question

BIS monitor

answer

Bispectral Index System Noninvasive monitors level of consciousness (LOC) and prevent intra-operative awareness, try to keep it under 60

question

capnography

answer

noninvasive measures end-tidal CO2 levels

question

esophageal probe

answer

Invasive temperature monitor listen to heart/lung sounds

question

Pulmonary artery catheter

answer

Invasive right atrium entry monitors cardiac output, PCWP also called Swan-Ganz

question

pulse oximetry

answer

noninvasive monitors oxygen level

question

arterial line

answer

Invasive radial or femoral entry monitors B/P

question

EKG/ECG

answer

noninvasive detects arrhythmia AKA electrocardiogram

question

spirometry

answer

noninvasive monitors ventilation volume, pressure

question

doppler

answer

ultrasonic device assess vascular sounds

question

nerve stimulator

answer

noninvasive assesses muscle relaxer effectiveness

question

agonist

answer

drug that potentiates the release or uptake (or both) of other medications

question

amnesia

answer

lack of recall of events or sensations

question

analgesia

answer

absence of pain produced by drugs

question

anaphylaxis

answer

life threatening allergic reaction to a drug or substance

question

anesthesia

answer

absence of sensory awareness or medially induced unconsciousness

question

Anesthesia technician

answer

allied health professional trained to assist the anesthesia care provider

question

anesthetic

answer

drug that reduces or blocks sensation or induces unconsciousness

question

antagonist

answer

drug that counteracts the effects of another agent or physiological process

question

anxiolytic

answer

drug that reduces anxiety

question

apnea

answer

period of cessation of breathing

question

balanced anesthesia

answer

use of multiple drugs to produce sedation, analgesia, amnesia, and muscle relaxation during general anesthesia

question

bier block

answer

regional anesthesia where the anesthetic is injected into a vein

question

bronchospasm

answer

involuntary smooth muscle spasm of bronchi

question

coma

answer

deepest state of unconsciousness where most brain activity ceases

question

consciousness

answer

neurological status in which a pt is able to SENSE environmental stimuli (touch, sound, pain, pressure, heat, cold)

question

ACP- Anesthesia Care Provider

answer

licensed to administer anesthetic agents, manage the pt through out anesthesia, & respond to anesthetic and surgical emergencies

question

CRNA- Certified Registered Nurse Anesthetist

answer

trained and licensed to administer anesthetic agents

question

cricoid pressure

answer

direct manual pressure on the cricoid cartilage to prevent aspiration and facilitate intubation -Also called "Sellick Maneuver"

question

cyanosis

answer

blue or dusky hue of skin

question

gas scavenging

answer

capture and safe removal of extraneous anesthetic gases from the machine

question

general anesthesia

answer

alteration in the patients perception of their environment through alterations in their level of consciousness

question

homeostasis

answer

state of balance in physiological functions

question

hypothermia

answer

subnormal temperature

question

infusion

answer

giving a drug over a specified period

question

intraoperative awareness (IOA)

answer

rare condition where a pt undergoing general anesthesia is able to feel pain and other stimuli but unable to respond

question

malignant hypothermia (MH)

answer

rare but life threatening reaction in which an inherited muscle condition causes a hyper-metabolic state in patients exposed to specific trigger agents; experience deficit in calcium transportation within the skeletal muscle fibers

question

Monitored Anesthesia Care (MAC)

answer

monitoring of vital functions during regional or local anesthetics to ensure the pts safety and comfort

question

parasympathetic nervous system (PNS)

answer

part of autonomic nervous system responsible for energy conservation and rest, relaxation of muscle groups, dilation of blood vessels and decreased blood pressure

question

protective reflexes

answer

nervous system response to harmful environmental stimuli like pain, obstruction of airway, extreme temperature, coughing, blinking, shivering, withdrawal

question

airway

answer

anatomical passageway or artificial tube through which the pt breathes

question

pulmonary embolism (PE)

answer

obstruction in a pulmonary vessel by a blood clot, air bubble, or foreign body causing sudden pain or possible pulmonary arrest

question

regional block

answer

anesthesia to specific area of body achieved by injection of an anesthetic around a major nerve or group of nerves

question

sedation

answer

rousable state in which an individual is unaware of sensory stimuli Depression of the CNS

