Preoperative Evaluation and Fasting Guidelines
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Questions and Answers

What amount of long-acting insulin should patients with type 1 diabetes take on the day of surgery?

  • One quarter of their usual dose
  • Their full usual dose
  • No insulin
  • One third of their usual dose (correct)

    • Which class of medication should be discontinued 24 hours before elective surgery?

  • Thiazide diuretics
  • SGLT2 inhibitors (correct)
  • Non-insulin antidiabetic medications
  • COX-2 inhibitors

    • How long before surgery should warfarin be discontinued for most patients?

  • 7 days
  • 1 day
  • 3 days
  • 5 days (correct)

    • Which of the following medications should be continued on the day of surgery?

    <p>Diuretics for hypertension</p> Signup and view all the answers

    What action should be taken with topical medications on the day of surgery?

    <p>They should be discontinued</p> Signup and view all the answers

    What is the recommended preoperative discontinuation time for Ephedra: ma huang due to its sympathomimetic effects?

    <p>At least 24 hours</p> Signup and view all the answers

    Which of the following herbal medications is associated with irreversible inhibition of platelet aggregation?

    <p>Garlic</p> Signup and view all the answers

    What is the physiological impact of nicotine found in e-cigarettes?

    <p>Sympathomimetic, cardiac, vascular, and endocrine toxicity</p> Signup and view all the answers

    Which of the following statements is true regarding Ginger: Zingiber officinale and its preoperative guidelines?

    <p>It should be discontinued at least 7 days before surgery.</p> Signup and view all the answers

    Which substance found in e-cigarettes is known to generate pulmonary toxicity?

    <p>Diacetyl</p> Signup and view all the answers

    What is the impact of long-term alcohol intake on anesthetic requirements?

    <p>Increased requirements due to withdrawal syndrome</p> Signup and view all the answers

    What is the required cessation time for Ginkgo: duck foot tree before surgery?

    <p>At least 36 hours</p> Signup and view all the answers

    Which constitutes a significant risk factor for perioperative complications?

    <p>A smoking history of more than 20 pack years</p> Signup and view all the answers

    How long should Kava: awa be discontinued before surgery to minimize sedation and anxiolysis risk?

    <p>At least 24 hours</p> Signup and view all the answers

    Which herbal medication does not have a specified preoperative discontinuation time?

    <p>Valerian</p> Signup and view all the answers

    What should be done with antihypertensive medications on the day of surgery?

    <p>Continue all except ACEIs and ARBs on the day of surgery</p> Signup and view all the answers

    How should aspirin be managed for patients with prior percutaneous coronary intervention on the day of surgery?

    <p>Discontinue aspirin 3 days before surgery unless specific conditions apply</p> Signup and view all the answers

    What is the recommended action regarding the discontinuation of insulin for patients on the day of surgery?

    <p>Only short-acting insulin should be discontinued</p> Signup and view all the answers

    Which statement is true regarding the management of P2Y12 inhibitors before surgery?

    <p>Discontinuation should occur 5–7 days before surgery for clopidogrel and ticagrelor</p> Signup and view all the answers

    What is a key consideration for corticosteroid use in patients undergoing surgery?

    <p>Patients may require stress dosing if they have not taken oral corticosteroids recently</p> Signup and view all the answers

    What is recommended concerning the continuation of antidepressants on the day of surgery?

    <p>Antidepressants can be continued on the day of surgery without modification</p> Signup and view all the answers

    Which category of medications is explicitly stated as needing to be discontinued on the day of surgery?

    <p>Short-acting insulin</p> Signup and view all the answers

    What should be documented regarding allergies before surgery?

    <p>Responses to past medications and contact allergies should be documented</p> Signup and view all the answers

    Which of the following substances is NOT typically considered an illicit drug?

    <p>Anabolic steroids</p> Signup and view all the answers

    What does the acronym LEMON stand for in airway evaluation?

    <p>Look, Evaluate, Mallampati, Obstruction, Neck</p> Signup and view all the answers

    Which of the following is NOT part of the physical examination process as outlined?

    <p>Patient history review</p> Signup and view all the answers

    Which factor is assessed during the airway evaluation concerning the patient's anatomy?

