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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)
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
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)
Objective: Understand the components of the pre-anesthetic evaluation and anesthetic planning.
History

Physical exam

Diagnostic studies

Formulate anesthesia plan and discuss options with patient.

Discuss Risk and Benefits with patient and obtain informed consent
poor exercise tolerance=

(bolded)
poor outcome
why is it important to know the cardiovascular conditions that a pt has?
Many anesthetics act as cardiovascular depressants:

Decrease inotropy
Vasodilatation with decreased preload and afterload
Hypotension
if a pt has respiratory illness and you give them general anesthesia, what should you consider postoperatively?
Postoperative ventilation
what can be a complication of diabetes with anesthesia?

(bolded)
silent infarction
what can be 2 complications of hyperthyroidism with anesthesia?

(bolded)
cardiac failure, thyroid storm
what can be a complication of hypothyroidism with anesthesia?


(bolded)
MI
Liver/Renal disease have high mortality associated with them... because... 2

(bolded)
Drug metabolism/elimination is diminished

and CNS involvement
Sleep apnoea, CVS problems, difficult post operative recovery, are all associated with...
Morbid obesity
Please list the ASA classification:

normal healthy pt
ASA 1
Please list the ASA classification:

smokers, children under age 2
ASA 2
Please list the ASA classification:

Mild systemic disease
ASA 2
Please list the ASA classification:

severe systemic disease that limit activity

examples?
ASA 3

(obesity, kidney disease)
Please list the ASA classification:

incapacitating disease that is constant threat to life

plz give examples
ASA 4

unstable angina, kidney & liver diseases
Please list the ASA classification:

decleared brain death whose organs are being harvested.
ASA 6
Please list the ASA classification:

a moribund pt. not expected to survive 24hours
ASA 5

multi-organ system failure, aoritic dissection
Please list the ASA classification:

emergency procedures
E
What are the 4 standard monitors used in anesthesia?

***
Oxygenation: pulse ox, o2 analyzer

Ventialtion: canography (end-tidal CO2)

Circulation: ECG, BP, Stehoscope

Temp
What are some of the additional monitors used in anesthesia ? (you probably only need to remember those other 4 but just read this)
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
what is the minimum fasting time for solids/milks?

what about for fried/fatty meals? **
6hrs

8hours
when should your pt stop drinking clear fluids prior to surgery? **
2 hours

(note: coffee counts here)
a patient is ready for surgery and is chewing gum. is it go time or no? **
Chewing gum should not be permitted on the day of surgery.
minimum fasting time for:

Clear liquids
2 hrs
minimum fasting time for:

Breast Milk
4 hrs
minimum fasting time for:

Infant Formula
6 hrs
minimum fasting time for:

Non-human milk
6 hrs
minimum fasting time for:

Light meal
6 hrs
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)
Anesthetic Choice:

Sedation
Monitored Anesthesia Care (MAC)
Anesthetic Choice:

General
Patient unconscious, likely intubated
Anesthetic Choice:

Epidural
Catheter placed in epidural space to deliver local anesthetic to numb nerve roots that supply area of surgery
Anesthetic Choice:

Spinal
Single dose of local anesthetic given into CSF to numb lower thorax, abdomen, and lower extremities
Anesthetic Choice:

Peripheral nerve block
Local anesthetic injected near nerve(s) that supply area of surgery, ex. brachial plexus
Anesthetic Choice:

Bier Block
intravenous regional anesthesia by injecting local anesthetic in vein after squeezing blood, and a tourniquet has been applied
Is spinal safer than general anesthesia?
not necessarily, so that is not a good rule of thumb

No one plan is safer than any other
what are the 3 general anesthesia phases?
Induction and intubation
Maintenance
Emergence
There is one fundamental difference between pilots and anesthesiologists that makes flying a plane easier than giving anesthesia-
…. 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
what is the major method of induction?
intravenous
Propofol, Fentanyl, and Midazolam are what type of agents? (probably not on test)
Intravenous agents
Nitrous oxide-weak
Isoflurane
Sevoflurane
Desflurane
Halothane

are what type of agents? (probably not on test)
Inhalational anaesthetics
what reduces maintenance doses of anaesthetic agents needed for inhalation or IV?
muscle relaxants
Succinylcholine

Duration and depol or non depol?

main use?
Short acting (quick onset too)

Depolarizing

good for intubation
Tracurium

Duration and depol or non depol?
medium/long acting

Non-depolarizing
Vecuronium

Duration, onset, and depol or non depol?
works really fast, but is medium/long acting

Non-depolarizing
Rocuronium

Duration and depol or non depol?
medium/long acting

Non-depolarizing
largest side effect of succinylcholine?

**
HYPERKALEMIA with CARDIAC ARREST
please list 2 high risk pts that you should avoid the use of succinylcholine
Burn patients, even after few hours

Patients with denervation injury:
Spinal cord injury
Stroke with significant deficit
Bed-ridden patients
What are the Mallampati score and Thyro-mental distance used for?
to predict the difficulty of ventilation or intubation
Mallampati Classification:

uvula, faucial pillars, soft palate visible

when asked to open mouth wide
Class I
Mallampati Classification:

faucial pillars, soft palate visible

when asked to open mouth wide
Class II
Mallampati Classification:

Only soft palate visible

when asked to open mouth wide
Class III
Mallampati Classification:

Soft palate not seen

when asked to open mouth wide
Class IV
Moderate head elevation, extension of atlanto-occipital, and flexion of the lower portion of the cervical spine is known as what?
the sniffing position
Laryngoscopic View Grade?

the vocal cords are visible
Grade I
Laryngoscopic View Grade?

the vocal cords are only partly visible
Grade II
Laryngoscopic View Grade?

only the epiglottis is seen
Grade III
Laryngoscopic View Grade?

the epiglottis can not be seen
Grade IV
what are the 2 most common causes of anesthestic complications?
Inadequate preoperative planning and errors in patient preparation
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:
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
AWARENESS

Usually paralyzed and awake (muscle relaxants do NOT cause sedation, need deep sedation FIRST)
inhalation gases and succinylcholine can cause this side effect that is an autosomal dominant inherited moypathy...
Malignant Hyperthermia
What is the treatment for Malignant Hyperthermia?

***TEST
DANTROLENE