Surg 102 Chapter 24 (B&K)--Part 1 Flashcards
Anesthesia is a specialty that requires knowledge of _____, _____, _____, and _____.
biochemistry, clinical pharmacology, cardiology, and respiratory physiology
The American Society of Anesthesiologists (ASA) was founded in _____.
1905
Selection of anesthesia in made by the _____ in consultation with the _____ and the _____.
anesthesia provider, surgeon, patient
Choosing the safest anesthesia agent and technique is a decision predicated on thorough _____, _____, and _____.
knowledge, sound judgement, and evaluation of each individual situation
Selection of anesthesia should be based on the following characteristics:
- provide maximum safety for the patient
- provide optimal operating conditions for the surgeon
- provide patient comfort
- have a low index of toxicity
- provide potent, predictable analgesia extending into the postoperative period
- produce adequate muscle relaxation
- provide amnesia
- have a rapid onset and easy reversibility
- produce minimum side effects
The patient’s ability to tolerate stress and adverse effects of anesthesia and the surgical procedure depends on _____; _____; and function of the _____, _____, _____, and _____.
respiration; circulation; and function of the liver, kidneys, endocrine system, and central nervous system (CNS)
The following factors are important to the patient’s ability to tolerate stress and adverse effects of anesthesia:
- age, size, and weight
- physical, mental, and emotional status
- presence of complicating systemic disease or concurrent drug therapy
- presence of infection at the site of the surgical procedure
- anticipated procedure
- position required for the procedure
- type and expected length of procedure
- local or systemic toxicity of the agent
- expertise of the anesthesia provider
- preference of the surgeon and patient
Both the _____ and _____ play essential roles in clinical anesthesia.
central and autonomic nervous systems
The effect of anesthetic drugs is one of _____.
progressive depression of the CNS
The anesthesia state involves control of _____, _____, _____, and _____.
motor, sensory, mental, and reflex functions
Specific drugs are used to achieve the desired results: _____, _____, and _____.
amnesia, analgesia, and muscle relaxation
ASA developed the taxonomy for classifying patients by physical status from class I, the _____, to class VI, the _____.
lowest risk, highest risk
ASA Class I includes:
relatively healthy patients with localized pathologic processes
ASA Class II includes:
mild systemic diseases (diabetes mellitus)
ASA Class III includes:
severe systemic disease that limits activity but is not totally incapacitating (COPD or hypertension)
ASA Class IV includes:
an incapacitating disease that is a constant threat to life (cardiovascular and renal disease)
ASA Class V includes:
moribund patients who are not expected to survive 24 hours with or without the surgical procedure. Operation is intended to save their life or a resuscitative measure
ASA Class VI includes:
declared brain dead but whose organs will be removed for donor purposes.
Minimal or light sedation (anxiolysis):
- patients respond normally to verbal command
- cognitive function and coordination may be impaired
- ventilatory and cardiovascular functions are unaffected
Moderate sedation/analgesia:
- a drug-induced depression of consciousness
- can respond purposefully to verbal commands
- no interventions are required to maintain a patent airway
- spontaneous ventilation is adequate
Deep sedation/analgesia:
- a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully after repeated or painful stimulation
- ability to independently maintain ventilatory function may be impaired
- may require assistance to maintain a patent airway
- spontaneous ventilation may be inadequate
Full anesthesia:
- drug-induced loss of consciousness during which patients cannot be roused, even by painful stimulation
- ability to independently maintain ventilatory function is often impaired
- often require assistance to maintain patent airway
- cardiovascular function may be impaired
Anesthesia may be produced in several ways, these include _____, _____, _____, and _____
general anesthesia, balanced anesthesia, local or regional block anesthesia, and spinal or epidural anesthesia
During general anesthesia, pain is controlled by _____.
general insensibility
Basic elements of general anesthesia include _____, _____, _____, and _____.
loss of consciousness, analgesia, interference with undesirable reflexes, and muscle relaxation
During balanced anesthesia, the properties of general anesthesia are produced, in varying degrees, by a _____.
combination of drugs
During local (or regional block) anesthesia, pain is controlled without loss of _____.
consciousness
During local (or regional block) anesthesia, the _____ in one area or region of the body are anesthetized.
sensory nerves
During spinal (or epidural) anesthesia, sensation is blocked at a level below the _____ without loss of consciousness.
diaphragm
During spinal (or epidural) anesthesia, the agent is injected into the _____.
spinal canal
In general anesthesia, association neurons are broken in the _____ to produce more or less complete lack of sensory perception and motor discharge.
cerebral cortex
In general anesthesia, unconsciousness is produced when _____ contains an adequate amount of the anesthetic agent.
blood circulation to the brain
During general anesthesia, the anesthesia provider must constantly observe the body’s reflex to stimuli and other guides to determine the degree of _____, _____, and _____ during induction and the surgical procedure.
CNS, respiratory, and circulatory depression
The three methods of administering general anesthetic are _____, _____, and _____.
inhalation, IV injection, and rectal instillation
Induction involves putting the patient safely into a state of _____.
unconsciousness
During induction, a _____ and _____ must be ensured.
patent airway and adequate ventilation
During induction, a _____ may be inserted to decompress the gastrointestinal tract and evacuate stomach contents.
nasogastric tube
During _____, the anesthesia provider may have the patient breathe pure (100%) oxygen by face-mask for a few minutes.
preoxygenation
The process of _____ provides a margin of safety in the event of airway obstruction or apnea during induction.
preoxygenation
During induction, _____ is induced by IV administration of a drug or by inhalation of an agent mixed with oxygen. (technique is rapid)
unconsciousness
During induction, a patent airway must be established to provide _____ and _____ of the unconscious patient.
adequate oxygenation and control breathing
The anesthesia provider evaluates the airway for the risk of difficult intubation using the _____.
Mallampati classification chart
While monitoring a patient for a possible difficult intubation, the anesthesia provider also checks _____, _____, and _____.
thyromental distance, neck flexion/extension range, and the ability to prognath (protrude the mandible)
During intubation an _____, _____, _____, or _____ may be inserted.
oropharyngeal airway, nasopharyngeal airway, laryngeal mask, or endobronchial tube
Physiologic indicators of a difficult airway include the following:
- inability to open the mouth (previous jaw surgery)
- immobility of the cervical spine (vertebral disease or injury)
- chin or jaw deformities
- dentition can be an issue if the patient has loose teeth or periodontal disease
- short neck or morbid obesity
- pathology of the head and neck (tumors, enlarged tongue)
- previous tracheostomy scar
- trauma
Intubation is insertion of an _____ between vocal cords.
endotracheal tube
Tubes may be made of _____, _____, _____, or _____
metal, plastic, silicone, or rubber
Most styles of tubes for adult sizes have a built-in cuff that is _____ with a measured amount of _____, _____, or _____ after insertion.
inflated
air, water, or saline
The anesthesia provider will be informed is a _____ will be used so that a laser-resistant endotracheal tube can be used.
laser
Neuromuscular blocking agents are given before intubation to _____ and _____.
relax the jaw and larynx
An _____ during induction and _____ during emergence from anesthesia are precarious times for the patient
intubation
extubation
Another hazard is _____, especially in a patient with a full stomach or with increased intraabdominal or intracranial pressure.
aspiration
