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25 Cards in this Set
- Front
- Back
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Pre Induction Phase
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1. DAMMITTS
2. Greet pt and intro and do eval. 3. IV access 4. Pt sedation 5. Transport to operating room 6. Establish baseline physiologic monitoring (BP, HR, EKG, SpO2) |
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Determine the types of anesthesia used for the surgery.
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Local (local with sedation)
General (sedation, hypnosis) Amnesia, analgesia, +/- muscle relaxant. Neuroaxial blocks: spinal and epidural. |
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Spinal anesthesia
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Local anesthesia placed in subarachnoid space.
Blocks both sensory and motor function. An all or none effect. Pt in sitting position for application of anesthesia. |
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Epidural anesthesia
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Local anesthesia is placed in epidural space (btw dura and vertebral canal).
Can block sensory nerves alone or in combination with motor nerves. |
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Induction of Anesthesia
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Preoxygenation
a. Comm. with pt that you want him to breathe some O2 before going to sleep. b. 100% via tight fitting mask c. 6L/min+ d. Take deep breathes thru nose and mouth and fully exhale. |
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What is the end point of preoxygenation? And why?
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When the near complete replacement of nitrogen in the lungs occurred.
So that a margin of safety is provided when the pt is not breathing during the time that you are trying to intubate or apply an LMA. |
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ET and FI for O2 during preoxygenation should be?
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90+
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Administration of Induction Drugs and which drugs?
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Tell pt that he is about to "go to sleep"
Adm hypnotics, i.e. propofol, sodium thiopental, etomidate |
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What are the peak effects for propofol, sodium thiopental, and etomidate?
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Propofol: 1-2.5 mg/kg--> 1-2mins
Thiopental: 3-5 mg/kg--> 45s-2mins Etomidate: 0.2-0.6mg/kg--> 45sec-2mins. |
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Adm of local anesthestic
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Usually it is given before hypnotic drugs.
To alleviate discomfort of hypnotic drug. To suppress airway reflexes |
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Dose of Lido 2%
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0.5-1.0 mg/kg
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The usefulness of administering opiods during induction is?
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Helps to blunt body's rxn (sympathetic stimulation) to laryngoscopy.
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Doses and peak time for fentanyl and morphine?
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Fentanyl: 2-5 mcg/kg-->5-7mins
Morphine .05-.15 mg/kg--> 15-30 mins |
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Assessment of adequate hypnosis?
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Talk to them, i.e. open your eyes. Hearing is the last sense to go away.
Eye lash test. If pt is asleep, now is a good time to protect the eyes. |
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Bag/mask ventilation:
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Extend neck and pull chin up.
Close the APL valve. Note: when a pt can breathe spontaneously, leave the APL valve open. |
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What does it mean when ET and FI of O2 are equal?
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Pt is not breathing. No ventilation.
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Once bag/mask ventilation is established, what is your next step?
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Adm. NMBD and monitor the effect with the PNS.
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When can you start to intubate?
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When the PNS indicates that the pt is relaxed (paralyzed).
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T or F
No muscle relaxant is necessary. |
True
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What reading would help you determine if you've placed the ET tube properly?
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Capnogram
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Balanced anesthetic technique is consisted of:
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1. Inhalation anesthetic agent (hypnosis and amnesia)
2. Opioids 3. NMBDs No one drugs can provide the surgical environment of hypnosis, analgesia, and muscle relaxation. |
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In monitoring the depth of anesthesia, how is BP reading compared to HR?
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BP is more predictable. As stimulation increases, so does BP and vice versa. Not necessarily true with HR.
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Sings of depth of anesthesia:
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Shallow breathing
Decreased RR Decreased pupil size |
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BIS values and their indications:
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100 Awake
0 Isoelectric EEG 40-60 High predictor of hypnosis |
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As a general rule, hypnosis or unconsciousness is controlled by? and pain is controlled by?
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Unconsciousness--> inhalation agent.
Pain--> Opioids (narcotics) |
