Understanding Anesthesia

Question 1

4 A’s of Anesthesia

Answer 1

1. Autonomic Stability
2. Amnesia
3. Akinesia
4. Analgesia

Question 2

Awareness

Answer 2

Unconsciousness; lack of memory

Question 3

Amnesia

Answer 3

lack of memory of the event (procedure)

Question 4

Analgesia

Answer 4

inability to feel pain

Question 5

Akinesia

Answer 5

lack of movement (muscle relaxation)

Question 6

Propofol

Answer 6

drug administered to cause relaxation and sleepiness before and during surgery or other medical procedures

Question 7

Common muscle relaxant used in anesthesia

Answer 7

Succinylcholine

Question 8

RSI

Answer 8

Rapid Sequence Induction: technique used to minimied the time between inducing anesthesia and securing an airway with a cuffed ET tube for patients with increased risk of aspiration

Question 9

3 Phases of General Anesthesia

Answer 9

1. Induction
2. Maintenance
3. Emergence

Question 10

Induction

Answer 10

Phase of GA whereby the goal is to induce
unconsciousness in a fashion which is safe,
rapid and maintains hemodynamic stability.

Question 11

Maintenance

Answer 11

phase of anesthesia involves the use of inhaled agents and intravenous medications to keep the patient asleep and stable during the procedure, achieving the 4 A’s and remaining hemodynamically stable throughout

Question 12

Emergence

Answer 12

phase of anesthesia when the patient is waking up from anesthesia

Question 13

Extubation

Answer 13

removal of a tube previously inserted into the trachea; or removal of an LMA

Question 14

3 Criteria for Successful Extubation

Answer 14

1. Patient can breathe on their own
2. Patient has normal muscle strength (i.e. tongue doesn’t fall back)
3. Patient is awake enough to obey commands

Question 15

Intubation

Answer 15

process when an healthcare provider inserts a tube through a person’s mouth or nose, then into their trachea. The tube keeps the trachea open so that air can get through to ventilate the lungs; also, insertion of a supraglottic airway can be considered an intubation.

Question 16

3 Commonly used inhaled agents during maintenance phase

Answer 16

1. desflurane
2. isoflurane
3. sevoflurane

Question 17

General Anesthesia

Answer 17

Anesthesia that acts on a patient so they are completely UNAWARE of any sensations throughout their body by making them unconscious

Question 18

3 Anesthetic Techniques

Answer 18

1. Regional
2. Monitored Anesthetic Care
3. General Anesthesia

Question 19

Triad of Anesthesia

Answer 19

1. Sleep hypnoses (Amnesia)
2. Muscle relaxation (akinesia)
3. Pain analgesia

Question 20

ASA Classification Scale

Answer 20

degree of sickness of a patient, scale of 1-6

Question 21

Monitored Anesthesia Care (MAC)

Answer 21

patients are not completely asleep; administration of various levels of sedations for minor procedures; typically there is no ET tube or LMA utilized; an oral/nasal airway could be used

Question 22

Pulse Oximetry

Answer 22

measuring of the level of oxygen saturation of arterial blood

Question 23

Anesthesia

Answer 23

a loss of feeling or awareness caused by drugs or other substances; keeps patients from feeling pain during surgery or other procedures

Question 24

Positive Pressure Ventilation

Answer 24

pressure needed to inflate the lungs when under anesthesia

Question 25

Difficult Airway

Answer 25

clinical situation in which a trained healthcare provider experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both

Question 26

Frequency of Can’t intubate/Can’t Ventilate

Answer 26

1/10,000 cases

Question 27

Indicators of a Difficult Airway (13)

Answer 27

1. length of upper incisors
2. Cormack-Lehane grades
3. Overbite
4. Small chin
5. Interincisor distance less than 3 cm
6. Mallampatti View
7. Shape of palate
8. TMJ
9. Thyromental distance < 3 fingers length
10. Length of neck
11. Neck thickness
12. Limited range of motion (head)
13. Airway history

Question 28

3 Key Points in 2022 ASA Difficult Airway Algorithm

Answer 28

1. Optimize oxygenation
2. Limit # attempts per device
3. Be aware of the passage of time

Question 29

Vagus Nerve

Answer 29

the nerve responsible for tasks such as heart rate, sweating, and muscle movements in the mouth, including speech

Question 30

Factors that determine the type of airway device used

Answer 30

1. ASA Classification
2. Spontaneous breathing or controlled breathing
3. Duration of the procedure
4. Patient weight
5. Reflux
6. Patient Positioning
7. Type of procedure
8. Anesthesia provider experience
9. Difficult airway

Question 31

ASA 1

Answer 31

normal, healthy patient

Question 32

ASA II

Answer 32

patient with mild systemic disease (i.e. smoker, social drinker, obesity)

Question 33

ASA III

Answer 33

patient with severe systemic disease (i.e. poorly controlled diabetes, COPD, morbid obesity, etc)

Question 34

ASA IV

Answer 34

patient with severe systemic disease that is a constant threat to life (i.e. MI, cardiac ischemia, sepsis, etc)

Question 35

ASA V

Answer 35

moribund patient who is not expected to survive without the operation (i.e. abdominal aneurysm, massive trauma, etc)

Question 36

ASA VI

Answer 36

declared brain-dead patient whose organs are being removed for donor purposes

Question 37

GERD

Answer 37

chronic condition where acid regurgitates from the stomach into the esophagus.

Question 38

Spontaneous Respiration (negative pressure)

Answer 38

movement of gas in and out of the lungs that is produced in response to an individual’s respiratory muscles. (natural breathing)

Question 39

Controlled ventilation (positive pressure)

Answer 39

used to inflate the lungs of a patient when spontaneous breathing is inadequate or ceases entirely (apenea); pressure that is needed to blow up or inflate the lungs; the pressure needed to inflate the lungs is dependent on the elasticity of the lung

Question 40

Most common cause of airway obstruction

Answer 40

tongue

Question 41

Difficult airway

Answer 41

the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both

Question 42

Answer 42

Mallampatti Views Class 1-4