Quiz 3 Flashcards
top 3 (in order) closed claims
Death
Nerve injury
Brain damage
Airway injuries
Sore throat (Most common side effect) Arytenoid dislocation Dysphagia Dental injury (most common injury) TMJ Esophageal perforation Vocal cord paralysis (forceful intubation) Vocal cord granuloma (large tubes/long intubation)
Role of positioning
Patient
position
procedure
complication related to positioning for nerve injuries
hypotension
Complication for sitting, prone, reverse trend? Prevention?
Air embolism
maintain venous pressure above zero at the wound
complication for supine, lithotomy, trend? Prevention?
Alopecia
Normotension, padding, head turning
Complication of particularly Lithotomy
Compartment syndrome
Maintain perfusion pressure, avoid external compression
High risk cases of awareness
Trauma
Open Heart
OB
Risk factors for awareness
Female Previous awareness Age (younger adults) Clinician experience Emergency procedures After normal hours of operation Obesity Use of nondepolarizing relaxants
what level MAC for amnesia?
1/3 MAC
Most common cause of post operative loss of vision? Etiology?
Ischemic Optic Neuropathy
Optic nerve infarction due to decreased oxygen delivery via one or more arterioles supplying the optic nerve
contributing Pt conditions r/t eye injuries?
HTN
DM
CAD
Smoking
Surgical factors to ION (Ischemic Optic Neuropathy)
- Intraoperative deliberate hypotension
- Anemia
- Prolonged surgical time in position that compromises venous outflow (Prone, Head down, Compressed abdomen)
Prevention of ION:
- Enhance venous outflow by positioning the patient head up.
- Minimize abdominal constriction.
- Monitor blood pressure carefully with arterial line.
- Limit degree and duration of deliberate hypotension
- Avoid anemia in patients at risk for ION.
- Consider staging long surgical procedures in patients at risk for ION
s/s prior to arrest?
- Gradual decline in heart rate and BP (20% below baseline values)
- Bradycardia
- Hypotension
- Cyanosis
treatment for bradycardia unresponsive to Atropine?
Small doses Epi (5-10 ug)
how much intravascular volume can you lose to anaphylaxis response?
up to 50% to capillary leaking
Type I reaction (immediate)
- Atopy
- Urticaria
- angioedema
- Anaphylaxis
Type II reaction (Cytotoxic)
- Hemolytic transfusion reactions
- Autoimmune hemolytic anemia
- Heparin-induced thrombocytopenia
Type IV reaction (Delayed, cell-mediated)
Contact dermatitis
Graft rejection
Type III reaction (immune complex)
Rheumatoid Arthritis
Serum sickness
chance of anaphyaxis in OR?
1 in 5k - 1 in 25k
mediators of anaphylaxis
Histamine
Leukotrienes
BK-A
Platelet-activating factor
clinical manifestations of anaphylaxis
- Cardiovascular - hypotension, tachycardia, arrhythmias
- Pulmonary - bronchospasm, cough, dyspnea, pulmonary edema, laryngeal edema, hypoxia
- Dermatologic - urticaria, facial edema, pruritus
Risk factors associated with hypersensitivity to anesthetics
Female gender d/t cosmetics
Atopic history
Preexisting allergies
Previous anesthetic exposure
first thing to do if anaphylaxis occurs?
d/c drug administration
Treatment of anaphylactic and anaphylactoid reactions:
Discontinue drug administration first thing to do
Administer 100% oxygen
Epinephrine (0.01-0.5mg IV or IM)
Consider intubation or tracheostomy
Intravenous fluids (1-2 liters Lactated ringers)
Diphenhydramine (50-75mg IV) H1 blocker
Ranitidine (150mg IV) H2 blocker
Hydrocortisone (up to 200 mg IV) or methylprednisolone (1-2mg/kg)
what makes ppl susceptible to a muscle relaxant allergy?
Over the counter drugs, cosmetics, and food products that contain tertiary or quaternary ammonium ions may sensitize susceptible individuals
most common to least common muscle relaxant drug that causes anaphylaxis?
Rocuronium
succinylcholine
atracurium
other anesthetic drugs that can cause anaphylaxis?
Pentothol (1 in 30k)
Propofol (1 in 60k)
antibiotics that cause anaphylaxis?
B-lactam antibiotics - Penicillin, Cephalosporin
Sulfonamides
Vancomycin - “Red man’s syndrome”
second most common cause of anaphylaxis during anesthesia?
Latex allergy
Occurance of MH? adults and peds
Pediatrics 1:15k
Adults 1:40k
s/s MH
Increased carbon dioxide production ETCO2 Increased oxygen consumption Low mixed venous oxygen tension Metabolic acidosis Cyanosis Mottling Tachycardia some books say most sensitive, but not specific enough to MH Initial hypertension Arrhythmias
S/S muscle damage of MH
Masseter spasm Generalized rigidity Elevated serum creatine kinase Hyperkalemia Hypernatremia Hyperphosphatemia Myoglobinemia Myoglobinuria
S/S MH hyperthermia
Fever
Sweating
core temperature can rise as much as 1C every 5 minutes LATE SIGN
what receptor issue for MH
Ryanodine
what does Bicarb do for MH
Pushes K back into cells
S/S Bronchospasm?
Prolonged expiration
High inflation pressures
Expiratory wheezes
Decreased oxygen saturation
