Podcast
Questions and Answers
What is the primary purpose of a preoperative cardiac evaluation?
What is the primary purpose of a preoperative cardiac evaluation?
- To diagnose underlying cardiac conditions.
- To identify patients at risk for perioperative cardiac complications. (correct)
- To assess the patient's overall health status.
- To determine the best type of anesthesia for the patient.
Which of these factors is NOT consistently associated with a higher incidence of postoperative cardiac complications?
Which of these factors is NOT consistently associated with a higher incidence of postoperative cardiac complications?
- History of asthma (correct)
- Advanced age
- History of congestive heart failure
- History of coronary artery disease
What is a key element of the preoperative evaluation that should be considered when assessing the patient's medical history?
What is a key element of the preoperative evaluation that should be considered when assessing the patient's medical history?
- Previous pregnancies
- Social habits, such as alcohol consumption
- Family history of allergies
- Previous surgical procedures and anesthesia (correct)
Which of the following is NOT considered a major perioperative cardiac complication?
Which of the following is NOT considered a major perioperative cardiac complication?
What does the abbreviation 'NPO' stand for and what does it indicate?
What does the abbreviation 'NPO' stand for and what does it indicate?
What is the significance of a family history of problems with anesthesia?
What is the significance of a family history of problems with anesthesia?
What is the main goal of the anesthetic evaluation?
What is the main goal of the anesthetic evaluation?
Why is it important to distinguish between true allergies and drug intolerances/side effects?
Why is it important to distinguish between true allergies and drug intolerances/side effects?
A student is learning about vascular access. Which is the MOST common experience they will have with arterial catheter insertions?
A student is learning about vascular access. Which is the MOST common experience they will have with arterial catheter insertions?
What is the PRIMARY function of the Site Rite device regarding central venous catheter insertion?
What is the PRIMARY function of the Site Rite device regarding central venous catheter insertion?
A student is learning about monitoring during anesthesia, and should be able to understand the following:
A student is learning about monitoring during anesthesia, and should be able to understand the following:
Which of the following is MOST important for a student to learn regarding intraoperative fluid management?
Which of the following is MOST important for a student to learn regarding intraoperative fluid management?
In the post-anesthetic care unit (PACU), what is the MOST important aspect of recovery that students should recognize?
In the post-anesthetic care unit (PACU), what is the MOST important aspect of recovery that students should recognize?
A student is reviewing pain management in the PACU. Which of the following nerve blocks should they understand the use of, in addition to epidural catheters?
A student is reviewing pain management in the PACU. Which of the following nerve blocks should they understand the use of, in addition to epidural catheters?
What is one of the MOST important respiratory complications students should understand management of in the PACU?
What is one of the MOST important respiratory complications students should understand management of in the PACU?
A student is learning about circulatory issues in the PACU. What should they understand the management of?
A student is learning about circulatory issues in the PACU. What should they understand the management of?
What is the most significant preoperative evaluation for pulmonary complications?
What is the most significant preoperative evaluation for pulmonary complications?
Which condition is absolutely linked to increased postoperative risk?
Which condition is absolutely linked to increased postoperative risk?
Which of the following is NOT a risk factor for postoperative pulmonary complications?
Which of the following is NOT a risk factor for postoperative pulmonary complications?
In what circumstance can pulmonary function tests predict postoperative morbidity?
In what circumstance can pulmonary function tests predict postoperative morbidity?
What is a significant physical finding that may indicate acute airflow obstruction?
What is a significant physical finding that may indicate acute airflow obstruction?
What does the Mallampati scale assess?
What does the Mallampati scale assess?
Which aspect of airway examination is crucial in identifying a potentially difficult airway?
Which aspect of airway examination is crucial in identifying a potentially difficult airway?
What is the recommended approach to chest X-rays prior to surgery?
What is the recommended approach to chest X-rays prior to surgery?
What is a common cause of obstructive apnea?
What is a common cause of obstructive apnea?
Which maneuver can help relieve airway obstruction?
Which maneuver can help relieve airway obstruction?
Why is evaluating a patient’s airway critical before anesthesia?
Why is evaluating a patient’s airway critical before anesthesia?
What is the primary function of the laryngeal mask airway (LMA)?
What is the primary function of the laryngeal mask airway (LMA)?
