Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spring '20/ L. BASICS- Immune, OR Hazards, OP > OR Awareness > Flashcards

OR Awareness Flashcards

1
Q

The biggest fears intraoperatively:

A

Awareness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Explicit Memory =

A

Conscious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Implicit Memory =

A

Unconscious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Conscious recollection of previous is what type of memory

A

explicit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Memory equivalent to remembering is

A

Experience(s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Awareness during anesthesia describes

A

conscious recall (explicit memory ) of Intraop events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Patients can respond to commands and lack conscious recall in what form of memory?

A

Implicit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Questions to evaluate awareness:

Brice Questionnaire

A
  1. )What was the last thing you remember bf going to sleep?
    2) What is the first thing you remember after your operation?
    3) Can you remember anything in b/w?
    4) Can you remember if you had any DREAMS during the procedure?
    5) What was the worst thing about your procedure?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Incidence of awareness US & Sweden:

A

12,000 patients (sweden)
0.18% (18/10,000) had awareness under GA w/NMBD

.10% (10/10,000) had no NMB
0.13% (13/10,000) overall incidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Awareness most likely in:

A

-Co-exisiting morbidities
-OB
Cardiac procedures (EMERGENT/light sedation)
-Patients with INCREASED anesthesia requirements
-anesthetic delivery problems (machine, meds, circuit)
-When volatile anesthetics aren’t used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why would you have light anesthesia?

A

hemodynamic intolerance
OB or Cardiac surgeries
Reduced anesthetic doses for safety of hypovolemic or limited cardiac reserves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Patients Requiring increased Anesthesia:

A

ASA 3-5 (in major surgery)
Abuse of ETOH or Drugs
Genetics (redheads)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MAC Dose known to prevent conscious recall is:

A

MAC >= 0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What might mask Awareness?

A

NMBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most Patients often recall:

A

Lights, sounds, feelings of helplessness, fear, anxiety

-pain is less common; may occur w/NMBD use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Psychological Sequelae is:

A
  • flashbacks, ANXIETY, nervousness, loneliness, nightmares, fear and panic attacks.
  • 1/3 patients who experience awareness manifest this
  • an acute emotional reaction to the experience significantly predicted the development of late psychological sequela.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Interventions for Psychological Sequelae

A

early psychotherapy may reduce acute and long term

-explain or validate the awareness effect presence and duration of psychological consequences.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

can patients report awareness?

A

yes - registry exists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Preop Evaluation to reduce awareness complications (box 47.1)

A

*Identify Risk Factors:
*Interview Patient:
-listen to pt fears. answer questions.
Obtain informed consent:
-talk to pt about the anesthesia procedure
-let them know what to expect –> MAC case vs
Regional w/sedation, vs. GA
-let them know they’ll get pain & antiemetics; more if
they need when awake.

20
Q

Use of BIS (bispectral index system)?

A

Used to aid anesthesia administration and reduce awareness

  • Not Gold Standard
  • clinical trials: if one more pt had reported awareness, they would not be statistically significant. (Hawthorne effect)
21
Q

Hawthorne Effect

A

the alteration of behavior by the subjects of a study due to their awareness of being observed.

22
Q

Prevention of Awareness:

A
  • Premed w/Benzo (VERSED)
  • Adequate doses of induction drugs
  • avoidance paralysis if possible
  • MAC at least 0.7
23
Q

Out of how many injuries from negligent care result in malpractice claims (and fewer when standard of care was delivered)?

A

1 out of 25

24
Q

Approx how many claims per year are made for awareness?

A

10 per year

25
Q

Factors that influence Awareness Lawsuits:

A
  • poor communication
  • unmet expectations
  • financial pressures on the pt
  • poor relationship with their physician/provider
26
Q

Brain Function monitoring

A
  • Assess depth of anesthesia (EEG activity) - BIS
  • frontal eeg activities into an index of hypnotic level
  • 100 (awake) to 0.
27
Q

BIS Range recommended to reduce consciousness during GA?

A

40-60

28
Q

Compared to routine care, BIS is shown to reduce awareness in use of:

A

TIVA (total IV anesthesia)

29
Q

Does BIS or End Tidal gas monitoring decrease awareness?

A

end tidal anesthetic gas monitoring

30
Q

Preinduction Phase of Anesthesia:

to prevent awareness complications (box 47.1)

A
  • Use checklist for machine/equip check
  • verify function of IV and infusion equip
  • Consider preop benzo
31
Q

Intraop Monitoring:

[ to prevent awareness complications (box 47.1)]

A
  • multiple modalities to monitor depth of anesthesia
  • clinical (purposeful or reflex movement)
  • conventional monitoring (bp, hr, end tidal analyzer)
  • brain function monitoring
32
Q

Intraop and postop managment:

to prevent awareness complications (box 47.1)

A
  • benzo may be needed if pt unexpectedly becomes conscious
  • speak w/pt postop
  • interview pt to determine pt experience (Brice questionnaire)
  • offer pt psychological counseling
33
Q

The anesthetic depth required to block implicit memory is GREATER THAN, OR LESS THAN that required to block explicit memory?

A

Greater than

34
Q

awareness is considered what form of memory?

A

explicit

35
Q

What types of patients tend to have awareness more frequently?

A

patients w/ co existing morbidities tend to have more frequent incidence of awareness

36
Q

tell me the three major causes of awareness

A

light anesthesia
increased patient anesthesia requirements
anesthetic delivery problems

37
Q

examples of when light anesthesia may be necessary:

A

due to hemodynamic intolerance of anesthetic drugs
OB or caridac surgeries
reduced anesthetic doses may be necessary for optimal physiology and safety in hypovolemic patients or those w/limited cardiac reserve.

38
Q

Name examples of when patients may have greater anesthesia requirements:

A
  • ASA 3-5 undergoing major surgery
  • abuse of ETOH, opioids, amphetamines and cocaine
  • Genetics
39
Q

Who else is also more likely to experience awareness?

A

Children (p. 813)

40
Q

Intraoperative awareness is more likely to happen during…

A

induction of anesthesia with N20 and IV administered anesthetics.

41
Q

Awareness is less likely to occur ….

A

when volatile anesthetics are used.

MAC 0.7 or greater

42
Q

what prevents us from seeing early signs of inadequate anesthesia?

A

NMB

-miss patient movement

43
Q

A MAC of 0.7 or more prevents ______ _____.

A

Conscious recall

44
Q

A MAC of 0.7 or more prevents conscious recall in anesthetized patients similar to that achieved by:

A

a brain function monitor of anesthetic depth.

45
Q

What early sign of awareness is unavailable when NMB ‘s are used?

A

patient movement

46
Q

what is important in the pathogenesis of awareness during anesthesia?

A

anesthetic technique

47
Q

intraoperative awareness can occur in the absence of

A

tachycardia or htn

Spring '20/ L. BASICS- Immune, OR Hazards, OP (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions