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Patient Monitoring/ Instrumentation Kristi > Miscellaneous Monitors > Flashcards

Miscellaneous Monitors Flashcards

1
Q

febrile temperature

A

> 38 degrees

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2
Q

hypothermia temperature

A

<36 degrees

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3
Q

room temperature

A

23 degrees

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4
Q

the recommended operating room temperature

A

between 68-75 degrees (20-24 Celsius)

  • helps to inhibit bacterial growth
  • certain patients (infants, children, burn patients) require a warmer environment for the purpose of preventing hypothermia
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5
Q

what is the best estimate of core temperature

A

Blood (from the pulmonary artery catheter)

-not practical in most cases because most patients do not have a swan Ganz catheter

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6
Q

what is the most consistently reliable estimate of core body temperature during general anesthesia

A

esophageal (distal esophagus)

-less reliable in open chest cases and in cardiac bypass

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7
Q

when is rectal temperature not reliable?

A

when the rectum is not clear

-feces can blunt temperature measurement

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8
Q

temperature monitoring site that isn’t as accurate as esophageal temperature but a good choice for open heart surgery

A

nasal

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9
Q

reliable estimate of core temperature only when urine output is not low

A

bladder

- if urine output is low, becomes less reliable

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10
Q

not accurate reflections of core body temperature

A

skin and axillary

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11
Q

list 4 etiologies of intraoperative temperature loss

A
  1. IV fluids
  2. vasodilation
  3. blood products
  4. volatile agent
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12
Q

one unit of refrigerated blood or 1 L of crystalloid solution administered at room temperature each decreases mean body temperature by _____

A

0.25 degrees Celsius

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13
Q

intraoperative temperature loss from vasodilation can be caused by?

A

spinal/epidural anesthesia

  • similar degrees of hypothermia as general anesthesia
  • redistributes heat from warm central compartments (abdomen/thorax) to cooler peripheral tissues (arms/legs)
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14
Q

these blood products are stored in cooler temperatures to preserve shelf life and should be given through a blood warmer and used with IV tubing that has a filter

A

Packed red blood cells (PRBC)
cryoprecipitate
fresh frozen plasma

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15
Q

type of blood products that are stored at room temperature and should NOT be given through a fluid warmer

A

platelets

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16
Q

how does volatile agent cause intraoperative temperature loss

A

interferes with hypothalamic thermoregulation

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17
Q

4 adverse cardiovascular effects of hypothermia

A
  1. platelet dysfunction and bleeding
  2. decreased stroke volume
  3. bradycardia/ arrhythmias
  4. increased blood viscosity
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18
Q

hypothermia causes (increased/decreased) stroke volume

A

decreased

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19
Q

hypothermia causes (tachycardia/ bradycardia)

A

bradycardia

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20
Q

hypothermia causes (increased/ decreased) blood viscosity

A

increased

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21
Q

hypothermia causes a (increase/decrease) in cerebral vascular resistance and a (increase/decrease) in cerebral blood flow

A

increase

decrease

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22
Q

in hypothermia, for every 1 degree Celsius drop in temperature, cerebral blood flow decreases ____-____%

A

5-7%

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23
Q

hypothermia causes a (increased/decreased) GFR and (impaired/increased) renal tubular function

A

decreased

impaired

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24
Q

hypothermia causes a (increase/decrease) in respiration

A

decrease

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25
Q

hypothermia causes a (left/right) shift of the HbO2 dissociation curve

A

left shift

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26
Q

hypothermia causes (increased/decreased) drug metabolism and (rapid/delayed) emergence from anesthesia

A

decreased

delayed

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27
Q

hypothermia causes (increased/decreased) wound healing

A

decreased

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28
Q

hypothermia causes (shivering/non-shivering) metabolic effect

A

shivering

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29
Q

shivering (increases/decreases) oxygen consumption by ____ fold

A

increases

5

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30
Q

in which patients is shivering particularly concerning for?

A

patients with coronary artery disease

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31
Q

list 3 circumstances that shivering is more likely with

A
  1. lower intraoperative temperature
  2. longer surgeries
  3. higher concentrations of volatile agent
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32
Q

2 treatments for shivering

A
  1. warming the patient

2. demerol 25 mg IV

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33
Q

list the 4 types of heat loss in the operating room in order from greatest to least

A
  1. radiation
  2. evaporation
  3. convection
  4. conduction
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34
Q

type of heat loss that is described as losing heat to the colder temperature of the atmosphere

A

radiation

-does not require contact

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35
Q

radiation accounts for _____% of heat loss in the operating room

A

60

36
Q

type of heat loss where the body loses heat through the loss of water

A

evaporation

-sweating, and in surgery when the body is opened up

37
Q

evaporation accounts for _____% of heat loss in the OR

A

20

38
Q

type of heat loss when air flows over exposed surfaces

A

convection

-moving air currents with operating room circulation

39
Q

convection accounts for _____% of heat loss in the OR

A

15

40
Q

type of heat loss that involves the transfer of heat between adjacent surfaces

A

conduction

-laying on a cold metal table or immersing yourself in cold water

41
Q

conduction accounts for _____% of heat loss in the OR

A

5

42
Q

2 purposes to an esophageal stethescope

A
  1. measure temperature

2. listen to heart and lung sounds

43
Q

2 reasons to use a precordial stethescope

A
  1. constant heart/lung sounds

2. popular in pediatrics

44
Q

this monitor uses EEG to monitor awareness during anesthesia

A

BIS (bispectral index monitor)

45
Q

on the BIS monitor a reading of ____ to _____ indicates sedation

A

65-85

46
Q

on the BIS monitor, a reading of ____ to ____ indicates general anesthesia

A

40-65

47
Q

on the BIS monitor, a reading of ____ indicates that the patient is too deeply anesthetized