What should limit peak airway pressure during bag ventilation?
What should limit peak airway pressure during bag ventilation?
What is the main technique used during tracheal intubation?
What is the main technique used during tracheal intubation?
Which factors could contribute to difficulty with mask ventilation?
Which factors could contribute to difficulty with mask ventilation?
Which airway obstruction treatment involves physical separation from the palate?
Which airway obstruction treatment involves physical separation from the palate?
What is the primary effect of anticholinesterase agents like neostigmine and edrophonium at the neuromuscular junction?
What is the primary effect of anticholinesterase agents like neostigmine and edrophonium at the neuromuscular junction?
Which symptom is NOT typically associated with malignant hyperthermia (MH)?
Which symptom is NOT typically associated with malignant hyperthermia (MH)?
What effect does the administration of anticholinesterase agents have on the heart?
What effect does the administration of anticholinesterase agents have on the heart?
Which of the following anesthetic agents is known to trigger malignant hyperthermia?
Which of the following anesthetic agents is known to trigger malignant hyperthermia?
Which lead is primarily used for monitoring atrial activity and rhythm disturbances in ECG?
Which lead is primarily used for monitoring atrial activity and rhythm disturbances in ECG?
What is the primary function of a pulse oximeter during surgery?
What is the primary function of a pulse oximeter during surgery?
In malignant hyperthermia, what metabolic condition can occur due to muscle hypermetabolism?
In malignant hyperthermia, what metabolic condition can occur due to muscle hypermetabolism?
Which of the following is the role of Dantrolene in the management of malignant hyperthermia?
Which of the following is the role of Dantrolene in the management of malignant hyperthermia?
What is the primary purpose of pulse oximetry?
What is the primary purpose of pulse oximetry?
Which factor is likely to cause inaccuracies in pulse oximetry readings?
Which factor is likely to cause inaccuracies in pulse oximetry readings?
What does the P50 value indicate in the context of the oxyhemoglobin dissociation curve?
What does the P50 value indicate in the context of the oxyhemoglobin dissociation curve?
Why is capnography considered the gold standard for endotracheal tube placement confirmation?
Why is capnography considered the gold standard for endotracheal tube placement confirmation?
How does the oxyhemoglobin dissociation curve change as SaO2 decreases?
How does the oxyhemoglobin dissociation curve change as SaO2 decreases?
What is the relevance of measuring end tidal carbon dioxide (ETCO2)?
What is the relevance of measuring end tidal carbon dioxide (ETCO2)?
What happens during esophageal intubation that can cause complications?
What happens during esophageal intubation that can cause complications?
Which of the following conditions does NOT affect pulse oximetry readings?
Which of the following conditions does NOT affect pulse oximetry readings?
What is the MOST common cause of airway obstruction leading to obstructive apnea?
What is the MOST common cause of airway obstruction leading to obstructive apnea?
Which of these is NOT a method to relieve airway obstruction?
Which of these is NOT a method to relieve airway obstruction?
What is the PRIMARY function of oral and nasal airways in managing airway obstruction?
What is the PRIMARY function of oral and nasal airways in managing airway obstruction?
Which of these factors is LEAST likely to cause difficult mask ventilation?
Which of these factors is LEAST likely to cause difficult mask ventilation?
Where is the laryngeal mask airway (LMA) typically placed?
Where is the laryngeal mask airway (LMA) typically placed?
During bag ventilation, what is the recommended limit for peak airway pressure to avoid gastric distention?
During bag ventilation, what is the recommended limit for peak airway pressure to avoid gastric distention?
What is the FIRST step commonly done during tracheal intubation using direct laryngoscopy?
What is the FIRST step commonly done during tracheal intubation using direct laryngoscopy?
What does the grading of laryngoscopic views (Grades I-IV) primarily assess?
What does the grading of laryngoscopic views (Grades I-IV) primarily assess?
A Grade III laryngoscopic view during intubation would expose which structure?
A Grade III laryngoscopic view during intubation would expose which structure?
Which of the following is NOT an alternative method of endotracheal intubation?
Which of the following is NOT an alternative method of endotracheal intubation?
In pharmacokinetics, what is the half-life of a drug defined as?
In pharmacokinetics, what is the half-life of a drug defined as?
