Basics Of Anesthesia

Front 1

What are some cardiac considerations of prone position?

Back 1

pooling of blood in extremities
compression of abd muscles (pt should have TEDS/SCDs)
pooling can --> decreased preload, decr CO, decreased BP
increased SVR and PVR

Front 2

What are some cardiac considerations of sitting position?

Back 2

minimal effects on CV

Front 3

What are some cardiac considerations with reverse t-burg?

Back 3

decr CO, preload, BP
baroreceptor reflexes incr SNS tone, HR, PVR

Front 4

What are some cardiac considerations with Trendelenburg?

Back 4

activation of baroreceptors --> decr in CO, PVR, HR, and BP
research suggests t-burg does not improve CO in hypotension and hypovolemia

Front 5

What does cardiogenic oscillations on ETCO2 waveform indicate?

Back 5

interference from heart or aorta pulsation

Front 6

What does a cleft on alveolar plateau on ETCO2 waveform indicate?

Back 6

spontaneous respiration

Front 7

Common injury with lithotomy position?

Back 7

peroneal nerve injury from fibula pressing against candy canes

Front 8

5 Complications of lateral decub positions

Back 8

1. backache/neck pain
2. compartment syndrome
3. contusion "folding" ear
4. Inc IOP, ischemia to dependent eye
5. stretch injury to suprascapular nerve (too much rotation of non-dep arm)

Front 9

3 complications of lithotomy position

Back 9

1. peroneal nerve injury
2. compartment syndrome
3. digit amputation

Front 10

5 complications of prone position

Back 10

1. ischemic optic neuropathy
2. central retinal artery occulsion
3. periorbital, conjunctival edema (keep HOB at lvl of heart of higher)
4. brachial plexus injury
5. impaired cerebral perf

Front 11

Deoxyhemoglobin looks dark b/c of the _______ absorption of red light

Back 11

increased

Front 12

Does Hb absorb more infrared or red light?

Back 12

red (660nm)

Front 13

Does HbO2 absorb more infrared or red light?

Back 13

infrared (960nm)

Front 14

How does the mass spectrometer work?

Back 14

analyzes inspired (FI) and end tital (ET)
o2, no2, co2, anesthetic gases
compares the mass:charge ratio & places into specturm

Front 15

explain the 1st phase of exhalation

Back 15

deadspace gas leaving the lung (no CO2)

Front 16

explain the 2nd phase of exhalation

Back 16

includes deadspace gas and gas from the alveoli mixing, which causes a rapid rise in CO2

Front 17

explain the 3rd phase of exhalation

Back 17

all deadspace gas is out.
CO2 slowly rises (dependant on V/Q ratio)

Front 18

explain the 4th phase of exhalation

Back 18

peak ETCO2 which is the highest level exhaled CO2 during respiration (plateau)

Front 19

AANA: standard of care for nurse anesthesia practice (Standard V)

Back 19

Monitor ventilation continuously. Verify intubation by auscultation, chest excursion, and confirmation of CO2 in expired gas. Monitor ETCO2 during ventilation incl. anesthesia or sedation req. artificial airway support. Use spirometry and vent pressure monitors

Front 20

Capnogram

Back 20

Actual waveform generated by capnometer

Front 21

Capnography

Back 21

Graphic record of CO2 concentration on screen or paper

Front 22

Raman spectrometry

Back 22

Laser interacts with gas molecule and measures the fraction of energy absorbed at different light wavelengths called “scattering”
Advantages – multi-gas/agent, fast, no scavenging, accurate
Disadvantages - costly

Front 23

What are the advantages and disadvantages of Mass Spectometry?

Back 23

Advantages - Multigas, multiagent, fast, reliable, low cost

Disadvantages - Measures only preprogrammed gases, must be scavenged, warm-up time, space

Front 24

What are the advantages and disadvantages of Mainstream Sampling?

Back 24

Measures gas directly in the breathing system
Advantages – fast, good waveform, water & secretions not issue
Disadvantages – heavy in circuit, incr dead space, opport for disconnect, gas options limited

Front 25

What are the advantages and disadvantages of Sidestream Sampling?

Back 25

Advantages – Accurate < 40 Resp/min, lightweight, less chance of disconnect
Disadvantages – water/secretions may clog line, flexible tube can be easily obstructed

Front 26

What is mainstream sampling?

Back 26

Measures gas directly in the breathing system

Front 27

What is sidestream sampling?

Back 27

Pump in the monitor aspirates a sample of gas through a thin, flexible sampling line

Front 28

What is a Galvanic cell?

Back 28

Fuel or microfuel cell sensor used for O2 analysis
Calibrated daily to room air (21% O2)

Front 29

What are the principles behind O2 sat monitoring?

