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2-General Anesthesia Exam 2 > Resp/Neuro monitoring > Flashcards

Resp/Neuro monitoring Flashcards

1
Q

What is the difference between ETCO2 and PACO2?

A

Approximately 5 torr, up to 10 torr

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2
Q

Define capnometry.

A

Encompasses all means of measuring carbon dioxide

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3
Q

Define capnography..

A

Recording of the measurement of carbon dioxide

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4
Q

Define capnogram.

A

Uses infrared analysis, A continuous display of carbon dioxide

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5
Q

What are the two forms of capnogram?

A

Nondiverting and diverting

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6
Q

Define nondiverting/mainstream monitor.

A

Measures gas directly within the breathing system

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7
Q

What are the advantages of nondiverting/mainstream monitoring?

A

Minimal time delays, no scavenging necessary

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8
Q

What are the disadvantages of nondiverting/mainstream monitoring?

A

Cannot measure gases other than carbon dioxide and nitrous oxide, increased deadspace

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9
Q

Define diverting/sidestream monitor.

A

Extracts gas from sample tubing near the patient end of the circuit and pushes it into monitor

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10
Q

What are the advantages of diverting/sidestream monitoring?

A

Minimal increase in deadspace, versatile gas analysis

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11
Q

What are the disadvantages of diverting/sidestream monitoring?

A

Need for scavenging, risk of contamination from secretions

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12
Q

Id the A-B portion of the waveform. What does this mean?

A

Baseline (anatomic deadspace)

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13
Q

Id the B-C portion of the waveform. What does this mean?

A

Expiratory upstroke (deadspace and alveolar gas)

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14
Q

Id the C-D portion of the waveform. What does this mean?

A

Expiratory plateau (alveolar gas)

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15
Q

Id the D portion of the waveform. What does this mean?

A

End-tidal concentration

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16
Q

Id the D-E portion of the waveform. What does this mean?

A

Descent to original baseline (inspiration)

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17
Q

Capnogram – What is occurring?

A
  • Rebreathing – Waveform fails to return to baseline
  • Caused by inadequate fresh gas flow or depleted absorber
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18
Q

Capnogram – What is occurring?

A
  • Prolonged expiration
  • Caused by obstruction of expired gas flow or ventilation-perfusion mismatch
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19
Q

What respiratory commorbities could cause this? (3)

A

Asthma, bronchospasm, COPD, etc.

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20
Q

Capnogram – What is occurring?

A

Curare Clefts

  • Spontaneous respiratory effort in an anesthetized patient who is mechanically ventilated and/or paralyzed
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21
Q

Be able to differentiate hyperventilation from hypoventilation.

A

Slide 90

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22
Q

Capnogram – What is occurring?

A
  • Loss of end tidal waveform – Dislodged ETT or ETT disconnected
  • Sudden loss of circulation, e.g. PE
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23
Q

What can increase ETCO2?

A
  • Increased carbon dioxide delivery or production
  • Hypoventilation
  • Equipment problems
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24
Q

What can decrease ETCO2?

A
  • Decreased carbon dioxide delivery or production
  • Hyperventilation
  • Equipment problems
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25
Q

What are spirometry loops (pressure volume Loops)?

A

Assess changes in lung compliance and resistance

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26
Q

What relationship do spirometry loops (pressure volume Loops)demonstrate?

A

Relationship between (pressure and volume) or flow and volume

  • Flow on vertical axis
  • Volume on horizontal axis
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27
Q

Understand pressure loops picture.

A

Slide 94-97

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28
Q

Describe the relationship of flow volume loops and obstructive diease.

A

Reduced peak flow rate and sloping of expiratory limb occurs as small airways close during expiration, reducing the flow rate during expiration; can’t get the air out (COPD, asthma)

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29
Q

Describe the relationship of flow volume loops and restrictive diease.

A

Normal or heightened peak expiratory flows with a very narrow loop reflecting reduced vital capacity

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30
Q

What are some characteristics of restrictive disease?

A

Can’t get the air in- scarring of the lungs, interstitial dz: sarcoidosis); neuromuscular disorders; obesity

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31
Q

Identify the difference between spontaneously breathing patients flow volume loops and mechanically ventilated patients.

A

Slide 98

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32
Q

What does pulse oximetry measure?

A

heart rate and percent of oxygen saturation (SaO2) of hemoglobin continuously and non-invasively

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33
Q

What is true about oxgenated verus unoxygenated hemoglobin?

A

Oxygenated hgb absorbs light at a different wavelength than unoxygenated hgb

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34
Q

What type of light absorbs deoxygenated light more?

A

At a red wavelength between 650 and 750nm reduced oxygen hgb absorbs more light than oxyhemoglobin

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35
Q

What type of light absorbs oxygenated HGB more?

A

In infrared wavelengths of 900-1000nm oxyhemoglobin absorbs more light than reduced oxygen hgb

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36
Q

What is the algorithm that determines light absorption?

