Neuro, Ob, ENT, Optho Flashcards
common neuro procedures
anterior cervical dicectomy and fusion
posterior lumbar interbody fusion
lumbar laminectomy
craniotomy
neuromonitoring purpose
prevent and detect neurological injury
what can happen from nerve injury or ischemia
disabling weakness
paralysis
loss of sensation
what is monitored during neurosurgery
sensory and motor function
most common method of neuromonitoring
evoked potentials
evoked potential
stimulus generated and result is measured at target tissue
- assessed by latency and amplitude of waveforms
what delivers/receives impulses of evoked potential
tiny needles
evoked potential: somatosensory
SSEPs
afferent nerve conduction
stimulates proprioception, pressure, vibration at peripehral nerve
SSEPs can cause what
artifact readings with SpO2 and BP
hand/feet moving regulary
evoked potentials: motor
MEPs
efferent nerve conduction
stimulates muscle movement in brain
MEPs can cause
large jolt
what changes to anesthetics during neuromonitoring?
no non-depolarizing muscle relaxants
<0.5 MAC of gas
typical anesthetic for neuromonitoring
TIVA
or
<0.5 MAC + IV anesthetics
– propofol + remi
– ketamine/precedex/lido
caveats to neuromonitoring paralysis
anterior approach lumbar will require paralysis
some surgeons request low dose paralysis
what must you place during a neuromonitoring case?
soft bite block
anterior cervical positioning
supine
arms tucked
cervical visualizer/pins/traction
anterior cervical considerations
IV access/infusions prior to prep/drape
BP might need to move to leg
arterial line
posterior lumbar positioning
prone
arms in superman
what is critical to do prior to positionming pt for posterior lumbar?
100% fiO2
what should you be checking frequently during prone cases?
eyes/nose are pressure free
posterior thoracic positioning
prone
tucked arms
posterior cervical positioning
prone
tucked arms
mayfield pins
what is important to consider during mayfield pin placement?
pt needs to be deep
this is very stimulating
have propofol ready to bolus
crani positioning
supine or prone
arms tucked
possible mayfield pins
crani bed positioning
180 degrees
considerations when bed is turned 90 or 180 degrees
circuit extension
IV extension
TOF twitches on ankle
considerations for prone
ETT extension
temp probe for spine cases
use esophageal
which monitor can you use to monitor during TIVA
BIS
propofol spine dosing
75-150mcg/kg/min
remi spine dosing
0.05-0.2 mcg/kg/min
phenylephrone spine dosing
0.1-1 mcg/kg/min
which cranis dont usually need an arterial line for healthy pt
burr hole decompression
what meds can help for tight BP control
phenylephrine
cleviprex
cardenen
nitroglycerine
what fluids for crani for BP control?
mannitol
hypertonic saline
what is a common anticonvulsant for cranis?
keppra
what should you use for crani eye tape?
tegaderm
what cases should you consider a fluid warmer?
crani
OB pts are considered a ________ aspiration risk
Higher aspiration risk
RSI, espcially 1st and 3rd trimester
OB pts are likely a __________ airway
difficult
what drugs do not cross placenta to baby?
Heparine
Insulin
Glyco
Neostigmine
Steroidal paralytics (Roc/Vec)
what drugs do we try to minimize exposure to for OB pts?
benzos
narcotics
volatile agents
C-section drugs
fentanyl - 15 mcg for spinal
morphine - 150 mcg for epidural
what is common after spinal or epidural placment?
sympathectomy
low BP
vomiting
what side is pillow positioned
under right side to minimize IVC
when do you induce gernal anesthesia for emergent C section
surgeon is scrubbed in w/scalpel in hand
emergency c section airway
use video and small ETT
what is administered following delivery of baby
pitocin
cervical cerclage
indicated for a weakened or short cervix to help prevent preterm labor
suture in cervix
cervical cerclage anesthesia
done under spinal anesthesia
suction d&c anesthesi
general w/LMA
first trimerster
organogenesis
highest risk to feturs
third trimester
highest risk for inducing pre-term labor
bilateral myringotomy and tubes anesthesi
mask only
laryngospasm with no IV?
IM sux or atropine
IM sux dosing
3-5mg/kg
IM atropine dosing
20-30mcg/kg
what should you prep with BMT cases
IM small gauge needle sux
IM small guage needle atropine
which procedure is indicated with OSA
adenoidectomy
what should you keep FiO2 at for T& A surgery
<30%
coblator has a _______ fire risk
minimal
what should you do with throat packs
chart time placed and removed
N2O supports
combustion
T&A positioning
arms tucked
bed 90 degrees
T&A pts are a high risk for
laryngospasm
what type of suction should you use in T&A pts
soft catheter
types of tubes for Diagnostic Laryngoscopy
small ETT
microlaryngoscopy tube
oral RAE
jet ventilation
anesthetic for diagnostic laryngoscopy
TIVA
diagnostic laryngoscopy positioning
arms tucked
bed 90 degrees
what is a mayo stand used for
diagnostic laryngoscopy
what surgeries require nerve monitoring
thyroidectomy
parathyroidectomy
NIM tube is used for
nerve monitoring of recurrent laryngeal nerve
can you paralyze with NIM tube
no
thyroidectomy/parathyroidectomy positioning
supine
arms tucked
functional endoscopic sinus (FESS)
removal of obstructing tissue for better sinus drainage
FESS anesthesia
GETA
FESS pts are high risk for
bleeding
laryngospasm
oculocardiac reflex
occurs when pressure is applied to extraocular muscles
profound bradycardia or asystole
what nerves trigger oculocardiac reflex
ophthalmic branch of trigenial nerve and vagus nerve
when does oculocardaic reflex occur
during injection of local
during operation
what should you prep in adv for oculocardiac reflex
glyco
atropine
syringe
opthomalogical blocks provide
akinesia
anesthesia
optho block complication
brainstem anesthesia
into subarachnoid covering of optic nerve sheath –> complete respiratory arrest
cataract anesthesia
MAC
– fentanyl/versed
– propofol if pt wants a block
cataract positioning
supine
virectomy anesthesia
GETA w/paralysis
regional block by surgeon
what is contraindicated during virectomy
nitrous
can expand tamponading bubble
