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ZANDER CNOR > safe administration of anesthesia part 2 > Flashcards

safe administration of anesthesia part 2 Flashcards

1
Q

How long does it take for lidocaine to be in tissue and not in vasculature for bier blocks?

A

15 minutes

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2
Q

Why is 15 minutes for lidocaine important?

A

you can’t have a procedure less than 15 minutes because it needs to get into the tissues

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3
Q

How does bier block?

A
  1. place IV in operative hand
  2. place 2 tourniquets on arm
  3. esanguinate limb
  4. inflate proximal cuff labeled A
  5. put 60 mL of lidocaine into the arm through the IV
  6. Inflate distal cuff labeled B
  7. deflate proximal cuff labeled A
  8. Take IV out before prep
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4
Q

What does a bier block create?

A

a bloodless field

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5
Q

Lidocaine has rapid onset less than what?

A

5 minutes

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6
Q

Motor function returns rapidly then what when it comes to amides and esthers?

A

motor function returns rapidly then sensation

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7
Q

How does motor function and sensation work?

A
  1. nerve goes numb
  2. you can’t move
  3. then you can move
  4. then you get sensation back
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8
Q

What is the order the cuffs go up with tourniquets for bier blocks?

A
  1. proximal up
  2. distal up
  3. proximal down
  4. distal down
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9
Q

If a patient who got a bier block does not get any drugs within moderate sedation what can the patient do?

A

drive themselves home

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10
Q

The femoral block is well-suited for what surgery?

A

anterior thigh and knee like quadriceps tendon repair

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11
Q

The femoral block is good postoperative pain after what 2 surgeries?

A

femur and knee surgery

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12
Q

If you are doing nerve stimulator technique for a femoral block, what muscle would you see twitching?

A

quadricep twitch

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13
Q

Neuraxial anesthesia is what?

A

amide or esther in the form of epidural and spinal

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14
Q

For spinal anesthesia, where is the medication going to go?

A

goes into cerebrospinal fluid.

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15
Q

How does spinal work?

A
  1. Inject spinal needle
  2. feel it pop through the dura
  3. CSF leaks out.
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16
Q

Where does an epidural go?

A

tissue space outside of the dura

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17
Q

How does epidural work?

A
  1. advance spinal needle
  2. feel tough resistance of dura
  3. pull back a smidge
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18
Q

What is important for epidurals? why?

A

aspirate before injection because the epidural vein runs through that tissue space

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19
Q

What is the most common accidental injection site for LAST?

A

epidural. Bupiv in the epidural vein can cause LAST

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20
Q

What do epidurals and spinals facilitate?

A

motor, sensory and autonomic block of nerve roots and spinal cord

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21
Q

How do we want to position patients with neuraxial anesthesia?

A

position and transfer patients with care due to lack of motor/sensory function

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22
Q

What 2 things should we pay attention to with neuraxial anesthesia?

A
  1. body alignment
  2. too rapid a position change can cause severe hypotension
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23
Q

Peridural or epidural/caudal where is the medication injected?

A

into epidural space

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24
Q

What can Peridural or epidural/caudal be used for?

A

postoperative pain

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25
Q

What is longer with Peridural or epidural/caudal?

A

longer duration

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26
Q

What is larger with Peridural or epidural/caudal?

A

larger dose

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27
Q

Where does Peridural or epidural/caudal go?

A

thoracic and lumbar region

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28
Q

Peridural or epidural/caudal is preferred for?

A

obstetrics

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29
Q

Onset for Peridural or epidural/caudal is how many minutes?

A

15-30 minutes

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30
Q

Subdural or spinal/saddle medication is injected into the?

A

spinal fluid

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31
Q

Subdural or spinal/saddle lasts how long?

A

2 hours

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32
Q

Subdural or spinal/saddle injected below what?

A

L2

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33
Q

Subdural or spinal/saddle is not for what?

A

postoperative pain

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34
Q

Onset of Subdural or spinal/saddle is how many minutes?

A

5 minutes

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35
Q

Is it ok to leave an epidural catheter in the epidural space? spinal catheter in the subdural sapce?

A

yes; that is why it is good post op pain

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36
Q

What commonly do we use for epidurals?

A

ropivicaine; it is more gentle with motor suppression and it lasts for 12 hourrs

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37
Q

What are 4 considerations (NOT contraindications) for neuraxial anesthesia considerations?

A
  1. history of spinal malformation
  2. previous spinal surgery
  3. psychological status
  4. high skill level required in children
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38
Q

What are neuraxial anesthesia contraindications?

A
  1. patient is anticoagulated - bleeding disorders, pharmacological
  2. increased ICP - do not need to add volume
  3. septicemia - meningitis
  4. skin infection at the insertion site
  5. pre-existing neurologic disorders - MS (accelerates disease)
  6. cancer of brain/spinal cord
  7. patient refusal
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39
Q

What are 2 neuraxial anesthesia complications?

A
  1. respiratory depression
  2. bladder distention
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40
Q

What is respiratory depression associated with neuraxial anesthesia usually caused by?

A

sedatives used with regional anesthesia OR high placement effecting phrenic nerve

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41
Q

What do we want to treat respiratory depression associated with neuraxial anesthesia?

A

treat the underlying cause and maintain respirations

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42
Q

What are the last to recover in neuraxial anesthesia?

A

sacral autonomic fibers

43
Q

What does the patient not sense in neuraxial anesthesia because of the sacral autonomic fibers?

A

patient does not sense a full bladder

44
Q

REMEMBER motor function returns before what?

A

sensory function

45
Q

With bladder distention offer a what?