A

The algorithm used to determine the SaO2 based on light absorption is derived from the Beer-Lambert law

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37
Q

How does pulse oximetry differentiate pulsatile flow?

A

Uses plethysmography to differentiate pulsatile flow

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38
Q

Pulse oximetry: Shown to be accurate within 2% when oxygen saturation is between _______-_______%

A

80-100%

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39
Q

Pulse oximetry: Shown to be accurate within 5% when saturation falls below ____%

A

below 80%

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40
Q

What are some other locations for pulse oximetry?

A

Forehead, ear or nose probes shown to have comparable accuracy and reliability

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41
Q

What are some causes of abnormal hemoglobin that could result in false pulse oximetry readings?

A

Methemoglobin, carboxyhemoglobin, sickle cell anemia, injectable dyes (methylene blue or indigo carmine)

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42
Q

Review the oxyhemoglobin curve.

A

Slide 101-102.

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43
Q

Why are ORs kept at a low temperatures? (3)

A
  • Cool to decrease bacterial growth
  • Surgeon comfort
  • Slows the solidification of bone cement
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44
Q

What are complications of the hypothermic patient? (5)

A
  • Delayed wound healing
  • Impaired coagulation
  • Unstable cardiac cycle
  • Vasoconstriction (esp. CAD pts)
  • Shivering
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45
Q

How can shivering effect oxygen requirements?

A

Shivering (increased oxygen requirements 400%)

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46
Q

What are the types of temperature monitoring?

A
  • Bladder
  • Pulmonary artery
  • Esophageal
  • Nasopharynx
  • Tympanic
  • Axillary
47
Q

What is true about axillary temperature monitoring?

A
48
Q

What are the different types of heat loss?

A

Radiation, Convection, Conduction & Evaporation

49
Q

Define radiation.

A

Transfer of heat energy to environment

50
Q

Define convection.

A

Loss of heat via air currents

51
Q

Define conduction.

A

Transfer of heat by physically touching less warm objects

52
Q

Define evaporation.

A

Loss of energy when liquid is converted to a gas

53
Q

What is the most significant form of heat loss under anesthesia?

A

radiation

54
Q

What is the second most significant form of heat loss under anesthesia?

A

convection

55
Q

What are the components of neurological monitoring (4)?

A
  • Frequency
  • Amplitude
  • Morphology
  • Four common EEG waves
56
Q

Define frequency.

A

Rate of impulses or duration between impulses

57
Q

Define amplitude.

A

Peak to peak measurements in the vertical plane

58
Q

Define morphology.

A

shape

59
Q

What are the most common EEG waves (4)?

A

alpha, beta, delta and theta

60
Q

Define alpha brain waves.

A

Occurs with eyes closed during deep relaxation

61
Q

Define beta brain waves.

A

Normal awake consciousness, alertness, logic and critical thinking

62
Q

Define delta brain waves.

A

High amplitude; Associated with deep sleep

63
Q

Define theta brain waves.

A

Light sleep

64
Q

What effect does etomidate and propofol have on EEG?

A

Induction doses of etomidate and propofol increase EEG frequency and decrease amplitude of beta waves

65
Q

What effect does ketamine have on EEG waves?

A

abolition of alpha waves and dominance of theta

66
Q

What is possible on EEG with high doses of etomidate and propofol?

A

Burst suppression

67
Q

Variable effects on EEG _________ depending on class of medications

A

frequency

68
Q

Variable effects on EEG ______ depending on class of medications

A

amplitude

69
Q

What is burst suppression?

A

An electroencephalogram pattern observed in states of severely reduced brain activity, such as general anesthesia, hypothermia and anoxic brain injuries

70
Q

What is the EEG pattern associated with burst supression?

A

EEG pattern associated with alternating high voltage, mixed frequency, slow wave activity, along with periods of electrical suppression that last several seconds

71
Q

What effect does burst suppression have with anesthetic agents?

A

results in a large reduction in the cerebral metabolic rate of oxygen (CMRO2)

72
Q

When would burst suppression be advantageous?

A

Advantageous during manipulation of brain tissues for neuroprotection

73
Q

What is cerebral oximeter?

A
  • Monitors adequacy of oxygenation specific to the brain
  • Uses near infrared spectroscopy
74
Q

What does cerebral oximeter proveide?

A

measurements of oxygen supply versus demand within a region

75
Q

What does cerebral oximeter measure?

A

Measure the ratio of oxygenated hgb to total hgb within a region

76
Q

Nonquantitative cerebral oximeters use wavelengths of _____-______nm

A

730-810nm

77
Q

Quantitative cerebral oximeters utilize wavelengths of _____, _____,______ and _____ nm

A

775, 825,850 and 904nm

78
Q

What is the goal of cerebral oximeter?

A

Goal to maintain value at a minimum of 75% of baseline reading

79
Q

What is transcranial doppler ultrasonography?

