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7835 Exam IV > Mod11: Anesthetic Considerations for Radiology & Radiation Therapy > Flashcards

Mod11: Anesthetic Considerations for Radiology & Radiation Therapy Flashcards

1
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why must caution be used with IV contrast agents during Radiology & Radiation Therapy procedures?

A

It’s not uncommon to see people with IV contrats allergies

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2
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is allergy to IV contrast mostly associated with older agents?

A

Older ionized contrast media were hyperosmolar and toxic

Pts who received IV contrast in the 70s or 80s and had a reaction, will have it documented in their chart as an “allergy”.

These pts may benefit from Benadryl or a steroid pretreatment

If history of Anaphylactic reaction or a more recent history of allergic raction, talk to the physician about maybe trying out something else besides IV contrast (e.g., cancelling the procedure, non using contrast at all)

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3
Q

Anesthetic Considerations for Radiology & Radiation Therapy

How do new IV contrast agents differ from the older agents?

A

Newer non-ionized contrast media have lower osmolality and improved side-effects

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4
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Predisposing factors to adverse reactions from contrast media include a history of:

A

Bronchospasm - Allergy - Cardiac disease

Hypovolemia - Hematologic disease - Renal dysfunction

Extremes of age - Anxiety

Medications (Beta-blockers, aspirin, and NSAIDs)

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5
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is a history of Bronchospasm a Predisposing factor to adverse reactions from contrast media?

A

….

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6
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is a history of Allergy a Predisposing factor to adverse reactions from contrast media?

A

…

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7
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is a history of Cardiac disease a Predisposing factor to adverse reactions from contrast media?

A

…

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8
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is a history of Hypovolemia a Predisposing factor to adverse reactions from contrast media?

A

…

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9
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is a history of Hematologic disease a Predisposing factor to adverse reactions from contrast media?

A

…

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10
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is a history of Renal dysfunction a Predisposing factor to adverse reactions from contrast media?

A

…

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11
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is Extremes of age a Predisposing factor to adverse reactions from contrast media?

A

….

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12
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is a history of Anxiety a Predisposing factor to adverse reactions from contrast media?

A

…

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13
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Why is a history of using some Medications (Beta-blockers, aspirin, and NSAIDs) a Predisposing factor to adverse reactions from contrast media?

A

…

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14
Q

Anesthetic Considerations for Radiology & Radiation Therapy

How does a mild reaction to IV contrast agents manifest?

A

Nausea - Perception of warmth - Headache

Itchy rash - Mild urticaria

Not really considered a reaction; more of a side effect from the contrast

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15
Q

Anesthetic Considerations for Radiology & Radiation Therapy

How does a Severe reaction to IV contrast agents manifest?

A

Arrhythmias - Bronchospasm - Dyspnea - Chest pain

Feeling faint - Rigors - Vomiting - renal failure

Severe urticaria

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16
Q

Anesthetic Considerations for Radiology & Radiation Therapy

How does a Life-threatening reaction to IV contrast agents manifest?

A

Arrhythmias - Cardiac arrest

Glottic edema/bronchospasm - Pulmonary edema

Seizures/unconsciousness.

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17
Q

Anesthetic Considerations for Radiology & Radiation Therapy

How are reactions to IV contrast treated?

A

O2 - Bronchodilators - Epinephrine

Corticosteroids - Antihistamines - Intubation

Circulatory support with IV fluids/pressors

Also refer to lecture on Anaphylaxis reaction

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18
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Contrast-induced nephropathy accounts for what % of hospital-acquired renal failure

A

10%

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19
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Contrast-induced nephropathy is more common in which clinical conditions?

A

Renal insufficiency

DM

NSAIDs

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20
Q

Anesthetic Considerations for Radiology & Radiation Therapy

How could the risk of Contrast-induced nephropathy be reduced in susceptible patients?

A

Adequate hydration

Monitoring U/O

Low osmolarity contrast media

Administer NaHCO3 IV infusion 1hr before contrast administration

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21
Q

Anesthetic Considerations for Radiology & Radiation Therapy

Radiation exposure is a unique hazard. What could it lead to?

