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APA 2 > Outpatient Anesthesia > Flashcards

Outpatient Anesthesia Flashcards

1
Q

__ to __% of all procedures in the US performed on outpatient basis. This has increased the need for anesthetists and short acting anesthetics

A

60-70%

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2
Q

Advantages of outpatient setting

A

reduced costs, increases number of inpatient beds available, decreaseded exposure to nosocomial infections, minimal interruption in ADLS, more uniform staffing, predictable surgical outcomes

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3
Q

Disadvantages of outpatient setting

A

decreased privacy, screening may require multiple trips, need for adequate care at home, patient compliance, decreased time for orientation/adaptation, decreased observation post-op

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4
Q

What is the only age limit for outpatient setting

A

no premature babies

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5
Q

Surgical length is usually less than __ hrs and rarely exceeds __ hrs

A

2 and 4

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6
Q

Most common surgical procedure is ______ and the second are _______ surgeries

A

opthalmic / gynecologic

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7
Q

Anticipated surgery should be minimally ________ and have _____ post op problems or pain issues

A

invasive / insignigicant

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8
Q

If acute substance abuse/intoxication, the case should be ________

A

cancelled

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9
Q

What is a good anesthetic technique for someone with substance abuse problems or taking suboxone or methadone

A

regional anesthesia

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10
Q

What is considered a premature infant

A

37 weeks or earlier gestation

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11
Q

Premature infants are unacceptable, why?

A

Anemia, underdeveloped gag reflex, immature temperature control, apnea,

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12
Q

Apnea can develop as late as ___ hrs post op in the premature infant

A

12 hrs

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13
Q

Healthy former premature infants should be greater than ___ to ____ weeks postconceptual age. Each should be evaluated individally.

A

50 to 60

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14
Q

Infants displaying bronchopulmonary dysplasia should _____ be considered for surgery.

A

NOT

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15
Q

What puts an infant at increased risk of SIDS?

A

history of apnea/bradycardic events, siblings with SIDS

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16
Q

Children with prior history of apnea/bradycardia should be free of apnea/bradycardia for ___ months prior to surgery

A

6

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17
Q

Greater than 37 weeks gestation

A

full term infant

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18
Q

A healthy full-term infant that is free of any complications can be considered case by case at __ to ___ weeks of age

A

2 to 4

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19
Q

When considering the geriatric population it is wise to consider ________ age and not just chronologic age

A

physiologic

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20
Q

Those aged 85 years or greater are at greater risk for what?

A

Hospital admission and death within the week following surgery

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21
Q

What is important to consider when geriatric having surgery on outpatient basis?

A

must have adequate home care and transportation

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22
Q

When should someone with a convulsive disorder have a procedure

A

Very early in the day to provide optimal observation (min of 4-8 hrs postop)

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23
Q

T/F Uncontrolled seizure activity is not acceptable in the outpatient setting?

A

TRUE

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24
Q

A patient with cystic fibrosis needs to be evaluated very early. ______ function is the primary predictor. Need to consider ability to manage respiratory distress and hydration with these patients.

A

pulmonary

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25
Q

Malignant hyperthermia suscpetibility criteria

A

previous MH episode, masseter ridgity with previous anesthesia, 1st degree relative with MH episode or positive muscle biopsy

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26
Q

For someone that is MH susceptible, trigger free anesthesia myst be provided with at least ____ hr post-op observation

A

4

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27
Q

MH preparedness considerations

A

adequate monitoring, minimum of 36 vials of dantrolene, schedule early in day, overnight obsercation in the 23hr outpatient has been advocagted

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28
Q

Tell me about Ryanodex

A

250 mg/vial, reconsititute with 5 ml of sterile water, looks like orange propofol

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29
Q

Ryanodex dose

A

2.5mg/kg/IV up to 10 mg. Continue with 1 mg/kg Q4-6hrs for at least 24 hrs

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30
Q

If someone is morbidly obese with co-morbidities such as cardiac, endocrine, hepatic, renal or pulmonary….where should surgery take place?

A

inpatient

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31
Q

T/F Most recent information is BMI of 40 or less is considered acceptable for ambulatory surgery. BMI of 40 to 50 judged on case by case basis.

A

TRUE

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32
Q

T/F BMI greater than 50 considered very high risk and unacceptable for amublatory surgery center

A

TRUE

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33
Q

T/F Sickle cell crisis may occur if patient is subject to hypoxia, acidosis or dehydration

A

TRUE

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34
Q

Sickle cell disease criteria for outpatient

A

no major organ disease, no sickle crisis for minimum of one year, compliant medical care, schedule early appointment for optimum observation post-op

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35
Q

Unacceptable patient conditions for SDS

A

ASA III or IV (unstable conditions), active substance abuse, psychosocial problems, uncontrolled seizures, newly diagnosed or untreated OSA, uncontrolled diabetes, isolation necessary, post-op pain not controlled with oral meds

36
Q

T/F podiatrists are not physicians and can’t write History and Physicals

A

TRUE

37
Q

For stable patient, an H/P should be done within ____. For high risk it should be done within ______

A

30 days / 72 hrs

38
Q

Lab values are good within _____ days of surgery if patient is stable. Potassium level within ___ days if on a diuretic or dig

A

60 / 7 days

39
Q

Review slides

A

34 and 35

40
Q

IF coumadin is going to be held how many days prior to surgery should it be held and what should happen morning of surgery?