Back 29

Measures pulsatile signals across perfused tissue at 2 wavelengths where absorption is compared as a ratio of oxyhemoglobin to all functional hemoglobins (algorithms used)

Front 30

What does the pulse ox probe contain?

Back 30

light source (light-emitting diodes - red and infrared)
light detector (photodiode)

Front 31

What are the principles of O2 sat monitoring? (simplified answer)

Back 31

the absorption of radiation (light) is proportional to the concentration of the substance

Front 32

Oxyhemaglobin looks red b/c of the _______ absorption of red light

Back 32

decreased

Front 33

Name 7 factors that influence accuracy of pulse ox reading.

Back 33

1. excessive ambient light
2. motion
3. methylene blue
4. low CO, hypothermia
5. profound anemia
6. nail polish
7. bovie

Front 34

When are Pulse Ox (sats) not very accurate?

Back 34

<70%

Front 35

When is the esophageal steth C/I?

Back 35

esophageal varices or strictures

Front 36

Describe how air embolism/PE affects ETCO2

Back 36

Decreased CO2

Front 37

Describe how circuit disconnect affects ETCO2

Back 37

Decreased CO2

Front 38

Describe how CO2 insufflation during laproscopic procedure affects ETCO2

Back 38

Increased CO2

Front 39

Describe how hyperventilation affects ETCO2

Back 39

Decreased CO2

Front 40

Describe how hypothermia affects ETCO2

Back 40

Decreased CO2

Front 41

Describe how hyperthermia affects ETCO2

Back 41

Increased CO2

Front 42

Describe how hypoventilation affects ETCO2

Back 42

Increased CO2

Front 43

Describe how improved blood flow (CO) affects ETCO2

Back 43

Increased CO2

Front 44

Describe how release of clamp/tourniquet during vascular surgery affects ETCO2

Back 44

Increased CO2

Front 45

What are some limitations & proper application of esophageal steth?

Back 45

Limited to use with intubated patients
Placed in nasally or orally & rest in lower 1/3 of esophagus

Front 46

What is a Precordial stethoscope?

Back 46

Special stethoscope that is placed on various locations of a pts chest
Wenger chest piece is large (heavy/adult) or small (lightweight/pedi)

Front 47

Improper prone positioning can cause abdominal pressure.. why does this matter?

Back 47

increased abdominal pressure can cause
decreased preload
cephalad movement of the diaphragm
decreased FRC and compliance
increased peak airway pressure

Front 48

In standard lithotomy position how is pt positioned?

Back 48

thighs flexed approx 90 deg.
knees bent parallel to floor
legs well padded
arms tucked or on armboards <90 angle

Front 49

what is the maximum angle armboards and arms should be in the supine position? what is the desirable angle?

Back 49

<90degrees (max)
60 degrees (optimal)

Front 50

what nerve can be injured by the anesthetist's fingers on the patient's mandible during masking?

Back 50

Facial Nerve

Front 51

What surgical access is possible with prone position?

Back 51

posterior fossa of skull
posterior spine
buttocks
perirectal area
posterior lower extremities

Front 52

Which position increase pressure in cerebral veins, inc ICP/CVP/IOP, inc preload, and causes nasal congestion?

Back 52

Trendelenburg

Front 53

Who is ulnar neuropathy more common in?

Back 53

Older males

Front 54

Why use an axillary roll in lateral decub position?

Back 54

to raise the thorax and prevent shoulder compression and brachial plexus injury

Front 55

Wrist drop, weakness of abduction of thumb, loss of sensation b/w thumb and index finger, inability to extend the distal phalanx of the thumb

Back 55

Radial Nerve Injury

Front 56

how should you place the patient's palms when the pt is in the supine position? why?

Back 56

palms up (supination)
relieves pressure on the ulnar nerve as it passes through the humeral notch at the elbow

Front 57

Trendelenburg positon causes swelling where?

Back 57

head
neck
possible airway obstruction

Front 58

What is lateral jackknife position?

Back 58

-intended to widen intercostal spaces
-pt down-side iliac crest over the hinge
-table is flexed so the thighs become lateral to the trunk
-chassis of table re-oriented so that flank and thorax become horizontal

Front 59

inability to completely extend elbow, numbness over dorsal and palmar areas of the distal phalanges of the 1 and 2nd fingers. caused by AC trauma s/p IV attempt.

Back 59

Median nerve dysfunction

Front 60

What was found when ASA close claim analysis was done b/w 1990-1999 of 2 separate studies.

Back 60

Both studies - 16% of settlements were related to peripheral nerve injuries but no MOI could be found