myocardial ischemia
________ is done to help manage the body temp in the OR
warming!!
can start before the pt even enters the OR
Who is responsible for fluid management in the OR?
anesthesia
Ηуроvоlеmiа results in reduced _______ and ______. Persistent hурοvοlemiа can lead to _____ and ______
cardiac output
tissue perfusion
shock
multiorgan failure
Preoperative _____ may increase the risk of significant decreases in ______ during induction of anesthesia
hуроvοlеmiа
blood pressure
What would cause hypervolemia in an OR setting?
anesthesia giving excessive fluid administration to treat hypotension during general
treatment of surgical bleeding
What are some consequences seen after the fact from hypervolemia during surgery?
Impairs oxygen exchange and increases risk for postoperative respiratory failure and pneumonia.
GI edema, decreased GI motility and possible ileus
dehiscence of anatomosis
dilutes clotting factors
increased wound healing time
What is the fluid management protocol for a minimal/moderately invasive surgery?
1 to 2 L of a balanced electrolyte solution to provide adequate intravascular hуdrаtiоn
Lactated Ringers
Use caution with known CHF or COPD
Typically administered during sսrgery over a period of 30 minutes to two hours.
What is the fluid management protocol for an invasive surgery with expected blood loss of less than 500mL? At what rate?
restrictive strategy, zero balance strategy
only the fluid that is lost during ѕurgerу is replaced
rate of approximately 3 mL/kg per hour during the intraoperative period
What is the fluid management protocol for an invasive surgery with expected blood loss of MORE than 500mL? At what rate?
goal directed therapy
continuous monitoring of hemodynamic parameters to guide fluid administration, aiming to optimize tissue perfusion by giving only the necessary amount of fluid to achieve specific physiological goals, like maintaining adequate blood pressure and cardiac output.
How do you know how much blood has been lost? What level is considered concerning?
surgical sponges/tapes
Visualization of suction canister
Pt vitals can be clue
Hgb levels
over 500mL is considered concerning
Where should the grounding pad be placed on the patient?
somewhere that is on clean exposed skin out of the operative field
aka NOT hairy and cannot be placed over anything metal inside the pt’s body
Sterile items that are below the ______, or items held below _____ are considered to be non-sterile.
waist level
waist level,
Sterile fields must always be kept ____ to be considered sterile. What should you NOT do?
in sight
NEVER turn your back on the sterile field
Once a sterile field is set up, the border of _______ of the sterile drape is considered non-sterile
one inch at the edge
What should you do if you have to cough/sneeze in the OR?
DO NOT TURN YOUR HEAD TO COUGH
need to sneeze/cough into your mask as to keep the germs contained
If needed, when is a catheter placed?
Urinary catheter (if needed) is placed after patient is asleep and prior to final positioning.
What are some patient prep solutions used in surgery? How long should you scrub?
Chlorhexidine
Betadine
Hibiclens
Alcohol
approx 3 minutes
What is the proper way to scrub/gown/glove?
How are surgical instruments cleaned and disinfected?
