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Principles > taxonomy of an anesthetic/MAC > Flashcards

taxonomy of an anesthetic/MAC Flashcards

1
Q

anesthesia definition

A

a drug-induced reversible depression of the CNS resulting in loss of response to and perception of all external stimuli

not simply a deafferented state
-amnesia and unconsciousness also important

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2
Q

components of anesthesia

A
  1. amnesia
  2. analgesia
  3. immobility - muscle relaxation

also unconsciousness
attenuation of autonomic response to noxious stimuli

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3
Q

types of anesthesia

A
  • monitored anesthesia care
  • general anesthesia
  • regional anesthesia
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4
Q

room prep

A
  • gas machine
  • suction
  • monitors
  • OR table/arm boards
  • warming devices
  • all equipment needed for case
  • set up cart
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5
Q

what are all the things you need to do pre-op

A 
pre-op visit
pre-op orders
pre-op notes
consultations
anesthesia care plan
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6
Q

what do you do during a preop visit

A 
identify surgical procedure
med history
physical exam
develop plan (ASA status, choice of technique)
informed consent
preop note
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7
Q

what are the goals for pharmcologic premed

A 
anxiolysis
sedation
analgesia
amnesia
antisialagoue 
antiemetic
increase gastric pH
decrease gastric fluid volume - prokinetic
antibiotics
prophylaxis against allergic reaction
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8
Q

induction steps

A 
preoxygenate/denitrogenate
reconfirm patient for surgery/anesthesia
sweep of monitors and equipment - SUCTION
"PATIENT IS FIT FOR ANESTHESIA"
administer meds
1. hypnotic
2. narcotic
3. induction agent
* confirm unconsciousness, patient apneic, position head, and assess ability to mask ventilate
4. muscle relaxant
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9
Q

airway management steps

A

establish airway
confirm adequate ventilation (bilat breath sounds, presence of ETCO2)
DO NOT FORGET TO VENTILATE PATIENT
turn on anesthetic gases
secure airway
don’t forget continuous monitoring of patient

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10
Q

post airway/induction prep for start of surgery

A

stabilize VS
apply additional monitors
positioning and prep
abx given?

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11
Q

rapid sequence induction differences

A

do not mask ventilate during induction - may precipitate vomiting and aspiration
suction must be readily available
cricoid pressure applied as induction agent administered and maintained until ETT placement confirmed

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12
Q

intraoperative management

A

maintain vigilance
anticipate surgical stimulus, bleeding, med limits
evaluate t response to surgery and anesthetic
fluid replacement/ monitor blood loss
record keeping

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13
Q

waking the patient

A

timing
anesthetics discontinued/reversed
patient placed on 100% O2
allow spontaneous breathing
extubation criteria met for safe removal of ETT
assure patent airway and make sure you have adjuncts

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14
Q

failure to emerge possiblities

A 
residual NMBD
excess opioid/benzo
intraop CVA
pre-existing patho
electrolyte abnormalities
acidosis
hypothermia
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15
Q

leaving the OR

A 
patient must be stable before leaving OR
keep monitoring
transport on O2
you're responsibility does not end until patient is safely handed off to PACU
-patient history
-surgical procedure
-intraop course
-fluid balance
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16
Q

why choose MAC

A

Therapeutic or diagnostic procedures that may be uncomfortable or unsafe without the presence of an anesthesia provider and where general anesthesia is not wanted

When patients need the cocktail of anxiolytic, hypnotic, analgesic, and amnestic medications

When you want less physiologic disturbances and a more rapid recovery

Can be used alone or in combo with regional techniques

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17
Q

Can you lose protective reflexes with MAC?