question

sedative

answer

drug that induces a range of unconscious states

question

sensation

answer

ability to feel stimuli in the environment

question

Sympathetic Nervous System (SNS)

answer

part of autonomic nervous system responsible for Fight or Flight response to danger or stress

question

Fight or Flight response (SNS response)

answer

physiological reaction includes diversion of blood to essential organs, increased heart rate and BP

question

topical anesthesia

answer

anesthesia of superficial nerves of skin or mucous membranes

question

unconsciousness

answer

neurological state where one is unable to respond to external stimuli

question

ventilation

answer

physical act of taking air into the lungs by inflation and releasing CO2 from lungs by deflation

question

Crawford Long

answer

first to use ether during a surgical procedure (tumor removal) 1842

question

Horace Wells

answer

dentist that used nitrous oxide for teeth

question

James Simpson

answer

introduced chloroform to anesthesia

question

John Snow

answer

first anesthetist

question

Sir Ivan Whiteside Magill

answer

Developed and refined techniques of endotracheal intubation (namesake: Magill forceps for anesthesia)

question

Sir Ivan Whiteside Magill

answer

First anesthetist to describe technique of blind nasal intubation

question

Sir Ivan Whiteside Magill

answer

many styles of endotracheal tubes and laryngoscopes are based on his designs

question

Goal of surgical anesthesia

answer

to allow the pt to tolerate surgery and maintain the body in a balanced physiological state (homeostasis)

question

preoperative anesthesia interview

answer

Confirm use/type/amount of prescription drugs, alcohol, tobacco, and illegal drugs Prior surgeries and complications experienced Family history of anesthetic complications Record vital signs Evaluate airway Examine organ systems in question

question

Physical status codes established by

answer

American Society of Anesthesiologists

question

Physical status codes

answer

ASA 1: normal healthy pt ASA 2: mild systemic disease that's controlled and doesn't limit activities ASA 3: moderate to severe systemic disease, possibly uncontrolled, can alter activities ASA 4: severe systemic disease that is a constant threat to life ASA 5: morbid and substantial risk of death within hours with or without intervention E: emergency status or undergoing emergency procedure (added to ASA code)

question

Preoperative evaluation

answer

Perform assessment to determine pt specific needs and risk factors

question

Selection of anesthesia based on:

answer

Current physical status Presence of metabolic disease Psychological status Type and length of procedure Past history of adverse reactions Preference of doc, pt

question

Preoperative checklist

answer

Chart Identity Correct procedure, site, side Consent forms Resuscitation orders Allergies Preop meds Prostheses & Jewelry removed Medical records Test results CBC Coagulation studies ECG Chest X-ray

question

What helps place endotracheal tubes?

answer

Stethoscope

question

Assistive devices

answer

Laryngoscopes Magill forceps Styles Oral/ nasal airway Nerve stimulator

question

Antiemetic drugs

answer

Reduce nausea and vomiting Ex. Reglan, zofran, droperidol

question

Histamine 2/ antacid blockers

answer

Decrease gastric acidity and volume Ex. Tagamet, Zantac, bicitra

question

Narcotic analgesics

answer

Controlled substances given to minimize perception of pain and to potentiate anesthesia; usually given 1 hour prior to surgery in order to have peak effect Ex. Demerol, morphone

question

Anticholinergics

answer

Used to block secretions, prevent laryngospasms, prevent reflex Bradycardia ( can cause dry mouth and not for glaucoma pts) Ex. Atropine, robinul

question

antianxiety drugs

answer

Reduce anxiety, are antiemetic, antihistamine, potentiate anesthesia Ex. Phenergan, Valium, Ativan, versed

question

Sedative/ amnesia drugs

answer

Promote sleep and lack of memory Ex. Versed, Valium, ativan

question

Sedative/ hypnotic drugs

answer

Promote sleep and reduce anxiety, can cause hallucinations Ex. Phenobarbital, ketamine

question

Airway management

answer

Endotracheal tube Laryngeal airway mask Oropharyngeal airway Nasopharyngeal airway Nasal cannula Oxygen mask

question

Endotracheal tube

answer

Invasive airway that extends from the mouth to the trachea, with a rigid laryngoscope

question

Laryngeal airway mask (LMA)

answer

Manages airway without laryngoscope, fits over larynx, used for pts with difficult airway conditions but doesn't protect against aspiration

