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64 Cards in this Set
- Front
- Back
what is meant by the fact that an anesthesiologist is a "perioperative" physician? (objective)
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they play a role in the:
preoperative phase (Identify potential anaesthetic difficulties; Existing medical conditions ) the intraoperative phase (type of anaesthtic, need for monitoring, special meds) postoperative phase |
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what are the 5 basic goals of anesthesia?
*** |
The 5 A's
Awareness Amnesia (make sure pt doesn't remember the operation) Analgesia Autonomic Stability (vital signs under control) Appropriate surgical conditions (muscle relaxant) |
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Objective: Understand the components of the pre-anesthetic evaluation and anesthetic planning.
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History
Physical exam Diagnostic studies Formulate anesthesia plan and discuss options with patient. Discuss Risk and Benefits with patient and obtain informed consent |
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poor exercise tolerance=
(bolded) |
poor outcome
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why is it important to know the cardiovascular conditions that a pt has?
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Many anesthetics act as cardiovascular depressants:
Decrease inotropy Vasodilatation with decreased preload and afterload Hypotension |
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if a pt has respiratory illness and you give them general anesthesia, what should you consider postoperatively?
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Postoperative ventilation
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what can be a complication of diabetes with anesthesia?
(bolded) |
silent infarction
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what can be 2 complications of hyperthyroidism with anesthesia?
(bolded) |
cardiac failure, thyroid storm
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what can be a complication of hypothyroidism with anesthesia?
(bolded) |
MI
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Liver/Renal disease have high mortality associated with them... because... 2
(bolded) |
Drug metabolism/elimination is diminished
and CNS involvement |
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Sleep apnoea, CVS problems, difficult post operative recovery, are all associated with...
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Morbid obesity
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Please list the ASA classification:
normal healthy pt |
ASA 1
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Please list the ASA classification:
smokers, children under age 2 |
ASA 2
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Please list the ASA classification:
Mild systemic disease |
ASA 2
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Please list the ASA classification:
severe systemic disease that limit activity examples? |
ASA 3
(obesity, kidney disease) |
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Please list the ASA classification:
incapacitating disease that is constant threat to life plz give examples |
ASA 4
unstable angina, kidney & liver diseases |
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Please list the ASA classification:
decleared brain death whose organs are being harvested. |
ASA 6
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Please list the ASA classification:
a moribund pt. not expected to survive 24hours |
ASA 5
multi-organ system failure, aoritic dissection |
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Please list the ASA classification:
emergency procedures |
E
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What are the 4 standard monitors used in anesthesia?
*** |
Oxygenation: pulse ox, o2 analyzer
Ventialtion: canography (end-tidal CO2) Circulation: ECG, BP, Stehoscope Temp |
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What are some of the additional monitors used in anesthesia ? (you probably only need to remember those other 4 but just read this)
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Urine output
Neurologic: Nerve stimulator, EEG, BIS ( Bi-spectral index) Invasive cardiovascular monitors: Arterial catheter, Central venous catheter, Pulmonary artery catheter. Transesophageal echocardiography Labs as needed |
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what is the minimum fasting time for solids/milks?
what about for fried/fatty meals? ** |
6hrs
8hours |
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when should your pt stop drinking clear fluids prior to surgery? **
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2 hours
(note: coffee counts here) |
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a patient is ready for surgery and is chewing gum. is it go time or no? **
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Chewing gum should not be permitted on the day of surgery.
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minimum fasting time for:
Clear liquids |
2 hrs
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minimum fasting time for:
Breast Milk |
4 hrs
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minimum fasting time for:
Infant Formula |
6 hrs
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minimum fasting time for:
Non-human milk |
6 hrs
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minimum fasting time for:
Light meal |
6 hrs
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If patient has full stomach and needs emergency surgery, must use ?
