Therapeutic And Dx Procedures Flashcards by Jennifer Pitt

ORAL Premedication dose regimen for IVP dye

Predisone 50 mg PO 13, 7 and 1 hour prior to procedure

- Benadryl 50 mg 1 hour prior to procedure

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NPO premedication for IV dye allergy:

hydrocortisone 200 mg IV 13, 7, and 1 hour prior to procedure
Benadryl 50 mg IV/IM 1 hour prior to procedure

NOTE: 40 mg methylprednisolone can be substituted for 200 mg hydrocortisone dose for dose

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URGENT premedication protocol for IV dye allergy (emergent):

Hydrocortisone 200 mg IV 5 hours and 1 hour prior to procedure
Benadryl 50 mg PO (or IM or IV if pt cannot take PO) one hour prior to procedure

NOTE: methylprednisolone 40 mg IV can substitute hydrocortisone 200 mg, dose for dose

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Which of the following are accepted characteristics of ‘modified’ ECT?
A. Anesthesia w/ muscle relaxants is used to facilitate ECT
B. A tonic-clonic seizure is induced
C. A seizure longer than 30 seconds is classified as a prolonged seizure
D. Is always effective
E. Can be performed unilaterally

A, B, E

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Absolute contraindications to ECT include:
A. MI in last 3 months
B. Presence of cochlear implant
C. Hx of epilepsy
D. Presence of pacemaker
E. Pregnancy

NONE are absolute contraindications - pheochromocytoma is ONLY ABSOLUTE contraindication

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Common side effects of ECT include:
A. Headache
B. Confusion
C. Myalgia
D. Long bone fx
E. Urinary incontinence

A. Headache

B. Confusion

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Treating epileptics with anti-convulsants May increase seizure threshold, what does this mean for ECT?

May require higher energy

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ECT will do what to ICP, CBF, cerebral O2 requirements, and glucose utilization?

INCREASE them

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What will ECT do regarding the BBB?

Increase permeability

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T/F: Headache, confusion, and transient memory loss are common in immediate post ECT treatment period?

TRUE

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What 3 things can Tricyclic antidepressants cause?

Postural hypotension In elderly
Widening QRS complex
Prolong QT interval

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What can be precipitated by using indirectly acting sympathomimentic drugs?

Hypertensive crisis

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Monamine oxidase inhibitors are found to do what with both direct & indirectly acting sympathomimetics? How long before ECT therapy should they be stopped?

A profound pressor effect and should be stopped at least 2 weeks prior to therapy

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SSRIs interact with meperidine and tramadol and may cause what?

Serotonin Syndrome (hyper-relfexia, agitation and hyperthermia)

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What are the 7 relative contraindications of ECT?

MI within 3 mos
CVA within 3 mos
Incr. ICP or cerebral aneurysm
Unstable fx or cerebral spine injury
Pheochromocytoma?
Uncontrolled cardiac failure or sever valve disease
DVT

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What is the preferred muscle relaxant and dose for ECT?

Succinylcholine dose 0.5-1.5 mg/kg

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What can be used to prevent parasympathetic response of ECT and dose(2)?

Glycopyrrolate (0.2 mg)

2. Atropine (0.4 mg)

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What can be used to treat sympathetic response of ECT with dose (2)?

Labetolol (0.3 mg/kg)

2. Esmolol (1 mg/kg)

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What are the triggering agents for MH & what does having these mean in the office-based setting?

inhaled general anesthetics (desflurane, isoflurane, sevoflurane) and Succinylcholine

Must have Dantrolene available if using these agents (36 vials of Dantrolene or 3 vials of Ryanodex)

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What is the initial dose of dantrolene?

2.5 mg/kg

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What are the required monitors/therapies for anesthesia(6)?

Supplemental O2
Pulse ox
EtCO2 with disconnect alarm
EKG and NIBP
Temperature
Patient positioning

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What can radiation exposure cause?

Leukemia & fetal abnormalities

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What is yearly max radiation exposure A. Annually, B. Lifetime, C. Monthly for pregnant women?

Yearly = 50 mSv
Lifetime = Age x 10 mSv
Pregnant = 0.5 mSv/month

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What are the 9 predisposing factors to adverse reactions from contrast media?