A

Leukemia and fetal abnormalities

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22
Q

Anesth. Considerations for Radiology & Radiation Therapy - Radiation exposure

Why are providers required to wear dosimeters?

A

Measure amount of radition providers are exposed to

Turned back in monthly

Allows to identify locations with excessive emissions

Allows for reassignment of providers with elevated readings

23
Q

Anesth. Considerations for Radiology & Radiation Therapy - Radiation exposure

What is the maximum amount of radiation a provider should be exposed annually?

A

50 mSv or 5,000 milirams

24
Q

Anesth. Considerations for Radiology & Radiation Therapy - Radiation exposure

Which equipments should be used for the purpose of protection from ionizing radiation each time radition exposure is and anticipate?

A

Lead apron (front and back)

Protective goggles

Thyroid shield

Leaded glass screens

25
Q

Anesth. Considerations for Radiology & Radiation Therapy - Radiation exposure

Which eye condition could result from exposure to radition overtime if Protective goggles are not used?

A

Cataract

26
Q

Anesthesia for Radiology & Radiation Therapy - Angiography (Spinal/Cerebral)

What is the typical access for Angiography (Spinal/Cerebral)?

A

Femoral artery

27
Q

Anesthesia for Radiology & Radiation Therapy - Angiography (Spinal/Cerebral)

In which cases would the Femoral vein be accessed for Angiography?

A

During AVM imaging or

Dual Venous abnormalities

28
Q

Anesthesia for Radiology & Radiation Therapy - Angiography (Spinal/Cerebral)

Since Diagnostic angiography is only associated with minimal discomfort, what are anesthetic requirements?

A

Local with or w/o light sedation
by non anesthesia providers

29
Q

Anesthesia for Radiology & Radiation Therapy - Angiography (Spinal/Cerebral)

What are the anesthetic requirements for angiograpgy procedure in pts unable to tolerate procedure (neuro disorder, severe pain, lengthy procedure)?

A

Deep sedation

General anesthesia

Anesthesia provider must be present

30
Q

Anesthesia for Radiology & Radiation Therapy - Angiography (Spinal/Cerebral)

What physiological changes accompany injection of IV contrast dye?

A

Discomfort, burning, pruritus around face

(often masked by anesthesia)

Hypotension & bradycardia

(if reaction)

31
Q

Anesthesia for Radiology & Radiation Therapy - Angiography (Spinal/Cerebral)

During angiography, when pt is placed on moving gantry, and the C-arm is used to track catheter from groin into cerebral vessels, anesthesia provider should carefully monitor extensions cords/tubing to prevent dislodgement of which equipments?

A

Breathing circuits

IV tubing

Monitors

Caution injury occurring to pt from radiology equipment

32
Q

Anesthesia for Radiology & Radiation Therapy - Angiography (Spinal/Cerebral)

True or False: EKG electrodes may interfere with imaging during spinal angiography.

A

True

33
Q

Anesthesia for Radiology & Radiation Therapy

Interventional Neuroradiology is used for the the Endovascular treatment of which neurosurgical conditions?

A

Intracranial aneurysms with detachable coils

Arteriovenous malformations

34
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

What size sheath is used to gain Arterial access via the femoral artery during Interventional Neuroradiology?

A

6 - 7 French sheath

35
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

Besides Femoral artery access, what other access can be used for interventional Neuroradiology procedures?

A

Carotid or axillary artery

Possible but rare

36
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

What happens as the catheter is advanced?

A

Guide catheter is advanced through sheath

Road mapping technique employed

Boluses of IV contrast dye injected to outline vascular anatomy

Guide advancement of microcatheters for placement of embolic materials into aneurysm or feeding vessels of AVM

37
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

When and how long is anticoagualtion required with Interventional Neuroradiology procedures?

A

During & 24hrs after procedure

38
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

When Heparin is used after the procedure, what’s the protocol?

