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Anesthesiology > Required Reading-Preop/Airway > Flashcards

Required Reading-Preop/Airway Flashcards

1
Q

Majority of anesthetic complications are due to ___ injuries; these result from ____.

A

respiratory; difficult intubation, difficult airway, poor dentition

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2
Q

Factors affecting mask ventilation (5)

A

(1) Beard (2) BMI>26 (3) Missing teeth (4) Age>55 (5) Snoring

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3
Q

Determine preop CV functional capacity with _____. A score of greater or equal to ____ have better periop outcomes in NONcardiac surgery.

A

metabolic equivalent [MET] activity; 4 [raking leaving, weeding or pushing power mower; MET scores 1-12]

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4
Q

If sx not urgent, then active cardiac condition/clinical risk factors should be assessed preop. If cleared, low-risk sx have

A

endoscopic procedures, superficial procedures, cataract, breast, most ambulatory surgeries

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5
Q

Intermediate-risk sx for CV include ____. High-risk sx include ____

A

intraperitoneal, intrathoracic, carotid endarterectomy, head/neck, orthopedic; aortic, major vascular, peripheral vascular

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6
Q

Patients with a MET

A

heart rate control; cardiac testing

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7
Q

Pulmonary patient-related periop risks:

A

smoking, poor general health (ASA>2), age>70, obesity, COPD, reactive airway dz (asthma)

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8
Q

Pulmonary PROCEDURE-related periop risks:

A

surgery >3hr, gen anesthesia, type of sx, pancuronium

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9
Q

Risk reduction for pulmonary risks (A) preop (B) periop (C) postop

A

(A) smoking cessation for 8wks, tx COPD/asthma, Abx for URI, incentive spirometry (B) limit

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10
Q

Important to remember that hepatic dysfunction can cause ____ and ____.

A

altered coagulation; altered drug pharmacokinetics

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11
Q

GI dz can increase potential of ____, ____, ____ and ___.

A

aspiration; dehydration; electrolyte disturbances; anemia

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12
Q

All diabetics should be evaluated for ____, ____ and _____. Most docs will avoid ___ anesthesia due to peripheral neuropathy.

A

CAD, HTN, nephropathy (Cr levels); regional

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13
Q

Diabetics need to take ___ of morning dose insulin on day of surgery; if elective, should do earlier in day to avoid _____.

A

half; prolonged fasting

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14
Q

Physical exam consists of vitals, airway eval, cardiopulm, GI, MSK and neuro exam. Airway exam assesses ___

A

Mallampati score, facial trauma, large incisors, beard, large tongue, neck masses, tracheal deviation, thyromental distance (

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15
Q

Important to look at chronic pain and ___ use, because may lead to increased requirements during surgery. Also look for long-term ___ use, which can lead to ____ and may require supplementation during sx.

A

opioid; steroid; adrenal insufficiency

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16
Q

Supplements: ___ and ___ can potentiate anticoagulation meds, ___ can prolong anesthesia, ___ can cause arrhymias

A

ginko; garlic; St Johns Wort; Ephedra

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17
Q

Poss preop studies and indicated dz: (A) CBC (B) T/S & albumin (C) PT/PTT (D) Electrolytes

A

(A) CBC; EtOH, anemia, radiation therapy, etc. (B) T/S & albumin; hematologic dz, malnutrition (C) PT/PTT; hepatic dz, Fhx bleeding, anticoag (D) Electrolytes; renal dz, DM, etc.

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18
Q

Poss preop studies and indicated dz: (E) BUN/Cr (F) Glucose (G) AST/ALP (H) EKG (I) CXR

A

(E) BUN/Cr; cancer w/ chemo, renal dz, digoxin/diuretics (F) Glucose (G) AST/ALP; EtOH, cancer w/ chemo, statins (H) EKG; statins, digoxin, radiation, etc. (I)CXR; smoking hx, radiation therapy, rheumatoid arthritis, etc.