A

offer bedpan or urinal

46
Q

What BP issue is associated with neuraxial anesthesia complications?

A

hypotension

47
Q

Hypotension associated with neuraxial anesthesia occurs in what?

A

1/3 of patients

48
Q

What happens during hypotension with neuraxial anesthesia?

A

decreased venous return and cardiac output GREATLY enhanced by hypovolemia (CHF, dialysis)

49
Q

What are 3 treatment options for hypotensive neuraxial anesthesia complications?

A
  1. IVF
  2. vasopressors
  3. slight head down positions (5-10 degrees)
50
Q

What kind of headache is associated with neuraxial aanesthesia?

A

Post Dural Puncture Headache (PDPH)

51
Q

For spinal anesthesias to prevent PDPH, use what?

A

pencil point needles preferred over beveled

52
Q

PDPH can occur from accidental what?

A

dural puncture in epidural anesthesia

53
Q

Noninvasive treatments for PDPH with neuraxial anesthesia include what?

A

HOB flat, fluids, analgesics, caffeine, and sumatriptan (for migraines)

54
Q

Invasive treatment for PDPH?

A

epidural blood patch (venous blood injected into epidural space)

55
Q

Hypoventilation is the most common what?

A

postop complication

56
Q

Where does hypoventilation come from with anesthesia? (2 things)

A

Muscle relaxants not fully reversed, CNS depressants

57
Q

What is consideration for hypoventilation?

A

maintain respirations

58
Q

Emergence delirium is more common in men or females?

59
Q

Emergence delirium often occurs in what age group?

A

adolescents

60
Q

What are patients in when they are in emergence delirium?

A

dream state

61
Q

What is the best treatment for emergence delirium?

A

time and safety

62
Q

Laryngospasm is what kind of reflex?

A

drowning reflex

63
Q

encourage what with laryngospasm?

A

coughing!!

64
Q

Give what with laryngospasm?

65
Q

If laryngospasm is severe what do we do?

A

sedate and paralyze

66
Q

If you have difficult intubation what could have?

A

trauma and swelling

67
Q

What do you give with trauma/swelling?

A
  1. 100% O2
  2. vaporized epinephrine
68
Q

What do you give for bronchospasm?

A
  1. 100% O2
  2. bronchodilators
69
Q

General anesthesia is a state of what?

A

being unaware and unresponsive to painful stimuli

70
Q

What are the 4 aspects of general anesthesia?

A
  1. lack of conscious awareness
  2. lack of perception of pain
  3. lack of movement
  4. modification of autonomic responses
71
Q

Lack of conscious awareness means what?

A

unconsciousness

72
Q

Lack of perception of pain from what?

73
Q

Lack of movement from what?

A

muscle relaxant

74
Q

Modification of autonomic responses still comes with what?

A

increase in HR and BP

75
Q

When is the excitation phase of induction?

76
Q

excitation phase of induction with general anesthsia has quick what with short what?

A

quick onset, short acting medications

77
Q

What meds are given during stage 2 of induction?

A

non-barbiturate hypnotics

78
Q

What stage of anesthesia do we do surgery?

79
Q

Excitement phase of induction you are going to lose what?

A

laryngeal reflexes

80
Q

Induction agents DO NOT provide what?

81
Q

Inhalation induction occurs often in who?

82
Q

Inhaled induction is also used in patients that lack what?

A

cooperation and comprehension

83
Q

What are 3 nursing considerations for general anesthesia?

A
  1. support ventilation, maintain open airway
  2. at risk for aspiration
  3. suction ready
84
Q

Stage I of induction is what?

85
Q

What are 3 characteristics of stage I?

A

analgesia and amnesia; drowsy

86
Q

What are patients in stage I of induction?

A

conscious, can follow simple commands

87
Q

Stage II of induction is what?

A

delirium/excitation

88
Q

What are 2 characterstics of stage II - delirium/excitation?

A

dream, excitement

89
Q

are patients conscious or unconscious in stage II - delirium/excitation?

A

unconscious

90
Q

there is a risk of what 2 things with stage II - delirium/excitation?

A

risk of laryngospasm and cardiac arrest

91
Q

Pupils are what in stage II - delirium/excitation?

92
Q

Stage III is the what of induction?

A

surgical stage/unable to protect airway

93
Q

the 1st plane of stage III - surgical stage/unable to protect airway is characterized how?

A

regular respirations

94
Q

the 2nd plane of stage III - surgical stage/unable to protect airway is characterized how?

A

regular respirations, no longer moving

95
Q

the 3rd plane of stage III - surgical stage/unable to protect airway is characterized how?

A

diaphragmatic respirations

96
Q

what plane of stage III is optimal for surgeon?

97
Q

the 4th plane of stage III - surgical stage/unable to protect airway is characterized how?

A

irregular respirations

98
Q

Stage 4 of induction is what?

99
Q

What happens to patients in stage 4 of induction?

A

respiratory paralysis

100
Q

Patients are what than necessary in stage 4 of induction?

101
Q

What is the aldrete score?

A

is a scoring system for readiness for discharge

102
Q

What are the 5 parts of the aldrete score?

A
  1. activity
  2. breathing
  3. circulation
  4. consciousness
  5. oxygen saturation
103
Q

You can be discharge from PACU with a what on the aldrete score? You can go home from PACU with a what?

A

PACU with an 8, go home with a 9

104
Q

Is there a regulatory requirement that you have to use the aldrete score?

A

no as long as you have outlined what your discharge criteria are you may or may not use the scoring system

ZANDER CNOR (15 decks)

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