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Advanced Anes. Spring 21 > NORA > Flashcards

NORA Flashcards

1
Q

ASA NORA guidelines

A
  1. Oxygen and backup
  2. Suction
  3. Scavenging System
  4. Resus Bag (90% fio2)
  5. Drugs, Supplies for Proc
  6. Monitoring
  7. Electrical Outlets
  8. Space
  9. Crash Cart
  10. Communication, 2 way
  11. Observation of Codes
  12. PACU
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2
Q

When to consider GA…

A

longer procedures

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3
Q

JCAHO anesthesia definition

A

admin of IV, IM or inhalation agents that may result in loss of protective reflexes

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4
Q

Should pts expect same standard of care outside of OR when receiving sedation/anesthesia?

A

yea, duh

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5
Q

Needed for transport to recovery area…

A

oxygen and monitoring

emergency meds

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6
Q

Office based anesthesia: general

A
  • pt needs full preop workup
  • difficult airway not ideal
  • prop, des, nitrous, sevo
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7
Q

Office based anesthesia: JCAHO and ASA guidelines

A
  • trained, credentialed personnel
  • maintained anes equip
  • documentation tool
  • monitors and emerg equip
  • PACU and trained nursing
  • protocols
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8
Q

Radiation exposure can cause

A
  • leukemia & fetal abnormalities
  • dosimeters required (max 50 mSv annually
  • lead
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9
Q

Iodinated contrast media

A 
old= hyperosmolar and toxic
new = lower osmolality & improved s/e
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10
Q

Predisposing factors for rxn to contrast media…

A

hx of bronschospasm, allergy, cardiac disease, hypovolemia, hematologic disease, renal dysfunction, extremes of age, enxiety, meds (betablockers, aspirin, NSAIDs)

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11
Q

Pre-treatment for contrast media…

A
  • prednisone 50 mg, 12 hrs before

- benedryl 50 mg immediately before

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12
Q

Mild rxn to contrast media

A

nausea, perception of warmth, headache, itchy, rash, hives

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13
Q

severe rxn to contrast media

A

vomiting, rigors, feel faint, chest pain, severe hives, bronchospasm, dyspnea, arrythmias, renal failure

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14
Q

life-threatening rxn to contrast media

A

glottic edema/bronchospasm, pulmonary edema, arrythmias, cardiac arrest, seizures

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15
Q

Treatment of contrast reaction

A 
oxygen
bronchodilators
epi
corticosteroids
antihistamines
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16
Q

Metformin & contrast media

A

-pts can develop life-threatening lactic acidosis (NIDDM)

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17
Q

Which med has been shown to decrease nephrotoxicity with admin of contrast media?

A

acetylcysteine

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18
Q

CT

A
  • need immobility

- inaccessibility to pt

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19
Q

MRI

A
  • good soft tissue contrast
  • no ionizing radiation
  • movement = artifact
  • thermal injury potential
  • magnet is always on
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20
Q

Is hearing protection mandatory for MRI?

A

yes, > 90 dB

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21
Q

MRI contraindications

A

schrapnel, vascular clips, shunts, spiral ETT, pacemaker, some tattoo ink

22
Q

Is deep sedation advisable for MRI?

A

No, you don’t have good access to the pt

23
Q

Which procedures often require deliberate hypotension and deliberate hypocapnia?

A

cerebral and dural AVM’s, coiling, etv.

24
Q

When may deliberate HTN be called for?

A

cerebral ischemia - want to maximize collateral blood flow

25
Q

Cerebral coiling

A
  • deep sedation –> GA spectrum
  • always 2 IV, art-line
  • fluid warmer, upper bair
  • ACT’s - goal 2-2.5x normal
26
Q

Why is smooth emergence so important in IR?

A

-prone to device migration or intracranial hemorrhage

27
Q

Stenosis of coronary artery >50-70% the normal diameter indicates…

A
  • pt considered hemodynamically significant

- after dilation of stenotic coronary artery, ventricular arrhythmias may develop

28
Q

Glucagon

A

-decreases spasm at sphincter of oddi, but can cause sinus tachycardia

29
Q

If sphincter of oddi manometry is being performed, which meds should be avoided?

A

glucagon, opioids, glycopyrrolate & atropine

30
Q

TIPS procedure

A
  • transjugular intrahepatic prtosystemic shunt
  • decompresses portal circulation
  • minimal stim, 2-3 hrs
31
Q

TIPS considerations

A
  • airway - aspiration
  • decreased FRC d/t ascites
  • esophageal varices
  • coagulopathy
  • hepatic encephalopathy
32
Q

ECT therapy response

A
  • grand mal (10-15 second tonic phase, 30-60 second clonic phase)
  • increased CBF & ICP
  • bradycardia –> HTN and tachy
  • muscle aches, fractures
  • sudden death
33
Q

Contraindications to ECT

A

absolute: pheochromocytoma
relative: increased ICP
recent CVA, CV conduction defects, high risk pregnancy, aneurysms

34
Q

ECT anesthesia considerations

A

-bite block
-maybe paralytic to prevent injury
-toradol 15-30 mg
-hyperventilate w/ 100%
goal = seizure lasting 30-60 seconds

35
Q

Preferred NMB for ECT

A

anectine (0.75-1.5 mg/kg)

36
Q

ECT: robinul & atropine

A

can prevent parasympathetic effects of ECT (salivation, bradycardia, asystole)

37
Q

ECT: labetolol & esmolol

A

labetolol 0.3 mg/kg
esmolol 1 mg/kg
aid in hemodynamic response, esmolol has lesser effect on seizure duration

38
Q

ECT: clonidine & precedex

A

control BP without effecting seizure duration

39
Q

Seizure activity causes…

A

initial parasympathetic discharge –> bradycardia.

40
Q

Are arrythmias a contraindication to ECT therapy?

A

not in themselves…need other reasons

41
Q

Most common cause of death with ECT

A

MI & arrythmias

42
Q

Dental surgery: ketamine

A 
IV = 1-2 mg/kg
IM= 2-4 mg/kg
oral = 5-10 mg/kg
43
Q

Minimal sedation (anxiolysis)

A

-respond normally, just chill

44
Q

Moderate sedation/analgesia

“conscious sedation”

A

-still follow commands either alone or with light tactile stim

45
Q

Deep sedation/analgesia

A
  • not easily aroused, but respond to noxious stim

- may need some airway support

46
Q

General anesthesia

A
  • not arousable

- cannot protect airway

47
Q

Ramsay scale

A

1-6
1- anxious
2- normal
6- no response

48
Q

Modified Aldrete

A

adds up
used in PACU
need 9 or better to get out of pacu

49
Q

NPO guidelines

A

meal - 8 hrs

clears 2-4 hrs

50
Q

PACU guidelines

A

VS q10 mins x 3
then q1hr x2, or until fully recovered using aldrete score
if pt was resus, then need an hour

Advanced Anes. Spring 21 (7 decks)

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