2 bolded |
Rapid sequence induction
Cricoid pressure (stops aspiration of stomach contents during anesthesia) |
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Anesthetic Choice:
Sedation |
Monitored Anesthesia Care (MAC)
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Anesthetic Choice:
General |
Patient unconscious, likely intubated
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Anesthetic Choice:
Epidural |
Catheter placed in epidural space to deliver local anesthetic to numb nerve roots that supply area of surgery
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Anesthetic Choice:
Spinal |
Single dose of local anesthetic given into CSF to numb lower thorax, abdomen, and lower extremities
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Anesthetic Choice:
Peripheral nerve block |
Local anesthetic injected near nerve(s) that supply area of surgery, ex. brachial plexus
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Anesthetic Choice:
Bier Block |
intravenous regional anesthesia by injecting local anesthetic in vein after squeezing blood, and a tourniquet has been applied
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Is spinal safer than general anesthesia?
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not necessarily, so that is not a good rule of thumb
No one plan is safer than any other |
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what are the 3 general anesthesia phases?
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Induction and intubation
Maintenance Emergence |
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There is one fundamental difference between pilots and anesthesiologists that makes flying a plane easier than giving anesthesia-
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…. that is a pilot does not have to contend with a surgeon messing around with his airplane
ha. ha. ha. super funny laugh time joke |
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what is the major method of induction?
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intravenous
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Propofol, Fentanyl, and Midazolam are what type of agents? (probably not on test)
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Intravenous agents
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Nitrous oxide-weak
Isoflurane Sevoflurane Desflurane Halothane are what type of agents? (probably not on test) |
Inhalational anaesthetics
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what reduces maintenance doses of anaesthetic agents needed for inhalation or IV?
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muscle relaxants
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Succinylcholine
Duration and depol or non depol? main use? |
Short acting (quick onset too)
Depolarizing good for intubation |
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Tracurium
Duration and depol or non depol? |
medium/long acting
Non-depolarizing |
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Vecuronium
Duration, onset, and depol or non depol? |
works really fast, but is medium/long acting
Non-depolarizing |
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Rocuronium
Duration and depol or non depol? |
medium/long acting
Non-depolarizing |
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largest side effect of succinylcholine?
** |
HYPERKALEMIA with CARDIAC ARREST
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please list 2 high risk pts that you should avoid the use of succinylcholine
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Burn patients, even after few hours
Patients with denervation injury: Spinal cord injury Stroke with significant deficit Bed-ridden patients |
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What are the Mallampati score and Thyro-mental distance used for?
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to predict the difficulty of ventilation or intubation
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Mallampati Classification:
uvula, faucial pillars, soft palate visible when asked to open mouth wide |
Class I
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Mallampati Classification:
faucial pillars, soft palate visible when asked to open mouth wide |
Class II
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Mallampati Classification:
Only soft palate visible when asked to open mouth wide |
Class III
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Mallampati Classification:
Soft palate not seen when asked to open mouth wide |
Class IV
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Moderate head elevation, extension of atlanto-occipital, and flexion of the lower portion of the cervical spine is known as what?
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the sniffing position
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Laryngoscopic View Grade?
the vocal cords are visible |
Grade I
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Laryngoscopic View Grade?
the vocal cords are only partly visible |
Grade II
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Laryngoscopic View Grade?
only the epiglottis is seen |
Grade III
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Laryngoscopic View Grade?
the epiglottis can not be seen |
Grade IV
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what are the 2 most common causes of anesthestic complications?
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Inadequate preoperative planning and errors in patient preparation
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what are 5 specific anesthetic complications?
*** |
Human error (technical problems, lack of communication, experience, fatigue,)
Airway: (breathing circuit, defect of monitoring equipment, anesthesia machine) Positioning: (peripheral nerve damage) Anaphylaxis: ( Latex allergy) Burns: |
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this is a rare complication of anesthesia that is very traumatic, seen in in high-risk patients such as trauma, open heart surgery, or obstetric because not always able to give adequate doses of anesthesia if patient unstable or hypotensive
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AWARENESS
Usually paralyzed and awake (muscle relaxants do NOT cause sedation, need deep sedation FIRST) |
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inhalation gases and succinylcholine can cause this side effect that is an autosomal dominant inherited moypathy...
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Malignant Hyperthermia
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What is the treatment for Malignant Hyperthermia?
***TEST |
DANTROLENE
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