Non-Operating Room Anesthesia (NORA) Flashcards
What type of anesthetic is recommended for cerebral coiling?
GETA w/ arterial line and large bore IV.
what standard?
pt’s rights: autonomy, privacy, safety
1
what standard?
Pre-anesthesia assessment/eval
2
what standard?
Transfer of Care (GA needs appropriate recovery)
11
what standard?
infection control
10
what standard?
patient posiitoning
8
what standard?
monitoring/alarms
9
what standard?
pt specific plan
3
what standard?
documentation: accurate, timely, legible
5
what standard?
informed consent
4
what standard?
Equipment: verify functioning
6
What standard?
Plan/modification of plan
*CRNA provides anesthesia care until the responsibility has been accepted by another professional
7
what are the five components of modified aldrete scoring system?
○ 1. Respirations
○ 2. Oxygen Saturation
○ 3. Consciousness
○ 4. Circulation
○ 5.Activity
Post Anesthesia Discharge Scoring System 5 components
○ 1. Vital signs
○ 2. Surgical bleeding
○ 3. Activity & mental status
○ 4. Intake & Output
○ 5. Pain/Nausea/Vomiting
Conscious sedation or
General anesthesia?
responsiveness: purposeful response to verbal or tactile stimulation
conscious sedation
Level of sedation:
■Responds to verbal commands
■Anxiolysis
minimal
Level of sedation:
■Responds to painful stimuli
■Independent ventilation may be impaired
deep
Level of sedation:
■Responds to verbal/tactile stimulation
■Depressed LOC
moderate
at what point dose conscious sedation turn into general anesthesia?
●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
Conscious sedation or
General anesthesia?
airway: intervention often required
GA
Conscious sedation or
General anesthesia?
spontaneous ventilation: frequently inadequate
GA
Conscious sedation or
General anesthesia?
cardiovascular function: usually maintained
conscious sedation
increased ETCO2 has what effect in the brain and in the lungs?
cerebral vasodilation
lungs: vasoconstriction
What type of anesthetic and recommended for abdominal aneurysms?
large bore IV
a-line
foley catheter
controlled mild HoTN
frequent ACTs (heparin/protamine)
What does TIPS stand for
Transjugular intrahepatic portosystemic shunt
The shunt that is placed in a TIPS procedure connects what two veins
hepatic vein to portal vein
the catheter is fed through what vein to place the shunt in a TIPS procedure
internal jugular vein
With liver patients what do you need to think about when picking your anesthetic plan?
decreased protein binding
TAVR stands for
transcatheter aortic valve replacement
Induction approach for TIPS patients
RSI and GETA
If you suspect moderate blood loss in a procedure, do you want to get a type and cross or a type and screen?
type and cross
What is most important in prevention of radiation damage, shielding or distance?
Distance
What parenteral drugs are thrombin fXA? (2)
Heparin
LMWH
What parenteral drug(s) works on fXA?
fondaparinux (arixtra)
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
cardioversion
be prepared for multiple attempts w/cardioversion
*synchronized cardioversion: 50-100 J
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
3 (II,IX,X) OR 4 (II,VII,IX,X) - PCC: prothrombin complex
What is the effect of CO₂ levels on cerebral blood flow?
Hypercapnia = Increased CBF
What procedure is done to diagnose/tx biliary and pancreatic disorders
ERCP: endoscopic retorgrade cholangiopancreatography
what is the pt position for ERCP?
Prone with head turned to side
*GETA recommended
Tx of spasm of oddi
*prevention: avoid narcotis
all given IV
-Glucagon 2mg
-naloxone: 40 mcg
-atropine 0.2 mg
-nalbuphine 10 mg
-NTG: 50 mcg
What are the physiologic responses after electro-convulsive therapy?
■Initial parasympathetic activity
■10-20 minute sympathetic stimulation
■Incontinence
■Myalgias (may last for 2-7 days)
■Headache
■Emergence agitation/confusion
Anesthesia implications for ECT: (7)
■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)
ablation effectiveness on 1st attempt?
60-85%
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
ablation
What VA should you avoid using for an ablation?
ISO
●ISO increases refractoriness, making it difficult for interpretation
●SEVO no effect… acceptable for ablation (DOC for general anesthesia for ablation