A

4-5 days / PT should be drawn

41
Q

Restart coumadin __ to ___ days post op

A

1 to 7

42
Q

New indication is that lisinopril should be continued up until surgery. What can this cause?

A

May not be responsive to phenylephrine and may have to resort to vasopressin

43
Q

Want to maintain glucose levels where?

A

below 180

44
Q

Rhinorrhea - 20 to 30% of all children have off and on most of the year. Children 2 yrs and younger have __ to ___ viral infections per year.

A

5 to 10

45
Q

T/F Recently acquired rhinorrhea 12-24 hrs prior to surgery or chronic condition is not contraindicated in otherwise healthy child.

A

TRUE

46
Q

Read slide 41

A

URTI symptoms

47
Q

Symptomatic URTI should be scheduled at least _____

A

4 weeks later

48
Q

Asymptomatic URTI can be done if what?

A

Child is older than 1 year, otherwise healthy and surgery is not on thorax or abdomen. AND ETT intubation is not planned

49
Q

Anesthesia increases respiratory complications __ to ___ fold

A

2 to 7

50
Q

What’s going to happen if baby smells like an ashtray

A

bronchospasm and laryngospasm

51
Q

Most used anesthetic technique in SDS

A

General

52
Q

Why should you use smaller ETT in SDS?

A

to decrease incidence of post extubation croup, sore throat, and increase ability to resume PO sooner

53
Q

With neuraxial blockade you want the _____ acting agent capable of providing adequate blockade without prolonging discharge

A

shortest

54
Q

Review regional advantages on slide 53

A

slide 53

55
Q

Regional anesthesia disadvantage

A

sympathetic block associated with spinal and epidural may complicate discharge with orthostatic hypotension, inability to empty bladder, PDPH, TNS

56
Q

Stage I means what

A

you need PACU nurse watching over you

57
Q

When can you go to stage II

A

If you can maintain your airway, not on oxygen, and doesn’t need any IV medications, can sit in chair

58
Q

In the geriatric patient, greatest risk for postop mortality is __ week

A

one

59
Q

A gentle jaw thrust with initial insule is OK, prolonged airway management is a _____ anesthetic

A

general

60
Q

MAC monitoring standards

A

pulse ox, BP, EKG, temp when clinically significant, capnography not required but ventilation assessment by adequate chest rise must be continuous

61
Q

Is the incidence of brain damage or death higher in MAC or General

A

MAC

62
Q

T/F Moderate sedation can be directed by physician performing procedure - depth should not allow loss of protective reflexes

A

TRUE

63
Q

Most common cause of hypotension

A

hypovolemia

64
Q

PAC and PVC causes

A

hypomagnesemia, hypokalemia, increased sympathetic tone, myocardial ischemia

65
Q

Post op laryngospasm

A

first line treatement is positive pressure. If unresponsive then succinylcholine 0.1 mg/kg IV

66
Q

Droperidol considerations

A

avoid in patients with pre-existing ECG abnormalites, recommend 2-3 hrs monitoring and 12-lead ECG following admin

67
Q

Least effective routes for pain meds

A

subq and IM

68
Q

Prominent ambulatory surgeries

A

D&C hysterospcopy, orthodontic/dental, shoulder arthroscopy, tonsilectomy/adenoidectomy, knee arthroscopy

69
Q

Pitosin can be given

A

IU and IV

70
Q

Methergine can be given ___ only. Also, do not give to HTN patient

A

IM

71
Q

D and C positioning

A

dorsal lithotomy, less than 40 degree abduction recommended

72
Q

With cervical dilation your patient becomes bradycardic and hypotensive. Why did this occur and what is the treatment?

A

Vasovagal response. Release of cervix and treat with atropine 0.4 mg IV if needed

73
Q

Hysteroscopy allows for examination of the _______ cavity

A

endometrial

74
Q

Position for hysteroscopy

A

lithotomy

75
Q

Intrauterine pressure should be less than ____ mmHg

A

200

76
Q

Adequate sensory level for hysteroscopy?

A

T10

77
Q

Nerves susceptible to damage with hysteroscopy from lithotomy position

A

femoral, lateral femoral cutaneous, obturator, saphenous

78
Q

Does muscle relaxation and GA always improve mouth opening in TMJ patients?

A

NO

79
Q

Who needs a GA requiring dental surgery?

A

mentally retarded, young children, patients with oral sepsis, patients with poorly controlled seizure disorders, patients presenting for TMJ procedures

80
Q

Tube placement for dental surgeries

A

nasotracheal

81
Q

Damage to the lingual nerve during surgical tooth extraction can cause what?

A

tongue numbness

82
Q

Damage to the inferior alveolar nerve during surgical tooth extraction can cause what?

A

lip numbness

83
Q

Preferred technique for shoulder arthroscopy

A

regional/GA technique, interscalene block, horner’s syndrome means block is working

84
Q

Do not premedicate what patients?

A

OSA or upper airway obstruction

85
Q

Hypercapnia during emergence can increase _______ which can increase _______

A

vasodilation / bleeding

86
Q

Most common complication of knee arthroscopy

A

hemarthrosis

APA 2 (7 decks)

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