The Anesthesia Plan

Question 1

*HTN - at increased risk for ?
(make sure all 5 leads are working, have preoperative EKG available)
~Induction - try to blunt their hemodynamic response to laryngoscopy with opioids, induction agent, muscle relaxant, IA- after __ but before ?
~Can also use __ to blunt response to laryngoscopy. If after all this patient is still hypertensive may consider giving __. Same thing with?

Answer 1

an MI
induction 
intubation 
lidocaine
esmolol
CAD

Question 2

Asthma - have them use their __ prior to surgery, __ - gas on (ventilating for about 60 seconds on 2 MAC of sevoflurane).

Obesity - !!!, GI meds, pre-oxygenation (they do not have a very long safe apnea time), have them in __

Answer 2

inhaler
Pre-intubation
RAMP UP
optimal position

Question 3

Anesthetic Considerations based on ??

*After intubation with RSI pass NG/OG tube and suction ___.

Answer 3

co-morbidities
surgical procedure

stomach contents

Question 4

Prone Position = patient intubated on stretcher prior to placing prone on ___. ___ placed on face prior to flipping patient over, ensures padding does not compress around eyes. ___ to prevent corneal abrasions. Imperative to do ___ - at risk for optic nerve ischemia leading to post-op visual defects. Pad all pressure points (eyes, ears, nose, genitalia). Ensure the ___ is in neutral position to ensure adequate blood flow to the head via vertebral arteries. Arms ___ less than ___ to prevent brachial plexus stretching, bend and pad elbows-prevent ulnar nerve compression.

Answer 4

Jackson table
Prone pillow
Tape eyes 
frequent eye checks 
cervical spine 
abducted less than 90 degrees

Question 5

Give ___ if patient becomes hemodynamically unstable - tachycardia and hypotension with sudden blood loss.
___ can also be used for volume expansion, but be aware that they can cause an allergic reaction.
Hypotensive technique requested by surgeon requires an ? (may use esmolol, NTG, SNP).
Monitor U/O closely for kidney perfusion.

Answer 5

PRBCs
Colloids
arterial line (for invasive monitoring - keep MAP above 60-70 mmHG)

Question 6

Obstructive Sleep Apnea:
These patients may be very sensitive to all CNS depressant drugs - potential for upper airway obstruction or apnea. Therefore preop meds with sedatives including ___ or ___ used sparingly if at all.
-Upper airway abnormalities can predispose to difficult exposure of ___ during DVL, maybe use ___ or ___ to make DL easier.

Answer 6

Benzos or opioids
glottic opening
intubating LMA or lightwand

Question 7

Obstructive Sleep Apnea:
These patients are at increased risk for developing ___ during the post-op period. Place them on oxygen via NC, monitor pulse ox. Use ___ judiciously to prevent worsening hypoxia and hypercarbia. If OSA significant enough a ___ might be warranted.
-___ may be more ideal for providing postop analgesia since it is associated with a low incidence of apnea and arterial hypoxemia.

Answer 7

arterial hypoxemia
opioids
monitored bed
Regional anesthesia

Question 8

What is the ___ of the patient’s coexisting diseases and how will that alter your anesthetic choices?
For example - HTN, CAD, Asthma, Obesity

*Consider preoperative meds, what have they taken? Keep MAP within ___ of what their normal is.

Answer 8

Pathophysiology

20%

Question 9

Be aware that during induction an exaggerated ___ may occur, particularly if ___ is present preoperatively. This most likely reflects ___ in the presence of a decreased intravascular fluid volume, as is likely in the presence of ___. It is possible that systemic BP decreases during induction are more noticeable in patients receiving ___ preoperatively.

Answer 9

decrease in SBP
systemic HTN
drug-induced peripheral vasodilation 
diastolic HTN
ACE inhibitors

Question 10

• Patients with systemic HTN are at increased risk for ___ during induction and intubation. For this reason, it may be prudent to increase the ___ or to inject a ___ prior to initiating direct laryngoscopy.
• The goal during maintenance anesthesia is to adjust the depth of anesthesia to minimize ___.
• Correct sustained hypotension with ephedrine or phenylephrine.

Answer 10

myocardial ischemia
concentrations of inhaled anesthetic
potent opioid
wide fluctuations in systemic BP

Question 11

Patients may have an exaggerated reflex HTN upon emergence and postoperatively and this can lead to ___. If HTN persists despite adequate treatment of postoperative pain it may be necessary to administer vasodilator drugs such as ___ or ___.

Answer 11

myocardial ischemia
hydralazine
labetalol