Hx of bronchospasm
Allergy
Cardiac disease
Hypovolemia
Hematologic disease
Renal dysfunction
Extremes of age
Anxiety
Medications (beta blockers, aspirin, NSAIDs)

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What are considered MILD reactions to contrast media? (5)

Nausea, warmth, headache, itchy rash, mild hives

What are considered SEVERE reactions to contrast media (9)?

1. Vomiting 2. Rigors 3. Feeling faint 4. Chest pain 5. Severe hives 6. Bronchospasm 7. Dyspnea 8. Arrhythmias 9. Renal failure

What are considered LIFE THREATENING reactions to contrast media? (5)

1. Glottic edema/bronchospasm 2. Pulmonary edema 3. Arrhythmias 4. Cardia arrest 5. Seizures/ unconsciousness

What is considered to predispose people to renal dysfunction due to IV contrast?

Preexisting renal dysfunction, especially dysfunction d/t diabetes

Administration of this medication can decrease nephrotoxicity d/t contrast media? What is the dosing?

Acetylcysteine | IV = 150 mg/kg x 1 hour —> 50 mg/kg x 4 hours —> 100 mg/kg x 16 hours

What can happen in non-insulin dependent on Metformin if given contrast media?

Life threatening lactic acidosis

What is the number 1 problem in providing anesthesia in CT?

Inaccessibility to the patient

Why is hearing protection mandatory in MRI?

> 90 dB

What is the MOST SIGNIFICANT risk for MRI? | What are some examples?

Ferrous objects - shrapnel, vascular clips and shunts, wire spiral ETTs, pacemakers, ICDs, mechanical heart valves, recent sternal wires, implanted biological pumps, foreign ferrous intraocular objects, some tattoos

What type of sedation is NOT advised in MRI? Why?

Deep sedation is not advised because of decreased access to airway. If sedation greater than moderate sedation is needed, GA is advised

If a cardiac or respiratory arrest occurs in MRI, what is the first thing that should be done?

Move patient outside of MRI suite for resuscitation attempts d/t equipment incompatibility with the magnet

What type of anesthesia is typically requested for radiology RFA?

GA with ETT

What are 4 major anesthetic requirements with cerebral coiling?

1. 2 large bore IVs 2. Pre-induction a line 3. Frequent ACT checks 4. Smooth emergence

What is a normal ACT range? What is ACT with heparin usually?

Normal = 70-120 seconds | With heparin = 180 - 240 seconds

With gastroenterology cases, most require incremental propofol administration until the _________________ is gone, and then maintain

Eyelid reflex

When doing an ERCP which antispasmodic is typically asked for? Dose? What adverse reaction can it cause?

1. Glucagon 2. 0.2-0.5 mg IV/IM 3. ST

What 4 medications should be avoided if sphincter of Oddi manometry is being performed in ERCP?

1. Opioids 2. Robinol 3. Atropine 4. Glucagon

Urgent/emergent ERCP patients may have significant comorbidities that include: (5)

1. Acute cholangitis with septicemia 2. Jaundice (liver dysfunction) 3. Coagulopathy 4. Esophageal varices 5. Biliary stricture

What happens in a TIPS procedure?

Transjucular Intrahepatic Portosystemic Shunt = connects right and left portal vein to one of three hepatic veins —> decompress portal circulation in patients with portal HTN

Patients with Down Syndrome are commonly seen in anesthesia for dental surgery, what things should you be aware of?

1. Cardiac abnormalities (conduction abnormalities & structural defects) 2. R/O Atlanto-occipital dislocation 3. Airway difficulties (macroglossia, hypoplastic maxilla, palatal abnormalities, mandibular protrusion)

What meds with doses are common to use in dental surgery?

1. Ketamine IV 1-2 mg/kg; Orally 5-10 mg/kg; IM 2-4 mg/kg | 2. Oral midazolam 1 mg IV q 2-3 mins (max 2.5 mg); oral = 0.5-0.7 mg/kg 30 mins prior

How does ECT typically affect non-insulin dependent diabetics vs. insulin dependent diabetics?

1. Typically improves glucose levels in non-insulin dependent 2. Causes hyperglycemia in insulin-dependent

What is the typical CV response after ECT?

Bradycardia (parasympathetic) followed by hypertension, tachycardia (sympathetic)

According to Levi what is an absolute contraindication to ECT?

Pheochromocytoma (no absolute contraindications according to other sources)

What is a good med for attenuating hemodynamic response and has anticonvulsant effects for ECT?