Which of the following describes pharmacodynamics?
Which of the following describes pharmacodynamics?
During the distribution phase of a drug, immediately following an initial bolus, where does the drug initially redistribute from?
During the distribution phase of a drug, immediately following an initial bolus, where does the drug initially redistribute from?
What does 'emergence' refer to in the context of general anesthesia?
What does 'emergence' refer to in the context of general anesthesia?
Which of the following is a component of general anesthesia maintenance?
Which of the following is a component of general anesthesia maintenance?
Extubation of an intubated patient is performed when the patient demonstrates which set of characteristics?
Extubation of an intubated patient is performed when the patient demonstrates which set of characteristics?
Which characteristic of an anesthetic agent allows it to cross the blood-brain barrier more rapidly?
Which characteristic of an anesthetic agent allows it to cross the blood-brain barrier more rapidly?
What does MAC (Minimal Alveolar Concentration) represent regarding volatile anesthetics?
What does MAC (Minimal Alveolar Concentration) represent regarding volatile anesthetics?
Which volatile anesthetic has the highest MAC value, indicating it is the least potent?
Which volatile anesthetic has the highest MAC value, indicating it is the least potent?
What is a common characteristic shared by all volatile anesthetics?
What is a common characteristic shared by all volatile anesthetics?
Which intravenous anesthetic is commonly used for induction in hemodynamically unstable patients due to its minimal impact on blood pressure?
Which intravenous anesthetic is commonly used for induction in hemodynamically unstable patients due to its minimal impact on blood pressure?
Which intravenous anesthetic is known for increasing blood pressure and heart rate?
Which intravenous anesthetic is known for increasing blood pressure and heart rate?
What is the main use of Midazolam (Versed) in the context of anesthesia?
What is the main use of Midazolam (Versed) in the context of anesthesia?
Which of the following effects is associated with the use of Propofol?
Which of the following effects is associated with the use of Propofol?
Which of the following best describes the primary mechanism by which opioids produce analgesia?
Which of the following best describes the primary mechanism by which opioids produce analgesia?
A patient is experiencing significant respiratory depression following an opioid administration. Which medication is MOST appropriate to reverse this effect?
A patient is experiencing significant respiratory depression following an opioid administration. Which medication is MOST appropriate to reverse this effect?
What is the primary mechanism of action of non-depolarizing neuromuscular blocking agents?
What is the primary mechanism of action of non-depolarizing neuromuscular blocking agents?
A patient with a history of recent stroke requires rapid sequence intubation. Which of the following neuromuscular blocking agents should generally be avoided?
A patient with a history of recent stroke requires rapid sequence intubation. Which of the following neuromuscular blocking agents should generally be avoided?
What is the predominant type of opioid receptor that is targeted by most common opioid analgesics?
What is the predominant type of opioid receptor that is targeted by most common opioid analgesics?
What is a common side effect associated with the use of opioid medications during anesthesia?
What is a common side effect associated with the use of opioid medications during anesthesia?
Which of the following characteristics is unique to succinylcholine compared to other neuromuscular blocking agents?
Which of the following characteristics is unique to succinylcholine compared to other neuromuscular blocking agents?
How is the action of succinylcholine terminated in the body?
How is the action of succinylcholine terminated in the body?
What is the primary mechanism by which neostigmine and edrophonium reverse neuromuscular blockade?
What is the primary mechanism by which neostigmine and edrophonium reverse neuromuscular blockade?
Why is an anticholinergic like atropine or glycopyrrolate often co-administered with an anticholinesterase?
Why is an anticholinergic like atropine or glycopyrrolate often co-administered with an anticholinesterase?
Which of the following best describes the underlying pathophysiology of malignant hyperthermia (MH)?
Which of the following best describes the underlying pathophysiology of malignant hyperthermia (MH)?
What is the primary purpose of a train-of-four (TOF) nerve stimulation?
What is the primary purpose of a train-of-four (TOF) nerve stimulation?
In the context of malignant hyperthermia (MH), what is the primary mechanism of action of dantrolene?
In the context of malignant hyperthermia (MH), what is the primary mechanism of action of dantrolene?
Which BIS (Bispectral Index) value range is generally considered optimal for general anesthesia in a healthy patient?
