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Intro to Anesthesia > Maintenance of the Anesthetized Patient > Flashcards

Maintenance of the Anesthetized Patient Flashcards

1
Q

Goals of maintenance (7)

A

maintenance of:

  1. ) anesthesia
  2. ) amnesia
  3. ) analgesia
  4. ) paralysis
  5. ) minimize negative effects of anesthetic
  6. ) fluid maintenance/ balance/ fluid resuscitation
  7. ) cardiac output and end organ perfusion
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2
Q

Why do anesthetists use monitors?

A
  1. ) detect deficit or overdose of anesthetic agents
  2. ) early detection of adverse events
  3. ) prevention of perioperative critical events
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3
Q

Respiratory parameters assessed continuously (4)

A
  1. ) airway
  2. ) respiratory rate, depth and quality
  3. ) oxygen saturation (SPO2)
  4. ) Capnography
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4
Q

Cardiovascular parameters assessed continuously (4)

A
  1. ) heart rate and rhythm
  2. ) pulse rate and strength
  3. ) mucous membrane color and capillary refill time
  4. ) arterial blood pressure
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5
Q

Other parameters assessed continuously

A
  1. ) body temperature
  2. ) anesthetic depth/pt status
  3. ) Equipment function
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6
Q

Manual monitoring techniques provide valuable information about ___ and ___.

A

depth of anesthesia; diagnosis of intraoperative complications

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7
Q

Manual monitoring techniques (3)

A
  1. ) visual inspection
  2. ) palpation
  3. ) auscultation
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8
Q

What do you watch out for during visual inspection? (6)

A
  1. ) Diaphoresis
  2. ) spontaneous movement
  3. ) respiratory rate and pattern changes esp when spontaneous
  4. ) abnormal retractions or inspiration
  5. ) cyanosis
  6. ) skin color and/or rash
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9
Q

What do you palpate for? (4)

A
  1. ) tracheal position
  2. ) subcutaneous emphysema
  3. ) pulsus paradoxus
  4. ) heart rate, rhythm
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10
Q

What do you auscultate for in respiratory system? (3)

A
  1. ) endotracheal tube placement/malposition
  2. ) wheezes/crackles
  3. ) stridor/decreased air entry
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11
Q

what do you auscultate for in cardiovascular system? (2)

A
  1. ) murmurs/bruits

2. ) changes in quality of heart sounds

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12
Q

2 ways to monitor rate and depth of respirations

A
  1. ) movement of chest

2. ) reservoir bag

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13
Q

Difficult or labored breathing may indicate the presence of what?

A

airway obstruction

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14
Q

Normal RR

A

8-12 breaths/min

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15
Q

abnormally low RR

A

<6

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16
Q

normal inspiration and expiration lasts how long?

A

1-1.5 seconds; 2-3 seconds expiration

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17
Q

How do you evaluate respiratory rate and quality of breath sounds?

A

esophageal stethoscope

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18
Q

What should you do if you see an increased ETCO2 on capnography?

A
  1. ) increase minute ventilation (RR or Vt)

2. ) check CO2 absorber

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19
Q

What should you do if you see decreased ETCO2 on capnography?

A
  1. ) sudden vs. slowly
  2. ) decrease ventilation
  3. ) verify other signs of hypoperfusion
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20
Q

measure how much carbon dioxide is present in the patients breath

A

capnography

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21
Q

respiratory alkalosis

A

<35

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22
Q

respiratory acidosis

A

> 45

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23
Q

Normal capnography

A

35-45 mmHg

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24
Q

Which gas absorbs infrared waves with wavelengths of 4.5 micrometers?

A

nitrous oxide

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25
Q

Direct reflection of capnography

A

elimination of CO2 by the lungs to the anesthesia circuit

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26
Q

Indirect reflection of capnography

A

production of CO2 by tissues and the circulatory transport of CO2 to the lungs

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27
Q

ETCO2 for a spontaneously ventilated pt

A

ETCO2 over 45 at incision

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28
Q

Respiratory function of a light patient (3)

A
  1. hyperventilation- increased RR/Vt and hypocapnia
  2. breath holding
  3. bronchospasm/laryngospasm
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29
Q

Respiratory function of a deep patient (1)

A

hypoventilation, decreased RR, Vt, and hypercapnia

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30
Q

Examples of non-invasive monitors

A
  1. ) expired agents/gases

2. ) end tidal agents/gases

31
Q

What can you do to the end tidal agent/gases if low and a patient appear light? (2)

A
  1. ) increase flow rate

2. ) increase percent of volatile agent delivered from vaporizer

32
Q

Factors that affect MAC (5)

A
  1. ) IV meds
  2. ) pre-op medications
  3. ) age
  4. ) medical conditions/patient health
  5. ) hypo/hyperthermia
33
Q

Hypoventilation

A

decrease in both rate and tidal volume, alveoli can’t inflate and atelectasis

34
Q

How should you handle an apneic pt?