question

oropharyngeal airway (OPA)

answer

Inserted I guess to prevent tongue or epiglottis from falling back against pharynx, for pts with respiratory function but need airway support Pts are semi conscious

question

Nasopharyngeal airway

answer

Provide passageway between nostril and nasopharynx. Pts are semiconscious, gagging, or mouth injury present

question

Oxygen delivery by

answer

Nasal cannula, oxygen mask

question

Hypnosis

answer

Altered state of consciousness, related to the pt perception of the surgical environment and the surgical procedure

question

Hypnotic drugs

answer

Produce varying levels of hypnosis from light to more natural sleep of sedation to full unconsciousness of General anesthesia

question

Amnesia permits:

answer

Use of safe, less toxic anesthetic agents and techniques while providing a calm and cooperative patient

question

Muscle relaxation

answer

Neuromuscular blockers in combination with inhalation agents are capable of producing a profound muscle relaxation, permitting tracheal intubation and ability to work in certain areas

question

Types of anesthesia

answer

General Nerve Conduction blockade Topical Local Regional

question

General anesthesia accomplished by:

answer

Inhalation agent Injection agent Instillation agent

question

Agent inhalation

answer

Delivery of gases that cross the Alveolar membrane to the vascular system where the agent can affect the CNS functions

question

Agent injection

answer

Administration of medications directly into the blood stream via IV

question

Agent instillation

answer

Administration of mediation's into areas where it can be absorbed such as the rectum, vagina, mucous membranes

question

Anesthetic state

answer

Characterized by unconsciousness and insusceptibility to pain produced by anesthetic agent or combination of agents

question

Stages of Anesthesia

answer

the patient passes through stages from consciousness to deep surgical anesthesia. They are based on physiological effects (body movement, respiratory rhythm, oculomotor reflexes, muscle tone)

question

Stage I: AMNESIA

answer

pt is conscious and with administration (induction) of anesthetic agent moves to loss of consciousness -received propofol, succinylcholine

question

Stage II: EXCITEMENT or DELIRIUM

answer

period of loss of consciousness to return of regular breathing and loss of eyelid reflex. Pt still responding reflexively and unpredictably to certain stimuli; uninhibited movements -may experience vomiting, laryngoscope, hypertension, tachycardia -use Sellick manuever

question

Stage III: SURGICAL ANESTHESIA

answer

period between onset of regular breathing and loss of eyelid reflex to cessation of breathing. Pt is unresponsive to painful stimuli and sensations, allowing incision to be made and procedure performed without negative response

question

Stage IV: OVERDOSE

answer

level of anesthesia so deep that cardiovascular and respiratory function is compromised to the point of collapse due to depression of those centers in the brain -characterized by dilated or nonreactive pupils and major drop in BP -experience shock, neurological issues - if uncorrected this stage will lead to pt death

question

Phases of General Anesthesia

answer

Pre-Induction 1. Induction 2. Maintenance 3. Emergence 4. Recovery

question

4 Stages of Anesthesia

answer

I- Amnesia II- Excitement or delirium III- Surgical anesthesia IV- Overdose

question

Pre-Induction Phase

answer

pt arrives in OR calm and stable, ACP attaches monitoring devices (vital signs, EKG) and pre-oxygenates patient

question

Phase 1: Induction

answer

Induction agents, IV agents or Inhalation agents are administered and loss of consciousness occurs and usually a muscle relaxant. Management of Airway is critical and may involve ET tube, nasal airways, or a laryngeal mask airway, or face mask -pt hearing is last to go

question

Michael Jackson drug

answer

propofol

question

Phase 2: Maintenance

answer

begins after insertion of airway and continues through surgical intervention until end of operation -pt monitoring is critical -surgical interventions can change pt status

question

Phase 3: Emergence

answer

end of surgical procedure anesthetic gases are discontinued and allowed to wear off. Process of regaining consciousness. -pt begins breathing on own, ET tube extubated, start hearing again

question

Phase 4: Recovery

answer

Vital signs are stable, oxygen needs to be on pt, pt returns to optimum level of consciousness. Usually begins in the OR and follows in PACU. -monitoring is still important -sounds heard

