Outpatient Anesthesia Flashcards

1
Q

What are the advantages for outpatient anesthesia?

A
COST
-Moedical cost
-Cost of the family
-Third party payers review/identify procedures suitable for outpatient to reduce costs
MEDICAL
-Increase number inpatient beds
-Decrease exposure to nosocomial infection
SOCIAL
-Minimize interruption of ADL
-Continued care from caregiver or family members
STAFFING
-Predictable surgical outcomes
-More uniform schedule
-Time utilization efficient
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2
Q

What are the disadvantages of outpatient anesthesia?

A
  • Privacy may be decreased/compromised
  • Screening may require multiple tirps
  • Adequate care at home
  • Patient compliance
  • Decreased time for orientation/adaptation
  • Decreased observation post-op
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3
Q

What are the demographic considered for outpatient anesthesia?

A
  • 30 % less than 12 y/o
  • 10 % greater than 65 y/o
  • Premature babies are the exception of outpatient anesthesia
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4
Q

What is the surgical time length of outpatient surgery?

A
  • Usually less than 2 hour

- Rare to exceed 4 hours

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5
Q

What are characteristics of an acceptable outpatient procedure?

A
  • Minimal blood loss and fluid shifts
  • Surgeon skill
  • Postoperative pain/immobilization
  • Facility to facility abilities
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6
Q

What is the most common procedure at outpatient surgeries?

A

Opthalmologic

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7
Q

What is the second most common precedure at outpatient surgery?

A

Gynecological

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8
Q

What shold be considered for every patient?

A
  • Acute substance abuse
  • Age
  • Convulsive disorder
  • Morbid obesity
  • Reactive airway
  • Sickle cell disease
  • Social consideration
  • Cystic fibrosis
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9
Q

Patient with substance abuse considerations are?

A
  • evaluation day of surgery
  • Cancellation of acute/intoxicated drug abuse
  • Consideration of regional technique with use of NSIADS to reduce opioid use
  • Discussion of pain management with the patient
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10
Q

What are the unacceptable characteristics in a premature infant ?

A
UNACCEPTABLE 
-anemia
-Underdeveloped gag reflex
-Immature temperature control
-Apnea
(OF NOTE IN PEDS COURSE INFANTS SHOULD NOT BE CONSIDERED UNTIL OR AFTER 50 - 60 WEEKS POST CONCEPTION)
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11
Q

Important points on apnea of the premature infant.

A
  • Short (6-15 seconds)
  • Prolonged (greater than 15 seconds)
  • Periodic breathing (3 or more period of apnea of 3-15 seconds separeated by < 20 seconds of normal breathing
  • Can develop as late as 12 hours post op
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12
Q

T/F: Considering physiologic not chronologic age of a geriatric patient is important.

A

TRUE

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13
Q

T/F: Geriatric patient greater than 85 years of age are at less risk for hospital admisison and death within the week following week of surgery?

A

FALSE

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14
Q

Convulsive disorder in the outpatient surgery:

A
  • Schedule early in the morning to allow longer observation of up to 4 to 8 hours post op
  • Ensure proper delivery of anticonvulsant medication
  • Uncontrolled seizure activity is not acceptable in the outpatient setting
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15
Q

Cystic fibrosis in the outpatient surgery:

A
  • Pulmonary function is the primary predictor

- Ability to manage respiratory distress and hydration

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16
Q

Morbid Obesity in the outpatient surgery:

A
  • Candidate are ASA 1 & 2
  • Comorbidities such as cardiac endocrine hepatic renal or pulmonary should be inpatient
  • Increase risk for difficult airway and sleep apnea
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17
Q

Reactive airway disease in the outpatient surgery:

A

-Base line status and severity determined prior to suregery
-patient should not experience acute symptoms
-Continue meds until time of surgery
-expect possible admissions
-

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18
Q

Sickle cell disease in the outpatient surgery:

A
  • may occur if patient subject to hypoxia, acidosis, dehydration
19
Q

What are the criteria for outpatient if patient has sickle cell disease?

A
  • No major organ disease
  • No sickle cell crisis for 1 year
  • Compliant medical history
  • Early appointment
20
Q

History and physical for a stable patient should be within __ days or within __ hours for the high risk patient.

21
Q

Lab values are good within __ days of surgery if patient is stable.

22
Q

If a patient is on diuretic/digitalis a potassium must be drawn within how many days?

23
Q

If coumadin is withheld it should be a minimum of _ to _ day and restarted _ to _ day after surgery.

A

4 to 5

1 to 7

24
Q

How long after should surgery be rescheduled for a upper respiratory tract infection?

25
When is fluid management considered?
- Surgery longer than 30 minutes - Increased PONV - Increased post op pain - Prolonged fasting - Bleeding - antibiotics
26
What are contributors to PONV?
- Ambulation - Postural hypotension - Uncontrolled pain - post op pain meds - oral intake - Low inspired O2 concentration - Reversal agent
27
What is seen in Phase 1 after surgery?
- Stable VS - No resp. impairment - Protective airway reflexes - Patient oriented to preoperative level
28
What is seen in Phase 2 after surgery?
- Ambulation assistance - No resp distress - Bleeding minimal - pain controlled - PONV minimal - Oral intake - Voiding - Caregiver present
29
T/F: MAC has a higher incidence of brain damage and death than general or regional anesthesia.
TRUE
30
What is deep sedation?
- Patient unable to be easily aroused - Responds appropriately to pain - May need assist to maintain airway
31
What is minimal sedation?
- Patient responds verbally but cognitive function may be impaired - Resp/CV function unchanged
32
What is moderate sedation?
- Physician can direct | - Patient should not be allowed to loose protective airway reflexes
33
What is the first line of treatment for laryngospasm?
-Positive airway | Second option is Succinylcholine 0.1 mg/kg IV
34
What are the pharmacology options for blood loss management of a D&C?
-Methylergonovine maleate (Methergine) (0.2 mg/IM) _Oxytocin(Pitocin) (10-20 units/IV
35
T/F: Methylergonovine mateate (Methergine) can be given to the patient with preeclampsia.
FALSE
36
With cervical dilitation your patient becomes bradycardic and hypotensive; why and the treatment?
- Vasovagal response | - Release of cervix and treatment with atropine 0.4 mg IV if needed
37
What is the adequate level for a hysteroscopy?
-T10
38
T/F: Nasotracheal tube is preferred placement in dental surgeris.
TRUE
39
Damage to lingual nerve during surgical tooth extraction will cause numbness to:
Tongue
40
Damage to inferioralveolar nerve during surgical tooth extraction will cause numbness to:
Lip
41
T/F: Nasal airway should NOT be placed for difficult mask ventilation of a tonsilectomy/adenoidectomy.
TRUE
42
Adult patient arries for T&A that has fever, nasal secretions, purlent sputum. Do they have the surgery?
No, they show signs of URTI
43
What is the post op position of the T&A patient?
Tonsilar position (Lateral, head down posstion)
44
What is the most common complication of knee arthroscopy?
-Hemarthrosis