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Fundamentals of Anesthesia > Postanesthesia Care > Flashcards

Postanesthesia Care Flashcards

1
Q

How often should vital signs be recorded in PACU?

A

At least every 15 minutes

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2
Q

What kind of incidents accounted for more than half of PACU malpractice claims?

A

Critical respiratory incidents

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3
Q

What period of time postop-wise is the patient at risk for an airway obstruction?

A

Transport from the OR to the PACU.

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4
Q

What are three causes of residual depressant on pharyngeal tone in the immediate post-op period?

A

IV anesthetics
Inhaled anesthesia
NMB

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5
Q

How does the loss of pharyngeal muscle tone lead to pulmonary edema?

A

If not treated, the loss of pharyngeal muscle tone will cause an airway obstruction. Airway obstruction will increase negative pressure in the alveoli. The increased negative pressure will cause rupture of the alveoli and fluid will leak into the bronchioles.

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6
Q

What maneuvers can be used to open the airway?

A

jaw thrust
CPAP
Oral/Nasal airway
LMA/ETT

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7
Q

Which muscles recover first from a NMB, diaphragm or pharyngeal muscles?

A

Diaphragm

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8
Q

Who cares if the diaphragm recovers before the pharyngeal muscle?

A

We do! If the diaphragm attempts negative pressure ventilation, ventilation will be ineffective if the airway is obstructed because of a loss of pharyngeal muscle tone. This could lead to pulmonary edema.

Often times, this may be missed because an LMA or ETT is in place.

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9
Q

Regarding use of TOF, significant weakness may persist to a ratio of ___. Pharyngeal function does not return to baseline until an adductor pollicus TOF ratio is greater than ___.

A
  1. 7

0. 9

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10
Q

When assessing the reversal of a NMB, what maneuver is considered to be the gold standard?

A

5-second sustained head lift.

This shows generalized motor strength and shows the patients ability to maintain and protect the airway.

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11
Q

What may contribute to the return of neuromuscular weakness?

A

respiratory acidosis
hypothermia
residual inhalational/IV anesthetics and opioids
hypermagnesemia
hypocalcemia
excess succinylcholine d/t decreased plasma cholinesterase activity

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12
Q

What is laryngospasm?

How do you treat it?

A

Laryngospasm is the sudden spasm of vocal cords that completely occludes the laryngeal opening.
Treat with a jaw thrust, CPAP to 40cm H2O, and succinylcholine (0.1 to 1 mg/kg IV)

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13
Q

What factors can contribute to airway edema?

A
  • prolonged procedures in prone or trendelenberg position
  • aggressive fluid resuscitation
  • surgery on the tongue, pharynx, and neck can cause tissue edema and/or hematoma
  • Facial/sclera edema
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14
Q

If the possibility of airway edema exists, what should be done to assess airway patency prior to extubation?

A

Suction the airway pharynx
Deflate the ETT cuff
Occlude proximal end of the ETT
See if the pt can breathe around the ETT

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15
Q

T/F. Most patients are diagnosed with sleep apnea?

A

False

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16
Q

Which has a greater likelihood of respiratory depression, benzos or opioids?

A

Benzos more than opiods. Reverse with nalaxone 0.1-2mg Q 2-3min Max 10mg.

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17
Q

At sea level, a rise in PaCO2 from 40 to 80 mmHg may result in a PaO2 of approximately ___.

A

50 mmHg

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18
Q

T/F. Pulse oximetry is a reliable marker of ventilation.

A

False. etCO2 is better.

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19
Q

What is HPV? What will inhibit this?

A

Hypoxia pulmonary vasoconstriction

Inhaled anesthetics, vasodilators (nitroprusside, dobutamine)

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20
Q

Will a true shunt respond to supplemental O2?

A

No. Because in a true shunt, deoxygenated blood bypasses areas of ventilation and returns to the left atrium still deoxygenated.

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21
Q

The most common cause of postoperative pulmonary shunting is:

A

atelectasis

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22
Q

Anatomic shunts contribute to __% of CO.

A

2-5%. Due to bronchial circulation and thebesian veins

23
Q

What is a common cause of pulmonary edema in the intubated patient?

A

Biting down on the ETT, creating a negative pressure in the lungs.

24
Q

Elimination of ____ donors of ____ has decreased the incidence of TRALI.

A

female donors of FFP

25
Q

Name four underlying lung diseases or conditions that decreases diffusion capacity.

