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Foundations of Anesthesia 1 > NonOR Anesthesia > Flashcards

NonOR Anesthesia Flashcards

1
Q

Which nonOR procedural area has more malpractice claims for death compared with OR settings?

A

GI Suite

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2
Q

Approximately what % of all anesthetics occur outside the OR?

A

~55%

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3
Q

NonOR anesthesia offers what kind of services?

A

Full range of anesthesia to all age groups

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4
Q

What NonOR adverse event had more closed claims than OR?

A

Death lol

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5
Q

How do standards of care in NonOR anesthesia compare to OR?

A

They don’t! They have the exact same standards.

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6
Q

What are the A-J (or 10) standards of NonOR anesthesia care

A

A. Preanesthesia Assessment
B. Obtain Informed Consent
C. Form a Patient-Specific Anesthesia Plan
D. Implement/Adjust the Plan based on pt response
E. Prepare, Dispense, and Label all Medications to be used
F. Adhere to safety precautions
G. Monitor and Document pt condition
H. Infection Control
I. Complete, Accurate, Timely Documentation
J. Transfer, continuity of care

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7
Q

Only what kind of anesthesia ensures amnesia?

A

General Anesthesia. So, discuss expectations with the patient.

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8
Q

When is temperature monitoring required vs optional in NonOR?

A

Required with general anesthesia. Optional during mild, moderate, or deep.

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9
Q

In cases of moderate or deep sedation, AANA and ASA mandate the measurement of?

A

etCO2

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10
Q

What must the anesthesia provider do before leaving the patient in the recovery area?

A

Thoroughly assess the stability of the patient and airway maintenance

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11
Q

Minimal Sedation was formerly known as?

A

Anxiolysis

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12
Q

During minimal sedation, what are the effects on:
Responsiveness,
Airway,
Spontaneous Ventilation, and
Cardiovascular Function

A

Responsiveness: Normal response to verbal stimuli. Some cognitive function and coordination may be impaired.

Airway: Unaffected
Spontaneous Ventilation: Unaffected
Cardiovascular Function: Unaffected

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13
Q

Moderate Sedation/Analgesia was formerly known as?

A

Conscious sedation

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14
Q

During moderate sedation, what are the effects on:
Responsiveness,
Airway,
Spontaneous Ventilation, and
Cardiovascular Function

A

Responsiveness: Purposeful response to verbile OR tactile stimulation.
Airway: No intervention required
Spontaneous Ventilation: Adequate
Cardiovascular Function: Usually maintained

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15
Q

Is reflexive withdrawal from a painful stimulus considered a purposeful response?

A

No, not considered purposeful

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16
Q

During Deep Sedation/Analgesia, what are the effects on:
Responsiveness,
Airway,
Spontaneous Ventilation, and
Cardiovascular Function

A

Responsiveness: Purposeful response following repeated or painful stimulation
Airway: Intervention may be required
Spontaneous Ventilation: May be inadequate
Cardiovascular: Usually maintained

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17
Q

What is deep sedation/analgesia?

A

Drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully after repeated or painful stimulation.

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18
Q

During General Anesthesia, what are the effects on:
Responsiveness,
Airway,
Spontaneous Ventilation, and
Cardiovascular Function

A

Responsiveness: Unarousable even with painful stimulation
Airway: Intervention often required
Spontaneous Ventilation: Frequently Inadequate
Cardiovascular: May be impaired

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19
Q

During anesthesia, what causes patients to need airway or ventilatory support?

A

Assistance maintaining a patent airway and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function.

20
Q

In NonOR anesthesia cases, what is one of the most common minor adverse events?

A

Inadequate pain control

21
Q

Children under ____ years old seem to be at the greatest risk for adverse events even with no underlying disease

A

Under the age of 5!

22
Q

The goals of nonoperating room anesthesia, no matter the environment, are:

A
  1. Get familiar with the environment
  2. As safe as the operating room
23
Q

What is one of the most common reasons for adverse events in pediatrics?

A

use of multiple drugs, especially sedative medication

24
Q

What problems are most often encountered with adverse events in pediatrics?

A

Respiratory events: depression, obstruction, apnea

25
Q

Pediatric adverse reactions are reduced with procedures that last?

A

Less than 1 hour

26
Q

It is essential to preoperatively assess for ____ in pediatric patients to reduce the risk of airway compromise

A

Respiratory Infection
-fever, snoring, sputum production, cough

27
Q

Initial cardioversion shock dose?

A

Start 50-100J, can go all the way to 360 J

28
Q

What is the initial bolus dose of propofol?

A

0.5-1 mg/kg

29
Q

What age group is at the highest risk of pediatric adverse events?

A

Less than 5 years old

30
Q

Do geriatrics have an increased or decreased affinity for lipid soluble agents?

A

Increased and have a decreased metabolic rate

31
Q

Geriatrics are more or less likely to experience delirium and post-operative cognitive deficits.

A

More!

32
Q

How does thermoregulation change in geriatrics?

A

decreased thermoregulation

33
Q

What two medications are preferred for cardioversion

A

propofol or etomidate for low EF

34
Q

What are some anesthetic requirements for cardioversion?

A

NPO
Oxygen, Monitors, Resuscitation equipment

35
Q

What kind of sedation is preferred for cardioversion?

A

Moderate to Deep Sedation or a Room Air General

Muscle Relaxant NOT needed.

36
Q

What medications need to be avoided during RadioFrequency (RFA) Cryoablation

A

Avoid Lidocaine (can mask arrhythmias)
Inhaled Volatile Gases (PA occluded during ablation)

37
Q

What anesthetic considerations are needed for RadioFrequency (RFA) Cryoablation

A

-Esophageal temp probe: risk for thermal injury with LA ablation
-Artline, vasoconstrictor, Inotropes
-Need patient to remain very still

38
Q

What can go wrong with a transeptal ablation technique?

A

Puncture LV and cause tamponade

39
Q

In the geriatric population, a MET score greater than ____ is a good predictor they will be able to handle anesthetic from a cardiac standpoint

A

METs of 4 or more

40
Q

RadioFrequency (RFA) or Cryoablation is usually accessed through?

A

the groin

41
Q

What sort of anesthesia is usually performed for RadioFrequency (RFA) or Cryoablation

A

Local/MAC
you could do TIVA or General

42
Q

During RadioFrequency (RFA) or Cryoablations, should the patient be anticoagulated?

A

Yes, often with heparin. Check frequent ACTs and then reverse with protamine (usually 10mg)

43
Q

What can happen if you give protamine too quickly?

A

Can tank blood pressure

44
Q

What must be covered for radiation safety during RadioFrequency (RFA) Cryoablation?

A

Thyroid, long bines, reproductive organs, and EYES if you are in frequently

45
Q

Complications of PCI

A

arrhythmogenesis
hemorrhage, embolism
Contrast: anaphylaxis, nephropathy
Vasovagal response
Htn/HoTn
Respiratory collapse
Cardiac arrest

46
Q
A

Foundations of Anesthesia 1 (17 decks)

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