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19
Q

The purpose of the ____ is to discuss w/ pt or rep the types of anesthetic options available for planned procedure and explain risks/benefits

A

anesthesia consent form

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20
Q

ASA Class ___ is a normal and healthy patient

A

1

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21
Q

ASA Class ___ is a pt w/ mild systemic dz

A

2

22
Q

ASA Class ___ is a pt w/ severe systemic dz that limits activity, but is a constant threat to life

A

3

23
Q

ASA Class ___ is a pt w/ incapacitating system dz that is constant threat to life

A

4

24
Q

ASA Class ___ is moribund pt not expected to survive 24h w/ or w/o sx

A

5

25
Q

ASA ___ designates emergency surgical procedure

A

E

26
Q

If a pt is perceived as difficult to intubate/ventilate, obtain ____.

A

fiberoptic equipment and skilled help

27
Q

If pt has heart dz/valve dz or risk of subacute bacterial endocarditis, consider ____ 1h prior to sx

A

prophylactic abx

28
Q

If pt Fhx malignant hyperthermia, have ___ ready

A

dantrolene

29
Q

If pt on MAOIs, discontinue therapy preop if pt not ____ and plan for periop pain therapy

A

suicidal

30
Q

If pt has peripheral motor neuropathy, avoid _____ drugs

A

depolarizing muscle relaxants

31
Q

If pt pregnant, use ____

A

oral antacids [monitor FHTs]

32
Q

Types of anesthesia are __, ____, ___ and ___

A

general, MAC (monitored anesthesia care), regional, local

33
Q

The best way to assess CV risk is asking about ____

A

exercise tolerance

34
Q

DO NOT quit smoking w/in a short period before sx because will increase ___ and ____ temporarily. Must try to quit greater than ___ weeks preop.

A

coughing; sputum production; 8

35
Q

Difficult laryngoscopy is defined as when no portion of ____ is visualized.

A

glottis (vocal cords and space)

36
Q

Medical conditions that portend difficult airway include ___

A

hx facial trauma/sx, rhuematoid arthritis, pregnancy, epiglottitis, previous cervial fusion, neck masses, Down’s syndrome, Treacher-collins, Pierre-Robin abnormalities

37
Q

Increasing difficult laryngoscopy correlated with Mallampati Class ____ and ___

A

3; 4

38
Q

Mask ventilation needs optimal ____, ____ visualized as pt in “sniffing” position, and sufficient ____ to overcome resistance of upper airway.

A

seal; oropharynx; positive pressure

39
Q

Mask ventilation is to augment a pt’s spontaneous ____ before definitive airway management.

A

tidal volumes

40
Q

___ can be used in pts receiving gen anesthesia w/ no endotracheal intubation and in situations when mask vent is difficult.

A

LMA

41
Q

LMA does NOT enter the _____, therefore pts tolerate it with less anesthetic; also, LMA does NOT protect against ____ to same degree.

A

glottis; pulmonary aspiration

42
Q

Contraindications to LMA include ___, ____, ____ and ___

A

increased risk pulmonary aspiration; pts w/ PEEP ventilation; long procedures; any position other than supine

43
Q

Common errors in direct laryngoscopy include ____ and ____

A

inserting blade too deeply; improperly sweeping tongue from line of signt

44
Q

MC laryngoscope blades are ____ [curved} and ____ [straight]

A

Macintosh; Miller

45
Q

Because of anatomical narrowing at level of cricoid cartilage in children ____ tubes are used and a seal forms directly between tube and trachea.

A

uncuffed

46
Q

Endotracheal intubation is gold standard b/c reduces possibility of ____ and increases amount of ____ that can be achieved via mech ventilation.

A

aspiration via gastric juices; positive airway proessure

47
Q

Risk factors for aspiration have to do with having eaten and include :

A

trauma pts, emergency sx (not fasting), pregnant pts in labor, GERD, DM/obesity, neurological impairment

48
Q

In order to dec time when pt awake (intact laryngeal m protecting from aspiration) and endotracheal tube, a ____ can be done.

A

RSI (rapid sequence induction)

49
Q

Rapid sequence induction does NOT use ____ (avoiding stomach distention), ____ pressure is maintained , and ___ is muscle relaxant drug of choice

A

mask ventilation; cricoid [surrounds trachea and will collapse esophagus lumen]; succinylcholine [rocuronium if burn or SC injury pts]

50
Q

Fiberoptic intubation can be accomplished in ____/____ patients.

A

awake [w/ local anesthesia]; anesthetized

51
Q

Two types of video assisted endotracheal intubation include ___ and ___ and are used if limited mouth opening.

A

Glidescope, C-Trach

Anesthesiology (3 decks)

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