Taxonomy of Anesthesia Flashcards
1
Q
Definition of anesthesia
A
a drug-induced reversible depression of the CNS resulting in loss of response to a perception of all external stimuli
2
Q
components of anesthesia
A
- amnesia
- analgesia
- unconsciousness
- immobility
- arreflexia (attenuation of autonomic responses to noxious stimulation)
3
Q
types of anesthesia
A
- MAC
- general anesthesia (inhaled or IV)
- regional (topical or infiltration; peripheral nerve block, plexus block; central neuraxial block either spinal or epidural)
4
Q
managing an anesthetic
A
- preparation
- preinduction
- induction
- maintenance
- emergence from anesthesia
- post-operative care
5
Q
OR preparation
A
- cart set up
- FDA machine check/monitors
- suction (oral and ETT size appropriate)
- OR table and accessory equipment (arm board, stirrup)
- warming devices (fluid warmer, warming blanket)
- other equipment (art line, infusion pump, precordial doppler, cerebral oximeter)
6
Q
airway supplies
A
- face mask
- oral airway, tongue blade
- nasal airway/lube
- laryngoscope handle
- blades (miller, mac)
- ETT, stylets, 10cc syringe
- ambu bag
- LMA/airway adjuncts
- difficult airway/MH cart
7
Q
IV supplies
A
- IV fluids
- extension tubing
- volume expanders
8
Q
anesthesia cart
A
- stocked
- other necessary supplies
9
Q
positioning equipment
A
- head rest
- arm board/pad
- prone pillow
- axillary roll
- extra pillow/padding
- eye pads/lubricant
- anesthesia circuit extenders
10
Q
med preparation
A
- methodical arrangement (in order you are going to give)
- labeled - drug name, concentration, date, time, initials
- double verify - medication vial and syringe label match
- sterile technique
- plan ahead for medications
11
Q
DAMMITTTS
A
- drugs
- airway
- mask
- machine/monitors
- IV (start kit, fluids, a line, central line)
- tape (eyes, tube, IV)
- tube (OGT)
- temp (bair hugger, temperature monitor)
- suction
12
Q
PAGES
A
- phenylephrine
- atropine
- glycopyrrolate
- epinephrine, ephedrine
- succinylcholine
13
Q
adaption of anesthetic plan should consider
A
- anatomical and physical findings
- functional status
- patient’s medical/surgical history
- surgical considerations
14
Q
common premedications
A
- anxiolysis
- sedation
- analgesia
- amnesia
- antisialagoue effect
- antiemetic
- increase gastric fluid pH
- decrease gastric fluid volume
- allergic prophylaxis
- antimicrobial protection
15
Q
apply monitors
A
- SpO2
- NIBP (on side without IV)
- ECG
- PNS
- BIS
16
Q
induction steps
A
- preoxygenate/denitrogenate with 100% O2
- reconfirm surgery type of anesthesia
- sweep monitors and equipment (suction ready)
- patient is fit for anesthesia
- administer meds (hypnotic, narcotic, induction)
- confirm unconsciousness, apnea, position head, mask ventilate
- muscle relaxant +/-
- establish airway
- confirm ventilation
- don’t forget to ventilate the patient!
