Test 3: NORA Flashcards
What can be used to decrease the risk of renal failure with the administration of contrast media?
Prevention = well hydrated, IV w bicarb, N-acetyl-cysteine
Who is at risk for renal failure with the administration of contrast media?
DM, ppl w CKD, dehydration
Why is contrast bad for the kidneys?
Contrast = iodinated compounds eliminated in the kidneys
How should an allergic reaction to contrast media be treated?
-Pre-treat those at risk (allergy to shellfish) w steroids (methylprednisone)
-Supportive care → bronchodilators, vasopressors
What are the mild symptoms of an allergic reaction to contrast media?
urticaria, fever, chills, facial flushing, N/V
What are the moderate symptoms of an allergic reaction to contrast media?
edema, bronchospasm, hotn, seizures
What are the severe symptoms of an allergic reaction to contrast media?
dyspnea, prolonged hotn leading to cardiac arrest, loss of consciousness
What is the Maximum annual occupational exposure to radiation?
5,000 mrem/yr
What is the cumulative lifetime occupational effective dose limit for radiation?
1,000 mrem/yr x age
How can radiation exposure be kept to a minimum?
ALARA = as low as reasonably achievable
-Wear lead aprons, thyroid shield, lead eyeglasses, dosimetry badges
What are the preoperative anesthetic considerations (not patient specific) when planning to administer a general anesthetic in the MRI suite?
-Anesthesia for claustrophobia, children, ppl that can’t lie still
-Concerns in MRI
Patient inaccessibility, Lack of patient visibility, Noise, Burns, Anxiety, Claustrophobia, Gadolinium nephrogenic systemic fibrosis
What are ferromagnet objects to be aware of when administering anesthesia in the MRI suite?
-Empty pockets/pagers/hair clips/phones…BE METICULOUS
-Beware of pt w implants, pacemakers, aneurysm clips, ocular implants
-Large tattoos made w ferromagnetic ink
-EKG leads special, temperature
-ALL anesthesia equipment must be for MRI – machine, tanks, pumps, etc
What is important to know regarding anesthesia in children with Down’s Syndrome?
-10-20% present w atlantoaxial instability
-Maintain neutral spine position w GA
Why is a cardiac echocardiogram performed prior to DC cardioversion?
Due to the risk of stroke from clots
What is Radiofrequency catheter ablation (RFCA)?
-Uses a catheter w an electrode at its tip
-Electrode is energized w radiofrequency energy & cells within path of electrode are obliterated
What is Cryoablation?
-liquid nitrous oxide circulated through catheter tip –super cold eliminates dysrhythmia cause
-Can transiently lose 25% of CO (often use TIVA instead of inhalationals)
Why is glucagon given during an endoscopic retrograde cholangiopancreatography (ERCP)?
Glucagon relaxes sphincter of ODDI – spasmolytic & decreases gastric motility
Why should lidocaine not be administered with the propofol for the patient undergoing electroconvulsive therapy (ECT)?
-Propofol is not ideal because it raises the seizure threshold, decreasing the duration of the seizure.
-Lidocaine is also associated with shortened duration of seizure
Both together is not ideal for procedure outcome.
What is the PNS Response during tonic phase of seizure during ECT?
bradycardia, hotn, bradydysrhythmias
What is the SNS Response during clonic phase of seizure during ECT?
tachycardia, htn, tachydysrhythmias
What is the Cerebral response to ECT?
increased cerebral blood flow, increased ICP
What are other Side Effects of ECT?
Increased IOP, Increased intragastric pressure, hypoventilation
Why is succinylcholine given to patients having ECT?
Sch = muscle relaxant of choice…rapid onset, short DOA, independent reversibility
Attenuates the potentially dangerous skeletal muscle contractions produced with the seizure activity (inflate BP cuff on ankle to monitor seizure via twitch monitor on foot)
What do you need to do to protect the patient during ECT?
Protect patient from injury against side rails, biting lips, tongue, hitting head
Why do you need to preoxygenate the patient prior to ECT?
Preoxygenate patient – lower seizure threshold to increase duration for better seizure
-Hypercarbia & hypoxia shorten seizure duration
-Hyperventilation/hypocapnia prolong seizure duration
Why do you need to preoxygenate the patient prior to ECT?
Preoxygenate patient – lower seizure threshold to increase duration for better seizure
-Hypercarbia & hypoxia shorten seizure duration
____Ventilation & ____capnia prolong seizure duration.
Hyperventilation/hypocapnia prolong seizure duration
What is the gold standard medication for induction with ECT?
Induce w methohexital (1-1.5 mg/kg) = gold standard!
What other drugs can you use to induce for ECT?
Etomidate or propofol (may raise seizure threshold) or ketamine (although increased ICP w this)
Why is Methohexital the gold standard drug for ECT?
-rapid induction of GA w/o adversely altering therapeutic seizure
-Also rapidly distributed out of the brain so wake up is quick
What other drugs can be given during ECT to counteract Side Effects?
-Anticholinergics as antisialagogue or to prevent asystole (Glycopyrrolate, atropine to prevent bradycardia)
-Esmolol as anti-hypertensive
-Toradol for myalgias
What meds prolong seizure duration?
Alfentanil w propofol, aminophylline, caffeine, clozapine, etomidate, ketamine
What meds shorten seizure duration?
Diltiazem, diazepam, fentanyl, lidocaine, lorazepam, midazolam, propofol, sevo
What meds have no effect on seizure duration?
Clonidine, dexmedetomidine, esmolol, labetalol, nicardipine, nifedipine, nitroglycerin, nitroprusside