    <p>Length of the upper incisors</p> Signup and view all the answers

    Obesity is defined in relation to what measurement?

    <p>Ideal body weight</p> Signup and view all the answers

    What is the primary purpose of the physical examination in the context described?

    <p>To detect abnormalities not evident in history</p> Signup and view all the answers

    Which condition is a co-morbidity that can impact the administration of anesthesia?

    <p>Obesity</p> Signup and view all the answers

    The Mallampati Airway Classification assesses the visibility of what anatomical structure?

    <p>Uvula</p> Signup and view all the answers

    What is the primary goal of the preanesthetic evaluation?

    <p>To optimize patient conditions and mitigate risks</p> Signup and view all the answers

    Which component is NOT typically included in a preanesthetic evaluation?

    <p>Patient’s socioeconomic status</p> Signup and view all the answers

    What is the purpose of the ASA classification system in a preoperative setting?

    <p>To classify patients based on their health status and anesthesia risk</p> Signup and view all the answers

    Which fasting recommendation is appropriate for a patient before surgery according to general guidelines?

    <p>Clear liquids should be allowed until 2 hours before surgery</p> Signup and view all the answers

    What is an important strategy to prevent aspiration pneumonitis in at-risk populations?

    <p>Ensuring adequate fasting prior to surgery</p> Signup and view all the answers

    What should the preanesthetic evaluation focus on regarding the patient's medical history?

    <p>Collecting comprehensive airway, cardiac, and pulmonary information</p> Signup and view all the answers

    Which best describes an outcome of inadequate preoperative planning?

    <p>Higher rates of surgical delay and complications</p> Signup and view all the answers

    What should a patient be educated about before surgery to reduce anxiety?

    <p>Intra- and postoperative care expectations</p> Signup and view all the answers

    How does the preanesthetic evaluation help with surgical efficiency?

    <p>By individualizing management plans based on patient assessment</p> Signup and view all the answers

    What is a crucial aspect to confirm during the preoperative drug history assessment?

    <p>Last dosage and timing of all medications</p> Signup and view all the answers

    Why is preoperative fasting important?

    <p>To minimize the risk of aspiration during anesthesia</p> Signup and view all the answers

    What combination of factors does the content of the preanesthetic evaluation assess?

    <p>Medical history, fasting guidelines, and past anesthetic experiences</p> Signup and view all the answers

    What key information should be prioritized during the patient interview component of preanesthetic assessment?

    <p>Past anesthetic experiences and risk factors</p> Signup and view all the answers

    Which of the following factors is least likely to directly influence anesthetic technique selection?

    <p>Availability of surgical tools</p> Signup and view all the answers

    What is the primary characteristic of general anesthesia?

    <p>Loss of response to all external stimuli</p> Signup and view all the answers

    Which anesthesia type is typically preferred for pediatric cases?

    <p>Inhalation only</p> Signup and view all the answers

    What is the ideal outcome regarding postoperative side effects when selecting an anesthetic technique?

    <p>Avoid postoperative complications</p> Signup and view all the answers

    Which of the following is typically NOT a consideration for anesthesia in critical care?

    <p>Type of anesthesia coverage required</p> Signup and view all the answers

    What is one of the main components of the anesthetic state that is typically inferred but not directly measured?

    <p>Unconsciousness</p> Signup and view all the answers

    Which patient consideration is crucial for determining the anesthesia technique for outpatient surgery?

    <p>Length of surgery</p> Signup and view all the answers

    Alice Magaw is recognized for her contributions primarily to which area?

    <p>Development of nurse anesthesia training</p> Signup and view all the answers

    What is the primary patient characteristic that disqualifies someone from being a good candidate for monitored anesthesia care?

    <p>Uncooperative behavior</p> Signup and view all the answers

    Which sedation level allows patients to respond purposefully to verbal commands with adequate spontaneous ventilation?

    <p>Moderate sedation/analgesia</p> Signup and view all the answers

    What is a key reason inhalation induction is commonly used for children scheduled for elective cases?

    <p>It is less traumatic and does not require an IV.</p> Signup and view all the answers

    What is included in the maintenance phase of anesthesia after induction?

