Week 6 Handout Flashcards
What does NORA stand for?
Non-Operating Room Anesthesia
NORA refers to anesthesia provided outside traditional operating rooms.
List three locations where NORA can be provided.
- Radiology
- Endoscopy
- Dental clinics
What is the growth trend for NORA?
Increasing demand for sedation/anesthesia in remote settings
What is the first step in the 3-Step Approach to NORA?
The Patient
What should be considered during the preanesthetic evaluation?
- Reasons for sedation/anesthesia
- Adjusting plan for special populations
- Appropriate monitoring and safety measures
What are the procedural demands to understand in NORA?
- Positioning
- Duration & Pain Level
- Equipment needs
What is crucial for collaboration with proceduralists in NORA?
- Emergency plans
- Potential adverse events
What are unique challenges in the NORA environment?
- Limited space for anesthesia setup
- Staff unfamiliar with anesthesia protocols
What should be checked before starting NORA?
All required equipment
What does the systematic approach for NORA ensure?
Safety
What is an office-based anesthetic?
Performed in an outpatient venue not accredited as an ASC or hospital
List two advantages of Office Based Anesthesia.
- Cost containment
- Improved privacy & continuity of care
What is a potential risk associated with Office Based Anesthesia?
Increased risk of injury due to remote location
What type of patients are ideal for Office Based Anesthesia?
ASA I or II
What is the role of the anesthesia provider in Office Based Anesthesia?
Ensure standards & advocate for patient
What is the most common reason for delayed discharge from Office Based Anesthesia?
Post Operative Nausea and Vomiting
What does MAC stand for?
Monitored Anesthesia Care
Who typically provides Monitored Anesthesia Care?
An anesthesia professional (e.g., anesthesiologist, CRNA)
What is the potential of Monitored Anesthesia Care compared to moderate sedation?
Potential for deeper sedation than moderate sedation
What standards does Monitored Anesthesia Care follow?
Same standards as general/regional anesthesia
What is the definition of a MAC?
Diagnostic/therapeutic procedure that involves sedation, analgesia, and anxiolysis as needed.
Requires readiness to shift to general anesthesia if necessary.
What are the components of a MAC?
Preprocedure: Examination & evaluation, Planning of anesthetic care; Intraprocedure: Continuous presence of anesthesia provider, Diagnosis/treatment of clinical issues, Support of vital functions; Postprocedure: Appropriate recovery & management.
What are the duties of the anesthesia provider during a MAC?
Administer sedatives, analgesics, and other meds; Maintain patient comfort & safety; Monitor vital signs (cardiovascular & respiratory); Be prepared to convert to general anesthesia.
What are the ASA requirements for a MAC?
Continuous physical or proximate presence of an anesthesia provider; Adherence to anesthesia-related institutional policies; Same payment level as general/regional anesthesia; Documentation & informed consent.
What are the benefits of choosing a MAC over general anesthesia?
Potential for less physiologic disturbance; Faster recovery and reduced side effects; Greater patient satisfaction (less invasive); Flexibility to adjust sedation level.
What are the goals of a MAC?
Provide patient comfort & anxiolysis; Maintain cardiorespiratory stability; Improve operating conditions; Prevent recall of unpleasant events.
What is meant by an individualized approach in MAC?
Identify specific causes of pain, anxiety, and agitation; Use combination therapies (analgesic, amnestic, hypnotic); Aim for minimal side effects (e.g., nausea, respiratory depression); Rapid, complete recovery is the goal.
Define context-sensitive half-time.
Time for plasma concentration to drop by 50% after stopping an infusion; Increases with infusion duration; Varies significantly among different drugs; Does not directly predict actual wake-up time.
What are practical takeaways for optimizing MAC sedation?
Optimize sedation to allow verbal communication whenever possible; Monitor for common causes of agitation or discomfort (e.g., pain, anxiety, hypoxia); Use pharmacokinetic principles to guide dosing; Aim for rapid, clear-headed recovery.
What is TIVA?
Anesthesia maintained solely with IV medications (e.g., propofol, opioids).
What is the difference between TIVA and inhalational anesthesia?
TIVA uses IV agents; Inhalational anesthesia uses volatile agents delivered via a vaporizer.
What are the pharmacokinetics/pharmacodynamics differences between TIVA and inhalational anesthesia?
TIVA: IV agents with known context-sensitive half-times, Rapid induction and emergence; Inhalational: Uptake and elimination via lungs, Alveolar concentration (MAC) guides depth of anesthesia.
What equipment is required for TIVA?
IV infusion pumps (e.g., syringe pumps); BIS or other depth monitors often recommended.
What are some advantages of TIVA?
Less environmental pollution (no inhaled agents); Often smoother emergence, less PONV (postoperative nausea/vomiting) with propofol; No risk of malignant hyperthermia from volatile agents.
What are some disadvantages of TIVA?
Risk of awareness if under-dosed; Requires precise pump management and vigilance.
What are the clinical applications of TIVA?
Outpatient surgeries (faster wake-up & less PONV); Neurosurgical cases (reduces intracranial pressure); MH-susceptible patients.
What are the clinical applications of inhalational anesthesia?
Longer surgeries with stable anesthetic requirements; Pediatric inhalation inductions (sevoflurane); Settings where alveolar concentration monitoring is preferred.
What does TIVA stand for?
Total Intravenous Anesthesia
TIVA involves the use of Propofol and IV adjuncts
What are the benefits of TIVA?
Minimal OR pollution, good recovery profile, requires careful pump management
What does inhalational anesthesia typically involve?
Volatile gas and possible IV adjuncts
What is a key advantage of inhalational anesthesia?
Easy to titrate and cost-effective in many settings
What concerns are associated with inhalational anesthesia?
Environmental concerns and malignant hyperthermia (MH) concerns
What is the ASA Physical Status Classification System?
A system to categorize patients based on their health status prior to anesthesia
What does ASA I indicate?
A normal healthy patient
What does ASA II indicate?
A patient with mild systemic disease
What does ASA III indicate?
A patient with severe systemic disease
What does ASA IV indicate?
A patient with severe systemic disease that is a constant threat to life
What does ASA V indicate?
A patient who is not expected to survive without surgery
What does ASA VI indicate?
A declared brain-dead patient whose organs are being removed for donor purposes
What is the AANA Professional Practice Manual?
A manual that outlines standards for nurse anesthesia practice
What is the hierarchy of practice rules in nurse anesthesia?
Standards, Guidelines, Position Statements, Practice Considerations
What is Standard 1 of AANA Standards for Nurse Anesthesia Practice?
Patient’s Rights: Respect the patient’s autonomy, dignity, and privacy
What is Standard 2 of AANA Standards for Nurse Anesthesia Practice?
Preanesthesia Patient Assessment and Evaluation
What does Standard 3 emphasize?
Plan for Anesthesia Care: Formulate a patient-specific plan after discussing options
What is the focus of Standard 4?
Informed Consent for Anesthesia Care and Related Services
What does Standard 5 require?
Documentation: Communicate anesthesia care data accurately and completely
What does Standard 6 address?
Equipment: Adhere to manufacturer’s instructions and perform daily checks
What is the main focus of Standard 7?
Anesthesia Plan Implementation and Management
What is Standard 8 about?
Patient Positioning: Collaborate to ensure proper body alignment
What does Standard 9 emphasize?
Monitoring and Alarms: Document physiological condition and set alarms
What does Standard 10 focus on?
Infection Control and Prevention: Adhere to established infection control policies
What is the purpose of Standard 11?
Transfer of Care: Evaluate when to transfer responsibility to another provider
What does Standard 12 involve?
Quality Improvement Process: Participate in reviewing and evaluating anesthesia care
What does Standard 13 state?
Wellness: Be physically and mentally able to perform duties
What does Standard 14 promote?
A Culture of Safety: Foster a collaborative patient care environment
What is the ASA statement on ambulatory anesthesia and surgery?
Guidelines for anesthesia care in outpatient settings
What is the focus of AANA Dental Office Sedation and Anesthesia Care?
Standards for sedation and anesthesia in dental office settings
AANA Discharge after Sedation or Anesthesia focuses on what aspect?
Guidelines for patient discharge on the day of the procedure
What does AANA Office Based Anesthesia encompass?
Standards for anesthesia care provided in office-based settings