A

Heparin 3000-5000 units IV initial bolus, and

1000 units/hr to maintain ACT at 2.5 times pt’s baseline

39
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

What are advantages of Interventional Neuroradiology procedures?

A

Avoids need for surgical craniotomy

Reduces cognitive impairment and frontotemporal brain damage

Reduces the risk of spontaneous recurrent hemorrhage following subarachnoid hemorrhage

Considered upstream surgical interventions vs a downstream surgical interventions which are interventions after the event already happened

40
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

What are complications of Interventional Neuroradiology procedures?

A

Hematoma/hemorrhage form femoral artery puncture

Air embolism via femoral artery sheath

Bradycardia/transient asystole during carotid artery stent placement

Pulmonary embolism (acrylic glue used - smells like garlic)

Intracranial hemorrhage - Thromboembolic stroke

41
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

What is the most likely cause of Bradycardia/transient asystole during Interventional Neuroradiology procedures?

A

Vagal stimulation from carotid artery stent placement

42
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

What are initial resuscitation intervevention in the Acute management of neurologic complications?

(What would you do if you notice a change when the pt is under light anesthesia or when she is waking up?)

A

Communicate with radiologists

Call for assistance

Secure airway & hyperventilate with 100% O2

Determine if problem hemorrhagic or occlusive

43
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

How do you treat a Hemorrhagic complication during an Interventional Neuroradiology procedure?

A

Immediate heparin reversal

(1mg protamine for each 100U heparin given)

Low normal pressure

44
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

How do you treat a Occlusive complication during an Interventional Neuroradiology procedure?

A

Deliberate hypertension titrated to neurologic examination

Angiography, or

Physiologic imaging studies (TCD, CBF)

45
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

How much Protamine is given per units of Heparin for Immediate heparin reversal during an Interventional Neuroradiology?

A

1mg Protamine for each 100U heparin given

46
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

While waiting for definitive tx of acute complications during Interventional Neuroradiology procedure, what could be done in the interim?

A

Head up 15˚ in neutral position

Titrate ventilation to a PaCO2 of 26-28mmHg

Mannitol 0.5mg, rapid IV

Anticonvulsants

Dilantin 50mg/min (slowly)

Phenobarbital

Titrate STP infusion to EEG burst suppression

Hypothermia (allow temp to rapidly ↓ to 33-34˚C)

Consider dexamethasone 10mg

47
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

In the acute management of neurologic complications during Interventional Neuroradiology procedures and as part of further resuscitation efforts, how should the head be positionned?

A

Head up 15˚ in neutral position

48
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

In the acute management of neurologic complications during Interventional Neuroradiology procedures and as part of further resuscitation efforts,

Titrate ventilation to a PaCO2 of

A

26-28mmHg

49
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

In the acute management of neurologic complications during Interventional Neuroradiology procedures and as part of further resuscitation efforts, what dose of Mannitol would you administer?

A

0.5mg, rapid IV

50
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

In the acute management of neurologic complications during Interventional Neuroradiology procedures and as part of further resuscitation efforts, which anticonvulsants would administer?

A

Dilantin 50mg/min (slowly)

Phenobarbital

51
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

In the acute management of neurologic complications during Interventional Neuroradiology procedures and as part of further resuscitation efforts, what would you titrate STP infusion to?

A

EEG burst suppression

52
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

In the acute management of neurologic complications during Interventional Neuroradiology procedures and as part of further resuscitation efforts, what’s your Hypothermic goal and strategy?

A

Allow temp to rapidly ↓ to 33-34˚C

53
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

In the acute management of neurologic complications during Interventional Neuroradiology procedures and as part of further resuscitation efforts, which dose of dexamethasone would you administer?

A

10mg

54
Q

Anesthesia for Radiology & Radiation Therapy - Interventional Neuroradiology

In the acute management of neurologic complications during Interventional Neuroradiology procedures and as part of further resuscitation efforts, why would you administer steroids?

A

To decrease swelling

7835 Exam IV (21 decks)

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