A

manually ventilate throughout procedure for 8-12 bpm

35
Q

increased CO2 in the blood and metabolic acidosis causes what?

A

tachypnea and hyperventilation

36
Q

what might happen as a response to surgical stimulus? (2)

A

hyperventilation, high blood pressure

37
Q

High ventilatory pressures is an early indication of ____

A

light anesthetic

38
Q

Problems associated with high ventilatory pressure (4)

A
  1. ) ventilator
  2. ) breathing circuit
  3. ) ETT
  4. ) pulmonary, chestwall compliance
39
Q

Treatment for high ventilatory pressure (3)

A
  1. deepen anesthetic
  2. paralysis
  3. reposition/suction/change ETT
40
Q

percentage of oxygen saturated Hgb and indicates how well the lungs are delivering oxygen to the blood

A

pulse oximeter (pulseOX) SPO2

41
Q

pulse ox measures ___ and ___ continuously.

A

SPO2 and heart rate

42
Q

pulse ox of 90-95% indicates what?

A

hemoglobin is not fully saturated and a respiratory or cardio problem may be present

43
Q

when does a pt become hypoxic

A

<90%

44
Q

cyanosis may occur at what SPO2 value?

A

<85%

45
Q

How do you asses for heart rate and rhythm?

A

auscultation

46
Q

bradycardia may indicate what? (2)

A
  1. ) excessive anesthetic depth

2. ) response to vagal stimulation or other causes

47
Q

Inadequate anesthetic levels might cause?

A

tachycardia

48
Q

How should heart beat be assessed?

A

pulse rate strength and quality

49
Q

result of respiratory failure or upper airway obstruction

A

cyanosis

50
Q

time for color return to a mucous membrane after the application of gentle pressure

A

capillary refill time

51
Q

a prolonged capillary refill time >2 seconds may indicate ____ resulting from excessive anesthetic depth or circulatory shock

A

hypotension

52
Q

Factors that prolong CRT (4)

A
  1. in pts with systolic blood pressure <80 mm Hg
  2. hypothermia
  3. vasodilation
  4. cardiac failure
53
Q

Ways to monitor arterial blood pressure

A
  1. ) automated oscillometric device
  2. doppler ultrasound probe coupled with a pressure cuff
  3. ) sphygmomanometer
54
Q

When a bp cuff is too small what happens?

A

reading that’s too high and error can be as much as 50 mm hg

55
Q

minimum acceptable BP

A

80/40

56
Q

Causes of hypotension

A
  1. excessive anesthetic depth
  2. hypovolemia (due to intraoperative bleeding or pre-op dehydration)
  3. hypothermia
  4. hypoxia
57
Q

How does general anesthesia affect core body temperature?

A

Initially, rapid decrease within first 1/2 hour up to slow linear reduction in core temperature up to 2 hours after induction then usually stabilizes after 3-4 hours

58
Q

basic rule of anesthetic depth of pt

A

decrease vaporizer setting

59
Q

eyelash reflex disappear during what stage of anesthesia

A

stage 2

60
Q

eyelid reflex is lost during which plane of stage 3 anesthesia

A

plane I

61
Q

Types of reflexes (6)

A
  1. palpebral
  2. swallowing
  3. laryngeal
  4. jaw tone
  5. eye position, pupil size, pupillary light response
  6. heart and respiratory rates
62
Q

how much MAC do you give for the first several minutes after induction?

A

1.5-2 MAC

63
Q

What flow rate should you use for oxygen?

A

0.5-2 L/min

64
Q

variable derived from EKG, measures the hypnotic effect of anesthetic

A

bispectral index

65
Q

which analgesic is slower onset and longer acting and must be titrated to respiratory rate at end of case?

A

morphine/hydromorphone

66
Q

what should you do to the volatile agent if patient is too light?

A
  1. ) increase flow rates of O2/air/ N2O

2. ) increase concentration from vaporizer

67
Q

What should you do to the volatile agent if a patient is too deep?

A

1.) increase flow rates AND DECREASE vaporizer concentration

68
Q

The MAC necessary to prevent response to verbal/tactile stimulation

A

Volatile: 0.3
N20: 0.6

69
Q

The MAC necessary to blunt the autonomic response to a noxious stimulus

A

1.6 MAC

70
Q

the MAC necessary to prevent laryngeal response to endotracheal intubation

A

1.3 MAC

71
Q

what should you give if patient has decreased BP, increased HR, decreased urine output ?

A

fluids

72
Q

what iv agent is used for awake patients?

A

midazolam

73
Q

use when the patient is light and experiencing pain

A

fentanyl

74
Q

effects of propofol on the CNS (3)

A
  1. ) decreased cerebral blood flow/volume
  2. ) intracranial pressure
  3. ) intraocular pressure

Intro to Anesthesia (5 decks)

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