Hnas 701 Outpatient And Offsite Anesthesia

Front 1

What is the greatest risk of postoperative apnea in pediatric patients in respect to chronological age?

Back 1

Postconceptual age less than 54 weeks/gest. age 35
Postconcept age 56 weeks and gest age 32 weeks

Front 2

What is the major factor to consider in judging the appropriateness of outpatient surgery in elderly patients?

Back 2

Medical control of disease

Front 3

What is a major important consideration in outpatients?

Back 3

PONV

Front 4

What is analgesia in the outpatient setting highly reliant on?

Back 4

Local anesthetic infiltration

Front 5

What are advantages of outpatient surgery?

Back 5

Decreased medical cost
Increased bedspace in hospitals
Protection of immunocompromised pt. from nosocomial infection
Avoidance of family unit disruption
Ability to rehab sooner

Front 6

What type of anesthesia is used at office based sites?

Back 6

MAC, general, regional

Front 7

True or False- Age is a factor in selecting patients for outpatient surgery

Back 7

False

Front 8

What considerations should be made for patient in regard to office anesthesia?

Back 8

Can the patient go home after?
AwaC- alert, awake, warm, comfortable, pain free
No PONV, minimal to absent

Front 9

What are fasting guidelines for preop?

Back 9

2 hours clears
4 hours breast milk
6 hours infant formula
6 hours light meal/solids

Front 10

What are considerations if there is Peds Rhinorrhea?

Back 10

Assume acute URI if doubt
Delay if T>38C and pt appears ill

Front 11

If Ped seperation anxiety what medication could you administer?

Back 11

Midazolam 0.5-1mg po or PR- may allow seperation within 20-30minutes

Front 12

Mentally challenged patient is uncooperative. What could you give?

Back 12

Ketamine Dart-
Ketamine 3mg/kg Midaz 0.2mg/kg Robinul 0.2mg IM

Front 13

If there is no IV what can you give to decrease preop anxiety?

Back 13

up to 10mg po Diazepam or 100mg Vistaril

Front 14

What inhalation induction agent can be used in Peds? What is disadvantage of this agent?

Back 14

Sevoflurane- Post op delirium possible

Front 15

What inhalation agent would you avoid if concern r/t PONV?

Back 15

N2O

Front 16

Describe PONV Dopamine antagonists

Back 16

Reglan
Droperidol

Front 17

Describe PONV 5 HT3 inhibitors

Back 17

Zofran, Anzamet

Front 18

What are some PONV Phenothiazines and steroids?

Back 18

Compazien, Phenergan
Steroid- Dexamethasone

Front 19

What could you do to help decrease incidence of PDPH?

Back 19

Thin >25G rounded or pencil point needles. Epidural as alternative if pt. high risk for PDPH

Front 20

What are other considerations regarding spinal anesthesia?

Back 20

Prolonged SAB frustrating to patients. Urinary retention. Don't add epi to local anesthetic

Front 21

What is concern with spinal lidocaine?

Back 21

Transient radicular symptoms.

Front 22

What are alternative drugs for SAB?

Back 22

Procaine
Mepivacaine
Bupivicaine
Ropivicaine
Cann add fentanyl but select patients carefully

Front 23

What type of postop analgesia allows continuous instillation of local? What can you add to prolong LA duration?

Back 23

Indwelling peripheral nerve and plexus catheters. May add a2 agonist to prolong. ON-Q pain pump.

Front 24

What can you use for anesthesia for inguinal herniorrhaphy?

Back 24

GA, RA, MAC

Front 25

What are pros and cons of GA for inguinal herniorrhaphy?

Back 25

Quick and controllable
Possible PONV, sore throat coughing stressing suture lines

Front 26

What are pros and cons of Regional for inguinal herniorrhaphy?

Back 26

Good sensory and motor block
Possible PDPH, urinary retention, duration of block

Front 27

What are pros and cons of MAC for inguinal herniorrhaphy?

Back 27

Controllable sedation, no airway instrumentation, pt can cooperate, rapid recovery
Local must be adequate

Front 28

Where can you admit patients in recovery if appropriate criteria met?

Back 28

Phase 2 area

Front 29

What is Fast-track criteria factors for direct transfer from OR to phase 2?

Back 29

Aldrete
PONV
Pain

Front 30

What are common postop problems in offfice setting? What is largest one regarding unexpected admission?

Back 30

PONV, pain, drowsiness, urinary retention.
PONV MOST.

Front 31

If patients EtCO2 goes out while in MRI, what do you do?

Back 31

Go in scanner right now and fix

Front 32

What is concern with offsite anesthesia in cardiology suite?

Back 32

Level of cardiac dysfunction

Front 33

What are considerations to make when going offsite?

Back 33

Where and who is backup
Routine and emergency equipment
Policies, staff, communication

Front 34

What are special considerations for MRI

Back 34

No ferromagnetic objects. Can lose access to airway. Bring extra tubing, careful with extensions.

Front 35

In ECT how long must seizure last for it to be effective?

Back 35

30-60 seconds

Front 36

We are giving a paralytic to ECT patient- how can we tell they are having a seizure?

Back 36

Limb isolation- tourniquest applied to distal limb.

Front 37

Describe Autonomic activation sequence for ECT

Back 37

First Tonic- PaSNS- bradycardia, hypotension possible asystole FIRST

Second- Clonic Phase- SNS- Tachycardia, HTN, arrythmias peaking 1 minute lasting 5-10min or longer

Front 38

What are cerebral changes in ECT?

Back 38

100-400% increase in cerebral blood flow, increased ICP

Front 39

What can we do to lower seizure threshold?

Back 39

Hyperventilate

Front 40

What are absolute contraindications of ECT?

Back 40

Pheochromocytoma, recent MI, recent CVA, or intercranial surgery, intracranial lesion, unstable Cspine, increased ICP

Front 41

What are relative contraindications for ECT?

Back 41

Angina, Pacer/ICD, Severe pulmonary disease, major bone fracture, glaucoma, retinal detachment, pregnancy

Front 42

Describe ESWL

Back 42

Extracorporeal shock wave lithotripsy, shock waves that pulveraze stones.
Risk of dysrhythmias > time lithotripsy shocks 20msec after R wave
Painful