question

Advantages of General Anesthesia

answer

-pt unaware of activities and noises associated with operation -depth and rate of respiration can be controlled & pulmonary tree is usually protected from aspiration (once airway established) -medications can be easily titrated -muscle relaxation for intubation and retraction at the surgical site is easily achieved

question

Risks of General Anesthesia

answer

Aspiration Cardiac dysrhythmias Cardiac arrest Laryngospasm/ Bronchospasm Allergic reactions Shock Malignant Hypothermia

question

Aspiration

answer

greatest during induction and emergence phase leading to aspiration pneumonia -use Cricoid pressure (Sellick Manuever) to prevent

question

Cardiac dysrhythmia

answer

abnormal heart rate or rhythm (atrial or ventricular)

question

Cardiac arrest

answer

cessation of heart pumping action and blood circulation

question

Laryngospasm/ Bronchospasm

answer

slight trigger of the gag reflex results in spasm or rigidity of the upper respiratory tract; can be triggered by saliva at back of throat, stimulation of lightly anesthetized pt, inflammation from ET tube placement

question

Allergic reactions

answer

skin irritation or anaphylaxis (immediate hypersensitivity) reaction, can result in life threatening respiratory distress that leads to vascular collapse or shock

question

Shock

answer

abnormal physiological state indicated by presence of reduced cardiac output, tachycardia, hypotension, diminished urinary output

question

Malignant Hypothermia more common in

answer

males

question

MH triggered by

answer

-Use of succinylcholine, curare, halogenated inhalation agents -Strenuous exercise, stress, trauma

question

Signs of MH

answer

1st unexplained tachycardia followed by tachypnea, increased CO2 levels, unstable BP, perspiration, muscle contraction, cyanosis, mottled skin, increased temperature

question

Treatment of MH

answer

Discontinue anesthesia administration Turn of inhalation agent Give 100% oxygen Non-triggering agent given (Dantrolene) Chilled saline and ice packed into cavities

question

Inhalation Anesthesia

answer

anesthetic agents are inhaled and pass to the blood stream through pulmonary function -Non-flammable -rapid acting

question

Advantages of Inhalation Anesthesia

answer

-Depth of A can be monitored and rapidly adjusted to alter depth -Gas or vapor is directly exposed to pulmonary circulation allowing for more rapid manifestation

question

Inhalation Agents

answer

Oxygen Nitrous Oxide Halothane Enflurane Isoflurane Desflurane Sevoflurane

question

Oxygen

answer

Inhalation Agent essential for pt, helps to maintain good O2 sats; green tank

question

Nitrous Oxide

answer

Inhalation Agent laughing gas used adjunct to IV anesthesia; blue tank

question

Halothane/ Fluorthane

answer

Inhalation Agent Volatile liquid used for rapid smooth induction, -Causes bronchodilation, shivering, liver toxicity, -Contraindicated for C-section -d/t smooth muscle relaxation

question

Enflurane/ Ethrane

answer

rapid induction and recovery, used for maintenance of anesthesia

question

Isoflurane/ Forane

answer

similar to halothane and enflurane

question

Desflurane/ Suprane

answer

has pungent aroma, has more rapid onset and recovery, safe to use with liver disease

question

Sevoflurane

answer

used for pediatric anesthesia, rapid induction and recovery

question

Induction Agents

answer

Diprivan (propofol) Amidate Pentothal Sodium Brevital

question

Induction Agents and IV Anesthesia

answer

-combination of drugs used -permits a rapid and pleasant transition from a state of consciousness to unconsciousness -provide sedation and amnesia

question

IV Agents

answer

narcotics/ Analgesic sedatives/ tranquilizers atropine sulfate succinylcholine hydrochloride morphine sulfate alfentanil fentanyl demerol

question

Sedatives used for

answer

amnesia, hypnotic effects

question

sedatives (agents)

answer

diazepam/ valium midazolam/ Versed ketamine/ ketalar

question

depolarizing muscle relaxant

answer

succinylcholine, anectine, quelicin -can cause fasciculations, temporary paralysis, MH

question

NON-depolarizing muscle relaxant

answer

Used to maintain relaxation during surgical procedures atracurium/ tracrium cisatracurium/ nimbex mivacurium/ mivacron rocuronium/ zemuron vecuronium/ norcuron