Which BIS (Bispectral Index) value range is generally considered optimal for general anesthesia in a healthy patient?
Which lead of a standard 5-lead ECG configuration is most useful for detecting anterior and lateral wall ischemia?
Which lead of a standard 5-lead ECG configuration is most useful for detecting anterior and lateral wall ischemia?
What is a contraindication for central venous catheter placement in the internal jugular vein?
What is a contraindication for central venous catheter placement in the internal jugular vein?
According to the Lambert-Beer Law, what is the difference in light absorption between oxyhemoglobin and deoxyhemoglobin that allows pulse oximetry to function?
According to the Lambert-Beer Law, what is the difference in light absorption between oxyhemoglobin and deoxyhemoglobin that allows pulse oximetry to function?
In the context of neuromuscular blockade monitoring, what does it mean when all four twitches are equal in intensity during nerve stimulation?
In the context of neuromuscular blockade monitoring, what does it mean when all four twitches are equal in intensity during nerve stimulation?
Besides volatile anesthetic agents, which other drug is known to trigger malignant hyperthermia?
Besides volatile anesthetic agents, which other drug is known to trigger malignant hyperthermia?
Which of the following scenarios would MOST likely warrant the use of a BIS monitor?
Which of the following scenarios would MOST likely warrant the use of a BIS monitor?
During pulse oximetry, which physiological property enables the continuous detection of arterial oxygen saturation?
During pulse oximetry, which physiological property enables the continuous detection of arterial oxygen saturation?
For what reason might a pulmonary artery pressure monitor be considered during surgery?
For what reason might a pulmonary artery pressure monitor be considered during surgery?
Which of the following is a potential complication of central venous catheter insertion?
Which of the following is a potential complication of central venous catheter insertion?
During general anesthesia and using neuromuscular blockade, how many twitches during a Train-of-Four (TOF) stimulation are typically maintained?
During general anesthesia and using neuromuscular blockade, how many twitches during a Train-of-Four (TOF) stimulation are typically maintained?
What is a key focus for students learning about intravenous catheter insertion?
What is a key focus for students learning about intravenous catheter insertion?
What is a typical learning experience for students regarding central venous catheter insertion?
What is a typical learning experience for students regarding central venous catheter insertion?
What is the primary purpose of monitoring during anesthesia, as students should understand?
What is the primary purpose of monitoring during anesthesia, as students should understand?
What aspect of fluid management should be understood by students during anesthesia?
What aspect of fluid management should be understood by students during anesthesia?
In the post-anesthesia care unit (PACU), what is a critical area of focus for students?
In the post-anesthesia care unit (PACU), what is a critical area of focus for students?
What should students understand about acute pain management in the PACU?
What should students understand about acute pain management in the PACU?
What is a crucial aspect of respiratory management that students should understand in the PACU?
What is a crucial aspect of respiratory management that students should understand in the PACU?
What should students focus on regarding circulatory complications in the PACU?
What should students focus on regarding circulatory complications in the PACU?
Which surgical procedure is MOST likely to be associated with significant alterations in pulmonary function due to large fluid shifts and/or blood loss?
Which surgical procedure is MOST likely to be associated with significant alterations in pulmonary function due to large fluid shifts and/or blood loss?
What is the primary goal of a preoperative pulmonary evaluation?
What is the primary goal of a preoperative pulmonary evaluation?
Patients with a significant history of wheezing are MOST at risk for developing which of the following complications during anesthesia induction?
Patients with a significant history of wheezing are MOST at risk for developing which of the following complications during anesthesia induction?
Impaired cough reflexes lead to altered pulmonary function which may result in which of the following complications?
Impaired cough reflexes lead to altered pulmonary function which may result in which of the following complications?
Which of the following directly contributes to a reduction in lung defense mechanisms during anesthesia?
Which of the following directly contributes to a reduction in lung defense mechanisms during anesthesia?
What causes alterations in gas exchange following surgery?
What causes alterations in gas exchange following surgery?
Which intervention is LEAST likely to address postoperative hypoxemia caused by altered gas exchange?
Which intervention is LEAST likely to address postoperative hypoxemia caused by altered gas exchange?
How does upper abdominal surgery impact diaphragmatic function?
How does upper abdominal surgery impact diaphragmatic function?
