Module 9 Part 4 Flashcards
Monitor core temperature with general anesthesia >___ minutes
> 30 minutes
Maintain core temp of >___C
> 36C
Hypothermia
<36C
Hyperthermia
> 38C
Normothermia
37C
What drug can inhibit the sweating response?
Atropine
The majority of heat loss in the preoperative setting occurs within the first ____ hour(s)
1 hour
Hypothermia reduces the MAC of volatile anesthetic agents by __% per degrees C
5%
Name 3 risks of hypothermia
- Increased O2 consumption through shivering
- Increased risk CV events & MI
- Increased risk sickling with sickle cell dz
- Impaired coagulation
- Increases surgical blood loss
- Decreased drug metabolism
- Reduced MAC of volatile anesthetic agents by 5% per C
- Increased wound infection and delayed healing
- Impaired immune function
- Prolonged PACU stay
What method of heat transfer accounts for the majority of heat transfer in the OR?
Radiation
2nd leading cause of heat loss?
Convection
Keep OR at least >___C
> 23C
1 unit of PRBCs or 1L of crystalloids can decrease temp by _____ degrees C
0.25C
Benchmark for adequate neuromuscular recovery is an adductor pollicis (_____ nerve) Train of Four (TOF) ratio of >_____
Ulnar nerve
>0.9
Device that uses electrical impulses transmitted from stimulator to superficial peripheral nerve by surface electrodes
peripheral nerve stimulator (PNS)
The ________ is most resistant to NMB and it recovers more _______ than peripheral muscles
Diaphragm
Quickly
Which nerve is the gold standard for PNS monitoring?
Ulnar nerve
Contraction of the _______ muscle of the ______ via stimulation of the ulnar nerve is the preferred site for determining the level of neuromuscular blockade
adductor
thumb
Out of the five clinical test types of neuromuscular function, the TOF and _______ stimulation are the most commonly used.
tetanic
When is the most useful time to use single twitch PNS monitoring?
Induction
Without a baseline for single twitch PNS measuring, if muscle movement is detected at all during stimulation, what does this simply mean?
NMB <100%
Single twitch PNS monitoring involves a single twitch at ___ to ___ hertz (Hz) for ___ to ___ milliseconds (ms)
- 1 - 1 Hz
0. 1 - 0.2 ms
The TOF test delivers four separate stimuli every ___ seconds at a frequency of __ (Hz) for __ seconds.
every 0.5 seconds
2 Hz
2 seconds
The most widely used means of stimulation is the ______
TOF
With TOF stimulation what is the term for the decrement in twitch height
Fade
Twitch suppression of 90% = TOF count of __ or less
1
TOF stimulation is most sensitive between ___% and ___% paralysis
70-100%
T1-T3 twitches are present. What is the percent NMB?
75-80% block
T1 & T2 twitches are present. What is the percent NMB?
80-85% block
Only T1 twitch is present. What is the percent NMB?
90-95% block
No twitches are present with TOF. What is the percent NMB?
100% block
What agent does not have a TOF fade?
Succinylcholine
Intraoperatively, the ideal degree of paralysis necessary for any procedure with sufficient anesthetic depth is ___% to ___%.
85-95% (1-2 twitches)
How many TOF twitches visible for ideal degree of paralysis intraop?
1-2 twitches visible
___-__________ agents have a TOF fade.
Non-depolarizing
What TOFR should be obtained before extubation?
0.9
During onset of _______ block, each of the four twitches is decreased equally in size; there is no fade
depolarizing
___-________ block → more fade = deeper block
Non-depolarizing
Depolarizing block → no fade; if fade present = _______ block
Phase 2 block
If larger doses of depolarizing agent are given, for example in techniques that require repeated bolus doses or infusions of succinylcholine, then a ________ block may develop
Phase 2
_______ blocks with depolarizing agents mimic non-depolarizing blocks
phase 2
Tetanus consists of continuous electrical stimulation for __ seconds at ___ or ___ Hz
5 seconds
50 or 100 Hz
With tetanus stimulation, if the muscle contraction produced is sustained for the entire 5 seconds of stimulation without fade, significant paralysis is ______.
unlikely
This type of stimulation test is painful and should not be repeated too often in order to avoid muscle fatigue
Tetanus stimulation
The adult brain comprises approximately __% to __% of body weight
2-3%
The adult brain requires approximately __% to __% of cardiac output
15-20%
The ______ monitoring system can monitor patient’s level of consciousness (LOC)
BIS (bispectral index)
A BIS monitor uses the analysis and processing of ____ electrical signals
EEG
What does BIS value of 0 mean?
No brain activity
What does BIS value of 100 mean?
Pt awake and alert
BIS values between ___ and ___ suggest adequate general anesthesia for surgery
40-60
______ is a controversial marker of renal function
UO
Try to keep UO >______
> 0.5mL/kg/hr
Increased response time and/or decrease in response rate to a clinical alarm as a result of too many alarms
Alarm fatigue
“_________” phenomenon is a natural behavior to disregard signals that have been false in the past
“Cry wolf”
