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Advanced Anesthesia 2 > Therapeutic and Diagnostic Procedures > Flashcards

Therapeutic and Diagnostic Procedures Flashcards

1
Q

T/F Standards of anesthesia care and patient monitoring are the same regardless of location

A

TRUE

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2
Q

Procedures that might be anticipated to last several hours may best be performed with ______ at the onset rather than late conversioin after failure of _________

A

GA / sedation

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3
Q

Consider performing anticipated difficult intubation in the _______. Then what?

A

OR / then transfer to the site of the planned procedure

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4
Q

JCAHO defines anesthesia care as the administration of IV, IM or inhalation agents that may result in the loss of _____ _____________

A

protective reflexes

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5
Q

JCAHO introduced standards requiring anesthesia services participate with non-anesthesiology departments in setting up a ________ quality of care for patients undergoing _________ in all parts of the hospital.

A

uniform / sedation

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6
Q

During the case qualified anesthesia personnel must be present for the entire case. Nurses and rad techs are often less familiar with the management of anesthesia, therefore they are often unable to provide skilled assitance in an ___________ unless they receive specific training.

A

emergency

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7
Q

Office-based anesthesia is often used for _____ and _______ procedures. Patient requires a full ___________ workup.

A

ENT and dental / preoperative

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8
Q

Office based anesthesia usually uses a combination of ______ plus _______ or light GA with a mask or LMA

A

local / sedation

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9
Q

What are the agents of choice for office-based

A

Propofol, des, sevo, N20

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10
Q

Office-based anesthesia follows ____ and _______ guidelines

A

ASA and JCAHO

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11
Q

Office based anesthesia standards

A

Employment of appropriately trained and credentialed anesthesia personnel. Availability of properly maintained anesthesia equipment. Complete documentation of the care provided as required by other surgical sites. Use of standard ASA monitoring and availability of emergency equipment. Provision of a PACU that is staffed by trained nursing personnel. Establishment of a written plan for emergency transport of the patient to a comprehensive care center if a complication occurs.

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12
Q

Unique hazard to the radiology suite is __________ exposure. Imagine that now.

A

radiation

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13
Q

Radiation exposure can result in somatic effects of _______ and in terms of genetic injury resulting in __________ abnormalities caused by damage to the _________ cells or developing fetus

A

leukemia / fetal / gonadal

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14
Q

Max exposure annually

A

50 mSv

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15
Q

Lifetime cumulative dose

A

10 mSv x age

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16
Q

Monthly max exposure for pregos

A

0.5 mSV

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17
Q

T/F Fluroscopy is significantly _______ exposure to everyone than taking a single shot x-ray

A

less

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18
Q

Older contrast media was IONIZED, _____-osmolar and _____

A

hyper / toxic

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19
Q

New contrast media is NON-IONIZED (NEW NON IONIZED), has a _____ osmolality and improved side-effects

A

lower

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20
Q

Predisposing factors to adverse reactions from contrast media include history of what?

A

bronchospasm, allergy, cardiac disease, hypovolemia, hematologic disease, renal dysfunction, extremes of age, and medications like beta-blockers, asa, and NSAIDS.

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21
Q

What is a good plan for pre-treatment for iodinated contrast media

A

prednisone 50mg 12 hrs before and benadryl 50 mg immediately before the procedure

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22
Q

Mild reaction to contrast media

A

nausea, perception of warmth, headache, itchy rash and mild hives

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23
Q

Severe reaction to contrast media

A

vomiting, rigors, feeling faint, chest pain, severe hives, bronchospasm, dyspnea, arrythmias, and renal failure

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24
Q

Life-threatning reaction to contrast media

A

glottic edema/bronchospasm, pulmonary edema, arrythmias, cardiac arrest, and seizures/unconsciousness

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25
Q

Treatment for contrast media reaction

A

oxygen, bronchodilators, epi, corticosteroids, and antihistamines

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26
Q

Reactions to contrast media is well documented with those with renal dysfunction and preexisting renal dysfuntion related to ________

A

diabetes

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27
Q

Most cases of new or worsened renal funtion related to contrast media are _________ and resolve within ______. However, some cases progress to the point they need dialysis.

