Lecture 2: Intraoperative procedures Flashcards
What is the universal protocol for pre-op marking?
- Verify pt name, DOB, and procedure
- Mark operative site and get signature
- Time out in OR prior to beginning procedure
What occurs day of surgery in Pre-op?
- Check in
- Holding room to chart and check
- Anesthesiologist confirms surgery and anesthesia type
- Surgeon marks surgery site via universal protocol
What occurs in the operating room initially?
- Apply monitors
- Anesthesia induction
- O2 mask
- IV Drugs
- Anesthetic agonist (decreases HTN response during intubation)
What are the anesthesia induction agents?
- Propofol (diprivan) = rapid, pain at injection site
- Ketamine = CNS effects, hallucincations
What is the MC muscle relaxant/neuromuscular blocker/paralytic for anesthesia?
Succinylcholine, except if you have malignant hyperthermia
Can cause postop myalgia
For children, how is anesthesia usually achieved?
Inhalation of isoflurane
What is malignant hyperthermia?
- Pharmacogenetic disorder of skeletal muscle, as a hypermetabolic response to anesthesia.
- Characterized by hyperthermia, tachycardia, tachypnea, increased O2 consumption, cyanosis, cardiac dysrhythmias, metabolic acidosis, respiratory acidosis, muscle rigidity
Cannot use Succ or fluranes if a patient has this response!
How is malignant hyperthermia treated?
- Dantrolene (prevent release of calcium)
- O2
- Body cooling/fluids
- Supportive care
If personal/FHx, flushing of anesthesia machine is done prior.
What 4 signs suggest malignant hyperthermia?
- Unexplained tachycardia
- Increased EtCO2
- Increased body temp
- Masseter rigidity
What two agents can someone with malignant hyperthermia not use for anesthesia?
- No inhaled anesthesia gases (Fluranes)
- No depolarizing muscle relaxants (Succ)
Describe the process of anesthesia induction.
- Preparation
- Preoxygenation 5 mins prior
- Pretreatment 3 mins prior
- Paralysis
- Protection 30 after
- Placement of ET tube 45s after
- Post-intubation management 60s after
What can be done if an airway is difficult?
- Cricoid pressure
- Fiberoptic laryngoscope
- GlideScope
How is intubation placement confirmed?
Auscultation/condensation in tube
What are the 4 types of anesthesia?
- Conscious sedation/MAC
- Regional
- General
- Combined regional & general
Describe MAC/conscious sedation
- Monitoring without intubation
- Common meds: Propofol, fentanyl, versed
- Common with endoscopies and non-surgical procedures
AKA twilight anesthesia. Person has depressed LOC, but not asleep.
Describe spinal/epidural anesthesia
- Used for invasive surgeries of extremities
- Done for waist/pelvic and below surgeries
- Meds: Lidocaine/Bupivacaine
Where is a spinal anesthetic placed?
L3-L4 in subarachnoid space
Where is an epidural injected?
Any point in vertebral column into epidural space
What is an LMA?
Laryngeal mask airway (Not intubation)
Is hypotension MC in a spinal or epidural anesthetic injection?
Spinal anesthesia
What is a shared common symptom for both spinal and epidural anesthesia?
Backache
Does spinal or epidural anesthesia have less SEs?
Epidural
What complication is most severe in spinal anesthesia?
Cauda Equina syndrome
When is spinal anesthesia CId?
- Back abnormalities
- Infections
What should NOT be used on distal extremities with local anesthesia?
Epinephrine
It can cause potent vasoconstriction
How is a digital block given?
