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Surgery > Lecture 2: Intraoperative procedures > Flashcards

Lecture 2: Intraoperative procedures Flashcards

1
Q

What is the universal protocol for pre-op marking?

A
  1. Verify pt name, DOB, and procedure
  2. Mark operative site and get signature
  3. Time out in OR prior to beginning procedure
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2
Q

What occurs day of surgery in Pre-op?

A
  1. Check in
  2. Holding room to chart and check
  3. Anesthesiologist confirms surgery and anesthesia type
  4. Surgeon marks surgery site via universal protocol
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3
Q

What occurs in the operating room initially?

A
  1. Apply monitors
  2. Anesthesia induction
  3. O2 mask
  4. IV Drugs
  5. Anesthetic agonist (decreases HTN response during intubation)
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4
Q

What are the anesthesia induction agents?

A
  • Propofol (diprivan) = rapid, pain at injection site
  • Ketamine = CNS effects, hallucincations
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5
Q

What is the MC muscle relaxant/neuromuscular blocker/paralytic for anesthesia?

A

Succinylcholine, except if you have malignant hyperthermia

Can cause postop myalgia

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6
Q

For children, how is anesthesia usually achieved?

A

Inhalation of isoflurane

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7
Q

What is malignant hyperthermia?

A
  • 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!

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8
Q

How is malignant hyperthermia treated?

A
  1. Dantrolene (prevent release of calcium)
  2. O2
  3. Body cooling/fluids
  4. Supportive care

If personal/FHx, flushing of anesthesia machine is done prior.

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9
Q

What 4 signs suggest malignant hyperthermia?

A
  1. Unexplained tachycardia
  2. Increased EtCO2
  3. Increased body temp
  4. Masseter rigidity
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10
Q

What two agents can someone with malignant hyperthermia not use for anesthesia?

A
  • No inhaled anesthesia gases (Fluranes)
  • No depolarizing muscle relaxants (Succ)
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11
Q

Describe the process of anesthesia induction.

A
  1. Preparation
  2. Preoxygenation 5 mins prior
  3. Pretreatment 3 mins prior
  4. Paralysis
  5. Protection 30 after
  6. Placement of ET tube 45s after
  7. Post-intubation management 60s after
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12
Q

What can be done if an airway is difficult?

A
  • Cricoid pressure
  • Fiberoptic laryngoscope
  • GlideScope
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13
Q

How is intubation placement confirmed?

A

Auscultation/condensation in tube

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14
Q

What are the 4 types of anesthesia?

A
  • Conscious sedation/MAC
  • Regional
  • General
  • Combined regional & general
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15
Q

Describe MAC/conscious sedation

A
  • 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.

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16
Q

Describe spinal/epidural anesthesia

A
  • Used for invasive surgeries of extremities
  • Done for waist/pelvic and below surgeries
  • Meds: Lidocaine/Bupivacaine
17
Q

Where is a spinal anesthetic placed?

A

L3-L4 in subarachnoid space

18
Q

Where is an epidural injected?

A

Any point in vertebral column into epidural space

19
Q

What is an LMA?

A

Laryngeal mask airway (Not intubation)

20
Q

Is hypotension MC in a spinal or epidural anesthetic injection?

A

Spinal anesthesia

21
Q

What is a shared common symptom for both spinal and epidural anesthesia?

A

Backache

22
Q

Does spinal or epidural anesthesia have less SEs?

A

Epidural

23
Q

What complication is most severe in spinal anesthesia?

A

Cauda Equina syndrome

24
Q

When is spinal anesthesia CId?

A
  • Back abnormalities
  • Infections
25
Q

What should NOT be used on distal extremities with local anesthesia?

A

Epinephrine

It can cause potent vasoconstriction

26
Q

How is a digital block given?

A

Surgery (8 decks)

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