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49 Cards in this Set
- Front
- Back
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Which of the following is not a goal of outpatient anesthesia?
a. smooth rapid induction and emergence b. minimize anesthetic side effects c. cost effective management d. improved patient satisfaction e. quickly achieve good operating conditions f. adequate pain control with oral meds g. maximize physiologic changes |
g. maximize physiologic changes
-goal is to minimize these changes. |
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True or False: Ambulatory surgical techniques are specific and should be adhered to strictly.
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False: According to notes, any technique is OK and depends on the procedure, patient, provider, and surgeon skill.
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True or False: Postoperative cognitive dysfunction is a short term transient mental status change that increases hospital stay , increases costs, increases morbidity and mortality, and increases transfer to a nursing home.
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False: These aspects describe postoperative delerium. Post operative cognitive dysfunction is long term.
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Patients at risk for post operative delirium include: Choose all that apply:
a. patients younger than 70 b. patients older than 70 c. history of delirium or depression d. history of marijuana abuse e. history of alcohol abuse f.preop narcotic use |
B, C, E, F
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The 2 biggest factors in delayed discharge for ambulatory surgery cases are:
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uncontrolled pain and PONV
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Contributing factors to PONV are:(choose all that apply)
A. age B. gender C. smokers D. pain |
A, B, D
(nonsmokers are more prone than smokers) |
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Types of emetogenic surgery are:(choose all that apply)
A. ear/eye cases B. intraabdominal cases C. gynecological cases D. extremities cases E. ENT cases |
A, C, E
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Propofol has antiemetic properties: T or F
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T
(notes say 10-20 mg on emergence helpful) |
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Methods to prevent PONV include:
A. avoid N2O B. adequate hydration C. serotonin blockers (Zofran) D. dexamethasone |
A, C, D
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TIVA is one method to reduce PONV: T or F
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T
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Anesthesia factors that contribute to PONV include:
A. volatile agents B. opioids C. regional anesthesia techniques D. reversal agents |
A, B, D
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Why might you want to avoid N2O and Etomidate in the ambulatory surgery patient?
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These are associated with increased risk of PONV.
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General rule of thumb for the ambulatory surg pt--> use short acting drugs as much as possible.
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T/F: For the amb surg pt, you should use Versed on every pt and use a little higher doses than normal.
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False. Judicious use of benzos and not every pt requires them. For short surgeries, they may prolong recovery time (PACU/discharge times)
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TIVA stands for?
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Total Intravenous Anesthesia
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T/F: Des is the best agent to use for a TIVA case b/c its low blood-gas solubility allows for quick emergence.
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FALSE. Inhalation agents aren't used for TIVA anesthesia.
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T/F: For TIVA cases, continuous infusions are preferable to iv push boluses.
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TRUE. Allows for steady level of anesthesia, less effect on BP.
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Which of the following are advantages of doing a case under local anesthesia only? (more than one answer)
a. avoids cognitive dysfunction b. less recovery/PACU time c. provides some post-op analgesia d. less CV effects e. can do major procedures under local. |
ALL are true except E.
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T/F: A major disadvantage to Regional anesthesia is the time required to administer the block and allow it to set up.
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TRUE
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All are advantages of Regional Anesthesia except:
a. generally provide excellent operating conditions b. require more intra-op narcotics c. shorter recovery times d. provide good post-op analgesia |
B is not true. Generally require less IV narcotics
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Who is NOT at increased risk for postoperative delirium?
a. age >70 b. h/o delirium or depression c. ETOH history d. Pre-op narcotic use e. SRNA |
E is debatable
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T/F: Post-op delirium is associated with increased morbidity & mortality
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TRUE
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The "Advantages" of ambulatory surgery include: (choose two)
a. Less pt privacy b. Less time in hospital setting c. More hospital beds for inpatients d. Emphasis is on efficiency |
B & C
Advantages are: -less time in hospital setting -decreased risk of nosocomial infections -more hospital beds for inpatients -More convenient for patients & families A & D = disadvantages |
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Disadvantages of Ambulatory surgery include: T or F
a. less pt privacy b. may need multiple trips for screening & evaluation c. must have adequate home care d. emphasis on efficiency e. time to monitor for adverse events is "less" |
True
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The original, acceptable ASA classification for ambulatory surgery included:
a. ASA 1 b. ASA 2 c. ASA 3 d. ASA 4 e. A & B f. B & C |
e (A & B)
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The current patient selection criteria for ambulatory surgery includes ASA 1 - ASA 4:
T or F |
True
It depends on patient, procedure, ability of facility to provide adequate care! |
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True OR False: Local anesthesia avoids postoperative cognitive dysfunction.
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True(because there is no loss of consciousness)
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Name two advantages of local anesthesia
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1.Has shortest time to discharge
2. Provides some postop analgesia. |
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Name two advantages of Monitored Anesthetic Concentration(MAC)
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1. It provides range of hypnotic states
2. Has good patient satisfaction. |
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Advantages of Regional Anesthesia includes all except:
a. Shorter recovery times b. Better postop pain control c. Generally excellent operating conditions. d. Poor recovery |
d. Poor recovery
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Name five disadvantages of regional anesthesia
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1. Time required to administer block and onset of block.
2. May have prolonged recovery with SAB 3. Hypotension 4. Urinary retension 4. Delayed ambulation 5. PDPHA |
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For the ambulatory patient, should you give small or large amounts of narcotics?
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small doses are preferred, larger doses may delay recovery and increase post-op nausea and vomiting
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What are some pain management options for the ambulatory patient?
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1. regional block if appropriate
2. local infiltration by surgeon 3. Toradol 4. Small doses of narcotics 5. Oral NSAIDs or other non-narcotic drugs |
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For the ambulatory patient, Dr. Preston recommended giving Toradol when during the case?
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Give up-front with antiemetic. May take 30-60 minutes to work
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What is Phase I recovery for the ambulatory patient?
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Standard PACU
Patient needs monitoring |
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What is Fast-track recovery?
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Short-stay recovery unit
Patinet is awake, oriented, hemodynamically stable, adequate respiration, normal SPO2, moving well, no or mild pain or nausea |
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What ages contributes to PONV?
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children
young adults >60y/o decreased PONV |
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What gender contributes to PONV?
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young women
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T/F - Non-smokers have increased PONV?
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True
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Does history of PONV increase risk of future PONV for that patient?
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Yes
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Anxiety decreases PONV?
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No, it increases chance of PONV
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T/F - Pain can trigger PONV?
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True
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What types of surgery can contribute to PONV?
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Eye
Ear Oral ENT OB/GYN Bone |
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What can be done for prevention of PONV?
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TIVA
Avoid N2O 10-20mg of propofol on emergence Scoplolamine patch Odansetron 4-8mg Dexamethasone 5-10mg Aprepitant (Emend) 40mg Droperidol 0.625-1.25mg |
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Longer anesthesia time, General anesthesia, Volatile agents, older agents, opiods, N2O, and reversal agents all contribute to what?
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PONV
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34.7 million visits
Hospital 57% or 42% |
57%, 42% were surgery centers
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______% of discharges are outpatient
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62%
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Top 3 most frequent procedures
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1.endoscopy(sm and lg intestine)
2.Lens extraction and implantment 3.Injection of fluid into spinal canal |
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Ambulatory surgery is any procedure done on outpatient basis. 2 examples
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same day surgery and discharge and overnight obs (23:59)
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