A

self-limited / 2weeks

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28
Q

What medication can be given to reduce nephrotoxicity due to contrast media

A

acetylcysteine

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29
Q

What is the problem with contrast media and metformin?

A

high risk of lactic acidosis

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30
Q

The number one problem with CT is _________________ to the patient

A

inaccessibility

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31
Q

What is mandatory protection required in the MRI?

A

hearing protection > 90 dB

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32
Q

_______ injury has been reported at site of EKG electrodes and areas where skin contacts the machine.

A

thermal

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33
Q

Most significant risk in the MRI suite is the effect of the magnet on _______ objects

A

ferrous

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34
Q

Contraindications for MRI include

A

shrapnel, vascular clips and shunts, wire spiral ETTs, PM, ICDs, mechanical heart valves, recently placed sternal wire, implanted biological pumps, tattoo ink with high concentrations of iron-oxide (permanent eyeliner) and intraocular ferromagnetic foreign bodies

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35
Q

Tattoo ink may contain high concentrations of iron oxide. Burns at tattoo sites have been reported after exposure to MRI magnetic fields but this is rare and the presence of permanenet eyeliner should not _______ the patient from an MRI

A

exclude

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36
Q

Examples of ferromagnetic items that should never be allowed in the vicinity of the MRI magnet

A

scissors, pens, keys, gas cylinders, anesthesia machine propak monitor, syringe pump, beeper (that’s funny), phone, steel chairs

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37
Q

MRI anesthesia: A common approach is to induce anesthesia in an area ________ to the MRI suite. What should be done for airway management?

A

adjacent / intubate with ETT or LMA to admin GA

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38
Q

MRI at UPMC HAMOT

A

MRI compatible laryngoscope, travel drug box, suction control is outside the MRI suite and induction happens in the MRI suite, use propofol, LMA with sevo @ 1 mac or less

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39
Q

T/F resuscitiation efforts should take place outside the scanner b/c laryngoscopes, 02 cylinders and defibrilators cannot be taken close to the magnet

A

TRUE

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40
Q

What do these procedures often require? Embolization of cerebral and dural AVM’s, coiling of cerebral aneurysms, angioplasty of sclerotic lesions, and thrombolysis of acute thromboembolic stroke.

A

deliberate hypotension and deliberate hypocapnia

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41
Q

________ ______________ is called for during cerebral ischemia in attempt to maximize collateral flow

A

deliberate hypertension

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42
Q

In interventional radiology, the radiologist may requrest rapid transition between deep sedation and _________ responsive state

A

awake

43
Q

Cerebral coiling tips

A

could be from deep IV sedation to GETA, 2 large bore Ivs, PRE-induction Art line, fluid warmer and upper bair hugger, ACTS checked frequently with goal of 2-2.5 times normal,

44
Q

What kind of emergence with cerebral coiling

A

smooth emergence, prevent coughing and prevent device migration. Admin antiemetics prior to emergence.

45
Q

Cardiac cath lab anesthesia is usually _________ and GETA is reserved for ________ failure or airway control to manage respiratory failure

A

sedation / sedation

46
Q

With RFA, what should medications should you consider during the RFA portion of the procedure

A

versed and fentanyl

47
Q

Stenosis of greater than ____ to ____% is considered to be significant. CAD is classified as one, two or three-vessel disease or Left ______ coronary disease

A

50-70% / main

48
Q

What is common after stenotic coronary artery is dilated from stenting or ballooning.

A

ventricular arrhythmias

49
Q

Target ACT for most cath lab procedures

A

> 300

50
Q

What can happen with protamine administration?

