Mod11: Anesthesia Provided at Alternate Sites

Question 1

_{Anesthesia Provided at Alternate Sites}

Alternate Sites

Answer 1

Locations remote from the OR

Located within Hospital

^{OR resources available, but not close}

^{Radiology suite, CT scan, MRI, IR}

^{Endoscopy suite}

Stand-alone facility

^{Remote from back-up a full surgical hospital}

^{Dental Clinic}

^{Doctor’s office}

Question 2

_{Anesthesia Provided at Alternate Sites}

Alternate Sites located within Hospital

Answer 2

OR resources available, but not close

Radiology suite, CT scan, MRI, IR

Endoscopy suite

Echo lab, EP suite

Question 3

_{Anesthesia Provided at Alternate Sites}

Alternate Sites that are considered Stand-alone facility

Answer 3

Remote from back-up a full surgical hospital

Dental Clinic

Doctor’s office

_{Be ready to transfer to a hospital if advanced care is needed}

Question 4

_{Anesthesia Provided at Alternate Sites}

Three-Step Paradigm for Anesthesia in general and more importantly anesthesia at Alternate Sites include:

Answer 4

1. Environment (location, resources)
2. Patient (health hx, comorbidities, etc.)
3. Procedure (is it appropriate for the pt & the location?)

Question 5

_{Anesthesia Provided at Alternate Sites}

Why is it vital to confirm presence & proper function of all anesthesia equipment & monitors the anesthesia provider would expect to have in the OR

Answer 5

Need to consider what you have there, and

what if anything additional you need to bring in yourself

Question 6

_{Anesthesia Provided at Alternate Sites}

Which agencies developed standards and guidelines that address anesthesia management in remote locations?

Answer 6

ASA

AANA

TJC (Joint Commission)

Question 7

_{Anesthesia Provided at Alternate Sites}

According to the ASA Guidelines for Remote Locations, what should you ensure is present there and in good working order?

Answer 7

Oxygen

^{1st and most important thing to have - Requires a reliable central source (pipeline, H-cylinder) & back-up supply (E-cylinder, full or near full)}

Suction

^{Adequate reliable wall suction - Portable suction acceptable}

Scavenging system

^{if volatile agents administered}

Electrical outlets

^{Enough outlets and enough power to run all the equipments - Isolated electrical power if wet procedures with GFCE sockets}

Question 8

_{Anesthesia Provided at Alternate Sites}

Which Anesthetic Equipments should you ensure are present and in good working order at an alternate site?

Answer 8

Continuous PPV source

^{Tested and in working order - Ambu-bag, nonrebreathing circuits will suffise}

Adequate Anesthetic drugs for pt population

^{Okay to “overorder” rather than to run out}

Adequate Anesthesia supplies

^{ETT - Mask - Airways - seringes - neddles - IV catheters - Etoh swabs - Etc.}

^{Get the “Out of OR cart if one is available to you}

Anesthesia machine

^{Machine must be equivalent to the one used in th OR to maintain the same standards}

^{Doing a full “Machine check” is of the utmost importance because these machines may not be used on a daily basis}

Adequate monitors

^{Adhere to ASA/AANA Standard for Basic Monitoring}

^{Must have: Pulse ox - EKG - BP - ET(as appropriate)}

^{These do not need to be connected to the Anesthesia machine - Could be stand-alone - Bust must be available as you are still kept to those standards}

Adequate illumination with battery-operated backups

—

Replacement batteries for any equipment that is battery powered

—

Sufficient space

^{Sufficient space for personel and equipements - Must be able to move aesily around the room so you can access the pt, the anesthesia machine and the monitors at all time}

Adequate support personnel

^{to support anesthesia team - very difficult at a “out of hospital site”}

Resuscitation equipment immediately available

^{Defibrillator - Emergency drugs - CPR equipment - Basic & difficult airway equipment - Supplemental O2 - Compression board - Suction equipement - Additional Emergency drugs (for MH, ACLS, etc.)}

Question 9

_{Anesthesia Provided at Alternate Sites}

Why must the Anesthesia machine used at an alternate site be equivalent to the one used in th OR?

Answer 9

To maintain the same standards of practice

Question 10

_{Anesthesia Provided at Alternate Sites}

Why is performing a full “Machine check” of the utmost importance at an alternate site?

Answer 10

Because these machines may not be used on a daily basis

May not work properly

May have missing parts

Question 11

_{Anesthesia Provided at Alternate Sites}

Which standards should you adhere to when it comes to basic monitoring at an alternate site?

Answer 11

ASA/AANA Standard for Basic Monitoring

Question 12

_{Anesthesia Provided at Alternate Sites}

According to the ASA/AANA Standard for Basic Monitoring, what are the minimum components of adequate monitoring?

Answer 12

Pulse ox - EKG - BP - ETCO2(as appropriate)

Question 13

_{Anesthesia Provided at Alternate Sites}

True or False: monitoring equipments must be connected to the anesthesia machine at the alternate site, the same way they are in the main OR.

Answer 13

False

Monitoring equipments do not need to be connected to the Anesthesia machine - Could be stand-alone

However, they must be available as you are still held to the same monitoring standards

Question 14

_{Anesthesia Provided at Alternate Sites}

Why is it important to have sufficient space for personel and equipements at an alternate site?

Answer 14

Must be able to move easily around the room so you can access the pt, the anesthesia machine and the monitors at all times

Question 15

Anesthesia Provided at Alternate Sites - ASA Guidelines for Remote Locations

Question 16

_{Anesthesia Provided at Alternate Sites}

Which Resuscitation equipment and drugs must be immediately available at an alternate site?

Answer 16

Defibrillator - Emergency drugs - CPR equipment

Basic & difficult airway equipment - Supplemental O2

Compression board - Suction equipement

Additional Emergency drugs (for MH, ACLS, etc.)

Question 17

_{Anesthesia Provided at Alternate Sites}

What are the ASA Guidelines regarding building, safety codes & facility standard for Remote Locations?

Answer 17

All building & safety codes and facility standard should be observed

Question 18

_{Anesthesia Provided at Alternate Sites}

According the ASA Guidelines for Remote Locations, what are your concerns with regard to Post anesthesia care at remote locations?

Answer 18

Adequately trained staff

Appropriate equipment to allow transport to main PACU

Question 19

_{Anesthesia Provided at Alternate Sites - Technical Equipment}

Characterics regarding equipement already present in the room and your concerns

Answer 19

Often bulky, fixed to floor where anesthesia has to work around it

Question 20

_{Anesthesia Provided at Alternate Sites - Technical Equipment}

Ionizing radiation from equipement already present at an alternate location is hazardous to the anesthesia provider only

A. True

B. False

Answer 20

A. True

B. False

Ionizing radiation is hazardous to both the patient & the anesthesia provider

_{Provider may wear a lead cover or go outside of the room while radiation are emitted, and remain available to intervene}

_{Patients may also wear lead (especially for longer scan)}

_{Be familiar with the type of procedure and the equipment used}

Question 21

_{Anesthesia Provided at Alternate Sites - Technical Equipment}

Why is it important to use “MRI safe” equipments in the MRI suite?

Answer 21

Magnetic fields creates its own environmental concerns

Question 22

_{Anesthesia Provided at Alternate Sites - Technical Equipment}

What are you concerned about if the alternate location is kept at low temperatures? How would you prevent or correct that issue?

Answer 22

Hypothermia

Will consider using an under or overbody warmer

Question 23

_{Anesthesia Provided at Alternate Sites - Technical Equipment}

How does staff exclusion from radiotherapy rooms during treatment offer protection against Ionizing radiation?

Answer 23

Radiotherapy rooms are shielded

Anesthesia will be provided and monitored remotely, often with surveillance cameras

Question 24

_{Anesthesia Provided at Alternate Sites}

AANA Standards for Office Based Anesthesia Practice

Answer 24

https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/standards-for-office-based-anesthesia-practice.pdf