Monitored Anesthesia Care/General Anesthesia/Sedation – Flashcards

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Trauma OB Cardiac Female Younger NMBD use -Fewer anesthetic drugs, more likely to experience tachycardia/hypertension -Anxiety/PTSD can be long-term effects

-Inhalational -Total IV -Combined IV/inhalational

-Patient responds normally to verbal commands. -Cognitive function/coordination may be impaired, but ventilatory/CV functions unaffected.

-Depression of consciousness -Patient responds purposefully to verbal commands (does not count reflex withdrawal to painful stimulus), either alone or accompanied by light tactile stimulation -No interventions required to maintain a patent airway -Spontaneous ventilation is adequate -CV function usually maintained

-Loss of consciousness -Patients cannot be easily aroused but respond purposefully following repeated or painful stimulation -Ability to maintain ventilatory function may be impaired -Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate -CV function usually maintained

-Loss of consciousness -Patients are not a rousable, even by painful stimulation -Ability to independently maintain ventilatory function often impaired -Often require assistance maintaining patent airway -Positive pressure ventilation may be required -CV function may be impaired

A.) Individuals administering moderate sedation/analgesia/conscious sedation - should be able to rescue patients who enter a state of deep sedation/analgesia B.) Those administering deep sedation/analgesia should be able to rescue patients who enter a state of general anesthesia -MAC same standards for preoperative eval, intraoperative monitoring, medical direction same as GA -Qualified person continuously present -Assessing blood oxygenation quantitatively (pulse ox) -Assess ventilation by clinical signs or EtCO2 -Continuous EKG and BP monitoring at least every 5 minutes -Means for continuously measuring temperature must be "available"

Monitoring: -Pulse ox -Response to verbal stimulus -Observe pulmonary ventilation -Exhaled CO2 when separated from caregiver (all the time when deep) -BP and HR q5 minutes -EKG for CV disease (and all cases when deep) Personnel: -Designated person who may assist with other tasks when patient stable (can't do other tasks when deep) -BLS - present -ACLS - within 5 minutes availability (present for deep) General: -Evaluation preop, consent, fasting -Emergency equipment, IV access, reversal agents, supplemental O2 -Recovery, etc.

A.) Risk: -Recent URI -Asthma/reactive airway disease -Smoker B.) Causes -Light anesthesia -Aspiration -Pulmonary edema -Anaphylaxis -Anesthetic drugs: histamine release (ex. Sux) C.) Treatment -Anesthetic agents -Bronchodilators -Epineprhine

A.) Forceful closure of laryngeal musculature -SUPERIOR LARYNGEAL NERVE innervation B.) Increased risk: -Younger -URI -Secondhand smoke exposure C.) Treatment: -Positive pressure -Propofol -Muscle relaxants

A.) aka Negative pressure pulmonary edema -50% due to laryngospasm in adults -Can follow acute airway obstruction, or after surgical relief of chronic airway obstruction -Immediate or delayed presentation (PACU) B.) Presentation: pink frothy sputum, hypoxia, rales, diffuse edema on CXR C.) Treatment: -Increase O2 -Relieve obstruction -Diuretics if tolerated

-Clear liquids - 2 -Breast milk - 4 -Infant formula - 6 -Nonhuman milk - 6 -Light meal - 6 -Fatty meal - 8

Pregnant Obese Diabetic Hiatal hernia or GERD Trauma Acute GI process

-Suppress gastric acid secretion A.) Cimetidine -inhibits p450 -cardiac arrhythmias -1-1.5 hour onset B.) Ranitidine -1 hour onset C.) Famotidine -IV onset 30 minutes -PO onset 1.5-3 hours

-Neutralize gastric fluid, increase gastric volume Bicitra (non-particulate) -Onset 15 minutes

-Suppresses gastric acid secretion Omeprazole -PO onset 2-4 hours -IV onset 30 minutes

-Dopamine antagonist -Prokinetic agent - reduces gastric volume -Increases gastroesophageal sphincter tone -IV onset: 15-30 minutes -PO onset 30-60 minutes *avoid in patients with Parkinsons!*

-Awake intubation vs. RSI -?cricoid pressure prior to induction for RSI -True RSI = no ventilation, modified RSI ventilate a few breaths -Do not remove cricoid pressure until ETT confirmed in correct position with cuff inflated

Droperidol -Inhibits dopaminergic receptors in chemoreceptor trigger zone (CRTZ) -Side effects: EPS, hypotension, tachycardia, sedation -BLACK BOX WARNING - QT PROLONGATION

Prochlorperazine (Compazine) -Antagonize DA receptors in CRTZ -Side effects: EPS, sedation, mucosal dryness, orthostatic hypotension, prolonged QT

-Depress conduction via vestibular-cerebellar pathways -Side effects: sedation, blurred vision, mydriasis

-Depress conduction via vestibular-cerebellar pathways -Side effect: sedation

-5HT3 receptor antagonist - Ondansetron -Side effects: constipation, diarrhea, headache, prolonged QT

-Maximize nicotinic transmission, minimize side effects of Ach on muscarinic receptors Muscarinic: end organ (bronchial smooth muscle, salivary glands and SA node) Nicotinic: autonomic ganglia and skeletal muscle

A.) Neostigmine -Onset 5-10 minutes -Duration ; 1 hour B.) Pyridostigmine -Onset 10-15 minutes -Duration ; 2 hours C.) Edrophonium -Onset 1-2 minutes -Duration 1 hour D.) Physostigmine ** crosses BBB**

-Specific and competitive antagonist -Dose: 0.2 mg, then 0.3 mg then 0.5 mg -Dosed Q 30 seconds - 1 minute -Max 3 mg/hour -Onset 30 seconds -Duration 30-60 minutes Side effects: diaphoresis, injection site pain, dizziness, blurred vision, agitation BLACK BOX WARNING - SEIZURES ** do not give to chronic BZD user**

-Mechanism: competitive antagonist -Dose: 0.04 mg titrated q3-5 minutes -Onset: 1-2 minutes -Side effects: sympathetic stimulation, acute withdrawal

From random study on pubmed: Liquid: 80 min (fluid test meal mean) Solids: 127 min (median)