A

predictable peripheral vasodilation, and less common anaphylaxis and anaphylactoid reactions or the rare catastrophic pulmonary vasoconstriction crisis associated with protamine administration

51
Q

Platelet aggregation inhibitors

A

abciximab, ticlodipine, clopidogrel

52
Q

A notable side effect of abciximab is elevation of the _____ independent of heparin

A

ACT

53
Q

T/F with an ERCP patients usually experience discomfort with instrumentation and stenting of the biliary and pancreatic ducts

A

TRUE

54
Q

Antispasmodics like glucagon decrease the incidence of spasm but may result in _____ _______

A

sinus tachy

55
Q

If sphincter of Oddi manometry is being performed what should be avoided?

A

opiods, glycopyrrolate, atropine and glucagon (due to alteration of the sphincter tone)

56
Q

Patients presenting for ERCP may have significant comorbidities such as

A

acute cholangitis with septicemia, jaundice with liver dysfunction, coagulopathy, bleeding from esophageal varices resulting in hypovolemia, biliary stricture after major hepato-biliary surgery including liver transplantation

57
Q

Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure connects the right or left portal vein to one of the three _______ veins to ______ the portal circulation in patients with portal HTN. Obviously, these patients have poor hepatic function. The procedure it self causes minimal stimulatioin as performed under sedation or GA.

A

hepatic / decompress

58
Q

AIRWAY preop considerations for TIPS procedure

A

Aspiration r/t recent GI bleed, increased intragastric pressure decreased LOC d/t hepatic encephalopathy

59
Q

RESPIRATORY preop consideratiosn for TIPS procedure

A

decreased FRC d/t ascites, pleural effusions, intrapulmonary shunts, pneumonia

60
Q

CARDIO preop considerations for TIPS procedure

A

associated alcoholic cardiomyopathy, altered volume status, acute hemorrhage d/t esophageal varices, intraperitoneal hemorrhage

61
Q

HEMATOLOGIC preop considerations for TIPS procedure

A

coagulopathy and thrombocytopenia

62
Q

NEUROLOGIC considerations for TIPS procedure

A

hepatic encephalopathy

63
Q

ECT therapeutic effects are thought to result from the release of ___________ during the electrically induced grand mal ________

A

neurotransmitters / seizure

64
Q

Nueroendocrine responses to ECT included increased levels of ______ ________. What are they?

A

stress hormones / ACTH, cortisol, arginine, vasopressin, prolactin, GH

65
Q

With ECT you can see _______ with NIIDDM, wheras ______________ may be seen when the diabetes is insulin dependent

A

improvement / hyperglycemia

66
Q

Physiologic response to ECT results in a grand mal seizure where the TONIC phase lasts _____ and the clonic phase lasts _______

A

10-15 sec / 30-60 sec

67
Q

ECT can cause ______ CBF and ICP

A

increased

68
Q

Cardiovascular response to ECT

A

initial bradycardia followed by HTN and tachycardia, dysrhythmias, myocardial ischemia

69
Q

ECT can also result in what other things?

A

short-term memory loss, muschle aches, fractures, dislocations, status epilepticus, and sudden death

70
Q

Absolute contraindication to ECT

A

pheocromocytoma

71
Q

Relative contraindications to ECT

A

increased ICP, recent CVA, cardio conduction defects, high-risk pregnancy, aortic and cerebral aneurysms

72
Q

ECT anesthetic considerations

A

Propofol (attenuates hemodynamic response to ECT), short acting opiods (remi, alfenta), muscle relaxants like succs to prevent fractures and dislocations, toradol in younger patients

73
Q

With ECT, robinul and atropine can prevent the ___________ effects of ECT (salivation, bradycardia, asystole)

A

parasympathetic

74
Q

With ECT, labetolol (0.3 mg/kg) and esmolol (1 mg/kg) both ameliorate the hemodynamic responses, although ____________ has a lesser effect on seizure DURATION

A

esmolol

75
Q

__________ and ___________ administered before induction for ECT are effective in controlling BP w/o affecting seizure duration

A

clonidine and dexmedetomidine

76
Q

Most common cause of death with ECT

A

MI and arrhythmia

77
Q

With ECT, seizure activity causes an initial ___________ discharge manifested by bradycardia, occasional asystole, PAC, PVC. Hypotension and salivation may be noted and then sympatetic activity

