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Unit 3 Flashcards

1
Q

Amnestic

A

Pertaining to the loss of memory

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2
Q

Analgesia

A

Condition without pain

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3
Q

Anticholinergic

A

An agent that blocks the action of acetylcholine

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4
Q

Antisialagogue

A

Agent that inhibits mucous secretions of respiratory and digestive tracts

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5
Q

Aspiration

A

Condition in which gastric contents enter the lungs

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6
Q

State the purposes of the preoperative anesthesia evaluation

A

Gather pertinent patient information to determine optimal anesthetic plan
Confirm surgical diagnosis
Assess concurrent medical conditions
Identify patient’s current medications

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7
Q

List the components of a preoperative evaluation.

A

Patient questionnaire
Follow up personal interview with anesthesiologist
Pre-anesthesia physical exam

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8
Q

Identify classification of preoperative medications

A 
Sedatives
     Relieve anxiety
          midazolam (Versed)
Analgesics
     Relieve pain
          meperidine (Demerol)
Anticholinergics
     Inhibit mucous secretions 
          Atropine
Gastric agents
     Reduce risk of nausea and vomiting which might lead to aspiration
     Minimize damage if aspiration occurs
Antacids
     Neutralize gastric acid present
          sodium citrate (Bicitra)
Antiemetics
     Reduce nausea and risk of postoperative vomiting 
Gastrokinetic
     Reduce gastric fluid volume
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9
Q

Capnometry

A

Measurement of carbon dioxide exhaled by patient

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10
Q

Local anesthesia

A

Parenteral administration of an anesthetic agent to nerve endings in the immediate surgical site

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11
Q

MAC

A

Monitored anesthesia care

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12
Q

Pulse oximetry

A

measure of the oxygen saturation of blood

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13
Q

Regional anesthesia

A

Technique used to accomplish both sensory and motor block to an entire area of the body

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14
Q

Pulse oximeter

A

Assess respiratory function

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15
Q

Sphygmomanometer

A

Measure of the force of blood against the vessel walls

Monitor cardiovascular status

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16
Q

BP – blood pressure

A

Instrument to measure patient’s temperature

Detect hypothermia or hyperthermia; Used to check effectiveness of heat loss prevention measures

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17
Q

Capnometer

A

Device to measure carbon dioxide (CO2) exhaled by patient

Assess respiratory function; adequate ventilation; and early detection of compromised ventilation or MH

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18
Q

Consciousness monitor

A

Modified EEG that records patient’s brain activity

To assess patient’s level of awareness under general anesthesia

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19
Q

nerve stimulator

A

A device that stimulates a nerve and measures response

Assess extent of motor blockade for intubation and surgical

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20
Q

List themost common local anesthetic agents used in surgery.

A

Lidocaine (Xylocaine)
bupivacaine (Marcaine, Sensorcaine)
ropivacaine (Naropin)

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21
Q

State safety considerations for use of epinephrine in local anesthetic agents.

A

Know purpose for each concentration of epinephrine
Know route for each concentration of epinephrine
Read and verify all medication labels before accepting

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22
Q

List and state the type of regional blocks

A

Spinal anesthesia (aka. intrathecal)
Blocks pain and motor response to the entire lower body
Injected through the dura into subarachnoid space, usually not higher than L3-L4
Epidural anesthesia
A regional anesthetic technique that blocks pain to the entire lower body
Injected outside the dura
Used for labor and delivery; Cesarean section; or for post-op pain control
Peripheral nerve block (aka. extremity block)
Provides motor and sensory block to an arm or leg
Injected into a nerve plexus supplying a limb
Also used whenever there is an increase risk of complications for the patient if using general
Intravenous regional anesthesia (IVRA) aka. Bier block
Provides motor and sensory block to an extremity, usually the arm
A double-cuff tourniquet is applied at the proximal arm
An IV cannula is inserted into a vein in the hand
The cuff of the tourniquet is inflated
Agent injected into IV cannula, filling the veins of the arm
Tourniquet keeps agent in the arm