- turn on gases
- secure airway
- continuously monitor/sweep
17
Q
confirmation of adequate ventilation
A
- bilateral breath sounds
- continuous ETCO2
- chest rise/fall
- condensation in ETT
- negative epigastric sounds
18
Q
preparation for start of surgery
A
- stabilize vitals
- apply additional monitors (esophageal stethoscope, OGT, precordial doppler)
- positioning of patient
- verify antibiotics and premedications administered
19
Q
RSI
A
- rapid sequence intubation
- patients considered full stomach (violated NPO, obsesity, pregnancy, GI pathology)
- suction MUST BE available
- cricoid pressure applied as induction agent administered and maintained until ETT placement confirmed
- DO NOT mask ventilate
20
Q
maintenance phase
A
- post induction to surgical end
- many different techniques to accomplish amnesia, analgesia, and arreflexia
- O2 with inhalation anesthetic gases
- +/- N2O
- narcotics
- muscle relaxants
- TIVA
21
Q
intraop management
A
- vigilance
- anticipate surgical stimulus, bleeding, medication limits
- evaluate patient’s response to surgery and anesthetic
- adjust anesthetic as necessary
- fluid management/replacement
- monitor blood loss and replace when neccessary
- accurate documentation
22
Q
failure to emerge
A
- residual NMB
- excessive opioid or benzo
- intraop CVA
- preexisting patho condition (CNS, hepatic insufficiency, ETOH)
- electrolyte abnormalities
- acidosis
- hypothermia
23
Q
PACU report
A
- patient history
- surgical procedure
- anesthetic
- intraoperative course
- fluid status (EBL and I&O)
24
Q
MAC
A
monitored anesthesia care
25
primary objective of MAC
provide patient safety and comfort during procedures for which general anesthesia is not used
26
conscious sedation/moderate sedation
- patient tolerance of unpleasant procedures
- maintains adequate cardiorespiratory function
- maintains ability to purposefully respond to verbal/tactile stimulation
- lighter level than MAC
- does not require qualified anesthesia provider
27
MAC considerations
- potential for deeper sedation
- loss of protective reflexes or consciousness is likely
- inadequate ventilation most common cause of brain injury
- vigilance required
- may require advanced airway management
28
MAC helps to
- relieve anxiety and apprehension
| - prevent recall of unpleasant perioperative events
29
preoperative MAC considerations
- patient must be able to cooperate
- patient must remain motionless during procedure
- thorough preoperative evaluation
- adherence to pre-procedural fasting guidlines
30
MAC planning
- room set up for plan B (general anesthesia)
- preop eval
- preop studies as necessary
31
evaluate and anticipate difficult airways
- intraoperative monitoring and vigilance
| - loss of lash reflex = loss of protective airway reflexes (patient is reflux or aspiration risk)
32
required MAC monitors
- blood pressure
- ETCO2
- EKG
- pulse oximetry
- assess ventilation adequacy
- presence of qualified anesthesia provider
33
additional MAC monitors
- precordial stethoscope
- temperature monitoring
- capnography
- consciousness monitor (BIS)
34
MAC airway monitoring
- chest excursion
- skin color
- nasal/oral air movement
- condensation in face mask
- precordial stethoscope
- ETCO2 monitoring (NC with monitor or IV catheter to connect to ETCO2 monitor)
35
MAC meds frequently used
- versed (anxiolysis and amnesia)
- fentanyl or remifentanil (analgesia)
- propofol (sleep)
- local anesthetic (infiltration/field block)
36
superior drug for MAC
propofol
- good sedative-hypnotic properties
- rapid onset and recovery, short half-life
- decrease N/V
37
bolus propofol for MAC
10-20 mg prn
38
continuous infusion propofol for MAC
- uses less drug, gains better steady state, reduces likelihood of inadequate or excessive sedation
- start at 25-75 mcg/kg/min, titrate to patient response, intermittent bolus for excessive surgical stimulus
39
additional MAC meds
- ketorolac
- ketamine
- clonidine
- dexmedetomodine
40
MAC type cases
- pacemaker insertions
- Burr hole
- simple GYN procedures
- cataract procedures
- simple hernia
- urological procedures
- skin and breast procedures
- arthroscopic surgery
41
why does MAC fail?
- inadequate local anesthetic
- painful position
- uncooperative patient
- paradoxical effects from sedation
42
inappropriate MAC cases
- surgeon requests muscle relaxation
- potentially difficult airway positioned in which airway access is limited
- pediatric patients
- patients with psychiatric disorders
- any uncooperative patient
- patient that refuses MAC
