Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

anesthesiology > Monitoring during anesthesia (Tenenbaum) > Flashcards

Monitoring during anesthesia (Tenenbaum) Flashcards

1
Q

Most important thing about monitoring before procedure

A
  • physical exam
    • heart
    • lungs
    • pulses
  • Know normals for that patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is monitored?

A
  • CNS
  • CVS
  • Respiratory
  • Renal
  • Temp
  • Other (case dep)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CNS

A
  • eye
    • palpebra
    • crneal
    • nystagmus
    • lacrimation
  • jaw tone
  • anal reflex
  • pedal reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

signs to monitor for good plane of anesthesia

A
  • position of eye
  • movement
  • muscle tone
  • certiain reflexes
  • response to sx stimulation
  • nystagmus (horse)
  • Shivering
  • eye reflexes present or absent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Light Plane of Anesthesia

A
  • central eye position
  • cessation limb movements
  • muscle tone remains
  • response to surgical stimulation
    • ​movement
    • breating/hemodynamic response
  • ​Nystagmus (horse)
  • eye reflexes present
  • shivering
  • moist cornea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Medium plane of anesthesia

A
  • No spontaneous movement
  • no reflex movement
  • no change in hemodynamic or breathing in response to surgical stim
  • moderate muscle tone
  • dec in tidal volume
  • no palpebral reflex
  • no shivering
  • ventromedial rotation of the eye
  • small pupil aperture
  • moist corneas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

deep plane of anesthesia

A
  • dec in tidal volume
  • abdominal breathing may be noted
  • eyes fixed centrally
  • no pedal reflexes
  • no spontanous or reflex movement
  • bradycardia/hypotension and worsening hemodynamic function
  • no palpebral and corneal reflex
  • dilated pupil
  • dry cornea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardiovascular system

A
  • maintain perfusion to body organs
  • maintain normal rhythm and rate
  • use clinical skills as well as a specific equipment to monitor
    • heart rate
    • blood pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mucous membranes

normal

white/pale

cyanosis

red/bright pink

A
  • normal: pale pink/pink
  • white/pale: anemia, vasoconstriction, lack of circulating fluid
  • cyanosis: lung disease, dec in oxygen flow to breathing circuit, endobronchial intubation
  • red/bright pink: hypercapnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Palpation of pulse

SA

A
  • lingual artery
  • femoral artery
  • digital artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pulse in LA

A
  • facial artery
  • transverse facial artery
  • digital artery artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Esophageal stethoscope

A
  • can evaluate rhythm, rate
  • can’t evaluate adequacy of circulation
  • can be annoying to anesthetist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ECG

A
  • good for
    • heart rate and rhythm
  • not good for
    • evaluating cardiac function
    • heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Common arrhythmias

A
  • Sinus tachycardia
  • Sinus bradycardia
  • second degree AV block
  • VPCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

mean blood pressure should be maintained at

A
  • above 60 mmHg
  • above 70 mmHg in horses
    • to prevent post-op myopathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

main organs we want to perfuse

A
  • heart
  • brain
  • kidneys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Direct BP

A
  • provides real time beat by beat pressure monitoring
  • invasive
  • aseptic technique
  • hematoma common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Indirect BP measuring

A
  • sphymomanometry
  • size of cuff: width => should be about 40% circumference of limb
    • big width: underestmates BP
    • small width: overestimates blood pressure
    • too tight: underestimates BP
    • too loose: overestimates BP
  • Systolic should be > 80
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Oscillometric method

A
  • cuff inflated to a pressure and it’s slowly released
  • go by the mean
    • MAP > 60mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cardiac output

A
  • invasive method (thermodilution)
    • not used routinely
  • Requires special and expensive equipment
  • CO = HR times stroke volume

*something about injecting cold saline and measuring the temp change of the heart….WTF?!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pulse oximetry

A
  • arterial oxygen saturation
  • heart rate monitoring
  • placed on tongue, ears, digits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pulse oximetry measures

