Non-Operating Room Anesthesia (NORA)

Question 1

What type of anesthetic is recommended for cerebral coiling?

Answer 1

GETA w/ arterial line and large bore IV.

Question 2

what standard?

pt’s rights: autonomy, privacy, safety

Answer 2

1

Question 3

what standard?

Pre-anesthesia assessment/eval

Answer 3

2

Question 4

what standard?

Transfer of Care (GA needs appropriate recovery)

Answer 4

11

Question 5

what standard?

infection control

Answer 5

10

Question 6

what standard?

patient posiitoning

Answer 6

8

Question 7

what standard?

monitoring/alarms

Answer 7

9

Question 8

what standard?

pt specific plan

Answer 8

3

Question 9

what standard?

documentation: accurate, timely, legible

Answer 9

5

Question 10

what standard?

informed consent

Answer 10

4

Question 11

what standard?

Equipment: verify functioning

Answer 11

6

Question 12

What standard?

Plan/modification of plan

*CRNA provides anesthesia care until the responsibility has been accepted by another professional

Answer 12

7

Question 13

what are the five components of modified aldrete scoring system?

Answer 13

○ 1. Respirations
○ 2. Oxygen Saturation
○ 3. Consciousness
○ 4. Circulation
○ 5.Activity

Question 14

Post Anesthesia Discharge Scoring System 5 components

Answer 14

○ 1. Vital signs
○ 2. Surgical bleeding
○ 3. Activity & mental status
○ 4. Intake & Output
○ 5. Pain/Nausea/Vomiting

Question 15

Conscious sedation or
General anesthesia?

responsiveness: purposeful response to verbal or tactile stimulation

Answer 15

conscious sedation

Question 16

Level of sedation:

■Responds to verbal commands
■Anxiolysis

Answer 16

minimal

Question 17

Level of sedation:

■Responds to painful stimuli
■Independent ventilation may be impaired

Answer 17

deep

Question 18

Level of sedation:

■Responds to verbal/tactile stimulation
■Depressed LOC

Answer 18

moderate

Question 19

at what point dose conscious sedation turn into general anesthesia?

Answer 19

●If a patient loses consciousness and the ability to respond purposefully, the anesthesia care is a general anesthetic

does not matter if patient is still maintaining their own airway

Question 20

Conscious sedation or
General anesthesia?

airway: intervention often required

Answer 20

GA

Question 21

Conscious sedation or
General anesthesia?

spontaneous ventilation: frequently inadequate

Answer 21

GA

Question 22

Conscious sedation or
General anesthesia?

cardiovascular function: usually maintained

Answer 22

conscious sedation

Question 23

increased ETCO2 has what effect in the brain and in the lungs?

Answer 23

cerebral vasodilation

lungs: vasoconstriction

Question 24

What type of anesthetic and recommended for abdominal aneurysms?

Answer 24

large bore IV

a-line

foley catheter

controlled mild HoTN

frequent ACTs (heparin/protamine)

Question 25

What does TIPS stand for

Answer 25

Transjugular intrahepatic portosystemic shunt

Question 26

The shunt that is placed in a TIPS procedure connects what two veins

Answer 26

hepatic vein to portal vein

Question 27

the catheter is fed through what vein to place the shunt in a TIPS procedure

Answer 27

internal jugular vein

Question 28

With liver patients what do you need to think about when picking your anesthetic plan?

Answer 28

decreased protein binding

Question 29

TAVR stands for

Answer 29

transcatheter aortic valve replacement

Question 29

Induction approach for TIPS patients

Answer 29

RSI and GETA

Question 30

If you suspect moderate blood loss in a procedure, do you want to get a type and cross or a type and screen?

Answer 30

type and cross

Question 31

What is most important in prevention of radiation damage, shielding or distance?

Answer 31

Distance

Question 32

What parenteral drugs are thrombin fXA? (2)

Answer 32

Heparin LMWH

Question 33

What parenteral drug(s) works on fXA?

Answer 33

fondaparinux (arixtra)

Question 34

These are anesthesia considerations for what procedure? ■Bite block, Cetacaine spray (preop cough?) ■Standards still apply! ■Propofol till loss of gag/lash reflex (keep them breathing!) ■Versed/Ketamine alternative - NO LIDOCAINE

Answer 34

cardioversion be prepared for multiple attempts w/cardioversion *synchronized cardioversion: 50-100 J

Question 35

How do direct thrombin inhibitors work?

Answer 35

Antagonizes thrombin to prevent fibrinogen → fibrin

Question 36

What laboratory test will measure Pradaxa's (Dabigatran) effects?

Answer 36

dTT

Question 37

What drug(s) is/are Factor Xa inhibitors?

Answer 37

- Rivaroxaban (Xarelto) - Apixaban (Eliquis) - Edoxaban (Savaysa)

Question 38

What is the MOA of Factor Xa inhibitors?

Answer 38

Prevents cleavage of prothrombin → thrombin

Question 39

What drugs can reverse the effects of coumadin?

Answer 39

Vitamin K FFP

Question 40

What drugs reverse the effects of direct thrombin inhibitors and factor Xa inhibitors?

Answer 40

- Factor concentrates 3 (II,IX,X) OR 4 (II,VII,IX,X) - PCC: prothrombin complex

Question 41

What is the effect of CO₂ levels on cerebral blood flow?

Answer 41

Hypercapnia = Increased CBF

Question 42

What procedure is done to diagnose/tx biliary and pancreatic disorders

Answer 42

ERCP: endoscopic retorgrade cholangiopancreatography

Question 43

what is the pt position for ERCP?

Answer 43

Prone with head turned to side *GETA recommended

Question 44

Tx of spasm of oddi *prevention: avoid narcotis

Answer 44

all given IV -Glucagon 2mg -naloxone: 40 mcg -atropine 0.2 mg -nalbuphine 10 mg -NTG: 50 mcg

Question 45

What are the physiologic responses after electro-convulsive therapy?

Answer 45

■Initial parasympathetic activity ■10-20 minute sympathetic stimulation ■Incontinence ■Myalgias (may last for 2-7 days) ■Headache ■Emergence agitation/confusion

Question 46

Anesthesia implications for ECT: (7)

Answer 46

■Pre-op eval.. Pregnancy test ■General Anesthesia -Bag valve mask (Ambu) with bite block -Atropine/Glycopyrrolate : given to counteract the initial PSNS response -Brevital (not used anymore), Propofol, & Anectine -Caffeine (to avoid headaches afterwards) ■Hyperventilation ■Protection of extremities ■Ativan, haldol on standby (if pt becomes manic) ■Treat HTN w/ short acting B-blockers ■IVs discontinued in PACU (even if in pt)

Question 47

ablation effectiveness on 1st attempt?

Answer 47

60-85%

Question 48

What surgery has this cons associated with the procedure? ●Often lengthy (2-6 hours) ●Often uncomfortable ●May induce V-tach and V-fib intra-op

Answer 48

ablation

Question 49

What VA should you avoid using for an ablation?

Answer 49

ISO ●ISO increases refractoriness, making it difficult for interpretation ●SEVO no effect… acceptable for ablation (DOC for general anesthesia for ablation