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SRNA4TopicsAnesthesia > M&M NonCardiac Monitoring > Flashcards

M&M NonCardiac Monitoring Flashcards

1
Q

Mandatory monitor for any anesthetic, including moderate sedation, no contraindications

A

pulse oximetry

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2
Q

Where is the pulse ox sensor applied?

A

A sensor with a light source and detector is placed across the tissue, that can be transilluminated.

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3
Q

Oxygenated hgb absorbs more

A

Infrared light (940nm)

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4
Q

Deoxygenated hgb absorbs more

A

RED light (660 nm)

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5
Q

What is the basis of oximetric determinations?

A

Change in light absorption

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6
Q

How does the pulse oximetry?

A

Microprocessor analyzes the ration of red to infrared absorptions. to provide O2 saturation.

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7
Q

Pulse ox , arterial pulsations, identified by

A

Plethysmography, allows for correction for absorption by nonpulsative venous blood and tissue.

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8
Q

Clinically detectable cyanosis requires

A

5 g of desaturated hgb and corresponds to an SPO2 of less than 80%

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9
Q

Usually goes undetected by pulse ox in the absence of lung disease or low FiO2

A

Bronchial intubation

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10
Q

Methemoglobin has the

A

Same absorption coefficient at both red and infrared wavelengths.

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11
Q

Red and infrared with methemoglobin absorps in what ratio?

A

1:1

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12
Q

1:1 absorption ration seen with methemoglobin corresponds to a saturation reading of

A

85%

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13
Q

Things causes pulse ox artifact.

A

Methylene blue dye
low perfusion
malpositioned sensor
leakage of light from the light emiting diode to the sensor.

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14
Q

What is required to obtain mixed venous blood oxygen saturation

A

Pulmonary artery catheter with fiberoptic sensor to determine SvO2

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15
Q

Noninvasive brain oximetry

A

monitors regional O2 saturation of Hg in the brain.

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16
Q

In contrast to pulse ox, brain oximetry measures

A

Venous
Capillary
Arterial saturation
thereby providing oxygen saturation of all regional hemoglboin

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17
Q

What can dramatic decrease regional oxygen saturation (rSO2)

A

Cardiac arrest
Cerebral embolization
Deep hyothermia
Severe hypoxia

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18
Q

Capnographs rely on the absorpition of

A

Infrared light by CO2

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19
Q

Capnography: Nondiverting (mainstream)

A

Measure Co2 passing through an adpator placed in the breathing circuit.

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20
Q

Capnography: Diverting (aspiration)

A

Continously suction gas from the circuit into a sample cell in the monitor.

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21
Q

Capnography: Diverting (aspiration): HIGH ASPIRATION rates

A

defined as up to 250ml/min and low dead-space sampling tubing usualy increase SENSITIVITY and decrease lag time.

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22
Q

Capnography: Diverting (aspiration): Low ASPIRATION rates

A

50ml/min can underestimated ETCO2 during rapid ventilation.

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23
Q

Capnography : diverting (sidestream) units are prone to

A

Water precipitation that can cause obstruction of the sampling line and erroneous readings.

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24
Q

How is expiratory valve malfunction determined

A

Detected by the presence of CO2 in inspired gas.

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25
Q

Capnographs reliably indicate ______Intubation but do not reliably detect ______intubation

A

Esophageal intubation ; bronchial intubation

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26
Q

May indicated a circuit disconnection is

A

Sudden cessation of CO2 during expiratory phase of the capnograph

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27
Q

A marked rise in ETCo2 may be caused by

A

the increased metabolic rate associated with MH

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28
Q

The PaCo2-ETCO2 gradient is usually

A

2-5 mmHg reflects alveolar dead space (alveoli that ventilated but not perfused)

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29
Q

What are the 3 phases of capnography and what do they mean?

A

Phase I : Dead space
Phase II: Dead space and alveolar gas
Phase III: Alveolar gas plateau

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30
Q

Characteristic of capnograph with no plateau before inspiration

A

COPD , shark fin

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31
Q

COPD on the ETCO2 and arterial CO2 gradient

A

Increases the gradient

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32
Q

Any depression during phase III (plateau) indicates

A

SPONTANEOUS respiratory effort.

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33
Q

Failure of the inspired CO2 to return to zero may indicate?

A

Incompetent expiratory valve or exhausted Co2 absorbent

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34
Q

Persistence of exhaled gas during the inspiratory phase signals the presence of

A

an incompetent inspiratory valve

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35
Q

2 ways anesthetic gas are analyzed

A

Infrared absorption

Piezoelectric Analysis

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36
Q

Infrared absorption is based on this law

A

Beer-Lambert law

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37
Q

Do not absorbed infrared light must be measure by other means

A

N2 and O2

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38
Q

What does the BEER-LAMBERT law states:

A

The absorption of infrared light passing through a solvent (inspired or expired gas) is proportional to the amount of unknown gas.