A

YES

18
Q

What is conscious sedation/moderate sedation

A

Sedation technique that maintains adequate cardio respiratory function and ability to purposefully respond to verbal/tactile stimulation

THIS IS LIGHTER ANESTHESIA THAN MAC so doesn’t require anesthesia provider

19
Q

What is the most common cause of brain injury with MAC

A

Inadequate ventilation

20
Q

How is MAC different from conscious sedation

A

MAC includes an anesthesia assessment, and the provider delivering anesthesia must be qualified and prepared to convert to general when necessary

To be qualified to provide MAC you must be able to rescue the airway

You must have 1. Preop eval 2. Intra-op monitoring 3. Anesthesia provider

21
Q

What does MAC help to do

A

Relieve anxiety and apprehension

Prevent recall of unpleasant period events

22
Q

Characteristics of minimal anesthesia - “anxiolytics”

A

Normal response to verbal stimulation
Airway patency unaffected
Spontaneous ventilation unaffected
CV function unaffected

23
Q

Characteristics of moderate sedation “conscious sedation”

A

Purposeful response to verbal/tactile stimulation
Airway patency requires no intervention
Adequate ventilation spontaneously
CV function usually maintained

24
Q

Characteristics of deep sedation (MAC?)

A

Purposeful response following repeated or painful stimuli
Intervention may be required to maintain airway patency
Spontaneous ventilation may be inadequate
CV function usually maintained

25
Q

characteristics of general anesthesia

A

Unarguable even with painful stimulus
Intervention often required to maintain airway patency
Spontaneous ventilation frequently inadequate
CV function may be impaired

26
Q

Preop considerations for MAC

A

Patient must be able to cooperate and remain motionless during procedure
Thorough preop evaluation
Pre-procedural fasting guidelines must be maintained in case patient must be converted to general

27
Q

Planning for MAC -

A
  1. Room setup: general anesthesia is always plan B so set up for that
  2. Preop and eval studies are necessary to help evaluate/anticipate difficult airways
  3. Intraop monitoring/vigilance is necessary
  4. Loss of lash reflex also means loss of protective airway reflexes
28
Q

Required MAC monitors

A 
BP
EKG
Pulse ox
Assess adequacy of vent
Qualified anesthesia provider
Additional:
Precocial stethoscope
Temp monitor
Capnography
BIS
29
Q

Meds frequently used for MAC

A

Versed: anxiolytics and amnesia
Fent/remifent: analgesia
Prop: sedation
Local: block

30
Q

Versed considerations during MAC

A 
Given first
Titration to effect
Anxiolysis/amnesia
Synergistic with opioids
May have paradoxical effect in elderly or patients with dementia
31
Q

What 3 things make med amounts highly variable during MAC

A

Surgical stimulus
Surgeon experience
Patient PMH

32
Q

Opioid considerations during MAC

A

May cause resp depression/Brady
Helps to alleviate pain with initial injection of local, but not appropriate as solo agent because large doses = resp depression
Pain management enhancer

33
Q

Propofol considerations during MAC

A

SUPERIOR drug

  • sedative/hypnotic properties
  • rapid on/off
  • decrease PONV
34
Q

Why choose a continuous infusion of propofol vs boluses?

A

Use less drug and gain steady state of drug

Reduces likelihood or inadequate/excessive sedation

35
Q

Doses for prop, bonus vs continuous

A

10-20 mg prn bolus

25-75 mcg/kg/min titrate to patient response

36
Q

positioning concerns for MAC

A

Can be done with any position, but remember general is your plan B, so prone can be a challenge if you need to convert to general

37
Q

What cases would you see MAC

A 
Pacemaker insertion
Burr hole
Simple GYN procedures
Cataract procedures
Simple hernia
Urological procedures
Skin & breast procedures
Arthroscopic procedures
AND MANY MORE
38
Q

Why does MAC fail

A

Inadequate local anesthetic
Painful position
Uncooperative patient
Paradoxical effects from sedation

39
Q

When can you NOT use MAC

A

Surgeon needs muscle relaxation that is not being provided by regional
Patients with potentially difficult airway where positioning may limit airway access
Peds
Pt with psych disorder
Uncooperative patients

40
Q

What backup airway supplies will you need for MAC

A

Suction, oral/NP airway, LMA, ETT, laryngoscope blades and handles

41
Q

What is the greatest danger during MAC

A

LACK OF VIGILANCE

Principles (11 decks)

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