Module 4.5 Remote Anesthesia – Flashcards
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Monitoring Standards Universal requirements ASA/AANA standards -Anesthesia provider presence -Oxygenation (pulse oximetry, FiO2) -Ventilation (PE, expired gases, ETT position, & ventilator w/ disconnect alarm) -Circulation (Document ECG, BP, & HR q__ mins) -Temperature monitoring available -NMB monitoring -Positioning
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5
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Properly Functioning Equipment M S M A I D D
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Machine Check (FDA) Suction Monitors Airway IV Access Drugs Defibrillator
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Medications Desirable characteristics -_____-acting agents -_____ re-distribution & elimination -Reversible -_____ side-effect profile
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short quick smaller
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Cardioversion Set-up -Check prior to procedure -Ambu bag -Monitors (EKG, SaO2, NIBP) (May sedate for TEE first. WHY? _____) (Rare use of invasive monitors) Patient Status -Stable arrhythmias -NPO? -Co-morbidities -Patient Prep -Informed Consent (PCP) -Anesthesia Pre-op Workup
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to make sure there are no clots
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AICD (VF)/pacemaker placement SedationGETA Threshold test -_____ CO & BP (be prepared to deal with this)
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decrease
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Radiofrequency Catheter Ablation (RFCA) -Hold _____ preop -Assess anti-coagulation -Thermal injury-esophageal thermometer -Long electrophysiology studies (_____ standard of care (long case 6-8 hrs) Cryoablation- safer & less discomfort
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antiarrhythmics GETA
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Endoscopic Retrograde Cholangiopancreatography (ERCP) -Coagulations & liver serum tests -Most ill patients -Prone or lateral decubitus -Bowel or duct rupture requiring surgical repair -Iodinated contrast -GETA +/- -be aware of meds that stimulate _____ ___ _____ (atropine, glycopyrrolate, and morphine) -the GI doc may give glucagon or hyoscyamine to decrease GI motility. These will cause _____ so be prepare
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sphincter of oddi tachycardia
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Bronchoscopic Considerations _____ assessment -Airway and symptoms of compromise -Review the pulmonologist's evaluations -CT scans of head and neck _____ use of premedication sedatives and anxiolytics TIVA vs Inhalational anesthetic
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Pre-OP Judicious
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Contrast Media _____ to prevent renal impairment -patients that are at higher risk (prior renal sx., renal toxic drugs, or DM) Anaphylactic/anaphylactoid reactions -Serious adverse reactions 1 in 200 -Fatal events 1 in 100,000 -Mild to severe presentations
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Hydration
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Contrast Media Reaction Risks -Prior reaction -Allergy to shell fish or seafood -_____ use -_____ use -Asthma
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Beta-blockers Interleukin-2
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Reactions to soluble contrast media _____ -nausea, retching -perception of warmth -HA -Itchy skin rash -Mild urticaria
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Mild
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Reactions to soluble contrast media _____ -Vomiting -Rigors -Feeling Faint -Chest Pain -Severe urticaria -Bronchospasm, dyspnea -Chest pain -Abdominal pain/diarrhea -Arrhythmias -Renal failure
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severe
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Reactions to soluble contrast media _____ _____ -Glottic edema/bronchospasm -Pulmonary edema -life threatening arrhythmias -cardia arrest -seizures/unconsciousness
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Life-threatening
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ECT Anesthetic Considerations Pre-procedure interview NPO status Identify co-morbidities Current medications (psychotropic) MAOIs -_____-acting sympathomimetics--> exaggerated responses; & _____-->?? BP, ? Sz, ?? T; ? NMB Lithium level -_____ duration ofNMB Tricyclic Antidepressants -_____-acting sympathomimetics--> exaggerated responses; ? effects of anticholinergic drugs
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indirect meperidine Prolongs direct
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ECT Therapy Absolute Contraindications -_____ -Recent MI (; ___ months) Relative Contraindications -ICP, recent CVA (; 3 months) -CV conduction defects -High risk pregnancy -Cerebral/Aortic aneurysm
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Pheochromocytoma 3
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ECT Anesthetic Technique -Standard monitors ; equipment -Pre-oxygenation -Induction -Neuromuscular Blocker Limb isolated _____ to NMB (BP cuff/tourniquet above SBP to prevent NMB from going to this limb) -Ventilation ensured -Bite block placed -Seizure induced
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prior
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Can use _____ to enhance seizure activity. Seizure will last 30-90 seconds.
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hyperventilation
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ECT Therapy Physiologic effects _____ Phase (Immediate) -Bradycardia/Asystole -Hypotension -PNS driven _____ Phase (After 1 Minute) -increase HR ; BP -ST segment/T-wave changes -Dysrhythmias -SNS driven Cerebral Effects -Increase CBF (1-7X baseline) -Increase ICP -Increase CRMO2 Other Effects -Increase IOP -Increase Intragastric Pressure
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Initial Latent
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ESWL Technique "_____" -Uses R wave of ECG to fire shockwave -Less ectopy -Takes more time "_____" -Random firing -More likely to have PVC's/PAC's -Shorter procedure time
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Gated Ungated