Which of the following best describes the PRIMARY goal of the anesthesiology rotation for a medical student?
Which of the following best describes the PRIMARY goal of the anesthesiology rotation for a medical student?
When assessing a patient's medical history prior to anesthesia, what is a PRIMARY focus area?
When assessing a patient's medical history prior to anesthesia, what is a PRIMARY focus area?
Why is the 'time of last oral intake' particularly important to note prior to anesthesia?
Why is the 'time of last oral intake' particularly important to note prior to anesthesia?
Which intervention is a medical student expected to be proficient in, as part of airway management during the anesthesiology rotation?
Which intervention is a medical student expected to be proficient in, as part of airway management during the anesthesiology rotation?
A student should learn the components of general anesthesia, which of the following is NOT typically one of those key components?
A student should learn the components of general anesthesia, which of the following is NOT typically one of those key components?
Which of the following is a PRIMARY educational goal regarding regional anesthesia for students during their rotation?
Which of the following is a PRIMARY educational goal regarding regional anesthesia for students during their rotation?
Which of the following is an important aspect related to pulmonary aspiration that a student should be aware of?
Which of the following is an important aspect related to pulmonary aspiration that a student should be aware of?
What is the significance of the ASA Physical Status Classification?
What is the significance of the ASA Physical Status Classification?
Which of the following opioid receptor types is predominantly targeted by most common anesthetic opioids for analgesia?
Which of the following opioid receptor types is predominantly targeted by most common anesthetic opioids for analgesia?
Which of these side effects is NOT typically associated with opioid administration during anesthesia?
Which of these side effects is NOT typically associated with opioid administration during anesthesia?
What is the mechanism of action of non-depolarizing neuromuscular blocking agents?
What is the mechanism of action of non-depolarizing neuromuscular blocking agents?
Which of the following statements accurately describes the mechanism of action of succinylcholine?
Which of the following statements accurately describes the mechanism of action of succinylcholine?
What is the primary way that succinylcholine's action is terminated in the body?
What is the primary way that succinylcholine's action is terminated in the body?
Why is the use of succinylcholine contraindicated in patients with a recent history of stroke or burns?
Why is the use of succinylcholine contraindicated in patients with a recent history of stroke or burns?
Which of the following agents is a pure opioid antagonist used to reverse the effects of opioids, especially respiratory depression?
Which of the following agents is a pure opioid antagonist used to reverse the effects of opioids, especially respiratory depression?
What is the primary mechanism by which anticholinesterase agents reverse the effect of non-depolarizing neuromuscular blocking agents?
What is the primary mechanism by which anticholinesterase agents reverse the effect of non-depolarizing neuromuscular blocking agents?
According to the provided text, what is the primary basis for obtaining laboratory tests on healthy, asymptomatic patients?
According to the provided text, what is the primary basis for obtaining laboratory tests on healthy, asymptomatic patients?
Which is the MOST appropriate use of a pregnancy test in a woman of childbearing age, prior to any surgery?
Which is the MOST appropriate use of a pregnancy test in a woman of childbearing age, prior to any surgery?
According to the ASA Physical Status Classification, a patient with unstable angina should be classified as:
According to the ASA Physical Status Classification, a patient with unstable angina should be classified as:
Which ASA Physical Status classification accurately describes a healthy 60 year old patient undergoing an elective hernia repair?
Which ASA Physical Status classification accurately describes a healthy 60 year old patient undergoing an elective hernia repair?
According to the ASA classification system, when should an 'E' be added?
According to the ASA classification system, when should an 'E' be added?
Which of the following is NOT a routine recommendation for preoperative labs in healthy individuals?
Which of the following is NOT a routine recommendation for preoperative labs in healthy individuals?
What information must be conveyed to the patient as part of the informed consent process regarding anesthesia?
What information must be conveyed to the patient as part of the informed consent process regarding anesthesia?
Which patient scenario BEST describes an individual with a PS-3 ASA classification?
Which patient scenario BEST describes an individual with a PS-3 ASA classification?
What is the primary mechanism by which anticholinesterase drugs, such as neostigmine, reverse the effects of neuromuscular blocking agents (NMBAs)?
What is the primary mechanism by which anticholinesterase drugs, such as neostigmine, reverse the effects of neuromuscular blocking agents (NMBAs)?