    <p>Monitoring physiological functions and maintaining homeostasis.</p> Signup and view all the answers

    What is a common risk associated with monitored anesthesia care, as indicated by the ASA Closed Claims Project database?

    <p>Over-sedation leading to respiratory collapse</p> Signup and view all the answers

    What is the role of the anesthesia provider during monitored anesthesia care?

    <p>Support of vital functions and diagnosis of clinical problems</p> Signup and view all the answers

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

    <p>Sevoflurane</p> Signup and view all the answers

    What is a correct statement about the administration of drugs during monitored anesthesia care?

    <p>Therapy is customized to treat pain, anxiety, and agitation.</p> Signup and view all the answers

    Which of the following is a crucial step in the inhalation induction process?

    <p>Ensuring the circuit is properly primed.</p> Signup and view all the answers

    In maintaining physiologic homeostasis during surgery, which goal is critical for normotensive patients?

    <p>Maintaining euvolemia and ensuring stable MAP.</p> Signup and view all the answers

    What is the primary focus of post-standard induction management?

    <p>Assessing the loss of lid reflex and maintaining ventilation.</p> Signup and view all the answers

    What defines the 'Valley of Anesthesia' period?

    <p>Time after induction but before surgical incision.</p> Signup and view all the answers

    What is NOT a goal of anesthesia maintenance?

    <p>Performing rapid sequence intubation.</p> Signup and view all the answers

    Which factor should be monitored to ensure adequate ventilation during inhalation induction?

    <p>Pulse oximetry primarily.</p> Signup and view all the answers

    What is the primary purpose of pre-oxygenation during the induction of anesthesia?

    <p>To replace nitrogen in the patient's functional residual capacity</p> Signup and view all the answers

    Which of the following anesthetic agents is known for providing rapid onset of unconsciousness?

    <p>Thiopental</p> Signup and view all the answers

    What does the application of cricoid pressure during rapid sequence induction aim to achieve?

    <p>Close the esophagus to reduce aspiration risk</p> Signup and view all the answers

    Which monitor is specifically used when consistent and continuous monitoring of blood pressure is necessary?

    <p>Arterial line</p> Signup and view all the answers

    What is a common characteristic of an ideal intravenous anesthesia induction drug?

    <p>Rapid onset and minimal respiratory depression</p> Signup and view all the answers

    Which reflex is considered a protective reflex during anesthesia induction?

    <p>Eyelid reflex</p> Signup and view all the answers

    In the context of pre-induction, what is the primary use of special monitors like cerebral oximeters?

    <p>To assess cerebral blood flow and oxygenation</p> Signup and view all the answers

    What factor determines the choice of anesthetic agent used during induction?

    <p>Patient-specific comorbidities and situational needs</p> Signup and view all the answers

    During a rapid sequence induction, which of the following is a critical step following the administration of induction agents?

    <p>Applying cricoid pressure until sufficient oxygenation occurs</p> Signup and view all the answers

    What is the primary goal of the standard induction sequence in anesthesia?

    <p>To ensure a safe and effective transition to unconsciousness</p> Signup and view all the answers

    What is the significance of Stage II during intravenous induction of anesthesia?

    <p>It includes involuntary movements and carries the highest risk for laryngospasms.</p> Signup and view all the answers

    Which criterion is essential for 'Awake Extubation'?

    <p>The patient should be fully conscious and responsive to simple commands.</p> Signup and view all the answers

    What is the primary goal during the emergence phase from general anesthesia?

    <p>To allow the patient to regain consciousness and protect their airway.</p> Signup and view all the answers

    What is a key characteristic of Stage III Plane 2 in general anesthesia?

    <p>Regular respiration with reduced tidal volume and lost sensation.</p> Signup and view all the answers

    Which method should be employed to minimize diffusion hypoxia after the use of N2O?

    <p>Providing 100% oxygen for a duration of 5-10 minutes.</p> Signup and view all the answers

    What denotes the end of Stage IV in general anesthesia?

    <p>Cessation of spontaneous respiration leading to circulatory collapse.</p> Signup and view all the answers

    What should be prioritized when evaluating a patient for deep extubation?

    <p>Verification of adequate NMBA reversal and stable hemodynamics.</p> Signup and view all the answers

    What is the essential responsibility during the maintenance monitoring phase of anesthesia?

