Anesthesia Techniques and History

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Questions and Answers

What is the primary aim of an ideal anesthetic technique?

Maximize the duration of surgery

Maximize provider preferences in anesthesia choice

Minimize the patient's preoperative anxiety

Ensure excellent operating conditions for the surgeon (correct)

Which anesthetic type is typically used in pediatric cases?

Combination Inhalation/IV

Intravenous only (TIVA)

General Anesthesia Care

Inhalation only (correct)

Which factor is NOT typically considered when determining anesthetic technique?

Coexisting disease

Patient comfort

Elective versus emergency procedure

Surgeon’s experience level (correct)

What measures unconsciousness during anesthesia?

EEG & BIS monitoring Signup and view all the answers

What is the primary function of local anesthetics in neuroaxial anesthesia?

Blocking signals to and from the nerve Signup and view all the answers

Which physician is credited with the first use of cocaine for intradermal infiltration and nerve blocks?

William Halstead Signup and view all the answers

When monitoring ETCO2, what is necessary to accurately assess quality of ventilation?

Sealed mask Signup and view all the answers

Which statement is true regarding patients' cardiovascular functions during neuraxial anesthesia?

Cardiovascular function tends to remain unchanged. Signup and view all the answers

Which of the following is NOT a method of delivering neuroaxial anesthesia?

Intravenous administration Signup and view all the answers

What is the primary reason a provider must be prepared to convert to general anesthesia during monitored anesthesia care?

To manage any unanticipated complications Signup and view all the answers

Which of the following best describes 'Moderate sedation/Analgesia'?

Patients respond purposefully to verbal commands or light tactile stimulation. Signup and view all the answers

Which groups of patients are generally considered poor candidates for monitored anesthesia care?

Children, confused patients, and those unable to follow commands Signup and view all the answers

How does deep sedation differ from moderate sedation/analgesia?

Patients can respond purposefully, but only after painful stimulation. Signup and view all the answers

What is a primary goal of administering monitored anesthesia care?

To maintain cardiopulmonary stability during the procedure Signup and view all the answers

What characterizes minimal sedation, also known as anxiolytics?

Patients retain the ability to respond normally to verbal commands. Signup and view all the answers

Which of these actions is NOT typically performed by the anesthesia provider during monitored anesthesia care?

Engage in extensive surgical procedures themselves Signup and view all the answers

Which potential complication is specifically associated with monitored anesthesia care?

Over-sedation and respiratory collapse Signup and view all the answers

What is the primary reason inhalation induction is commonly used for children undergoing elective cases?

It is less traumatic and does not require IV access. Signup and view all the answers

Which volatile anesthetic is known for being non-pungent and non-irritating, making it the most common for inhalation induction?

Sevoflurane Signup and view all the answers

What is the most critical monitoring device used during inhalation induction?

Pulse oximeter Signup and view all the answers

What is NOT a goal of the maintenance phase during anesthesia?

To induce immediate awakening Signup and view all the answers

Which of the following is a consideration for patients with long-standing uncontrolled hypertension during anesthesia?

To keep MAP within 20% of baseline. Signup and view all the answers

During the post-standard induction phase, what must be assessed if a patient has not regained consciousness?

The loss of lid reflex and level of consciousness Signup and view all the answers

What method should NOT be performed during rapid sequence induction (RSI)?

Positive pressure ventilation Signup and view all the answers

What combination of gases is typically used during the inhalation induction process?

Oxygen, nitrous oxide, and volatile agent Signup and view all the answers

What is a primary advantage of using regional anesthesia over general anesthesia?

Reduced cardiac complications in high-risk patients Signup and view all the answers

Which layer of the meninges is the innermost and in direct contact with the surface of the spinal cord?

Pia Mater Signup and view all the answers

Which abnormal curvature is characterized by an excessive hollowness of the lumbar vertebrae?

Lordosis Signup and view all the answers

At what level does the spinal cord typically end in adults?

L1 Signup and view all the answers

What anatomical feature provides structural support to the vertebrae anteriorly?

Longitudinal Ligaments Signup and view all the answers

What is the consequence of performing a needle puncture above L1 in adults?

Increased chance of spinal cord injury Signup and view all the answers

Which structures are responsible for forming spinal nerves as they exit the spinal canal?

Anterior and posterior nerve roots Signup and view all the answers

What is the composition of the subarachnoid space?

Cerebral spinal fluid Signup and view all the answers

Which ligaments serve as the final barrier to a needle before it enters the spinal canal?

Ligamentum flavum Signup and view all the answers

What defines the epidural space within the vertebral canal?

