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64 Cards in this Set
- Front
- Back
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Who is responsible for anesthetic choice
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all members of the anesthesia care team
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If CRNA doesn't agree with anesthetic choice - who are the options
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since still responsible - have option not to take the case
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What is typically the deciding factor for the anesthetic choice
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preoperative assmt and hx
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What are deciding factors for the anesthetic choice
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preoperative assmt and hx, review of lab data, informed consent
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How decide anesthesia technique
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preoperative assessment
site of surgery position required elective or emergent aspiration risk suspicion of difficult airway duration of surgery pt age anticipated recovery time post anesthesia care pt choice |
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What anesthesia technique for T&A - why
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ETT - b/c need good airway and painful
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What anesthesia technique for prone
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ETT - requires deeper sedation
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Elective cases allow more _____ than emergent cases
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options
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Risk for aspiration requires
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rapid airway
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Suspicious airway may impact
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impact using long/short acting meds
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A suspicious airway may limit
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limit choice to do a case without a protected airway
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What is limit for doing a case with an LMA
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about 2 hours
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Why would small children be a problem for a SAB
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they won't hold still
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Total knee - what would use for getting admitted what would use for going home
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admitted - choose longer acting local
going home - shorter acting or avoid SAB completely |
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Fem nerve blocks last
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12 hours
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What is the main difference between MAC and general
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MAC - pt has ability to control airway (general does not)
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Regional anesthetics include
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SAB, epidurals
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Peripheral nerve blocks include
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femoral blocks, ankle blocks, brachial plexus blocks, digital blocks
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For a conscious sedation procedure - the CRNA
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does not need to be there
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Combination cases involve
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more than one technique - ex: MAC (narcotic) + versed, propofol, ketamine (sedation) or
general + thoracic epidural |
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In combination cases, may have to consent
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for both
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What is ideal anesthetic
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optimal pt safety
optimal operating conditions rapid recovery times few side effects low cost early transfer or DC from PACU good pain control permit high turnover times |
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MediaCare will not pay for
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preventable conditions - ex: hypothermia
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Goals of general anesthesia
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pain relief (analgesia)
blocking memory of procedure (amnesia) producing unconsciousness (anesthesia) inhibiting normal body reflexes to make surgery safe and easier to perform relaxing muscles of the body |
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Anesthesia prerequisites
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oxygen
suction checked machine and confirmed circuit monitoring drugs airway equipment skilled assistance emergency equipment and drugs in room |
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Monitoring is considered a
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standard of care for anesthesia
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Triad of general anesthesia
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hypnosis - loss of consciousness, memory
analgesia - pain relief muscle relaxation - prn |
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Varying levels of hypnosis
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awake
amnesia sedation hypnosis coma death |
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MAC includes what levels of hypnosis
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amnesia - sedation
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General includes what levels of hypnosis
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sedation - hypnosis - coma
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What is the least pungent (irritating) volatile anesthetic
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sevoflurane
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What agent is used most for inhalation induction
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sevoflurane
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Two types of IV induction
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rapid sequence IV
non-rapid sequence IV |
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Steps for mask induction
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monitors on (kids - SpO2 only)
7LPM N2O + 3LPM O2 + 8% sevoflurane place head behind head watch stages as pt enters stage III - assist ventilations tape eyes maintain with mask ventilation |
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In what stage do you place the OP
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Stage III
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If IV is required, can be started when pt enters
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deeper state
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To preoxygenate make sure that
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the N2O is shut off
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Limitations to masking/mask ventilation
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1. airway is not secure
2. maximum pressure is 20 cm H2O 3. requires more hands on time 4. longer cases can result in tired hands 5. if need muscle relaxant - need ETT |
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An unsecure airway can lead to
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aspiration
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If airway is not secure, there is a potential
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loss of airway or obstruction with inability to ventilate
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What two types of patient would make mask ventilation difficult
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restrictive dz - requiring > 20cmH20 to ventilate
steep trendelenburg - requiring > 20cmH20 to ventialte |
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If case requires a NMB pt should be
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intubated
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A NMB reduces the
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airway muscle tone and tone of the esophageal sphincter
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The most important anesthetic skill that can be learned
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mask ventilation
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NRSI with LMA - procedure
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preoxygenate - denitrogenate
monitors narcotic - prevent sympathetic response to DVL induction agent tape eyes attempt ventilation mask mgmt or LMA insertion |
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NRSI with ETT - procedure
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preoxygenate - denitrogenate
monitors narcotic - prevent sympathetic response to DVL induction agent tape eyes attempt ventilation paralytic ventilate with volatile anesthetic (until paralytic works) - propofol will be wearing off check TOF intubate check all things post intubation mask mgmt or LMA insertion |
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What is purpose to ventilate before NMB
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couple things -
avoid can't intubate/can't ventilate scenario determine if can extubate deep or not |
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Be aware of length of case when choosing NMB agent because
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if case only lasts 15min - pt will not be ready to be reversed
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Do not give a long acting NDMR if anticipate
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difficult airway
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RSIV - procedure
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preoxygenate
priming dose of NDMR - roc 0.4-0.6mg 2kg cricoid pressure IV induction drugs succs or roc 4kg cricoid pressure tape eyes check TOF intubate check all things post intubation |
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Most common defasciculation agent used
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rocuronium
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what is the normal dose of rocuronium when used for defasciculating agent
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0.4mg-0.6mg
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Do not attempt ventilation during
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RSIV
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If succinylcholine is contraindicated use
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rocuronium
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Which has longer duration - roc or succs
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roc
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Only release cricoid pressure when
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ETT placement is confirmed
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Inhalation anesthetics
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N2O
isoflurane sevoflurane desflurane halothane |
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hypnotic drugs - IV
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pentothal - gold standard
propofol etomidate benzodiazepines ketamine |
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Good analgesia =
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good anesthesia
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Narcotics do not affect
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amnesia
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Purpose of muscle relaxers
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aids intubation
helps surgeon/surgery surgery of long duration reduces maintenance of anesthetics |
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MAC means
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monitored anesthesia care
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MAC - provides analgesia while pt maintains
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airway reflexes
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MAC is used in conjunction with
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localization or other regional techniques
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