    <p>Regular assessment of vital signs and anesthetic depth.</p> Signup and view all the answers

    Which of the following is NOT a sign of Stage III during the emergence phase?

    <p>Presence of slight muscle tone.</p> Signup and view all the answers

    In Monitored Anesthesia Care (MAC), what indicates that the anesthesia approach has transitioned to general anesthesia?

    <p>The patient loses consciousness and the ability to respond purposefully.</p> Signup and view all the answers

    What is the primary reason for performing pre-oxygenation before induction of anesthesia?

    <p>To replace nitrogen in the functional residual capacity</p> Signup and view all the answers

    Which statement accurately describes the characteristics of ideal intravenous induction agents?

    <p>They should allow for a fast recovery and minimal side effects</p> Signup and view all the answers

    What is a unique aspect of Rapid Sequence Induction (RSI) compared to standard induction?

    <p>It always includes a neuromuscular blocking agent right after unconsciousness</p> Signup and view all the answers

    Which monitor is considered a standard for all anesthetic techniques according to the established guidelines?

    <p>Temperature monitoring</p> Signup and view all the answers

    What component is critical during the setup procedure for RSI to prevent aspiration?

    <p>Applying cricoid pressure</p> Signup and view all the answers

    Which anesthetic agent is commonly utilized for inducing anesthesia due to its minimal effect on seizure threshold?

    <p>Brevital</p> Signup and view all the answers

    Which component is typically NOT included in the standard induction sequence checklist?

    <p>Patient medication review</p> Signup and view all the answers

    What does the AANA and ASA standard require regarding monitoring during anesthesia?

    <p>Standard monitors are mandatory regardless of location</p> Signup and view all the answers

    Which volatile anesthetic is known for being non-pungent and non-irritating?

    <p>Sevoflurane</p> Signup and view all the answers

    What is primarily assessed in the post-induction phase to determine ventilation effectiveness?

    <p>Ease of ventilation</p> Signup and view all the answers

    During inhalation induction, which component is essential for achieving a sufficient onset of anesthesia?

    <p>Use of nitrous oxide</p> Signup and view all the answers

    At which spinal level is local anesthetic solution typically injected for spinal neuraxial anesthesia?

    <p>Below L1</p> Signup and view all the answers

    What does 'maintenance of physiological homeostasis' during anesthesia require?

    <p>Constant monitoring of vital signs</p> Signup and view all the answers

    Which of the following is NOT a goal of the maintenance phase in anesthesia?

    <p>Increased heart rate</p> Signup and view all the answers

    Which structure must be penetrated to reach the subarachnoid space during a spinal block?

    <p>Dura mater</p> Signup and view all the answers

    In inhalation induction, what is the primary role of priming the circuit?

    <p>To ensure oxygen delivery effectively</p> Signup and view all the answers

    What is the primary blood supply to the lower two-thirds of the spinal cord?

    <p>Anterior artery</p> Signup and view all the answers

    What is a common feature of the 'valley of anesthesia' following induction?

    <p>Ongoing anesthesia management</p> Signup and view all the answers

    Which of the following statements best describes the mechanism of action of spinal anesthesia?

    <p>Local anesthetic acts primarily on the nerve roots.</p> Signup and view all the answers

    What is one potential complication of delayed gastric emptying when considering anesthesia?

    <p>Increased risk of aspiration</p> Signup and view all the answers

    What potential complication is associated with spinal blocks that result in sympathetic blockade?

    <p>Bradycardia</p> Signup and view all the answers

    What is indicated by a positive pressure ventilation technique in the post-standard induction phase?

    <p>Improving oxygen saturation</p> Signup and view all the answers

    Which airway device can be utilized without the administration of paralytics?

    <p>Laryngeal mask airway</p> Signup and view all the answers

    What is the primary purpose of neuroaxial anesthesia?

    <p>To block signals to and from the nerve adjacent to the spinal cord</p> Signup and view all the answers

    Which of the following statements about ETCO2 monitoring is correct?

    <p>A sealed mask is needed for accurate ETCO2 monitoring</p> Signup and view all the answers

    What does the original application of modern local anesthesia involve?

