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N928 - Basics of Anesthesia > Taxonomy of Anesthesia > Flashcards

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

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2
Q

components of anesthesia

A
  • amnesia
  • analgesia
  • unconsciousness
  • immobility
  • arreflexia (attenuation of autonomic responses to noxious stimulation)
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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)
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4
Q

managing an anesthetic

A
  • preparation
  • preinduction
  • induction
  • maintenance
  • emergence from anesthesia
  • post-operative care
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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)
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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
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7
Q

IV supplies

A
  • IV fluids
  • extension tubing
  • volume expanders
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8
Q

anesthesia cart

A
  • stocked

- other necessary supplies

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9
Q

positioning equipment

A
  • head rest
  • arm board/pad
  • prone pillow
  • axillary roll
  • extra pillow/padding
  • eye pads/lubricant
  • anesthesia circuit extenders
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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
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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
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12
Q

PAGES

A
  • phenylephrine
  • atropine
  • glycopyrrolate
  • epinephrine, ephedrine
  • succinylcholine
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13
Q

adaption of anesthetic plan should consider

A
  • anatomical and physical findings
  • functional status
  • patient’s medical/surgical history
  • surgical considerations
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14
Q

common premedications

A
  • anxiolysis
  • sedation
  • analgesia
  • amnesia
  • antisialagoue effect
  • antiemetic
  • increase gastric fluid pH
  • decrease gastric fluid volume
  • allergic prophylaxis
  • antimicrobial protection
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15
Q

apply monitors

A
  • SpO2
  • NIBP (on side without IV)
  • ECG
  • PNS
  • BIS
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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
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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
Q

primary objective of MAC

A

provide patient safety and comfort during procedures for which general anesthesia is not used

26
Q

conscious sedation/moderate sedation

A
  • 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
Q

MAC considerations

A
  • 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
Q

MAC helps to

A
  • relieve anxiety and apprehension

- prevent recall of unpleasant perioperative events

29
Q

preoperative MAC considerations

A
  • patient must be able to cooperate
  • patient must remain motionless during procedure
  • thorough preoperative evaluation
  • adherence to pre-procedural fasting guidlines
30
Q

MAC planning

A
  • room set up for plan B (general anesthesia)
  • preop eval
  • preop studies as necessary
31
Q

evaluate and anticipate difficult airways

A
  • intraoperative monitoring and vigilance

- loss of lash reflex = loss of protective airway reflexes (patient is reflux or aspiration risk)

32
Q

required MAC monitors

A
  • blood pressure
  • ETCO2
  • EKG
  • pulse oximetry
  • assess ventilation adequacy
  • presence of qualified anesthesia provider
33
Q

additional MAC monitors

A
  • precordial stethoscope
  • temperature monitoring
  • capnography
  • consciousness monitor (BIS)
34
Q

MAC airway monitoring

A
  • 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
Q

MAC meds frequently used

A
  • versed (anxiolysis and amnesia)
  • fentanyl or remifentanil (analgesia)
  • propofol (sleep)
  • local anesthetic (infiltration/field block)
36
Q

superior drug for MAC

A

propofol

  • good sedative-hypnotic properties
  • rapid onset and recovery, short half-life
  • decrease N/V
37
Q

bolus propofol for MAC

A

10-20 mg prn

38
Q

continuous infusion propofol for MAC

A
  • 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
Q

additional MAC meds

A
  • ketorolac
  • ketamine
  • clonidine
  • dexmedetomodine
40
Q

MAC type cases

A
  • pacemaker insertions
  • Burr hole
  • simple GYN procedures
  • cataract procedures
  • simple hernia
  • urological procedures
  • skin and breast procedures
  • arthroscopic surgery
41
Q

why does MAC fail?

A
  • inadequate local anesthetic
  • painful position
  • uncooperative patient
  • paradoxical effects from sedation
42
Q

inappropriate MAC cases

A
  • 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

N928 - Basics of Anesthesia (17 decks)

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