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39
Q

Piezoelectric analysisi uses

A

oscillating quartz crystals one of which is covered in lipid.

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40
Q

In piezoelectric analysis, Volatile anesthetic dissolve in the

A

Lipid layer, and their concentration is determined by the change in oscillation frequency. This method cannot distinguish different anesthetic agents.

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41
Q

3 ways OXYGEN is analyzed?

A

Galvanic cell
PARAMAGNETIC ANALYSIS
Polarographic electrode

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42
Q

Galvanic cell for the analysis of oxygen explain?

A

Galvanic cell hydroxyl ions are formed at the gold cathode and react with lead anode.

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43
Q

Galvanic cell for the analysis of oxygen An

A

electrical current is produced that is proportional to the amount of oxygen being measured

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44
Q

Oxygen is a nonpolar gas that is paramagnetic and expands when placed in a magnetic field. By switching the field on and off, the volume change can be used to measure O2 content. which concept of O2 analysis?

A

PARAMAGNETIC ANALYSIS concept

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45
Q

A semipermeable membrane separates gold cathode and silver anode . A voltage is applied and OH- are formed from O2; resulting current is proportional to the amount of O2. which concept of O2 analysis?

A

Polarographic electrode concept

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46
Q

SPIROMETRY: Low and HIGH peak inspiratory pressure:

A

Indicates circuit disconnect or airway obstruction, respectively

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47
Q

SPIROMETRY: Minute ventilation

A

Obtained by measuring Vt and breathing frequency.

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48
Q

Altered by certain diseases and events such as obstruction and bronchial intubation?

A

Spirometric loops and waveforms.

49
Q

EEG is a recording of

A

Electrical potentials generated by cells in the cerebral cortex that can be used during cerebrovascular surgery to confirm adequate cerebral oxygenation.

50
Q

Waves found in resting adult with eyes closed

A

Alpha waves

51
Q

Waves found in concentrating individuals and at times under anesthesia

A

Beta waves

52
Q

Wave found in brain injury, deep sleep and anesthesia

A

Delta waves

53
Q

Found in deep sleep and anesthesia

A

Theta waves

54
Q

Frequencies of alpha and beta waves

A

8-13 Hz

55
Q

Theta waves frequency

A

4-7 Hz

56
Q

Delta waves frequency

A

0.5 - 4 Hz

57
Q

Frequencies from HIGH to low

A

Alpha
Beta
Theta
Delta

58
Q

EEG waves are characterized by their _____and are examined for ______

A

Amplitude; left - right symmetry

59
Q

Inhalational agents cause initial ______

A

beta activation , then slowing, burst suppresion, and isolectricity.

60
Q

Used to detect EEG isoelectricity during hypothermic arrest?

A

EEG.

61
Q

BIS examined what components

A

4 EEG components

62
Q

What are the 4 EEG components examined by BIS

A

Low frequency (deep anesthesia)
High Frequency (light anesthesia)
Suppressed EEG waves
Burst suppression.

63
Q

BIS values of 65-85 indicates

A

Sedation

64
Q

BIS values recommended for GA

A

40-65

65
Q

Evoked potentials (EP) assess

A

neural function

66
Q

Evoked potentials (EP) assess neural function by measuring what/

A

Elecrophysiologic responses to sensory or motor pathway stimulation.

67
Q

Commonly monitored EPs are

A

Brainstem Auditory Evoked responses (BAEPs)
SomatoSensory evoked potentials (SSEPs)
Motor Evoked potentials (MEPs)

68
Q

For SEPs electrical current is applied to a

A

Sensory or MIXED PERIPHERAL nerve by electrodes . if the intervening pathway is intact, the action potential will be transmitted to the CONTRALATERAL sensory cortex to produce an EP that is detected by scalp electrodes.

69
Q

EPs are plotted as

A

Voltage vs time

70
Q

EPs waveforms are analyzed by their

A

poststimulus latency

peak amplitude

71
Q

Indications for EP monitoring

A

procedures associated with possible neurologic injury such as spinal fusion, spinal cord tumor resection, brachial plexus, epilepsy surgery and cerebral tumor resection.

72
Q

Used to monitor cerebral cortex ischemia

A

EPs

73
Q

Motor EVOKED potentials contraindicated in

A

after seizures
skull defect
implantable devices.

74
Q

Concern with MEPs are

A

repetitive stimulation of the cortex

inducement of seizures

75
Q

Nitrous and opioid and EP

A

Caused minimal changes with EPs

76
Q

Volatile agents and EPs

A

BEST AVOIDED or used at a low dose.