    <p>Topical anesthesia of the eye with cocaine</p> Signup and view all the answers

    Which of the following is NOT a known application of regional anesthesia techniques?

    <p>Continuous sedation for all surgical procedures</p> Signup and view all the answers

    How do local anesthetics primarily function on nerve fibers?

    <p>By interrupting conduction through sodium channels</p> Signup and view all the answers

    Which of the following is a characteristic of spinal anesthesia?

    <p>It can be performed as either a single injection or with a catheter</p> Signup and view all the answers

    Which surgeries are typically contraindicated for neuroaxial anesthesia?

    <p>Surgeries that may impair ventilation and may require an ETT</p> Signup and view all the answers

    Which of these is true about cardiovascular function during neuroaxial anesthesia?

    <p>It is typically maintained during procedures</p> Signup and view all the answers

    Who is credited with the development of spinal anesthesia?

    <p>Augustus Bier and Theodore Tuffier</p> Signup and view all the answers

    Which stage of general anesthesia begins with the onset of regular breathing and ends with the loss of spontaneous respirations?

    <p>Stage III: Surgical Anesthesia</p> Signup and view all the answers

    During which stage of general anesthesia is there a critical risk for laryngospasms, especially if the endotracheal tube is pulled?

    <p>Stage II: Delirium</p> Signup and view all the answers

    What is necessary for adequate spontaneous ventilation during awake extubation?

    <p>Patent airway and responding to commands</p> Signup and view all the answers

    What does the presence of dilated pupils and tachycardia indicate during the stages of general anesthesia?

    <p>Stage II: Delirium</p> Signup and view all the answers

    Which criterion is essential for deep extubation immediately prior to extubation?

    <p>Adequate reversal of neuromuscular blocking agents.</p> Signup and view all the answers

    What must be monitored during maintenance anesthesia in addition to vital signs?

    <p>Muscle relaxation level.</p> Signup and view all the answers

    What indicates that diffusion hypoxia may have occurred after the use of nitrous oxide?

    <p>Hypoxia due to displacement of nitrogen.</p> Signup and view all the answers

    When preparing for emergence from general anesthesia, what should be assessed specifically?

    <p>Estimate the remaining surgical procedure time.</p> Signup and view all the answers

    Which breathing irregularity during Stage II could indicate a patient's readiness for extubation?

    <p>Regular, deep breathing.</p> Signup and view all the answers

    What should a patient demonstrate before being considered safe for awake extubation?

    <p>Ability to lift their head off the table.</p> Signup and view all the answers

    Study Notes

    Preoperative Evaluation

    • Preanesthetic evaluation aims to assess a patient's medical history and intraoperative risk.
    • Identifying and mitigating risks is crucial for optimizing patient conditions and minimizing complications.
    • Inadequate planning may lead to increased anesthetic complications and surgical delays.

    Goals of Preoperative Evaluation

    • Optimize patient care, satisfaction, and comfort.
    • Minimize perioperative morbidity and mortality.
    • Ensure effective communication among care providers about patient management issues.
    • Educate patients regarding surgical and anesthetic expectations to reduce anxiety.

    Components of the Preanesthetic Evaluation

    • Chart review includes current medical records, previous anesthetic experiences, and patient medications.
    • A directed physical examination assesses vital signs, airway, cardiac, and pulmonary systems.
    • Preoperative tests and consultations based on patient needs.
    • ASA classification determines patients' health status and anesthesia risk.

    Medication Management

    • Certain medications should be continued, including antihypertensives, antidepressants, and anticonvulsants.
    • Medications to discontinue include:
      • Short-acting insulin (day of surgery)
      • Non-insulin antidiabetic meds (day of surgery)
      • Warfarin (5 days before surgery)
    • Herbal medications may require specific discontinuation times to avoid adverse effects.

    Fasting Guidelines

    • Applicable ASA fasting guidelines ensure patient safety prior to anesthesia delivery.
    • Preoperative fasting is essential to reduce the risk of aspiration pneumonitis.

    Aspiration Pneumonitis

    • Aspiration pneumonitis occurs when foreign substances enter the lungs, causing inflammation.
    • Prevention strategies focus on identifying at-risk populations and implementing appropriate fasting guidelines.
    • Treatment options vary based on the severity of the aspiration.