Why is an anticholinergic medication, like atropine or glycopyrrolate, often administered alongside anticholinesterase agents?
Why is an anticholinergic medication, like atropine or glycopyrrolate, often administered alongside anticholinesterase agents?
Which of the following best describes the underlying cause of malignant hyperthermia (MH)?
Which of the following best describes the underlying cause of malignant hyperthermia (MH)?
Which ECG lead is MOST useful for detecting anterior and lateral wall ischemia?
Which ECG lead is MOST useful for detecting anterior and lateral wall ischemia?
Based on the principles of pulse oximetry, which statement best explains how it differentiates between oxygenated and deoxygenated hemoglobin?
Based on the principles of pulse oximetry, which statement best explains how it differentiates between oxygenated and deoxygenated hemoglobin?
Which of the following clinical scenarios could suggest ongoing malignant hyperthermia?
Which of the following clinical scenarios could suggest ongoing malignant hyperthermia?
Besides volatile anesthetic agents, which other medication can trigger malignant hyperthermia (MH) in susceptible patients?
Besides volatile anesthetic agents, which other medication can trigger malignant hyperthermia (MH) in susceptible patients?
What should be the IMMEDIATE next step if a patient develops signs of malignant hyperthermia during surgery?
What should be the IMMEDIATE next step if a patient develops signs of malignant hyperthermia during surgery?
Flashcards
Intravenous Catheter Insertion
Intravenous Catheter Insertion
Choosing the right size and location for a vein, inserting the needle, and securing the catheter. Follows strict sterile techniques and universal precautions.
Arterial Catheter Insertion
Arterial Catheter Insertion
This procedure involves inserting a catheter into an artery, usually in the wrist or groin. It is primarily used to monitor blood pressure continuously and obtain blood samples.
Central Venous Catheter Insertion
Central Venous Catheter Insertion
A catheter is placed into a large vein in the neck, chest, or groin. Used for long-term access to the bloodstream for medications, fluid administration, or blood draws.
Pulmonary Artery Catheter Insertion
Pulmonary Artery Catheter Insertion
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Monitoring During Anesthesia
Monitoring During Anesthesia
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Intraoperative Fluid and Transfusion Therapy
Intraoperative Fluid and Transfusion Therapy
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Postoperative Anesthesia Care
Postoperative Anesthesia Care
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Phases of Recovery in PACU
Phases of Recovery in PACU
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Preoperative Cardiac Evaluation
Preoperative Cardiac Evaluation
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Major Perioperative Cardiac Complications
Major Perioperative Cardiac Complications
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Perioperative Myocardial Ischemia
Perioperative Myocardial Ischemia
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Patient Characteristics Associated with Postoperative Cardiac Complications
Patient Characteristics Associated with Postoperative Cardiac Complications
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Surgical Procedure Risk
Surgical Procedure Risk
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Preoperative History
Preoperative History
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Allergies
Allergies
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Social Habits
Social Habits
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Obstructive Apnea
Obstructive Apnea
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Central Apnea
Central Apnea
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Oral Airway
Oral Airway
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Nasal Airway
Nasal Airway
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Chin Lift
Chin Lift
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Jaw Thrust
Jaw Thrust
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Laryngeal Mask Airway (LMA)
Laryngeal Mask Airway (LMA)
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Tracheal Intubation
Tracheal Intubation
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Is Pulmonary Function Testing Crucial in Preoperative Evaluation?
Is Pulmonary Function Testing Crucial in Preoperative Evaluation?
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Who is at an Increased Risk of Post-Op Pulmonary Complications?
Who is at an Increased Risk of Post-Op Pulmonary Complications?
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What is the Mallampati Scale Used For?
What is the Mallampati Scale Used For?
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What Does a Mallampati Score of IV Indicate?
What Does a Mallampati Score of IV Indicate?
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How Does the Mallampati Scale Work?
How Does the Mallampati Scale Work?
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What Anatomical Features Can Suggest a Difficult Airway?
What Anatomical Features Can Suggest a Difficult Airway?
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Why is an Airway Examination Important in Preoperative Evaluation?
Why is an Airway Examination Important in Preoperative Evaluation?
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How Long Do Postoperative Pulmonary Complications Typically Last?