A

parasympathetic

78
Q

ECG changes with ECT include

A

ST-segment depression, T-wave inversion and without myocardial enzyme changes

79
Q

arrhythmias associated with ECT even when pre-existing are usually ____ _______

A

self-limited

80
Q

Anesthetic considerations for those with Down Syndrome

A

cardiac conduction defects, macroglossia, hypoplastic maxilla, palatal abnormalities, mandibular protrusion

81
Q

Anesthetic management for Down’s Dental surgery: Ketamine IV, IM or Oral. Oral midazolam. EMLA cream to place IV. Tracheal intubation (often nasal) is required to protect the airway. LMA has been used as well. Immediate post-op complications include bleeding, airway obstruction and laryngeal spasm. What are the ketamine doses?

A

IV=1-2 mg/kg ORAL=5-10mg/kg IM=2-4mg/kg

82
Q

Sedation comprises a continuum of states from minimal _______ to ______

A

sedation / GA

83
Q

_________ is a drug-induced state during which patients respond normally to verbal commands. Although congnitive functioin and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected

A

Minimal sedation (anxiolysis)

84
Q

________________ is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands either alone or accompanied by light tactile stimulation. No interventions are required to maintain patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

A

moderate sedation/analgesia (Conscious Sedation)

85
Q

___________ is a drug-induced depression of consciousness during which patients cannot be easilly aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assitance in maintaining a patent airway, and spontaneous ventilation may be INADEQUATE. Cardiovascular function is usually maintained

A

Deep Sedation / Analgesia

86
Q

__________ is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assitance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.

A

General Anesthesia

87
Q

Because sedation is a continuum, it is not always possible to predict how an individual patient will __________

A

respond

88
Q

Review the table on slide 69

A

continuum of depth of sedation

89
Q

Patient anxious and agitatated or restless or both

A

Ramsay 1

90
Q

Patient cooperative, oriented, tranquil

A

Ramsay 2

91
Q

Patient responds to commands only

A

Ramsay 3

92
Q

Brisk response to light glabellar tap or audiotory stimulus

A

Ramsay 4

93
Q

Sluggish response to a light glabellar tap or auditory stimulus

A

Ramsay 5

94
Q

No response to the stimuli mentioned in items 1-4

A

Ramsay 6

95
Q

Review modified aldrete score on slide 71. What areas does this look at?

A

Motor activity, Breathing, BP, Consciousness, Oxygen saturation (score range 0-10)

96
Q

Examples of difficult to sedate patients

A

high level of anxiety, psychiatric disorders, chronic opioid use, mental status changes, dementia

97
Q

For sedation procedures, ages 6 months to adult can have clear liquids up to ___ to ___ hours prior to surgery

A

2 to 4 hours

98
Q

Children younger than 6 months can have clear liquids up to ____ hours prior to sedation

A

2 hours

99
Q

Review table for solids and nonclear liquids

A

slide 77

100
Q

Application of sedation: Choice of agent and technique is dependent on __________________, requirements of contstraints imposed by the patient or procedure, and likelihood of producing a deeper level of sedation than anticipated. Because patiets are unpredictable, practitioners need to be able to rescue patient whose level of sedation becomes deeper than intended.

A

experience and preference of the practitioner

101
Q

Recovery and disposition after sedation: _________ score must be used. Vitals must be taken every _____ min X ___, then every _____ x _____ or until full recovery of Aldrete score of ___ or better

A

Aldrete / 10 min x 3 / 1 hr x 2 / 9 or better

102
Q

Patient must be observed a minimum of _____ min post procedure

A

30 min

103
Q

If resuscitative measures were required the patient needs to be observed for ______

A

1 hour

104
Q

Discharge from hospital criteria: Fully awake with an Aldrete of ___ or better. Hydration is adequate. Able to walk _____, where appropriate. Accompanied by a reasonable adult. Advised regarding aftercare with written and verbal discharge instructions. Responsible attending physician must write discharge order and note including patient status. A _______ may discharge the patient utilizing all the above criteria

A

9 / unassisted / registered nurse

Advanced Anesthesia 2 (4 decks)

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