    Airway Evaluation

    • Airway assessment utilizes the LEMON criteria, which includes examining the length of incisors, conditions of teeth, and visibility of the uvula.
    • Factors such as neck circumference and range of motion are critical for determining anesthetic management.

    Co-morbidities Impacting Anesthesia

    • Obesity is defined in relation to ideal body weight and can complicate anesthesia due to increased risk and altered pharmacokinetics.

    Social History Considerations

    • Substance abuse, including tobacco and alcohol, affects anesthetic care and requires careful assessment.
    • The impact of electronic cigarette use and its constituents on physiological function needs evaluation.

    Summary of Preoperative Interview Objectives

    • Streamline patient education on surgery and anesthesia.
    • Confirm comprehensive medication history, including over-the-counter and herbal supplements.
    • Gather information on patient's prior surgery and anesthetic experiences, including any adverse reactions.

    Overview of Anesthesia

    • Categories of anesthesia include obstetric, pediatric, cardiothoracic, neuro, outpatient surgery, ketamine clinic, office-based, pain management, and critical care.
    • Key historical figures include 1864's Morton, known for the first ether anesthetic, and Alice Magaw, recognized as the first nurse anesthetist.

    Considerations Influencing Anesthetic Technique

    • Patient safety is paramount in anesthetic decisions.
    • Patient comfort and provider preference also significantly influence techniques.
    • Coexisting diseases, surgical site, patient positioning, and age are critical factors.
    • Duration of surgery and recovery time vary based on procedure type and facility criteria.

    Ideal Anesthetic Technique

    • Prioritizes optimal patient safety, satisfaction, and low costs.
    • Ensures excellent operating conditions and allows for rapid recovery while minimizing postoperative side effects.

    Types of Anesthesia

    • General Anesthesia: Induces a drug-induced depression of the CNS leading to loss of response to external stimuli.
      • Types include inhalation-only, intravenous-only (TIVA), and a combination of both.
    • Components of anesthetic state: unconsciousness, amnesia (often achieved via benzodiazepines), analgesia, immobility, and attenuation of autonomic responses.

    Phases of General Anesthesia

    • Induction: Administers anesthetic drugs to achieve unconsciousness and requires monitoring (EKG, NIBP, pulse-ox, etc.).
    • Pre-Induction: Involves pre-oxygenation to replace nitrogen in lung capacity, preventing apnea.
    • Intravenous Induction: Common induction agents include Propofol (most used), Thiopental, and Ketamine, each with specific pharmacological characteristics.

    Standard Induction Sequence

    • Room setup includes machine checks and patient monitoring.
    • Pre-oxygenation and administration of induction agents are crucial.
    • Neuromuscular blockers are given if an airway device is needed, followed by airway instrumentation.

    Rapid Sequence Induction (RSI)

    • Administers anesthetic followed by neuromuscular blocking agents, critical for patients at risk of aspiration.
    • Requires careful monitoring and cricoid pressure to reduce aspiration risk during induction.

    Inhalation Induction

    • Common practice for pediatric cases; involves mask induction using oxygen and volatile agents.
    • Volatile anesthetics such as Sevoflurane are preferred for their non-irritating properties.

    Maintenance of Anesthesia

    • Focuses on maintaining unconsciousness, analgesia, and muscle relaxation.
    • Monitoring is essential for ensuring patient stability and preventing complications during procedures.

    Stages of General Anesthesia

    • Stage I (Analgesia): Begins with induction agent administration and ends with loss of consciousness.
    • Stage II (Delirium): Characterized by involuntary movements; to be avoided during extubation.
    • Stage III (Surgical Anesthesia): Four planes with varying levels of respiratory response; deep anesthesia where most surgeries occur.
    • Stage IV (Overdose): Respiratory paralysis; demands immediate intervention.

    Emergence from Anesthesia

    • Transition from general anesthesia includes regaining consciousness and airway reflexes.
    • Recovery involves careful monitoring, adequate reversal of neuromuscular blockers, and management of postoperative nausea and pain.

    Monitored Anesthesia Care (MAC)

    • MAC allows the anesthesiologist to administer varying sedation levels during procedures.
    • Requires preparedness to convert to general anesthesia if necessary; patient comfort and vitals are maintained throughout.