Surrounded by the dura mater and posteriorly by ligamentum flavum Signup and view all the answers

What is the function of the cauda equina?

Providing nerve pathways for lower extremities Signup and view all the answers

Where does cerebrospinal fluid circulate in relation to the spinal cord?

In the subarachnoid space Signup and view all the answers

Which of the following statements about anesthesia is true?

Regional anesthesia can decrease transfusion requirements Signup and view all the answers

Which patient scenario primarily indicates the need for rapid sequence intubation (RSI)?

A patient with a full stomach and obesity Signup and view all the answers

In monitored anesthesia care (MAC), which factor is crucial for maintaining the patient's comfort and safety?

Educating the patient about potential awareness during the procedure Signup and view all the answers

Which statement best characterizes the role of the anesthesia provider during monitored anesthesia care?

The provider must also be prepared to convert to general anesthesia if necessary. Signup and view all the answers

What is the primary concern when administering monitored anesthesia care to a patient at risk for gastric aspiration?

The potential need for immediate intubation Signup and view all the answers

When might a patient receiving monitored anesthesia care experience a transition to general anesthesia?

If the patient loses consciousness and cannot respond purposefully Signup and view all the answers

What is a common misconception regarding the expectations set for patients undergoing monitored anesthesia care?

Patients will be completely unconscious throughout the procedure Signup and view all the answers

What is the primary responsibility of a nurse anesthetist during the preanesthesia assessment?

Performing and documenting a thorough preanesthesia assessment Signup and view all the answers

How should a nurse anesthetist respond if a patient is unable to provide informed consent for anesthesia?

Verify that a qualified professional has obtained consent Signup and view all the answers

During the monitoring phase of anesthesia, which physiological condition must a nurse anesthetist continuously assess?

Patient's response to the anesthetic Signup and view all the answers

What is a critical component of monitoring oxygenation during anesthesia?

Continuously monitoring oxygenation through clinical observation and pulse oximetry Signup and view all the answers

Which standard requires the nurse anesthetist to formulate a patient-specific plan for anesthesia care?

Standard three Signup and view all the answers

What must a nurse anesthetist do before implementing the anesthesia care plan?

Implement and adjust the anesthesia care plan based on the patient's physiological status Signup and view all the answers

What is the minimum frequency to document blood pressure and heart rate during moderate or deep sedation?

Every five minutes Signup and view all the answers

Which action is essential for maintaining normothermia when body temperature changes are anticipated during sedation?

Continuously monitor body temperature Signup and view all the answers

When neuromuscular blocking agents are used, what should be continually monitored?

Neuromuscular response Signup and view all the answers

Which principle should be followed regarding documentation of anesthesia-related information?

Be accurate, complete, and timely in documentation Signup and view all the answers

What is a key responsibility when transferring a patient’s care to another healthcare provider?

Ensure continuity of care through accurate reporting Signup and view all the answers

When using an automatic mechanical ventilator, which safety precaution is critical?

Ensure the breathing system's integrity is monitored Signup and view all the answers

Which of the following is necessary when assessing patient positioning and protective measures?

Continuous monitoring and assessment are important Signup and view all the answers

What is the main concern when managing the risk of fire and electrical equipment malfunction during anesthesia?

Following established safety precautions Signup and view all the answers

Which pharmacologic action is essential for preventing intraoperative awareness during surgery?

Maintaining anesthetic depth according to stimulation levels Signup and view all the answers

What does the 4-2-1 rule primarily aid in determining during fluid management?

Replacement fluid requirements Signup and view all the answers

Why is it important to monitor pressure points during anesthesia maintenance?

To prevent positioning-related complications Signup and view all the answers

What is a critical consideration for patients with uncontrolled hypertension during anesthesia?

Maintaining baseline perfusion pressures Signup and view all the answers

What physiological state is considered essential for normotensive patients during anesthesia?

Euvolemia Signup and view all the answers

Which of the following factors most significantly influences anesthetic depth during surgery?

Type of surgical incision Signup and view all the answers

What is the primary role of vigilance during intraoperative management?

Preventing intraoperative awareness Signup and view all the answers

What should be monitored to estimate blood loss during a procedure?

Estimate and replace fluid loss Signup and view all the answers

What key aspect affects the positioning of patients during anesthesia?

Maintenance of ventilation pressures Signup and view all the answers

During what circumstance is it most necessary to adjust the anesthetic depth?

During high-stimulation procedures like an incision Signup and view all the answers

Study Notes

Anesthesia Overview

Types of anesthesia include obstetric, pediatric, cardiothoracic, neuro, outpatient surgery, and pain management.
Ketamine clinics offer specialized anesthetic care.
Alice Magaw is recognized as the first nurse anesthetist.