How Long Do Postoperative Pulmonary Complications Typically Last?
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What are anticholinesterases?
What are anticholinesterases?
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What is a side effect of anticholinesterases on the heart?
What is a side effect of anticholinesterases on the heart?
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What is Malignant Hyperthermia (MH)?
What is Malignant Hyperthermia (MH)?
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What is the pathophysiology of Malignant Hyperthermia?
What is the pathophysiology of Malignant Hyperthermia?
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What anesthetics can trigger Malignant Hyperthermia?
What anesthetics can trigger Malignant Hyperthermia?
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How is Malignant Hyperthermia treated?
How is Malignant Hyperthermia treated?
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What is a Peripheral Nerve Stimulator?
What is a Peripheral Nerve Stimulator?
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How does a Peripheral Nerve Stimulator work?
How does a Peripheral Nerve Stimulator work?
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What is pulse oximetry used for?
What is pulse oximetry used for?
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What is the oxyhemoglobin dissociation curve?
What is the oxyhemoglobin dissociation curve?
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What happens on the steeper part of the oxyhemoglobin dissociation curve?
What happens on the steeper part of the oxyhemoglobin dissociation curve?
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What is Capnography?
What is Capnography?
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How can capnography help confirm the placement of a breathing tube?
How can capnography help confirm the placement of a breathing tube?
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How can Capnography help monitor breathing?
How can Capnography help monitor breathing?
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Why is Capnography used for patients with increased intracranial pressure?
Why is Capnography used for patients with increased intracranial pressure?
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When can pulse oximetry be inaccurate?
When can pulse oximetry be inaccurate?
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Study Notes
Anesthesiology Goals and Objectives
- Goal: To introduce medical students to perioperative anesthesiology practice and concerns. Future physicians will care for patients needing anesthesia.
- Objectives: Students will understand and perform or observe preoperative patient evaluation, intraoperative care, and postoperative care.
Preoperative Patient Evaluation
- Knowledge: Evaluation of planned surgery and associated anesthetic concerns, including anesthesia type selection.
- Medical/Surgical History: Focusing on cardiac and pulmonary histories, allergies, and medications.
- Physical Examination: Inclusion of airway evaluation, time of last oral intake, and assessment of appropriate labs, consults, and other studies.
- ASA Classification: Will understand the American Society of Anesthesiology Physical Status Classification.
- Informed Consent: Knowledge of informed consent procedures.
Intraoperative Care
- Airway Management: Experience with bag-mask ventilation, oral and nasal airways, laryngoscopy and tracheal intubation, and placement of laryngeal mask airways, with observation of additional airway devices as appropriate. Simulations and direct patient care are utilized.
- General Anesthesia: Components, including intravenous and inhalational anesthetics, neuromuscular blocking agents, narcotics, and sedative-hypnotics are understood. Learn about Malignant Hyperthermia.
- Regional Anesthesia: Techniques, indications, complications, and contraindications of spinal and epidural anesthesia. Learn about local anesthetics.
- Intravenous Catheter Insertion: Proper catheter site and size selection, insertion technique, aseptic technique, and universal precautions are understood.
Postoperative Anesthesia Care
- PACU (Post Anesthesia Care Unit): Understanding emergency issues in the PACU, specifically the two phases of recovery.
- Pain Management: Acute pain management techniques, including narcotic administration and nerve blocks (e.g., epidural, interscalene).
- Respiratory Complications: Management of respiratory complications in the PACU, including airway obstruction, hypoventilation, and hypoxemia.
- Circulatory Complications: Management of circulatory complications in the PACU, including hypotension, hypertension, and dysrhythmias. discharge criteria are understood.
Preoperative Evaluation of Patients
- Patient History: Establish patient's problems, diagnosis, planned procedure, medical history, prior surgeries/anesthesia, allergies, medications, social habits, and NPO status.
- Cardiac Evaluation: Goal of this evaluation is to identify patients at risk for perioperative cardiac complications (e.g., death, MI, CHF, pulmonary edema, cardiac arrhythmias). Perioperative myocardial ischemia is common in patients with coronary artery disease. Risk factors include: history of CHF, CAD, and advanced age.
