Week 5 - Anesthesia for Remote Locations Flashcards
What are patient factors for requiring sedation or anesthesia for Non-OR procedures?
- Claustrophobia, anxiety and panic disorders
- Cerebral palsy, developmental delay and learning difficulties
- Seizure disorders, movement disorders and muscular contractures
- Pain, both related to the procedure and other causes
- Acute trauma with unstable cardiovascular, respiratory, or neurologic function
- Raised intracranial pressure
- Significant comorbidity and patient frailty (ASA grades III, IV)
- Child age, especially children <10 yrs
What are the Non-OR locations a patient might require sedation or anesthesia?
- Diagnostic Imaging (CT, MRI, PET)
- Interventional Radiology
- Radiation Therapy
- GI Endoscopy
- Bronchoscopy
- ECT
- Urology
- Reproductive health (IVF)
What are the ASA Standards on Non-OR Anesthetizing Locations
- Reliable oxygen source with backup
- Reliable suction source
- Any location with inhalation anesthetics must have waste gas scavenging
- Adequate monitoring equipment
- Self-inflating resuscitator bag
- Sufficient safe electrical outlets
- Adequate light and a battery-powered illumination device other than a laryngoscope
- Sufficient space
- Emergency cart with defibrillator, emergency drugs, and emergency equipment
- Means of reliable two-way communication
- Compliance with safety and building codes
- Appropriate post anesthesia management including appropriate equipment to transport patient to PACU
What are the patient monitoring standards for Non-OR anesthesia locations?
- Qualified anesthesia personnel must be present for the entire case.
- Continuous monitoring of patient’s oxygenation, ventilation, circulation, and temperature.
- Oxygen concentrations of inspired gas: low concentration alarm.
- Blood oxygenation: pulse oximetry.
- Ventilation: end-tidal carbon dioxide detection and disconnect alarm.
- Circulation: EKG, ABP (q 5min), invasive BP, and oximetry.
What are the considerations for remote anesthesia recovery care?
- Patient must be medically stable before transport.
- Patient must be accompanied to the recovery area.
- Provisions for O2 delivery and monitoring on the transport cart are required.
- Appropriate recovery facilities and staff must be provided
What are the contraindications for MRI?
- Shrapnel
- Vascular clips and shunts
- Wire spiral ETTs
- Pacemakers, ICDs, mechanical heart valves
- Recently placed sternal wire
- Implanted biological pumps
- Tattoo ink w/ high concentrations of iron-oxide
- Swan Ganz catheters
- Any ferromagnetic foreign bodies
What is the 5 gauss line?
A yellow ling within the MRI room which cannot be crossed with any ferromagnetic materials
*syringe pump, pen, and monitor can be within the room as long as they are behind this line
What are the radiation safety guidelines?
- Remain at least 1 to 2 m from radiation source
- Wear lead apron, thyroid shield, glasses
- Dosimeter (Less than 50mSv annual exposure)
- Clear communication between radiology team
With what type of contrast are adverse drug reactions more common?
With Iodated agents (used for CT or x-ray) than with gadolinium contrast agents (MRI)
- renal and/or hypersensitivity reactions
- contrast induced nephropathy occurs with an incidence of 7-15% (more frequently in DM and HTN)
What is Electroconvulsive Therapy (ECT) used for?
treatment of affective disorders after failure of pharmacotherapy
high acuity disorders such as suicidal patients
*therapeutic effects are possibly due to the release and “resetting” of neurotransmitters during the induced seizure
What are the 3 phases of seizure during ECT treatment?
Tonic Phase: skeletal muscles suddenly contract (use succinylcholine to prevent long bond fractures and muscle injury)
Myoclonic Phase: rapidly alternating contraction and relaxation of muscles (observe muscle response and duration of seizure)
Post Ictal Phase: altered state of consciousness after epileptic seizure, lasts between 5-30 min (sometimes longer)
-characterized by drowsiness, confusion, nausea, HTN, headache/migraine, and other disorienting symptoms
What physiologic response will occur with each phase of seizure during ECT treatment?
Tonic Phase (10-15 sec): profound Parasympathetic stimulation -bradycardia, hypotension
Myoclonic Phase (30-60 sec): sympathetic stimulation -transient tachycardia, arrhythmias, HTN
