Non-Operating Room Anesthesia (NORA) Flashcards
What type of anesthetic is recommended for cerebral coiling?
GETA w/ arterial line and large bore IV.
What is most important in prevention of radiation damage:
shielding, time or distance?
Distance
What drug(s) is/are direct thrombin inhibitors?
Dabigatran (Pradaxa)
How do direct thrombin inhibitors work?
Antagonizes thrombin to prevent fibrinogen → fibrin
What laboratory test will measure Pradaxa’s (Dabigatran) effects?
dTT
What drug(s) is/are Factor Xa inhibitors?
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
- Edoxaban (Savaysa)
What is the MOA of Factor Xa inhibitors?
Prevents cleavage of prothrombin → thrombin
What drugs can reverse the effects of coumadin?
Vitamin K
FFP
What drugs reverse the effects of direct thrombin inhibitors and factor Xa inhibitors?
- Factor concentrates (2, 7, 9, 10)
- PCC
What is the effect of CO₂ levels on cerebral blood flow?
Hypercapnia = Increased CBF (vasodilation)
Standard 1:
Patient’s Rights
- Autonomy
- Privacy
- Safety
Standard 2:
Pre-Anesthesia assessment/eval
Labs, METs
Standard 3:
Patient Specific Plan
- Legal rep
- healthcare team
Standard 4:
Informed Consent
Standard 5:
Documentation
Standard 6:
Equipment
Standard 7:
Plan/modification of plan
Accepting responsibility until another anesthesia personnel member takes over
Standard 8:
Positioning
Standard 9:
Monitoring/alarms
- Must be audible
Standard 10:
Infection control
Standard 11:
Transfer of care
What are the components of the Modified Aldrete Scoring System for the PAR score:
- Respirations
- O2 Saturation
- Consciousness
- Circulation
- Activity
needs 9 or 10
What are the components of the Postanesthesia Discharge scoring system for the PAR score?
- Vital Signs
- Surgical Bleeding
- Activity and mental status
- Intake and Output
- Pain/Nausea/Vomiting
T/F:
If a patient loses consciousness and the ability to respond purposefully, the anesthesia care is a general anesthetic, irrespective of whether airway instrumentation is required?
True
Common procedures in IR:
- Endovascular treatments
- Radiofrequency ablations
- TIPS: Transjugular Intrahepatic Portosystemic Shunt
- Angiograms
- MRI
- CT Scan Guided Biopsies
When doing a GETA for Cerebral aneurysms, what is recommended?
- Large bore IV
- Volatiles
- Propofol and Precedex
Complications that can arise from a Cerebral Aneurysm?
- Rupture/dissection
- contrast hypersensitivity (anaphylaxis)
- Groin hematoma
Recommendations for Abdominal Aneurysms?
- Large bore IV, Art line
- Heparin (ACT’s, protamine)
- Foley cath
- controlled, mild hypotension
What is the normal dose of protamine as a reversal agent for Heparin?
1-1.5 mg/ 100u of Heparin
Describe the patho of a TIPS procedure
Decompression of portal circulation in patients with portal hypertension and recurrent GI bleeds who have failed medical therapy.
Can a TIPS procedure correct the patient’s chronic liver damage?
Where are the catheter and stent inserted through?
NO
Through the Internal Jugular Vein
Comorbidities for TIPS
Recent GI bleed
Hepatic encephalopathy
Ascites
Pleural effusion
Alcoholic cardiomyopathy
Coagulopathy
Decreased protein binding
Anesthesia Implications for TIPS:
- GETA w/ RSI
- IV/Art
- Replace volume (Albumin, PRBC’s)
- Radiation Protection
Pros and Cons for EP Ablation:
Pros:
- Minimally invasive
- 60-85% success on 1st attempt
Cons:
- Long (2-6 hrs)
- Uncomfortable
- Could cause V-Tach/fib
When is cardioversion most successful in treating a-fib?
What medication should we avoid before performing a CV?
Within 7 days from a-fib onset
Lidocaine (Na+ Channel blocker)
Anesthesia considerations for an ERCP:
- These patients have extreme comorbidities
- Prone position w/ head to side
- Anti-spasmodic necessary (Glucagon)
- Narcotics not recommended
- GETA
What are some physiologic responses we expect to see during an ECT?
- Incontinence
- Myalgia (2-7 days)
- Headache
- Emergence agitation/confusion
Which comes first during an ECT:
Parasympathetic response or sympathetic response?
Parasympathetic response followed by a 10-20 min sympathetic response.
What are the anesthesia implications for ECTs?
- Hyperventilation
- Ativan/Haldol on standby
- Short acting B-Blockers for HTN
- Caffiene for HA