Historical Milestones

1864 marks the delivery of the first ether anesthetic by Morton.
WWII saw the establishment of modern anesthetic practices.

Considerations for Anesthetic Technique

Factors influencing anesthetic choices: patient safety, comfort, provider preference, coexisting diseases, surgical site, positioning, airway management, surgery duration, age, and recovery time.
Facilities have specific PACU discharge criteria.

Ideal Anesthetic Technique Goals

Ensure optimal patient safety, satisfaction, and excellent surgeon operating conditions.
Aim for rapid recovery and minimize postoperative side effects while reducing costs.

Types of Anesthesia

General Anesthesia: Drug-induced CNS depression resulting in unresponsiveness to external stimuli.
ASA continuum of sedation ranges from minimal to deep sedation levels.

General Anesthetic Methods

Methods include inhalation only (often for pediatric cases), intravenous (TIVA used in neuro-monitored scenarios), and a combination of inhalation and IV, which is the most common.

Inhalation Induction

Most common method for pediatric patients in elective cases, resulting in less trauma (known as mask induction).
Process includes administering oxygen and volatile agents to achieve loss of consciousness.

Monitoring During Anesthesia

Monitors such as pulse oximetry are critical throughout the induction and maintenance phases.
Post-induction assessment includes loss of lid reflex and ease of ventilation.

Maintenance of Anesthesia

Involves managing physiological functions until emergence from anesthesia.
Goals include maintaining unconsciousness, amnesia, analgesia, and muscle relaxation.
Vigilance is essential to respond to any physiological changes.

Neuroaxial Anesthesia

Local anesthetic placement near the spinal cord, blocking nerve signals to and from the brain.
Can be administered as a single injection (spinal) or via a catheter for continuous infusion (epidural).

Advantages of Regional Anesthesia

Compared to general anesthesia, regional methods can reduce blood loss, venous thromboembolism, cardiac complications, and postoperative ileus.
Regional anesthesia is often preferred for procedures below the umbilicus.

Anatomy of the Vertebral Column

Comprised of 33 vertebral bones and 24 intervertebral disks, providing structural support and protection for the spinal cord.
Consists of cervical, thoracic, lumbar, sacral, and coccygeal regions with characteristic curvatures.

Meninges and Spinal Cord Structure

The spinal cord is encased in three protective membranes: dura mater, arachnoid mater, and pia mater.
Cerebrospinal fluid (CSF) is located in the subarachnoid space, providing cushioning.

Anesthesia Candidates

Not ideal for children, uncooperative or confused patients, or those unable to maintain a stable position.

ASA Sedation Levels

Minimal Sedation: Patients respond to verbal commands; cognitive function may be impaired.
Moderate Sedation: Purposeful response to verbal commands or light touch; airway and spontaneous ventilation remain sufficient.
Deep Sedation: Patients are difficult to arouse but respond to pain; airway maintenance may be needed.

Epidural and Subarachnoid Spaces

Epidural space is outside the dura mater and contains vessels, fat, and nerve roots; it is a potential space subject to variability in size.
Subarachnoid space contains CSF and connects to the brain's ventricles.

AANA Standards for Nurse Anesthesia Practice

Thorough preanesthesia assessment and evaluation must be performed and documented.
Informed consent is required from the patient or legal guardian, or verification of consent obtained by a qualified professional.
Develop a patient-specific plan for anesthesia care.
Anesthesia care plan implementation must adapt based on the patient's physiologic status.
Continuous assessment of the patient's response to anesthetic and surgical interventions is essential, with timely interventions to maintain optimal condition.

Monitoring Standards

Continuous monitoring of patient's physiologic condition tailored to the anesthesia type and patient needs.
Oxygenation should be monitored using clinical methods and pulse oximetry; arterial blood gas analysis is used if needed.
Ventilation monitoring involves auscultation and confirming trachea intubation via expired carbon dioxide levels.
Cardiovascular status monitored through ECG; blood pressure and heart rate must be documented every five minutes.
Body temperature is monitored to maintain normothermia when changes are suspected.
Neuromuscular response should be monitored when neuromuscular blocking agents are used.
Patient positioning and protective measures must be assessed and monitored, ensuring proper safety.

Documentation and Transfer of Care

Accurate, complete, legible, and timely documentation of anesthesia-related information in the medical record is crucial.
Evaluate the patient's status for safe transfer of care, ensuring essential information is reported to the next qualified health care provider.

Safety Precautions

Adherence to safety protocols to mitigate risks of fire, explosion, or equipment malfunction is vital.
Automatic mechanical ventilation integrity must be monitored with audible alarms for disconnections.