Patient Induction

Question 1

oxygen rates

Answer 1

semiclosed system: 50-100 mL/kg/min
maintenance: 22-44 mL
non-rebreathing system: 130-300 mL/kg/min or 1-2 L/min

Question 2

what roles does fluid therapy have in surgery?

Answer 2

maintains hydration and compensates for vasodilation, decreased cardiac output, and fluid loss

Question 3

what are the different reflexes?

Answer 3

palpebral, corneal, menace, papillary light, dazzle, pinnal, pedal

Question 4

what are the different tones?

Answer 4

jaw, general, anal

Question 5

what are the different eye positions?

Answer 5

central, ventromedial, rolled back

Question 6

stages and planes of anesthesia

Answer 6

stage 1: awake/pre-induction
+/- stage 2: excitement phase
stage 3: plane 1- light anesthesia, plane 2- moderate anesthesia, plane 3- deep anesthesia, plane 4- anesthesia overdose
stage 4: moribund

Question 7

what tools are used to monitor anesthesia?

Answer 7

electrocardiography, pulse oximetry, capnography, BP: direct or NIBP, body temperature, +/- esophageal stethoscope/doppler

Question 8

getting ready for anesthesia

Answer 8

select endotracheal tube, establish venous access, check anesthesia machine (leak test, anesthetic level, O2 level), get warming devices, know code (CPR/DNR), have crash kit ready

Question 9

how do you size an ETT?

Answer 9

measure width of ETT against the width of the patient’s nasal septum

Question 10

what are the 8 rights for getting prepared?

Answer 10

right patient, right medication, right dose, right route, right time, right documentation, right reason, right response

Question 11

what percentages are isoflurane and sevoflurane usually put on when first turned on?

Answer 11

isoflurane: 1-2%
sevoflurane: 2.5-3.5%

Question 12

how can a change in depth occur?

Answer 12

+/- increase ventilation, +/- gave injectable anesthetic, +/- attempt to decrease MAC

Question 13

induction

Answer 13

take pre-TPR, pre-oxygenation, and pre-med
intubate
connect to circuit with O2 at induction rate
inflate ETT and turn on anesthetic
ventilation: 8-20 Bpm
monitor
apply eye lubrication
IV fluids

Question 14

ETT cuff inflation leak test

Answer 14

1. connect ETT to anesthetic circuit, make sure O2 is on
2. close pop-off valve
3. connect 12 mL syringe to pilot balloon
4. place ear by patient’s mouth
5. give IPPV to 15-20 cm H2O
6. fill pilot balloon with air until the sound of air escaping stops
7. open pop-off valve
8. you can now safely turn on anesthetic

Question 15

maintenance of O2 rate

Answer 15

continue monitoring patient
O2 rate: rebreathing- 22-44 mL/kg/min, non-rebreathing- 1-2 L/min

Question 16

recovery

Answer 16

1. turn off anesthetic
   O2 rate: rebreathing- 50-100 mL/kg/min, non-rebreathing- 1.5-2.5 L/min
2. be ready to deflate ETT
3. be ready with a phase 2 rescue plan
4. extubate once swallow reflex is present
5. continue monitoring vitals and assess/treat pain