Anesthesia/ Post Anesthesia Care
A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels
LAST (local anesthesia systemic toxicity)
signs and symptoms? treatment?
Name 2 risk factors for patients undergoing surgery who use alcohol
Lowered Immunity
Prolonged Bleeding Times
Increased Stress Response
Cardiac Complications
This group of nerves extends from the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the armpit and is at great risk of injury from improper surgical positioning.
brachial plexus
Rule of thumb: Where do you place a bovie pad in coordination to the incision site for a patient with a metal implant?
As close to the site as possible without the implant being in the pathway of the current from the bovie
Sterility is _________ ___________ not time related
event related
This type of anesthesia is injected into the space between the ligamentum flavum and the dura
epidural
What are special considerations that should be taken into account when caring for elderly patients (3)
Decreased metabolism of drugs
Thin skin (injury)
Decreased perception of pain
Prone to hypothermia
Co-morbidities
Name 3 positions that put patients at risk for impaired gas exchange?
Prone, trendelenburg, lithotomy, lateral, beachchair. jackknife.
Inspecting for proper insulation of endoscopic equipment prevents
capacitative coupling
Drapes help to reduce
hospital acquired infections
What score is used postoperatively to determine readiness for discharge?
Aldrete score
1. Consciousness
Fully awake (2 points)
Arousable (1 point)
Not responding (0 points)
2 Mobility
Able to move four extremities on command (2 points)
Able to move two extremities on command (1 point)
Able to move 0 extremities on command (0 points)
3 Breathing
Able to breathe deeply (2 points)
Dyspnea (1 point)
Apnea (0 points)
4 Circulation
Systemic BP ≠ 20% of the preanesthetic level (2 points)
Systemic BP between 20% and 49% of the preanesthetic level (1 point)
Systemic BP ≠ 50% of the preanesthetic level (0 points)
5 Color
Normal (2 points)
Pale, jaundiced, blotchy (1 point)
Cyanotic (0 points)
Name 2 of the 5 social determinates of health
economic stability
education
social/community context
health and healthcare
neighborhood/ built environment
**know examples of each: economic stability examples are employment, food insecurity, housing instability and poverty.
Name 2 intrinsic and 2 extrinsic factors that contribute to the development of a perioperative pressure ulcer
Intrinsic- Age, BMI, co-morbidities, smoker, malnutrition
extrinsic- duration of procedure, position, intensity and duration of applied pressure
Name 2 benefits of Robotic Surgery
more precise movement, arms are more flexible that surgeons wrists, efficient release of instruments d/t quick connections, safer d/t no inadvertent movement of instruments
***_______ is an important draping principle used to protect a scrub person's gloves from contamination.
Cuffing
What is the first action the anesthesia personnel takes if malignant hyperthermia is suspected?
Stop triggering agents
Name 3 desired patient outcomes for a patient undergoing surgery
1. Free from infection
2. Maintain normothermia
3. Free from injury
4. Maintained Airway
5. Free from anxiety
The goal of the skin prep is to remove soil and _____________ microorgamisms and to reduce the number of ____________ microorganism
Transient
Resident
Name 3 precautions that should be taken when utilizing a laser
Eyewear appropriate for the wavelength of laser being used, window coverings, tested before use, kept on standby when not in use, only activated by the operator, warnings signs outside of doors, remove the key from the laser when being stored, use ebonized instruments.
***______ is the term used for when fluid soaks through sterile drapes, gowns, or packages. Items that experience this are contaminated.
Strikethrough
What does ERAS stand for?
Enhanced Recovery After Surgery
Know the components of ERAS
Name a physiologic affect of cannibis as it pertains to these specific systems
CNS:
Cardiovascular:
Pulmonary:
GI
CNS: Mild sedative effect Anxiety Paranoia/psychosis Euphoria Dizziness Headache Memory dysfunction Analgesia, Similar to acute effects, but as tolerance develops, higher doses are needed for similar effects
CV:Tachycardia Vasodilation Orthostasis Atherosclerosis
Pulmonary Bronchodilation Hyperactive airway disease Airway edema Chronic bronchitis Emphysema
Gastrointestinal Antinausea Increased appetite Abdominal pain Hyperemesis
Contra indications of Chloraprep
Open wounds
Procedures above the neck
mucous membranes
***What are the 3 components of the fire triangle that need to be considered when using electrosurgical devices?
Oxygen
Ignition Source
Fuel
***Give the 4 main rationales for utilization of surgical drapes
1. Provide a fluid and blood-resistant barrier to minimize passage of microorganisms from sterile to unsterile areas.
2. Helps reduce risk of hospital acquired infections
3. Covers the patient
4. Covers additional equipment that may be utilized or adjacent to the sterile field