Propofol

What 2 meds can be used for ECT that control w/o affecting seizure duration

1. Clonidine (3mcg/kg 30 mins prior to procedure) | 2. Precedex (1 mg/kg over 10 mins)

What are the 2 most common causes of death due to ECT?

MI and arrhythmia

What side should BP cuff be placed for ECT?

OPPOSITE arm of the IV

What is the “goal” of ECT?

30-60 second seizure

What happens if a magnet is placed on pacemaker?

Asynchronous demand mode (DDD) —> paces at set rate of pacer with no sensing **good for increase slow HR if pacer set to a faster rate

What happens if Paget placed on ICD/pacemaker?

Shuts off defibrillator, no effect on pacer

What % of arterial stenosis is considered hemodynamically significant for cardia cath?

50-70% of diameter

What frequently occurs after revascularization following cardiac cath?

Arrhythmias that need treatment

What dose of heparin is commonly given during cardiac cath, with what goal?

2500-5000 units IV; GOAL ACT > 300 seconds

What is commonly the dose for protamine?

1-1.3 mg/100 units heparin given

What are 3 things to monitor for after protamine administration? Due to what?

1. Peripheral vasodilation 2. Anaphylactic/oid reactions 3. Pulmonary vasoconstriction crisis Due to histamine release

What is a side effect of the platelet aggregate inhibitor abciximab?

Increased ACT dependent of heparin

What is NPO time of solids/non-clears for adults? Clears?

``` Solids = 6-8 hours (or NPO after midnight) Clears = 2-4 hours ```

What is NPO time for children > 36 months for solids/non-clears? Clears?

Solids = 6-8 hours | Clears 2-4 hours

What is NPO time for children 6-36 months for solids/non-clears? Clears?

``` Solids = 6 hours Clears = 2-4 hours ```

What is NPO time for children < 6 months for solids/non-clears? Clears?

``` Solids = 4-6 hours Clears = 2 hours ```

What Aldrete score does pt have to have in order to be d/c from hospital?

Choose the statement that BEST describes the anesthetic considerations for pts undergoing ECT? A. Hypocarbia increases seizure duration B. Pregnancy is an absolute contraindication C. Lithium shortens the duration of action of succinylcholine D. There is an initial increase in sympathetic tone followed by an increase in parasympathetic tone

According to APEX, what is the “gold standard” med to use for anesthesia during ECT? Why?

Methohexital (dose 80 mg) a barbiturate | - use because it produces a rapid recovery and has NO effect on seizure duration

What conditions can increase seizure duration? (2)

Hyperventilation | Hypocapnia

What conditions can decrease seizure duration (3)?

Hypoventilation Hypercarbia Hypoxia

Which commonly used meds for ECT increase seizure duration? (4)

1. Etomidate 2. Ketamine 3. Alfentanil + propofol 4. Aminophylline

Which common meds for ECT DECREASE seizure duration? (5)

1. Propofol 2. Midazolam 3. Lorazepam 4. Fentanyl 5. Lidocaine

Which commonly used meds for ECT have NO EFFECT on seizure duration?

1. Methohexital (barbiturate - gold standard) 2. Precedex (higher alpha 2 selectivity) 3. Clonidine 4. Esmolol

What does the use of lithium prolong regarding anesthesia during ECT?

Duration of action of succs and NDNMBs

Patients on MAOIs who receive indirect acting sympathomimetics can experience?

Hypertensive crisis

What are the 5 areas points are awarded for the Aldrete score?

1. Activity (0-2) 2. Respiration (0-2) 3. Circulation (0-2) 4. Consciousness (0-2) 5. Oxygen saturation (0-2)

``` All of the following are assessed by the modified Aldrete scoring system EXCEPT? A. PONV B. Respiration quality C. Level of consciousness D. O2 saturation ```

A. PONV

List the different safety zones in MRI suite, the supervision required with examples:

1. Public access = no supervision = hallway outside MRI suite 2. Public access = minimal supervision = entrance to MRI suite 3. Limited access = strict supervision = MRI control room 4. Very limited access = strict supervision = MRI scanner room

What zone of MRI are ferrous objects NOT allowed in?

Zone 4

Lit 4 safe metals in MRI

1. Stainless steel 2. Titanium 3. Aluminum 4. Copper

What is rate of allergic reaction to contrast media?

< 1%

Therapeutic And Dx Procedures Flashcards

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