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Patient Monitoring/Instrumentation & SIM > Misc. Monitoring > Flashcards

Misc. Monitoring Flashcards

1
Q

Febrile temperature

A

> 38 C

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2
Q

Hypothermia

A

<36 C

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3
Q

Room temp

A

23 C

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4
Q

Recommended operating room temperature and why

A

68 to 75 F (20 to 24 C)

To inhibit bacteria growth)

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5
Q

Who may require warmer temperatures to prevent hypothermia?

A

Infants, children and burn patients

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6
Q

Temperature monitoring sites

A
  1. Blood (from a pulmonary artery catheter)
  2. Esophageal
  3. Rectal (less reliable if rectum is not clear)
  4. Nasal
  5. Bladder (less reliable if urine output is low)
  6. Skin/axillary
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7
Q

The best estimate of body temperature

A

Blood

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8
Q

The most consistently reliable measurement of body temperature

A

Esophageal

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9
Q

Etiologies of intraoperative temperature loss

A
  1. IV fluids (1 unit of blood or 1L of crystalloids can dec temp by 0.25 C)
  2. Vasodilation
  3. Blood products (except platelets)
  4. Volatile agents
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10
Q

Cardiac adverse effects of hypothermia

A
  1. Platelet dysfunction and bleeding
  2. Decreased stroke volumes
  3. Bradycardia and/or arrhythmias
  4. Increased blood viscosity
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11
Q

Neuro adverse effects of hypothermia

A
  1. Increased cerebral vascular resistance and decreased cerebral blood flow
    - for every 1 C drop in temperature, cerebral blood flow decreases 5-7%
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12
Q

Renal adverse effects of hypothermia

A
  1. Decreased GFR and impaired tubular function
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13
Q

Respiratory adverse effects of hypothermia

A
  1. Respiratory depression

2. L shift of HbO2 dissociation curve

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14
Q

Metabolic adverse effects of hypothermia

A
  1. Decreased drug metabolism and delayed emergence from anesthesia
  2. Decreased wound healing
  3. Shivering
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15
Q

Shivering is more likely with:

A
  1. Lower intraoperative temperature
  2. longer surgeries
  3. higher concentrations of volatile agents
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16
Q

Why is shivering concerning?

A

It increases O2 consumption 5 fold, which is concerning for patients with CAD

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17
Q

Treatments for shivering

A
  1. Warm the patient

2. Demerol (25mg IV)

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18
Q

Types of heat loss in OR in order from most to least

A
  1. Radiation (60%)
  2. Evaporation (20%)
  3. Convection (15%)
  4. Conduction (5%)
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19
Q

Purpose of esophageal stethoscope

A
  1. Measure temperature

2. Listen to heart and lung sounds

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20
Q

Purpose of precordial stethoscope

A
  1. Valuable in transport
  2. Constant heart/lung sounds
  3. Popular in pediatrics
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21
Q

BIS reading for sedation

A

65-85

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22
Q

BIS reading for general anesthesia

A

40-65

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23
Q

BIS reading for too deep anesthesia

24
Q

Ketamine (increases/decreases) BIS number

25
Q

Common situations for the BIS monitor

A
  1. Paralyzed patients
  2. Patients undergoing TIVA who are paralyzed
  3. Sick patients that require less anesthesia
26
Q

When can you not monitor vital signs for awareness?

A
  1. When B blockers are given

2. When patients cannot mount a normal sympathetic response

27
Q

Indicator of adequate cardiac output and renal perfusion

A

Urine output

28
Q

Common goal for urine output

A

> 0.5 -1 ml/kg/hr

29
Q

Ultrasound of cardiac structures, with the probe resting in the esophagus posterior to the heart

A

Transesophageal Echocardiography (TEE)

30
Q

What can the TEE estimate?

A
  1. Ejection fraction
  2. Cardiac output
  3. Patency of heart valves (stenosis vs regurg)
  4. Pulmonary artery pressure
  5. The BEST monitor for diagnosing venous air embolism (VAE)
31
Q

Purpose of evoked potentials

A

To monitor nerves that are close to the surgical site

32
Q

Method of evoked potentials

A
  1. The nerve is electrically stimulated, which produces a waveform
  2. Ischemic or damaged nerves produce abnormal waves
33
Q

Amplitude of evoked potentials

A

Height of the wave

34
Q

Latency of evoked potentials

A

Time from the onset of the wave to the peak of the response

35
Q

Effects of nerve damage and ischemia on evoked potentials

A

Decreased amplitude and increased latency

36
Q

True/false: anesthetics increase amplitude and latency

A

False. Anesthetics DECREASE amplitude and increase latency

37
Q

How can an anesthetist intervene if the evoked potential amplitude decreases and/or latency increases intraoperatively?

A

By increasing the patient’s blood pressure

38
Q

Effects of propofol and volatile agents on evoked potentials

A

Decrease amplitude and increase latency

39
Q

Volatile agents and nitrous oxide have the greatest effects on __evoked potentials

40
Q

Effects of versed on evoked potentials

A

Decrease amplitude

No effect on latency

41
Q

Effects of ketamine and etomidate on evoked potentials

A

Increases latency

Increases amplitude

42
Q

Effects of nitrous oxide on evoked potentials

A

Decreases amplitude

No change on latency

43
Q

Effects of opioids on evoked potentials

A

Minimal effect on evoked potentials

44
Q

Types of evoked potentials

A
  1. Somatosensory evoked potentials (SSEPs)
  2. Motor evoked potentials (MEPs)
  3. Brainstem auditory evoked potentials (BAEPs)
  4. Visual evoked potentials (VEPs)
45
Q

What is purpose of SSEPs?

A

To monitor the integrity of sensory nerves (dorsal nerve roots)

46
Q

True/false: muscle relaxants do not affect the sensory pathways for SSEPs

47
Q

Method of motor evoked potentials

A

Similar to SSEPs, but through the motor nerves instead

Anterior and lateral pathways of the spinal cord

48
Q

True/false. SSEPs are more sensitive to volatile agents than MEPs

A

False, MEPs are more sensitive to volatile agents

49
Q

True/false. Muscle relaxants should not be administered when MEPs are used

50
Q

What does BAEPs measure?

A

The integrity of the vestibulocochlear nerve (VIII) and the brainstem

51
Q

Which potentials are least affected by anesthetics?

52
Q

Which potentials are most affected by anesthetics?

53
Q

What do VEPs measure?

A

The integrity of the optic nerve, can be used for pituitary tumor resection

54
Q

Anesthetic management with evoked potentials

A
  1. <0.5 MAC volatile agent or use propofol drip or narcotic drip
  2. Keep anesthetic level as constant as possible
  3. Avoid muscle relaxants if MEPs are being used
55
Q

When does propofol have less of an effect on evoked potentials?

A

Infusions have less of an effect than boluses

Patient Monitoring/Instrumentation & SIM (12 decks)

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