Preparing For Anesthesia Flashcards
Bigeminy
PVC on every other heartbeat
Arrhythmia
Trigeminy
PVC on every third beat
Arrhythmia
Clear liquids
2 hours before
Breast milk
4 hours before
Infant formula
6 hours before
Light meal (toast, apple sauce)
6 hours before
Full fatty meal or fried foods
8 hours before minimum
Gum and candy
Increase gastric secretions
ASA 1 (or P1)
Normal healthy patient
No smoking, minimal or no alcohol use
No physiologic, psychologic, biochemical, or organic disturbance
ASA 2 (or P2)
Mild systemic disease, no substantial functional limits
Current smoker, BMI 30-40, well controlled DM/HTN
Asthma
ASA 3 (or P3)
Severe systemic disease w/ health issues, cardiac or pulmonary limiting activities
BMI >40, poorly controlled DM/HTN, COPD, pacemaker
Renal failure, dialysis
ASA 4 (or P4)
Severe systemic disease, threat to life, severely low EF
Requires regular medical intervention
Sepsis, DIC, ESRD no dialysis, cardiac ischemia, valve disease
ASA 5 (or P5)
Not expected to survive without surgery within 24 hours, near-death
Cerebral trauma, ruptured aneurysm, multiple organ failure, large PE
ASA 6 (or P6)
Declared brain dead
Organ procurement
Normal range for hemoglobin levels in adult woman
12 g/dL-16 g/dL 
Normal range for hemoglobin levels in adult men 
14 g/dL- 18 g/dL
Perioperative briefing process includes
Identification of the patient
Introduction of team members
Signed consent
All required documentation 
Person responsible for granting permission for a parent to accompany a child into the operating room is
Anesthesia professional 
Liver disease increases risk for
-anesthesia related complications
-bleeding due to increased liver enzymes
Liver produces vitamin K
Addiction causes:
-liver changes
-Esophageal varices
-pancreatitis
-malnutrition
-Withdraw (tremors, palpitations, clammy, skin, nausea, vomiting)
Renal dialysis
-fluid and electrolyte imbalances common
-Medications metabolized in the kidneys avoided
-Should know last time of dialysis
Burn patients
Prone to hypothermia
Fluid and electrolyte imbalances are common
Diabetes
-Glucose control can be a challenge
-Prone to high blood pressure, GERD
-Delayed wound healing
-Stress from injury/surgery increases glucose level
Diabetes insipidus
-Causes body to make large amount of urine
-Be mindful in surgeries involving the pituitary or hypothalamus or head trauma
-Treat with fluid ML/ML urine output
-vasopressin or desmopressin (DDAVP): antidiuretic hormones
Smokers
-7 to 8 weeks for Ciliary function to return
Helps clear airway up, cough things out
Elevated blood pressure
120-129 / less than 80
High blood pressure, hypertension stage one
130-139 / 80-89
High blood pressure hypertension stage two
140 or higher / 90 or higher
Hypertensive crisis
Higher than 180 and/or higher than 120
Hemophilia
Factor VIII deficiency
Synthetic factor VIII replacement throughout surgery, started in preop
Pregnancy
Check on all females from 11 to 55
Always position off vena cava, elevate right side
Have fetal heart monitor
-20 weeks or more
-20 weeks or less, monitor in preop/PACU
CHF
Prone to fluid overload
NPO and don’t take the diuretic
Under anesthesia, they dilate and need fluid 
Morbid obesity
BMI >40
Wound healing compromised
Difficult intubation common
Positioning can make ventilation difficult
-Decreased tidal volume, increased work of breathing
-ex: jackknife(kraske), prone
Obesity
BMI >30
Overweight
BMI >25
COPD
Low O2 stimulates breathing not high CO2 (normal ppl-breathing stimulated by high CO2 levels)
No rebreather
NC 2 L mask
Want low concentration O2 (<30%)
When is postop ventilator needed?
