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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.

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20
Q

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

A

Inadequate pain control

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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!

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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
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23
Q

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

A

use of multiple drugs, especially sedative medication

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24
Q

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

A

Respiratory events: depression, obstruction, apnea

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25
Q

Pediatric adverse reactions are reduced with procedures that last?

A

Less than 1 hour

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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

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27
Q

Initial cardioversion shock dose?

A

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

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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 bones, 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

ALARA stands for?

A

As Low As Reasonably Possible

47
Q

EGD evaluates what structures?

A

Mucosa of esophagus, stomach, or duodenum

48
Q

Colonoscopy evaluates?

A

Cecum to anus

49
Q

Why do we do ERCPs?

A

Biliary/Pancreatic Duct obstruction or drainage
Unexplained jaundice, abnormal CT
Biopsy
Mapping pancreatic duct
Sphincter of Oddi

50
Q

What position are patients in for ERCPs

A

Endoscopically and in the prone position

51
Q

Anesthetic considerations for GI procedures

A

Strict NPO guidelines: greater risk for aspiration
Moderate sedation: prop, midaz, fentanyl
Deep Sedation or GA for ERCPs
Bowel Prepped? consider volume
Prepare for vagal stimulation

52
Q

Is a foreign body considered a full stomach?

A

Yes. Intubate and remove.

53
Q

What is the primary concern for Post Op ERCP patients

A

contrast dye reaction
Mild: N/V, pruritus, sweating, flushing hives
Moderate: Syncope, hyperemesis, severe hives, hypotension, Tachy/brady, “mild” bronchospasm
Severe: shock, angioedema, seizures

54
Q

Colonoscopy PACU considerations

A

N/V
cramping
dehydration
must pass fart check

55
Q

Anesthetic Considerations for IVF

A

Moderate Sedation is usually sufficient.

Avoid Morphine, NSAIDS, and Reglan
Avoid Sevo and Des

ISO is A-OKAY

56
Q

Anesthetic Considerations for Hysteroscopic Sterilization

A

Contraindications: <6 wks PP, PID, contrast allergy, immunocompromised, positive HCG

Pretreat with NSAIDS

57
Q

Pediatric Dental Anesthesia Considerations

A
  1. Anxiolytics
    -ketamine, precedex, and midaz

Nasal Intubation, if possible for more visualization

58
Q

ECT procedure goal is to? What will you need?

A

Intentionally induced generalized seizure. Anticonvulsant Effects: Raises Threshold, Decreases duration

Meed conducting gel, electrodes, tourniquet (isolate one foot) , bite block, alternating electrical currents

59
Q

Do we usually intubate patients under ECT?

A

No. Ultra-quick general anesthesia. Bite Block, Mask Ventilate. Low-dose paralytics.

60
Q

Physiologic Effects of ECT

A

Massive Parasympathetic Outflow (tonic phase)
SLUDGE
S: Salivation
L: Lacrimation (excessive tearing)
U: Urination or urinary incontinence
D: Defecation or diarrhea
G: Gastrointestinal distress
E: Emesis
Bradycardia, Hypotension, Heart Blocks, Asystole

Massive Sympathetic Putflow (Clonic Phase)
Flushing, Tachycardia, HTN, Tachyarrythmias

Increased CBF
Increased ICP

Increased IOP
Increased IGP
Hypoventilation

HA, mixed amnesia

transiest but exaggerated

61
Q

What pharmacologic agents prolong seizure

A

alfentanil + propofol
Aminophylline
Caffeine 500mg
Clozapine
Etomidate
Ketamine
Hyperventilation

62
Q

What pharmacologic agents shorten seizure

A

dilitiazem
fentanyl
lidocaine
BZDs
propofol
sevo

63
Q

IV Contrast Media: HOCM vs LOCM

A

HOCM: High Osmolar Contrast Media - few dissolved particles and iodine atoms. Higher reaction solution. Draws fluid out of cells into vessels.

LOCM: Low Osmolar Contract Media - greater number of dissolved particles with iodine. More isotonic. Most costly.

64
Q

MRI ZONES

A

Zone I: Free Access to General Public
Zone II: Supervised, like a waiting room
Zone III: Restricted Ferromagnetic-Free Zone - where I bring the patient as an ICU nurse
Zone IV: Within zone 3, scanner room

65
Q

Prohibited Items in MRI

A

AICD, PPM, Wires, LEads
Mechanical Valves, Cochlear Implants
Surgical Clips, Coils

66
Q

MRI anesthesia considerations

A

MRI compatabile equipement
The table is hard; pad the pt
Blood flow decreases in strong magnetic fields: GA
Ear plugs
consider hands-off anesthesia

67
Q

How does electromagnetic fields influence pacemakers

A

Can cause inhibition, asynchrony, heating of battery or leads, dislodgement

68
Q

IR Anesthetic Considerations

A

Absolutely Immobile, controlled periods of apnea
Can be very painful
Full range of anesthesia
May need to do a wake-up neuro check

LEAVE THE ROOM
closed circuit monitoring - hands off anesthesia
Delayed Entry 30-60s heavy door

Foundations of Anesthesia 1 (29 decks)

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