A

Emphysema
Interstitial lung disease
Pulmonary fibrosis
Pulmonary hypertension

26
Q

Name 7 risk factors associated with HTN in the PACU.

A 
Hx of essential HTN
Pain
Hypoventilation/hypercapnia
Emergence excitement
Advanced age (>55)
Hx of cigarette smoking
Preexisting renal disease
27
Q

Name two surgical procedures that dispose the patient to postop hypertension.

A

craniotomy

carotid endarterectomy

28
Q

Hypovolemia in PACU is usually due to ____.

A

decreased intravascular fluid (and preload).

29
Q

How can a spinal anesthetic block contribute to hypotension?

A

A residual SAB could block sympathetic innervation to the heart, leading to an increased parasympathetic innervation that would decrease HR/BP.

30
Q

What classification of drugs is the most common cause of anaphylactic reaction? How is it treated?

A

NMB.

Treat with epi

31
Q

Postop patients complain of chest pain what percentage of time.

A

8-20%

32
Q

The peak age for emergence excitement is ____.

A

2-4 years

33
Q

What may cause shivering in the postoperative patient who is otherwise normothermic? How would you treat?

A

Brain and spinal cord do not recover from anesthesia at the same rate; the spinal cord recovers faster. Uninhibited spinal reflexes may be manifested as clonic activity.
Treat with meperidine 12.5 to 25mg.

34
Q

What drugs are know to help with PONV? When should they be given?

A

Dexamethasone at the start of surgery

Zofran (serotonin receptor antagonist) within 30 minutes before the end of surgery.

35
Q

____ can be used to reverse the sedative effects of anticholinergics.

A

Physostigmine

36
Q

What are some treatments for laryngeal edema?

A

humidified air
diuretic
racemic epi - watch for rebound effect
dexamethasone

37
Q

What patients are at greater risk for developing negative pressure pulmonary edema?

A

Young muscular

Head/neck surgery

38
Q

There is a (direct/indirect) correlation between obesity and OSA. Individuals with OSA are (more/less) sensitive to opioids?

A

direct

more

39
Q

T/F. Patients with aortic stenosis are okay to receive a spinal for pain control.

A

False. Do not use spinals due to the potential for a sympathectomy – decrease pressure = decrease flow to coronary arteries

40
Q

If your patient is given a spinal and has a sudden drop in BP, what is the first intervention the provider can do?

A

Drop the HOB down to supine.

41
Q

Postoperative agitation is common in the PACU and may be caused by:

A 
hypoxia
hypercapnia
preexisting agitation
foley
hemorrhage
ketamine
sepsis
42
Q

Risk factors associated with higher incidences of PONV include:

A 
female - menstration increases PONV
non-smoker
opioids or pain
decreased vagal
N2O
duration of srugery
sickness r/t motion
gastric distention
43
Q

List six negative factors associated with hypothermia.

A 
decreased O2 delivery (left shift)
coagulopathy
increased O2 demand
decreased wound healing
decreased drug metabolism
decreased cerebral metabolic requirement of O2
44
Q

30mg of ketamine is equivalent to ___ mg of morphine

A

10

45
Q

5 categories of the aldrete score used to determine discharge of a postop patient include:

A 
activity (4 extremities on command)
breathing
circulation (within 20%)
Consciousness
SpO2 >92% on RA
46
Q

The chemoreceptor trigger zone is ___ the BBB.

A

outside the blood brain barrier

47
Q

Consequence of nausea and vomiting:

A

pain/discomfort
delayed discharge from the pacu
unanticipated hospital admission
increased incidence of pulmonary aspiration

48
Q

What is urinary retention?

A

Urinary retention despite bladder volume of 500-600ml. Occurs between 5-70%.

49
Q

Risk factors for urinary retention?

A 
Age >50
male
volume of intraoperative fluid infusion
duration of surgery
bladder volume on admission
type of surgery
pre-op meds: anticholinergics, B-blockers, narcs
50
Q

Renal dysfunction is __ml/kg/hr.

A

0.5ml/kg/hr

51
Q

What factors increase the risk for postoperative delerium?

A

hip fracture

bilateral knee replacement

52
Q

With TRALI, CBC shows WBC cound trending:

A

down due the sequestration of granulocytes within the lung and exudative fluid.

53
Q

What s/s would be seen with postobstructive pulmonary edema?

A

arterial hypoxemia manifested within 90 min

bilateral fluffy infiltrates on chest radiograph

Fundamentals of Anesthesia (3 decks)

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