A
  • light absorption of two different wavelengths at fast intervals during pulsations
23
Q

Pulse oximetry detects

A
  • reduced hemoglobin and oxyhemoglobin
24
Q

Pulse oximetry

percent of saturated hemoglobin calculated based on

A
  • algorithms and displayed on screen
25
Q

Pulse ox is sensitive to

A
  • movement, cold, vasoconstriction
26
Q

Pulse ox should be maintained

A

at > 95%

27
Q

At what percent do you consider patient to be hypoxemic

A

< 90%

  • corresponds to 60 mmHg
  • blood gas is only way to be sure
28
Q

Central venous pressure

A
  • assess fluid status of patient
  • pressure within the thoracic vena cava
29
Q

Decreased CVP

A

hypovolemia

30
Q

Inc CVP

A

fluid overload

31
Q

Normal CVP

SA:

LA:

A

SA: 2-7 cm H2O

LA: 15-25 cm H2O

32
Q

Urine output dependant on

A

cardiac output, blood volume, and renal function

33
Q

Normal urine output

A

1-2 ml/kg/hr

34
Q

Clinical skills of respiratory system

A
  • monitor resp rate
  • check excursions
  • abdominal efort
  • tidal volume
  • mm color
35
Q

normal resp rate for a dog

A

10-30 bpm

36
Q

Normal tidal volume

A

10-15 mL/kg

37
Q

Lots of dead space can accidentally cause a patient to be

A

extubated

38
Q

Blood gas analysis measures levels of

A

oxygenation and carbon dioxide in arterial blood

39
Q

Blood gas analysis provides

A

acid-base status

40
Q

Blood gas analysis can also measure

A

electrolytes/glucose/lactate

41
Q

Blood gas analysis not required in ……..but almost necessary in ………

A

SA

LA

42
Q

Capnography measures

A

the end tidal carbon dioxide and inspired carbon dioxide tension

43
Q

Capnography is connected

A

between the patient and the breathing system

44
Q

Capnography useful to measure

A
  • hypoventilation
  • hyperventilation
  • apnea
  • disconnection
  • rebreathing
  • obstruction
  • embolism
45
Q

Capnography provides information on (3 things)

A
  1. Adequacy of ventilation
  2. Cardiovascular system
  3. Patients metabolism
46
Q

Phase 1 of capnogram

A
  • Phase 1: inspiratory baseline
    • inspiration of fresh gas
    • baseline should stay at the level that corresponds to zero conc (mmHg) of CO2
47
Q

Phase 2 of capnogram

A
  • phase 2: expiratory upstroke
    • this phase occurse shortly after inspiration ends
    • caused by rapid washing out of fresh gas in anatomic space, then replacement by CO2 - rich alveolar gas
    • upstroke should be steep
48
Q

phase 3 of capnogram

A
  • phase 3: expiratory plateau
    • represents continuous exhalation
    • this line will be perfectly horizontal if ventilation and perfusion were perfectly matched
      • CO2 conc will be constant throughout the exhalation phase
    • Ventilation and perfusion not perfectly matched
      • CO2 slowly increases as gas from lung areas with lower ratio of ventilation to perfusion reaches sampling site
49
Q

phase 4 of capnogram

A
  • phase 4: Inspiratory downstroke
    • occurs shortly after the expiration ends
    • represents rapid washing out of CO2 by fresh gas as inspiration starts
    • downstroke should be steep
50
Q

Pulse ox and respiratory system

A
  • lower oxygen tension means lower arterial oxygen saturation
  • will see low saturation with pulmonary embolism
51
Q

Should maintain a body temp greater than

A

94 deg F

52
Q

Hypothermia anesthetic complications

A
  • decrease in anesthetic requirements
  • non-response to anticholinergics
  • prolonged recovery
  • cardiopulmonary depression
53
Q

Hyperthermia

A
  • should be avoided
  • rule out malignant hyperthermia
    • esp pink pigs
54
Q

Normal end tidal CO2

A

35-45 mmHg

anesthesiology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions