Non-Operating Room Anesthesia Flashcards
What are types of satellite locations (5)?
Radiology Cardiac Catheterization Lab Psychiatric Unit Endoscopy Office Based Practice
What are equipment requirements per ASA at satellite locations?
Reliable O2 source with back-up
Suction source
Waste gas scavenging
Adequate monitoring equipment
Self- inflating hand resuscitator bag
Sufficient safe electrical outlets
adequate patient and anesthesia equipment illumination with battery power back-up
adequate space to freely access patient and anesthesia equipment
emergency cart with defibrillator, emergency drugs and other emergency equipment
reliable two way communication to request for help
adequately trained support staff in procedure room & in post-anesthesia care location
compliance with facility with all applicable safety and building codes
How should monitoring be completed in satellite locations?
standard/routines utilized in the OR must be maintained
What are the ASA/AANA guidelines require evaluation of patient’s
oxygenation
ventilation
circulation
temperature
What are some general comments about remote locations and anesthesia?
design of satellite location is for the procedure (anesthesia is an afterthought)
personnel may be less familiar with management of patient under anesthesia
procedure table limits
pre-procedures assessment/ optimization often not completed in advance= delays + cancelations
What are anesthesia implications for endoscopy (EGD)/ esophagogastroduodenoscopy?
local oropharygneal anesthesia with opioid + benzo VS general anesthesia with propofol (+/- ETT)
What are high risk groups for EGDs?
obese, OSA, GERD, asthma, obstruction/full stomach, hepatic disease
What is an esophagogastrodudenscopy?
endoscopic evaluation of the esophagus, pylorus, and stomach
may involve biopsy, mucosal/submucosal dissection, dilation and stenting
What is involved in a sigmoidoscopy & colonscopy?
biopsy, polypectomy/muscosal resection, stenting, dilation, etc.
What normally occurs in a sigmoidoscopy & colonscopy?
benzos + opioids VS propofol (GA)
generally involves insufflation of air, may involve the application of external pressure
What anesthesia can be performed in a sigmoidoscopy & colonscopy
benzos + opioids VS propofol (GA)
What are common complications of a sigmoidoscopy & colonscopy ?
laryngospasm, aspiration, and losing the airway
What is an endoscopic retrograde cholangiopancreatgraphy? (ERCP)
fluoroscopic exam of biliary and pancreatic duct that may involve stenting/removal of stones/laser lithotripsy
commonly in prone position
Who commonly receives ERCP?
pateints with cholangitis, pancreatitis, bile duct obstruciton, pancreatic cancer
What is required of the ERCP patient?
to be immobile
How is an ERCP performed?
GA with ETT
What are common bronchoscopic procedures?
endobronchial stenting, biopsy, laser therapy, dilation, cryotherapy, fiducial marker implant
What is common of patients receiving bronchoscopic procedures?
patients with signficant CV and pulmonary disease
What is the preferred method of bronchs?
TIVA
propofol, remifentanil, dexmedetomidine + muscle relaxants
what are associated complications of bronchs?
airway fire, bronchospams, bleeding and hypoxia
What makes up a radiology suite?
US
CT
MRI
Interventional (cardiac catheterization, neuroradiology)
non-invasive and don’t normally require anesthesia but may need anesthesia to lay still
What are general considerations in the radiology suite?
patient remains immobile for long periods
equipment is bulky
Why may general anesthesia be necessary in radiology suites?
lack of scavenging may limit the options
What are problems associated with bulky equipment in radiology suites?
impede access to patient
move and collide with anesthesia equipment
lines, pumps, ventilation tubing
will need extensions