- Pulmonary Evaluation: Goal is to identify patients at risk for adverse pulmonary outcomes by identifying patients with a history of reactive airway disease, previous upper respiratory infection, or significant smoking history. Common complications include: atelectasis, infection, and respiratory failure. Risk factors include smoking history, COPD, and upper respiratory infections.
Physical Exam
- Vital Signs: Measurement of vital signs, observation of the patient related to positioning, evaluation of heart and lungs.
- Dentition/Airway: Inspection of teeth and gums for loose or chipped teeth; caps, bridges, or dentures. Evaluate the airway, including the Mallampati score.
- Laboratory Examination: Routine labs for healthy asymptomatic patients may no longer be recommended. Based on history and physical findings, labs may be performed, and may include hemoglobin/hematocrit, pregnancy tests, and EKGs.
Monitoring
- Electrocardiography (ECG): Used to monitor the heart's electrical activity, looking for rhythm disturbances, inferior wall ischemia (lead II), and anterior/lateral wall ischemia (lead V5).
- Pulse Oximetry: Non-invasive continuous intraoperative monitoring of arterial oxygenation.
- Capnography: Monitoring of end tidal carbon dioxide (ETCO2) to help confirm proper ventilation and endotracheal tube placement.
- Arterial Blood Pressure: Measuring blood pressure utilizing auscultatory or oscillometric method. Invasive method uses arterial catheter.
- Temperature: Monitoring of body temperature, including esophageal, nasopharyngeal, skin, rectal, bladder, and pulmonary artery catheter sites.
Intravenous Fluid and Transfusion Therapy
- Crystalloids: Aqueous solutions containing low-molecular weight salts and possibly glucose. Provide types (e.g., normal saline). Fluid requirement determination includes maintenance, 3rd space losses, and deficits, replaced as needed.
- Colloids: Solutions containing high-molecular weight structures (e.g., blood products, albumin). Replaces fluid volume losses while minimizing fluid shifts.
- Blood Transfusion: Decision to transfuse based on anemia severity, surgery types, expected blood loss, and patient conditions. Includes blood typing, compatibility testing, cross-matching, and possible complications (e.g., hemolytic reactions).
Local Anesthetics
- Mechanism of Action: Local anesthetics interrupt depolarization by blocking sodium ion channels, preventing impulse conduction in nerve fibers.
- Chemical Structure: Classified into esters (e.g., procaine, tetracaine) and amides (e.g., lidocaine, bupivacaine). Amides are metabolized by hepatic enzymes; esters are hydrolyzed.
- Epinephrine Effects: Added to local anesthetic solutions to prolong duration of action and reduce systemic toxicity.
Systemic Toxicity of Local Anesthetics
- Dosage Limits: Each local anesthetic has maximum dosage limits to prevent overdosage and systemic absorption.
- Symptoms: CNS stimulation (restlessness, tremors) and depression, including cardiovascular symptoms (hypotension, tachycardia).
Spinal and Epidural Anesthesia
- Anatomy: Spinal anesthesia involves injecting local anesthetic into the subarachnoid space, affecting sensory and motor nerve fibers. Epidural anesthesia involves injecting local anesthetic into the epidural space.
- Complications: Including total or high spinal (from excessive local anesthetic administration), intravascular injection, retained catheters, epidural hematoma.
Post Anesthesia Care Unit
- Purpose: Emergence phase of general anesthesia continues in the PACU. Stresses include airway, shivering, pain, and autonomic lability.
- Phases: Phase 1 (immediate recovery) and 2 (readiness for discharge).
- Causes of Delayed Emergence: Residual drug effects, hypothermia, severe metabolic issues.
Respiratory Complications
- Airway Obstruction: Tongue, secretions, laryngospasm, glottic edema.
- Hypoventilation: Residual anesthetic effect, post-surgical splinting, and muscle paralysis.
- Hypoxemia: Hypoventilation, shunt. Early and rapid interventions are needed, including oxygen supplementation and potential mechanical ventilation.
Circulatory Complications
- Hypotension: Low blood pressure, possible etiology is hypovolemia, left ventricular dysfunction.
- Hypertension: High blood pressure, likely due to pain or sympathetic activation, possible adverse effects include ischemia and heart failure.
- Dysrhythmias: Irregular heartbeats, possibly from hypoxemia, hypokalemia, and acidosis.
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