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CNOR > Safe Administration Of Anesthesia > Flashcards

Safe Administration Of Anesthesia Flashcards

1
Q

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?

A

The anesthesia provider will suction the pt’s airway to remove any irritant causing the laryngospasm

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2
Q

What helps determine a patient’s discharge destination?

A

-patient acuity
-Access to follow up care
-The potential for postoperative complications 

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3
Q

Sellick maneuver

A

Applying pressure on the cricoid cartilage to occlude the esophagus 

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4
Q

Primary risk factors for postoperative nausea and vomiting (PONV)

A

Female sex
Non-smoking status
History of PONV or motion sickness
Volatile anesthetics
Opioid use for pain control
Duration and type of surgery 

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5
Q

Moderate sedation monitoring

A

Capnography, entitled CO2
Depth of sedation scale
Consider BIS monitoring (twitch meter)

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6
Q

Infant/toddler discharge

A

Second responsible adult rides in backseat with child

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7
Q

Local anesthesia – esters

A

Cocaine, procaine, tetracaine
-Metabolized by pseudocholinesterase
-Process releases para-aminobenzoic acid (PABA), some people are allergic

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8
Q

Local anesthesia- Amides

A

Bupivacaine, lidocaine, mepivacaine
-Metabolized in the liver

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9
Q

Local anesthesia monitoring

A

At baseline and every 5 to 15 minutes during case
-Heart rate/rhythm
-Pulse
-Blood pressure
-Pulse oximetry
-Pain, anxiety, and LOC

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10
Q

Local anesthetic systemic toxicity (LAST)

A

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

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11
Q

Patients at highest risk for LAST

A

-Advanced age
-Heart failure, ischemic heart disease, conduction abnormalities
-Liver disease
-Low albumin levels
-Metabolic or respiratory acidosis
-Medications that inhibit sodium channels

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12
Q

LAST initial phase

A

-metallic taste
-Numb tongue and lips
-Ringing in ears
-Lightheadedness
-Agitation

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13
Q

LAST excitation phase

A

-Shivering
-Slurred speech
-Confusion
-Seizures
-Tachycardia/hypertension

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14
Q

LAST depression phase

A

-Coma
-bradycardia/hypotension
-Ventricular arrhythmias
-Respiratory/cardiac arrest

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15
Q

LAST treatment

A

-hyperventilate with 100% O2
-establish IV access if not already there
-20% lipid emulsion

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16
Q

Max dose of 1% Lido

A

4-5 mg/kilogram/day
With epi 7 mg/kg
-epi is vasoconstrictor, absorption is slowed and prolonged

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17
Q

20% lipid emulsion dosage

A

1-1.5 ml/kg bolus over a minute
-can repeat bolus up to three times
-Then infusion add 0.25 ml/kg/min

18
Q

Interscalene block complications

A

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)

19
Q

Supraclavicular block complications

A

Pneumothorax
Phrenic nerve paresis less common

20
Q

Infraclavicular block

A

Short duration
Good pain control

21
Q

Axillary block complications

A

Hematoma
Accidental vascular injection
-Reliability improving with ultrasound technique

22
Q

Bier block

A

20 to 60 minute cases are ideal
Rapid onset <5 min
Motor function returns rapidly than sensation
For carpal tunnel

23
Q

In what order do you deflate and inflate tourniquet for bier block when patient complains of pain?

A

Proximal is inflated at beginning
Distal cuff is inflated
Deflate proximal
At end of procedure distal is deflated

24
Q

To rapid of a position change with a spinal or epidural can cause

A

Severe hypotension
-Due to no compensatory vasoconstriction

25
Q

Peridural or epidural/caudal

A

Medication injected into epidural space
Longer duration, larger dose (on pump)
Onset in 15 to 30 minutes

26
Q

Subdural or spinal/saddle

A

Medication injected into the spinal fluid (pops through Dura)
Lasts about two hours
Injected below L2
Onset in five minutes

27
Q

Neuraxial anesthesia contraindications

A

-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

28
Q

Neuraxial anesthesia complications

A

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

29
Q

Neuraxial anesthesia hypotension caused by

A

Decreased venous return and cardiac output
-Greatly enhanced by hypovolemia
Treatment :
-IVF
-Vasopressors
-slight head down position (5-10°)

30
Q

Neuraxial anesthesia post dural puncture headache

A

-In Spinal anesthesia
-Accidental dural puncture in epidural anesthesia
-Noninvasive treatments: HOB flat, fluids, analgesics, caffeine, and sumatriptan
-invasive treatment: epidural blood patch

31
Q

Anesthesia emergence – hypoventilation

A

Most common problem
-Muscle relaxant not fully reversed
-CNS depressants

32
Q

Anesthesia emergence- laryngospasm

A

Secretions/trauma
Strider/coughing
Treat with 100% O2
Sedate and paralyze if complete spasm

33
Q

Emergent delirium

A

Waking up wild

34
Q

Stage 1 of anesthesia – analgesia

A

-Analgesia and amnesia; drowsy
-Conscious, can follow simple commands

35
Q

Stage 2 of anesthesia – delirium/excitation

A

-Dream, excitement
-Unconscious
-Risk of laryngospasm and cardiac arrest
-Pupils dilated
-Rapid eye movement

36
Q

Stage 3 of anesthesia – surgical stage/unable to protect airway

A

-first plane: regular respirations
-Second plane: regular, respirations, no longer moving
-Third plane: diaphragmatic respirations, optimal for Surgeon
-fourth plane: irregular respirations

37
Q

Stage 4 of anesthesia – overdose

A

-Respiratory paralysis
-Deeper than necessary

38
Q

Aldrete score

A

Used my PACU to determine if patient is ready for discharge
-Need at least a five
-Scores on activity, breathing, circulation, consciousness, oxygen saturation

39
Q

The femoral block is well-suited for which surgery

A

Quadriceps tendon repair
Blocks thigh and knee

40
Q

First thing done for a partial spasm

A

patient still moving air
-hyperextend the neck
-give 100% O2
-suction the airway to remove the irritation

CNOR (14 decks)

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