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23
Q

Intubation

A

Process of placing an endotracheal tube

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24
Q

Extubation

A

Removal of an endotracheal tube

25
LMA
Laryngeal masked airway | An airway that is placed over the larynx
26
RSI
Rapid sequence induction | A process used to secure and control the airway quickly
27
State indications for general anesthesia.
``` The surgical procedure to be performed Multiple sites, like a skin graft, bone graft, breast reconstruction Need for motionless field Long duration Thoracic and most abdominal procedures The individual patient Age (all pediatrics) Impaired cognitive ability Mental/emotional state Patient preference when possible ```
28
List options for airway management.
Mask LMA Endotracheal (ET) tube
29
Outline steps in the process of endotracheal intubation.
Patient’s muscles relaxed with neuromuscular blocker Laryngoscope inserted; view vocal cords Intubate (insert ET tube); inflate cuff PRN Ventilate (O2 & inhalation agents) Assess lung sounds and secure tube
30
State facts regarding the concept of awareness under anesthesia.
Awareness under anesthesia is a condition that may occur when the patient does NOT demonstrate characteristic physiologic responses to pain and/or inadequate depth of consciousness, resulting in direct recall of events during surgery in other words failure of general anesthesia to render a patient insensate Unpredictable; unknown cause Those affected About 1/2 report auditory recall About 1/2 report sensation of being unable to breathe About 1/3 recall pain When patients have explicit recall of events; may have devastating patient results – such as PTSD What can a student do? NEVER make personal or insulting comments about a patient or negative comments about the procedure Set a good example Do not participate in or encourage inappropriate conversations Be an agent for positive change
31
Identify drug source, category, and purpose for papavarine.
Source: opium poppy Category: It is a smooth-muscle relaxant Purpose: Used to dilate small blood vessels that require anastomosis Such as in CABG
32
albuterol
Category: a Beta adrenergic agonist purpose: treat Bronchospasm (relaxes bronchial smooth muscle)
33
dopamine
category: an Adrenergic agonist purpose: Anaphylaxis (treat hypotension)
34
succinylcholine
category: a depolarizing muscle relaxant purpose: Laryngospasm (enable reintubation)
35
epinephrine
category: hormone, adrenergic agonist, vasopressor purpose: Anaphylaxis (raise blood pressure) Cardiac arrest (strengthen force and rate of contractions)
36
dantrolene
category: a skeletal muscle relaxant purpose: Malignant hyperthermia (reverse muscle contractions)
37
Intravenous induction agents
``` Produce unconsciousness Sedatives (Benzodiazepines) Valium, Versed, Ativan Hypnotics (Barbiturates) methohexital (Brevital), ketamine (Ketalar), etomidate (Amidate), propofol (Diprivan) ```
38
Analgesics
``` Prevent perception of pain acetaminophen (Ofirmev; an IV form) Natural opioid: morphine Synthetic opioids: fentanyl (Sublimaze), alfentanil (Alfenta), sufentanil (Sufenta), remifentanil (Ultiva) ```
39
Inhalation agents
``` Produce unconsciousness Prevent motor response to painful stimuli Nitrous oxide isoflurane (Forane) desflurane (Suprane) sevoflurane (Ultane) ```
40
Neuromuscular blockers
Relax muscles for intubation and surgical procedure Depolarizing succinylcholine (Anectine) Non-depolarizing Tracrium, Mivacron, Pavulon, Zemuron, Nimbex, Norcuron
41
Reversal agents
Counteract the action of a specific agent For opioids: naloxone (Narcan), nalmefene (Revex), naltrexone (ReVia, Trexan) For benzodiazepines: flumazenil (Mazicon) For non-depolarizing muscle relaxants: neostigmine (Prostigmine), edrophonium (Tensilon)
42
State each phase of general anesthesia and indicate beginning and ending of each phase.
First phase is Pre-induction Begins When patient is admitted to preoperative area and continues when patient transferred to OR; monitors applied; pre-oxygenation Ends At the initial administration of anesthetic agents Second phase is Induction begins Begins With administration of anesthetic agents Ends When airway is secured and adequate depth of anesthesia is achieved Third phase is Maintenance Begins When airway is secured/stable and adequate depth of anesthesia is achieved; agents given PRN Ends Conclusion of surgical procedure Fourth phase is Emergence Begins At end of surgical procedure Agents discontinued or allowed to wear off, patient begins to awaken, airway removed (PRN) Ends when the patient is Transported to PACU Fifth phase is Recovery Begins When patient is admitted to PACU Patient fully awakens, vital signs must be stable before discharge Ends Upon PACU discharge