A

Non-invasive measure of blood flow velocity within the large arteries of the brain

80
Q

What is transcranial doppler ultrasonography detect?

A

Detects instances of hypo and hyperperfusion

81
Q

What is transcranial doppler ultrasonography usually measure?

A

middle cerebral artery flow

82
Q

What is Jugular Bulb Oxygen Venous Saturation?

A
  • Measurement of mixed venous blood from the jugular bulb
  • Estimates degree of global oxygen extraction by the brain
83
Q

Where does the jugular blood receive drainage?

A

from both left and right cerebral hemispheres

84
Q

Jugular bulb drainage: ________b% from ipsilateral hemisphere and _______% from contralateral hemisphere

A

70% from ipsilateral hemisphere and 30% from contralateral hemisphere

85
Q

What are the two optical fibers of the jugular bulb catheter?

A

One emits light and one absorbs light and transmits it to a photosensor

86
Q

What does jugular bulb reading indicate?

A

Jugular bulb reading between 55-75% indicative of more positive outcomes in TBI if ICP remains normal

87
Q

What are the different evoked potentials?

A
  • SSEPs – Somatosensory evoked potentials
  • MEPs – Motor evoked potentials
  • BAEPs – Brainstem auditory evoked potentials
  • VEPs – Visual evoked potentials
88
Q

What are evoke poentials used for?

A

Used to guide surgical strategy and warn of neurologic deficits to prevent irreversible damage

89
Q

What three components of waveforms are monitored for evoke potentials?

A

General appearance, Amplitude & Latency

90
Q

Define amplitude.

A

Intensity of the evoked response

91
Q

Define latency.

A

Indicative of the time necessary for the evoked response to be measured in the brain

92
Q

What changes in evoke potentials are associated with cerebral ischemia?

A

50% decrease in amplitude or a 10% increase in latency

93
Q

What is the relationship between evoke potentials and inhalational agents?

A

Inhalational agents (generally) have greater depressant effect on evoked potentials compared with IV anesthetic agents

94
Q

What are somatosensory evoked potentials (SSEPs)?

A

Monitor the integrity of neural structures along the peripheral and central somatosensory pathways of the brain and spinal cord

95
Q

What is SSEPS induced by?

A

Induced by stimulating peripheral nerves electrically, which contain both motor and sensory components

96
Q

What is the anesthetic plan with SSEPs?

A
  • Narcotic based anesthetics, TIVA, or 0.5 or less MAC
  • No nitrous oxide
  • Administration of neuromuscular blocking agents acceptable if motor responses not required
97
Q

Review graph.

A

Slide 115.

98
Q

What is Motor evoked potentials (MEPs)?

A
  • Monitor the functional integrity of motor tracts, particularly in the corticospinal tract
  • Gold standard for monitoring motor pathways
99
Q

What is the stimuli for MEPS?

A

electrical or magnetic

100
Q

What is electomyography (EMG)?

A

can be both passive and active to allow for awareness of what nerves are being stimulated with surgical manipulation

101
Q

MEPS: What is needed for thyroidectomy or head and neck surgery?

A

Nerve integrity monitoring ETT for recurrent laryngeal nerve monitoring

102
Q

MEPS: What should be avoided?

A

Avoid use of neuromuscular blocking agents

103
Q

What is Brainstem auditory evoked potentials (BAEPs)?

A

Monitor the entire auditory pathway from the distal auditory nerve to the midbrain

104
Q

What does Brainstem auditory evoked potentials (BAEPs) used?

A

Uses a repeating click via an earphone placed in the auditory canal

105
Q

What is the anesthetic plan for Brainstem auditory evoked potentials (BAEPs)?

A
  • Avoid lidocaine infusion
  • Inhalational agents have proportional dose dependent effect
  • Avoid even mild hypothermia
  • Avoid hyperventilation
106
Q

What are Visual evoked potentials (VEPS)?

A

Monitor the function of the visual pathway, which comprises the retina to the occipital cortex

107
Q

What does VEPS use?

A

Uses a series of visual stimuli

  • Pattern stimulus used in awake patients
  • Flash stimulus used in anesthetized/sedated patients
108
Q

What is BIS?

A

Analysis and processing of EEG electrical signals resulting in a numeric value between 0 and 100 which represents the patient’s level of consciousness

109
Q

BIS Values: 100 equals ______

A

Awake

110
Q

BIS Values: 80-100 equals ______

A

Responds to verbal stimuli

111
Q

BIS Values: 60-80 equals ______

A

Responds to loud verbal/physical stimuli

112
Q

BIS Values: 40-60 equals ______

A

adequate general anesthesia

113
Q

BIS Values: <40 equals ______

A

Deep hypnotic state

114
Q

What is a BIS <40 associated with?

A

lasting for greater than 5 minutes may be associated with increased postoperative mortality

2-General Anesthesia Exam 2 (11 decks)

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