Safe Administration Of Anesthesia Flashcards
After surgery the patient is extubated in preparation for transfer to the recovery area. The patient’s respirations are stridorous. The patient is experiencing supraclavicular retractions. What is the first action taken to correct the patient’s condition?
The anesthesia provider will suction the pt’s airway to remove any irritant causing the laryngospasm
What helps determine a patient’s discharge destination?
-patient acuity
-Access to follow up care
-The potential for postoperative complications 
Sellick maneuver
Applying pressure on the cricoid cartilage to occlude the esophagus 
Primary risk factors for postoperative nausea and vomiting (PONV)
Female sex
Non-smoking status
History of PONV or motion sickness
Volatile anesthetics
Opioid use for pain control
Duration and type of surgery 
Moderate sedation monitoring
Capnography, entitled CO2
Depth of sedation scale
Consider BIS monitoring (twitch meter)
Infant/toddler discharge
Second responsible adult rides in backseat with child
Local anesthesia – esters
Cocaine, procaine, tetracaine
-Metabolized by pseudocholinesterase
-Process releases para-aminobenzoic acid (PABA), some people are allergic
Local anesthesia- Amides
Bupivacaine, lidocaine, mepivacaine
-Metabolized in the liver
Local anesthesia monitoring
At baseline and every 5 to 15 minutes during case
-Heart rate/rhythm
-Pulse
-Blood pressure
-Pulse oximetry
-Pain, anxiety, and LOC
Local anesthetic systemic toxicity (LAST)
High serum levels of the local anesthetic
-early signs usually appear around a minute after injection, but can be delayed for up to 30 minutes
-Frequent verbal communication with patient to assess for S/S
Patients at highest risk for LAST
-Advanced age
-Heart failure, ischemic heart disease, conduction abnormalities
-Liver disease
-Low albumin levels
-Metabolic or respiratory acidosis
-Medications that inhibit sodium channels
LAST initial phase
-metallic taste
-Numb tongue and lips
-Ringing in ears
-Lightheadedness
-Agitation
LAST excitation phase
-Shivering
-Slurred speech
-Confusion
-Seizures
-Tachycardia/hypertension
LAST depression phase
-Coma
-bradycardia/hypotension
-Ventricular arrhythmias
-Respiratory/cardiac arrest
LAST treatment
-hyperventilate with 100% O2
-establish IV access if not already there
-20% lipid emulsion
Max dose of 1% Lido
4-5 mg/kilogram/day
With epi 7 mg/kg
-epi is vasoconstrictor, absorption is slowed and prolonged
20% lipid emulsion dosage
1-1.5 ml/kg bolus over a minute
-can repeat bolus up to three times
-Then infusion add 0.25 ml/kg/min
Interscalene block complications
Horner’s syndrome
-Signs on the same side as the block
-Miosis (constricted pupil)
-Ptosis (droopy eyelid)
-Anhidrosis (decreased sweating)
Hoarse voice
Phrenic nerve paresis common (patient feels like they can’t breathe)
Supraclavicular block complications
Pneumothorax
Phrenic nerve paresis less common
Infraclavicular block
Short duration
Good pain control
Axillary block complications
Hematoma
Accidental vascular injection
-Reliability improving with ultrasound technique
Bier block
20 to 60 minute cases are ideal
Rapid onset <5 min
Motor function returns rapidly than sensation
For carpal tunnel
In what order do you deflate and inflate tourniquet for bier block when patient complains of pain?
Proximal is inflated at beginning
Distal cuff is inflated
Deflate proximal
At end of procedure distal is deflated
To rapid of a position change with a spinal or epidural can cause
Severe hypotension
-Due to no compensatory vasoconstriction
Peridural or epidural/caudal
Medication injected into epidural space
Longer duration, larger dose (on pump)
Onset in 15 to 30 minutes
Subdural or spinal/saddle
Medication injected into the spinal fluid (pops through Dura)
Lasts about two hours
Injected below L2
Onset in five minutes
Neuraxial anesthesia contraindications
-Patient is anticoagulated (bleeding disorders/pharmacological)
-Increased ICP
-Septicemia
-skin infection at the insertion site
-Pre-existing neurological disorders (MS)
-Cancer of brain/spinal cord
-Patient refusal
Neuraxial anesthesia complications
Respiratory depression
-Caused by sedatives used with regional anesthesia or high placement affecting phrenic nerve
-Treat underlying cause and maintain respirations
Bladder distention
-Sacral autonomic fibers are the last to recover
-Motor function returns before sensory function
Neuraxial anesthesia hypotension caused by
Decreased venous return and cardiac output
-Greatly enhanced by hypovolemia
Treatment :
-IVF
-Vasopressors
-slight head down position (5-10°)
Neuraxial anesthesia post dural puncture headache
-In Spinal anesthesia
-Accidental dural puncture in epidural anesthesia
-Noninvasive treatments: HOB flat, fluids, analgesics, caffeine, and sumatriptan
-invasive treatment: epidural blood patch
Anesthesia emergence – hypoventilation
Most common problem
-Muscle relaxant not fully reversed
-CNS depressants
Anesthesia emergence- laryngospasm
Secretions/trauma
Strider/coughing
Treat with 100% O2
Sedate and paralyze if complete spasm
Emergent delirium
Waking up wild
Stage 1 of anesthesia – analgesia
-Analgesia and amnesia; drowsy
-Conscious, can follow simple commands
Stage 2 of anesthesia – delirium/excitation
-Dream, excitement
-Unconscious
-Risk of laryngospasm and cardiac arrest
-Pupils dilated
-Rapid eye movement
Stage 3 of anesthesia – surgical stage/unable to protect airway
-first plane: regular respirations
-Second plane: regular, respirations, no longer moving
-Third plane: diaphragmatic respirations, optimal for Surgeon
-fourth plane: irregular respirations
Stage 4 of anesthesia – overdose
-Respiratory paralysis
-Deeper than necessary
Aldrete score
Used my PACU to determine if patient is ready for discharge
-Need at least a five
-Scores on activity, breathing, circulation, consciousness, oxygen saturation
The femoral block is well-suited for which surgery
Quadriceps tendon repair
Blocks thigh and knee
First thing done for a partial spasm
patient still moving air
-hyperextend the neck
-give 100% O2
-suction the airway to remove the irritation