43
Sedatives
``` Relieve anxiety benzodiazepines: Diazepam (Valium) Iorazepam (Ativan) Midazolam (Versed) most commonly used ```
44
Analgesics
Relieve pain Opiod (Natural Drug) Morphine (Astramorph, Duramorph) which is made using poppy plants. Opiod (Synthetic Drug) Meperidine (Demerol) which relieves pain for 2-4 hours
45
Anticholinergics
``` Inhibit mucous secretions useful if patient has Brady cardia because it can increase heart rate atropine glycopyrrolate (Robinul) scopolamine ```
46
Gastric agents
Purpose varies by subcategory of agents, so individual subcategories are listed for you on objective sheet Overall it is used to reduce risk of nausea and vomiting which might lead to aspiration Minimize damage if aspiration occurs
47
Antacid
Neutralize gastric acid present sodium citrate (Bicitra) Tums
48
H2 receptor antagonists
Block production of gastric acid | famotidine (Pepcid), ranitidine (Zantac)
49
Proton pump inhibitors
``` omeprazole (Prilosec) lansoprazole (Prevacid) esomeprazole (Nexium) Pantoprazole (Protonix) Rabeprazole (AcipHex) ```
50
Antiemetics
Reduce nausea and risk of postoperative vomiting (PONV) ondansetron (Zofran) Droperidol (Inapsine)
51
Anaphylaxis
Severe, life-threatening allergic reaction
52
Asystole
Absence of electrical activity in the heart.
53
Diaphoresis
condition characterized by excessive or heavy sweating with no clear cause.
54
Pyrexia
Rapid increase in body temperature
55
List emergency situations associated with anesthesia.
``` Anaphylaxis Transfusion (hemolytic) reaction Bronchospasm sudden constriction of the bronchioles. Laryngospasm Cardiac arrest Malignant hyperthermia ```
56
Explain the role of the surgical technologist during a cardiac emergency in surgery.
``` First scrub Cover surgical wound Prepare internal defibrillator paddles (if open chest) Cardiac compressions Second scrub Obtain crash cart Call for help Document event, meds and time Assist anesthesiologist as directed Surgical First Assistant Perform compressions Close incision PRN Record event Documents all the medications, their dosages and time they were administered. ```
57
List the clinical signs of malignant hyperthermia.
Increase in end-tidal carbon dioxide (CO2) Tachycardia-rapid heart rate Tachypnea-rapid breathing Muscle rigidity (e.g. masseter muscle rigidly) Unstable blood pressure Arrhythmias-is a condition where the heart is experiencing irregular rhythms or beats. Cyanosis-bluish skin, as a result of low oxygen level Diaphoresis-is an abnormal condition characterized by excessive sweating. Pyrexia-is a condition that causes the body temperature to rapidly increase Hyperkalemia-is a condition where the patient’s potassium level is higher than normal. Myoglobinuria-is a condition where found that myoglobin is present in the urine.
58
Outline the basic course of treatment for malignant hyperthermia.
Stop the procedure Discontinue any triggering agent Eliminate excess CO2 by hyperventilating the patient with 100% oxygen Administer intravenously a muscle relaxant like Dantrolene to the patient. Prepare to scrub out to help the anesthesiologist reconstitute Dantrolene as directed. Sodium bicarbonate administered Temperature reduction Diuretics administered Insulin administered
59
Explain the role of the surgical technologist in a malignant hyperthermia crisis.
First scrub role; stay sterile if procedure is underway Help close or cover wound securely PRN Pass iced saline irrigation as soon as you have it - if abdominal case Either help the surgeon or have the tech place a Foley catheter to the patient so that the anesthesiologist and the surgeon can measure the urine output. Second scrub role Break scrub; Get or send people for ice May help reconstitute dantrolene as directed by the anesthesiologist Help lower the patient’s temperature by helping acquire ice packs and applying them to places with large blood vessels. Goes out to acquire the malignant hyperthermia cart, which contains the items and medications they will need to relieve the patient. Change anesthesia machine when provider is ready Surgical First Assistant May stay scrubbed to protect wound or close May break scrub to do any of the tasks listed Record keeper Document all the medications, their dosages and time they were administered. Notify outside OR personnel of the situation

Pharmacology (4 decks)

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