question

Reversal NeuroMuscular blocking agents

answer

edorphonium neostigmine

question

Reversal of muscle relaxants agents

answer

"anticholinergics" atropine robinul

question

role of ST in Circulator role

answer

Assist during intubation (Sellicks manuever) Assist applying monitoring devices Maintain quiet environment Know equipment and use Know where shock cart and emergency supplies are kept Be attentive Help transport and position patient Ask ACP before performing anything on pt, removing instruments (post op)

question

Types of Regional Anesthesia

answer

Nerve Plexus block Bier block Spinal Block Epidural Anesthesia

question

Nerve Conduction Blocks

answer

involves use of pharmaceutical agents to prepare the transmission of sensory nerve impulses

question

Types of Nerve Conduction Blockade agents

answer

Nerve conduction blocking Amino amid group Amino ester group Adjunctive

question

Nerve block agents

answer

xylocaine/ lidocaine carbocaine/ mepivacaine marcaine/ sensorcaine duranest/ etidocaine pontocaine/ cetacaine

question

Regional Anesthesia

answer

aka Peripheral Nerve Block injection site is proximal to surgical site

question

regional anesthesia agent chosen by:

answer

length of procedure level of block needed pt condition and health

question

Spinal Anesthesia

answer

agent is injected into subarachnoid space and anesthetizes spinal motor nerve roots, eventually enters bloodstream -fast induction but shorter lived than epidural

question

how is patient tested for level of spinal anesthesia

answer

pinpricked

question

How to control level of spinal anesthesia

answer

Patient positioning: Lateral Sitting * arch back like "mad cat"

question

Epidural most commonly used for:

answer

anorectal vaginal perineal lower abdomen lower extremities

question

Advantages of Spinal

answer

Pt awake so control airway Non-irritating to respiratory tract Blockade of PNS and SNS Produces bowel contractions Facilitates abdominal exposure produces excellent muscle relaxant

question

Epidural Anesthesia

answer

agent is injected into epidural space, before the Dura, and infuses into spinal cord. Catheter placed and taped to pt back. Lumbar Caudal * commonly used in obstetrics/ C section * slower onset but longer duration and can be titrated

question

General Anesthesia accomplishes:

answer

unconsciousness analgesia amnesia muscle relaxation maintains homeostasis

question

Preoperative agents given

answer

benzodiazepines (sedation and amnesia) anticholinergic (inhibit secretions, increase heart rate) antacids antiemetics

question

Induction agents given

answer

depolarizing muscle relaxant hypnotics

question

Maintenance agents given

answer

inhalation agents nondepolarizing neuromuscular blocker analgesic/ opiod reversal agents

question

Non traditional anesthesia options

answer

Hypnoanesthesia Acupuncture

question

General Anesthesia aka

answer

Peripheral nerve block

question

Shock treatment

answer

Plasma expander Dextran Trendelburg position

question

Sedative/tranquilizer/ amnesia agents

answer

Versed Valium

question

Reverses Versed or Valium (sedatives)

answer

Mazicon Flumazenil

question

fasciculation

answer

muscle twitching

question

Nerve blockers/ esters

answer

Tetracaine Pontacaine

question

Agents that reduce secretions, treat bradycardia

answer

anticholinergic Atropine Robinul

question

Sedation/ anesthesia Induction agents

answer

Propofol Diprivan

question

Reverses Opioids & Narcotics (like Demerol)

answer

Narcan Revex

question

Nondepolarizing muscle relaxer

answer

Norcuron Tracrium Pavulon

question

Treat Cardiac ventricular fibulation/ amides

answer

anti arrhythmic Lidocaine HCL Xylocaine HCL

question

Disadvantages of Spinal Anesthesia

answer

spinal headache hypotension parasthesia/ paralysis (temporary)

question

Patients hard to intubate

answer

COPD, asthmatic -Need respiratory treatment first

question

another name for Spina anesthesia

answer

intrathecal

question

MAC

answer

Monitored Anesthesia Care

question

Monitored Anesthesia Care

answer

Local/ nerve block (light sedation, no intubation/gas) Need 2 RN's Patient is awake (twilight anesthesia) For Extremities

question

LMAC

answer

Local Monitored Anesthesia Care

question

halogenated

answer

The danger of fire in the OR has been reduced with the introduction of which kind of anesthetics?

Chapter 9_ Anesthesia – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards