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64 Cards in this Set

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