Tidal volume lower than 500ml in an adult
PCO2 >45
Rheumatoid arthritis
-Joint immobility- creative positioning
-Causes anemia, low hemoglobin
-Steroid coverage puts them at risk for an impaired stress response (hypo-adrenal crisis)
Sickle cell anemia
Specific anesthesia management
Avoid triggers
-Hypothermia (bair hugger, room can go over 75° for these patients)
-Hypotension
-Hypovolemia (can have clear liquids with calories two hours before surgery, Gatorade)
-Hypoglycemia (glucometer checks)
-Hypoxia
Infant
up to 18 months
-Sooth with pacifier
-Hold and rock
Toddler
18 to 30 months
-Separation anxiety
-Communicate with simple sentences
-Soothe with distraction and familiar objects
-include caregiver as member of team
Preschooler
2 1/2 to 5 years
-May believe they are in the hospital because they are in trouble
-Fear pain and mutilation, abandonment
-Provide independence when possible, have them help
-Communicate using compound sentences
-stories and imagination
School-age
6 to 11 years old
-Give honest simple information
-Able to be more cooperative
-give positive reinforcement
-Watch for loose teeth
Adolescent
12 to 18 years old
-Fear loss of privacy
-Body image is important
-talk to about good incision care
-hypersensitive to the opposite sex as caregivers
-Give honest information
How should neck alignment be maintained for young infants?
Neutral neck alignment
Young infants have short tracheas
Pediatric considerations
-very sensitive to heat loss
-Weigh sponges to keep accurate count of blood loss (1g = 1ml)
-Decompensate more suddenly/recover quickly
Newborn physiology of thermoregulation
-immature vasomotor control
-no shiver response prior to six months old
-Low muscle mass
Elderly physiology of thermoregulation
-Poor peripheral vasomotor control
-Low muscle mass
-Ineffective shiver response
Postop Pediatrics considerations
-semi prone for oral procedures
-Swaddle an infant to maintain position and comfort
-May need safety restraints to maintain tubes and drains
What is the best postop position for pediatrics?
Lateral
-Allows drainage or excess bleeding to be easily assessed
-keeps airway open
Braden scale
Assesses skin breakdown, the higher the score the less risk
Risk factors scored 1-4
-sensory perception
-Moisture
-Activity
-Mobility
-Nutrition
-Friction/shear
Braden scale- severe score
Less than 10
Braden scale – high risk score
10 to 12
Braden scale – moderate score
13 to 14
Braden scale – mild score
15 to 18
Number of people for transferring patient that weighs 72 kg or more
Four people
Number of people to transfer a patient that weighs less than 72 kg
Three people
Number of people to transfer a patient that weighs less than 20 kg
Two people
Obturator nerve
Closest to the surface in the groin
-Can be damaged during lithotomy
-Some devices or equipment leaning on the pt
-Pain and numbness of the inner thigh (years to recover)
Popliteal nerve
Common peroneal nerve and tibial nerve in posterior knee
-Weight of leg on thighs and knees, when in boot stirrups and candy canes
-1 to 4 months to recover
-Prone to re-injury
Sciatic nerve
-External rotation of the hips
-Lower vascular procedures, lithotomy, herniated disc
-Recovers without surgery in 80 to 90% of patients
Peroneal nerve
Runs laterally to hip and knee
-Can assess by having patient dorsiflex foot (toes to nose)
-Injury with long leg casts, lateral hip and total knee procedures, positioning
Saphenous nerve
Is medial to hip and knee
-Injury from vein harvest or stripping procedures
Brachial plexus
At Shoulders
-Injury increases when head is turned to the side
-some recover, some have permanent disability
Where does the kidney rest positioner go?
On the dependent iliac crest
What does ax roll help with?
Brachial plexus
Dependent lung to expand
Common types of hemodynamic monitoring
Central venous pressure (CVP)
Swan-Ganz catheter
Arterial line
Hemodynamic monitoring for what type of patients ?
Blood pressure
-Heart disease
-Respiratory disease
-High risk/type of surgery
-Shock
Central venous pressure
Pressure in the right atrium
-Normal 4 to 8 mmHg
-Low= hemorrhage, venous pooling, vasodilation
-High= pulmonary hypertension, pulmonary edema, right ventricular failure
Swan-Ganz catheter
Intra-jugular or subclavian, usually on the right side
-sits in pulmonary artery
-Risk: microshock from laparoscopic instruments with break in insulation 
Arterial line
For continuous monitoring of blood pressure
-Required for infusion of Nipride or other hemodynamic drugs requiring tight control
-Frequent blood test, ABGs
-Radial artery most commonly used
-Allen test before insertion
After transfer of a tonsillectomy patient to the transportation vehicle, which of the following positions should a patient be placed to facilitate drainage?
Semi prone
An eight year old boys being prepared for surgery. As the anesthesia provider is about to start the IV, the boy begins to cry. The most appropriate action at this point would be to:
Give the patient psychological support through tactile contact and verbal reassurance
In the instruction of an eight year old child, reasonable grasp of the information can often be ensured by the use of:
Audiovisual equipment