A

<40

48
Q

what drug can actually increase the BIS number

A

ketamine

49
Q

list 3 common situations in which we would use the BIS monitor

A
  1. paralyzed patients
  2. patients undergoing TIVA who are paralyzed
    - anesthetists do not monitor “end tidal” propofol to gauge awareness like MAC values
  3. sick patients that require less anesthesia
    - may not be able to mount a sufficient sympathetic response to alert the anesthetist of light anesthesia
50
Q

the 2 exceptions when we cannot use vital signs to monitor awareness ( need to use BIS)

A
  1. when beta blockers have been given

2. when patients aren’t healthy enough to mount a normal sympathetic response

51
Q

it is (easier/harder) to prevent awareness than it is to prevent movement

A

easier

-if a patient is deep enough to not move, they should be deep enough to not have awareness

52
Q

should an anesthetist need a BIS monitor if the patient is not paralyzed?

A

no

53
Q

______ output is an indicator of adequate cardiac output and renal perfusion

A

urine

54
Q

a common goal for urine output is > _____- ____mL/kg/hr

A

0.5-1

55
Q

an ultrasound of cardiac structures with the probe resting in the esophagus posterior to the heart

A

TEE (Transesophageal Echocardiography)

56
Q

4 things a TEE can estimate

A
  1. ejection fraction
  2. cardiac output
  3. patency of heart valves (stenosis vs. regurge)
  4. pulmonary artery pressure
57
Q

the best monitor for diagnosing a venous air embolism

A

TEE

58
Q

monitors nerves that are close to the surgical site and the technician monitors waves and can alert the surgeon when the nerve is ischemic or damaged

A

evoked potentials

59
Q

what is the method of evoked potentials

A
  1. the nerve is electrically stimulated, which produces a waveform
  2. ischemic or damaged nerves produce abnormal waves
60
Q

what are the two parts with evoked potential waves the technician looks at

A
  1. amplitude
    - height of the wave
  2. latency
    - time from the onset of the wave to the peak of the response
61
Q

nerve damage and ischemia cause a (increased/decreased) amplitude and (increased/decreased) latency of the wave

A

decreased

increased

62
Q

anesthetics display the (same/different) waveform of an ischemic nerve

A

same

63
Q

3 things that can effect evoked potential readings

A
  1. ischemia
  2. lack of perfusion
  3. hypotension
64
Q

what can an anesthetist do to intervene when the wave amplitude decreases or latency increases in evoked potentials

A

increase the patient’s blood pressure

65
Q

which 2 anesthetics have the greatest effects on somatosensory evoked potentials (SSEP)

A

volatile agents and nitrous oxide

66
Q

which anesthetics result in better signal quality of evoked potential waves

A

use of intravenous agents

67
Q

which 2 anesthetics decrease amplitude and increase latency of evoked potential waves (mimic nerve damage)

A

propofol and volatile agents

68
Q

what effect does versed have on evoked potential waves

A
  1. decreases amplitude

2. does NOT change latency

69
Q

what effect does ketamine and etomidate have on evoked potential waves

A
  1. increases latency

2. INCREASE amplitude

70
Q

what effects does nitrous oxide have on evoked potential waves

A
  1. decreases amplitude

2. does NOT change latency

71
Q

what effect do opioids have on evoked potential waves

A

minimal effect

72
Q

list the 4 types of evoked potentials

A
  1. somatosensory evoked potentials (SSEP)
  2. motor evoked potentials (MEP)
  3. brainstem auditory evoked potentials (BAEPs)
  4. visual evoked potentials (VEPs)
73
Q

type of evoked potential that are used to monitor the integrity of sensory nerves

A

somatosensory evoked potentials

-peripheral nerve is stimulated which travels through the dorsal nerve roots of the spinal cord

74
Q

class of drugs that do not affect somatosensory evoked potentials and can be dosed when SSEP are used

A

muscle relaxants

75
Q

type of evoked potential that are used to monitor the integrity of a motor nerve

A

motor evoked potentials

76
Q

somatosensory evoked potentials stimulate which nerves and where do they travel?

A

-peripheral nerve is stimulated which travels through the dorsal nerve roots of the spinal cord

77
Q

motor evoked potentials stimulate which nerves and where do they travel?

A

motor nerves and they travel through the anterior and lateral pathways of the spinal cord

78
Q

motor evoked potentials are (more/less) sensitive to volatile agents than SSEPs are

A

more

79
Q

which drug class should not be administered when MEPs are used?

A

muscle relaxants

80
Q

which evoked potentials measure the integrity of the vestibulocochlear nerve (VIII) and even the brainstem

A

brainstem auditory evoked potentials

-an audible click is delivered to the tympanic membrane through earphones

81
Q

which evoked potentials are the LEAST affected by anesthetics

A

brainstem auditory evoked potentials

82
Q

which evoked potentials measure the integrity of the optic nerve and can be used during pituitary tumor resection

A

visual evoked potentials

83
Q

which evoked potentials are MOST affected by anesthetics?

A

visual evoked potentials

84
Q

anesthetic management with evoked potentials:

use _____ MAC volatile agent

A

<0.5

85
Q

anesthetic management with evoked potentials:

what are two agents we can supplement volatile agent with?

A
  1. propofol drip
    - less effect on evoked potentials when infused, great effect on evoked potentials when bolused
  2. narcotic drips
    - sufentanil, remifentanil
86
Q

anesthetic management with evoked potentials:

Keep anesthetic level as ______as possible

A

constant

87
Q

anesthetic management with evoked potentials:

avoid ______ ______ if MEPs are being used

A

muscle relaxants

Patient Monitoring/ Instrumentation Kristi (4 decks)

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