77
Q

SEP identify _____________ damage but not necessarily identify __________

A

Dorsal spinal cord sensory pathway

Motor pathway damage

78
Q

From most to least sensitive

A

VEP, SSEP, BAEP (very, somewhat, barely)

79
Q

MEPs are sensitive to

A 
VA
High dose benzodiazepines
moderate hypothermia (less than 32C)
80
Q

MEP monitor the

A

Ventral spinal cord and are more sentitive to spinal cord ischemia than SSEPs.

81
Q

Cerebral oximetry uses

A

NEAR-INFRARED SPECTROSCOPY (NIRS)

82
Q

Cerebral oximetry NIRS work

A

Near infrared light is emitted by a scalp probe, which receptors positioned to detect the reflected light from intracranial structures.

83
Q

For cerebral oximetry saturation ________ on NIRS measures reflect decreased cerebral O2

A

less than 40

84
Q

For cerebral oximetry changes of _________may refelct decreased Cerebral O2

A

greater than 25%

85
Q

Jugular venous bulb saturation explain? Where should brain oxygen tension be?

A

Probe placed in IJ and directed toward the brain to determine the brain oxygen tension, which should be kept at 20 mmHg or greater.

86
Q

Interventions to improve brain tissue oxygen content include

A

Increasing fiO2, hemoglobin,
adjusting CO
Decreasing Oxygen demand

87
Q

Complications with temperature probes are caused by

A

Probe placement trauma

88
Q

Hypothermia definition

A

Less than 36C

89
Q

Risk factors for unintentional perioperative hypothermia

A

Extremes og f age
abdominal surgery
procedures of long duration
cold ambient OR temperature

90
Q

When does HYPOTHERMIA helpful?

A

Protective during time of cerebral or cardiac ischemia

91
Q

Postop HYPOTHERMIA IMPORTANT IMPLICATIONS

A

Increases O2 consumption as much as fivefold and is correlated with an increased in MI and angina

92
Q

Anesthesia induced vasodilation causes what with temperature

A

Redistribution of heart from WARM CENTRAL COMPARTMENTS to COOLER peripheral tissues.

93
Q

Anesthesia and hypothalamic function

A

GA inhibits hypothalamic function, reducing the body’s compensatory response to hypothermia.

94
Q

Solution to prevent GA hypothermia

A

Prewarming with forced-air warming blankets
Administering warm IV fluids
raising OR temperature room.

95
Q

Where should foley catheter be

A

below the bladder to min urine reflux and the risk of infection.

96
Q

Only reliable way to monitor UO

A

Catheterization

97
Q

Indications for foley catheter?

A 
CHF
Renal failure
hepatic disease
shock 
Procedures associated with large fluid shift or diuretic admnistration
98
Q

Benefit of a foley catheter as far at temp

A

ability to include a thermistor in the tip to measure bladder temperature.

99
Q

Inadequate UO is

A

Less than 0.5ml/kg/h

100
Q

Aid in differential dx of oliguria: 3 things

A

Urine electrolyte composition
osmolality
Specific gravity

101
Q

2 indications of PNS

A

monitor paralysis with admin of NMB

locate nerve to be blocked by regional anesthesia.

102
Q

Contraindications of PNS

A

Atrophied muscles caused by Hemiplegia or nerve damage may appear refractory to NMBA because of receptor proliferation, which can lead to potential overdosing of NMBA.

103
Q

PNS delivers current _______ mA

A

60-80 mA

104
Q

PNS stimulates the ulnar nerve at which muscle?

A

Adductor policis

105
Q

PNS stimulates the facial nerve at which muscle?

A

Orbicularis oculi

106
Q

Avoid what with placing electrodes?

A

Avoid direct muscle stimulation such as placing electrodes directly over the muscle

107
Q

Last muscle to recover

A

Adductor policis

108
Q

Muscles that recover before the adductor policis

A

Diaphragm, rectus abdominis, laryngeal adductors, and orbicularis oculi muscles.

109
Q

Indicators of recovery include

A

Sustained head lift (>5sec)
Generation of INSPIRATORY PRESSURE of at least -25 cm H2O
Forceful hand grasp.

110
Q

Train of four are

A

4 successive 200 microseconds stimuli in 2 s (2 Hz)

111
Q

Twitches fade progressievly as

A

relexation increases

112
Q

Sensitive indicator of NMBA relaxation:

A

Ratio of first (T1) and fourth (T4) twitches (T1/T4)

113
Q

Loss of fourth twitch represents

A

75% block

114
Q

Loss of third twitch represents

A

80% block

115
Q

Loss of second twitch represents

A

90% block

116
Q

Clinical relaxation from NMB requires

A

75-95% NMB

117
Q

Tetany applied at

A

50-100Hz

118
Q

Sensitive test of NM function: aside from TOF

A

Tetany at 50-100Hz

119
Q

With tetany , what indicates adequate, but NOT NECESSARILY complete reversal from NMB

A

Sustained contraction for 5 seconds

SRNA4TopicsAnesthesia (47 decks)

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