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Sp: Intro to Anes > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

anesthesia

A

chemically initiating and maintaining loss of sensation in a patient while maintaining hemodynamic stability in order to allow the surgical team to complete their task

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2
Q

goals of anesthesia (5)

A

1) antinociception
2) amnesia
3) akinesia
4) hemodynamic stability
5) unconsciousness

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3
Q

antinociception

A

no pain

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4
Q

amnesia

A

no memory

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5
Q

akinesia

A

no movement

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6
Q

hemodynamic stability

A

stable BP and HR

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7
Q

unconsciousness

A

“going to sleep”

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8
Q

phases of anesthesia

A

1) preoperative
2) intraoperative
3) postoperative

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9
Q

preoperative phase definition

A

all necessary steps prior to delivery of anesthesia including

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10
Q

intraoperative phase definition

A

patient is in the operating room

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11
Q

intraoperative phase steps

A

preinduction
induction
maintenance
cessation of surgery/anesthesia

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12
Q

preoperative phase steps

A
  • testing (labs, EKG, echo, respiratory)
  • evaluation of anesthetic plan
  • patient consent
  • place lines (catheters, A lines, IV)
  • premedication (anxiolytic, analgesic, antiemetic, antibiotics)
  • workspace setup
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13
Q

intraoperative phase monitoring devices

A

pulse ox (heme-bound O2)
blood pressure
temp
EKG

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14
Q

preoxygeneation

A
  • AKA denitrogenation
  • increases patients ability to sustain apnea
  • fills reservoir of O2 in lungs allowing time to intubate w/o desaturation
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15
Q

safe apnea time period definition

A

time it takes for patient to reach 88-90% saturation

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16
Q

preoxygenation safe apnea time period

A

up to 11 min (high)
typically 9 for healthy adult

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17
Q

preoxygeneation methods

A

1) 100% O2 for 3 min
2) 8 deep breaths of 10 LPM O2 at 100%

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18
Q

Induction definition

A

delivery of drugs to patient to achieve necesssary anesthetic plan

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19
Q

3 methods of induction

A

1) IV
2) Mask
3) Ketamine dart (IM)

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20
Q

Rapid Sequence Induction

A
  • decreases time between loss of airway reflexes and intubation
  • reduces likelihood of patient aspiration
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21
Q

RSI candidates

A

Full stomach patients
- trauma
- non-NPO emergency
- pregnant
- bowel obstruction
- appendectomy
- morbidly obese
- diabetic w/gastroparesis

gastroesophageal reflux disease

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22
Q

RSI general steps

A
  • preoxygenate thoroughly
  • IA dose (propofol)
  • succinylcholine (rapid acting MR)
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23
Q

IV induction advantages

A

faster = safer (10-20s)
less prolonged excitatory phase = decreased risk of laryngospasm and aspiration

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24
Q

IV induction disadvantages

A

rapid loss of airway protective reflexes and airway patency

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25
Q

Mask induction advantages

A

no iv needed prior to anesthetic

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26
Q

Mask induction disadvantages

A

slower
prolonged stage II phase

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27
Q

Mask induction (peds dose)

A

4 LPM N2O + 2 LPM O2
sevoflurane at 8%

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28
Q

IM induction

A

“ketamine dart”
4-6mg ketamine IM
21 ga 1 1/2” needle

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29
Q

IM induction advantages

A

useful for non-compliant patient

30
Q

IM induction disadvantages

A

non-compliant patient can cause injury to themselves/others

31
Q

Basic Positions

A

supine
prone
lateral decubitus
lithotomy

32
Q

other positions

A

beach chair
trendelenburg
reverse trendelenburg
sphinx

33
Q

Patient monitoring

A

Check:
EKG/HR
BP
EtCO2
IV fluid administration
Urine output
Blood loss

34
Q

Anesthetic cessation

A

prep for PACU/ICU
Gas/TIVA OFF
Reverse MR
adequate antinociceptic

35
Q

postoperative phase

A

-patient transport to PACU or ICU
-evaluate pain management

36
Q

PACU report

A

necessary Hx
surgery
fluids (blood loss, urine, fluids given)
drugs given
other pertinent info

37
Q

general anesthesia

A

anesthetic where the anesthetis accomplished all 5 goals of anesthesia

38
Q

general anesthesia stage 1

A

analgesia/induction
- period from initial administration of induction drugs to loss of consciousness

39
Q

general anesthesia stage 2

A

excitement/delerium
- period from loss of consciousness

40
Q

GA stage 2 physical signs

A

uncontrolled movements
pupillary dilation
irregular respiration
increased HR

41
Q

GA stage 3

A

surgical anesthetic

42
Q

Plane 1

A

from return of regular respirations to cessation of REM

43
Q

Plane 2

A

from cessation of REM to paresis of intercostal muscles

44
Q

Plane 3

A

from Intercostal paresis to complete paralysis of intercostals

45
Q

Plane 4

A

from paralysis of intercostal muscles to diaphragmatic paralysisS

46
Q

GA stage 4

A

overdose

47
Q

Regional anesthesia

A

blocking pain and motor neuron firing in specific regions of the body with local anesthetic without exposing patient to risk of GA

48
Q

Neuraxial anesthesia types

A

spinal
epidural
caudal

49
Q

peripheral anesthesia

A

ultrasound guidance to identify nerves proximal to surgical site with infiltration of local anesthetic and other adjuncts to disrupt nerve transmission

50
Q

epidural space

A

potential space between ligamentum flavum and dura

51
Q

Dermatomes

A

spinal roots project to level of skin

52
Q

C3-5

A

keep diaphragm alive

53
Q

T1-4

A

cardiac accelerator fibers

54
Q

T4

A

nipple line

55
Q

T6

A

xiphoid process

56
Q

T10

A

umbilicus

57
Q

L1-5

A

bowel function

58
Q

S1-3

A

innervation to perineum

59
Q

Absolute contraindications to spinal/epidural

A
  • infection at injection site
  • lack of consent
  • severe hypovolemia
  • coagulopathy
  • increased intracranial pressure (ICP)
60
Q

Relative contraindications to spinal/epidural

A
  • sepsis
  • uncooperative patient
  • preexisting neurological deficits (MS)
  • stenotic valvular heart lesions (aortic stenosis)
  • left ventricular outflow tract obstruction
  • severe spinal deformity
61
Q

peripheral nerve blocks

A

ultrasound guided infitration of local anesthetic around a nerve in order to block transmission of sensory nerve impulses

62
Q

monitored anesthetic care (MAC)

A

pharmacologic sedation using opioids or hypnotic agent with monitoring during sedation

63
Q

MAC risk

A

respiratory depression
UA obstruction
hypoventilation
hypoxemia

64
Q

MAC failure reasons

A

patient intolerance
patient discomfort
patient complication (hemodynamic instability, hypoxemia)
procedural factors (bleeding, prolonged surgical time, procedure change)

65
Q

Ramsey Sedation Scale 1

A

anxious
agitated
restless

66
Q

RSS 2

A

cooperative
oriented
tranquil

67
Q

RSS 3

A

drowsy but respons to commands

68
Q

RSS 4

A

asleep
brisk response to stimul

69
Q

RSS 5

A

asleep
sluggish response to stimulio

70
Q

RSS 6

A

asleep
no response

Sp: Intro to Anes (12 decks)

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