    Sedation Levels

    • Different levels of sedation range from minimal (anxiolytics) to deep sedation:
      • Minimal Sedation: Patients respond to verbal commands, maintaining airway reflexes.
      • Moderate Sedation: Patients respond purposefully, spontaneous ventilation is adequate.
      • Deep Sedation: Patients require significant stimulation for response; airway and ventilation must be closely monitored.

    Safety Protocols

    • Vigilance in monitoring and equipment readiness is essential to prevent complications during all sedation levels and anesthesia.

    General Anesthesia Overview

    • Immobility implies a lack of response to stimuli, not paralysis.
    • Autonomic responses to noxious stimuli are attenuated during anesthesia.

    Phases of General Anesthesia

    • Induction: The process of administering anesthetic drugs (IV or inhaled) to induce unconsciousness.
    • Pre-Induction Monitoring: Includes EKG, NIBP, pulse oximetry, CO2 levels, and temperature. These are minimum standards regardless of hospital location.

    Pre-Induction Procedures

    • Pre-Oxygenation: Patients inhale 100% oxygen for 3-5 minutes to replace nitrogen in functional residual capacity, facilitating airway security and reducing apnea risks.
    • Intravenous Induction: No single ideal drug exists; characteristics of a desirable agent include rapid onset, analgesia, minimal depression of cardiac/respiratory functions, and lack of toxicity.
    • Common IV Induction Agents: Propofol (most used), Thiopental, Brevital, Etomidate, Ketamine, Opioids, Benzodiazepines.

    Standard Induction Sequence

    • Ensure room setup, check machines, apply monitors, position the patient, establish baseline vitals, pre-oxygenate, administer induction agents, perform mask ventilation, and use neuromuscular blockers as needed.

    Rapid Sequence Induction (RSI)

    • Involves immediate administration of a neuromuscular blocking agent following an IV anesthetic, particularly crucial for patients with high aspiration risk.
    • Cricoid pressure is employed to reduce aspiration risk until CO2 detection is confirmed.

    Inhalation Induction

    • Common in children and involves administering oxygen with a volatile agent.
    • Volatile anesthetics include Sevoflurane (most common), Desflurane, and Isoflurane (slow onset).

    Post-Induction Monitoring

    • Assess loss of consciousness, eyelid reflex, and provide ventilation support as required. Ventilation quality must be maintained and monitored.

    Maintenance of Anesthesia

    • Surgical anesthesia characterized by sustained unconsciousness, amnesia, analgesia, immobility, and NS control over the sympathetic response to pain.
    • Vigilance is essential for monitoring vital signs and drug administration.

    Stages of General Anesthesia

    • Stage I (Analgesia): Begins with induction agent administration.
    • Stage II (Delirium): Involuntary movement, skipped in IV induction.
    • Stage III (Surgical Anesthesia): Divided into four planes; most surgeries occur in planes 1 and 2.
    • Stage IV (Overdose): Respiratory paralysis leading to circulatory collapse; requires urgent lightening of anesthesia.

    Emergence from Anesthesia

    • Transition from general anesthesia to consciousness, with attention on neuromuscular recovery and airway protection.
    • Awake extubation is considered when the patient meets specific criteria for safety.

    Monitored Anesthesia Care (MAC)

    • Anesthesia service participation in procedures, which may require general anesthesia if the patient becomes unconscious.

    History of Regional Anesthesia

    • Carl Koller, in 1884, introduced cocaine for topical anesthesia, followed by William Halstead for nerve blocks.

    Neuroaxial Anesthesia

    • Involves local anesthetic adjacent to the spinal cord, disrupting nerve signal conduction.
    • Can be performed as single injections or continuous infusions.
    • Spinal anesthesia requires injection below L1 and results in neural conduction blockade.

    Anatomy for Neuroaxial Anesthesia

    • Needle traverses several layers including skin, ligaments, and eventually into the epidural or subarachnoid space.

    Mechanism of Action

    • Local anesthetics disrupt nerve conduction primarily at nerve roots.
    • Spinal anesthesia leads to immediate action; heavy blocks (above T4) potentially cause cardiac complications.

    Spinal Anesthesia Techniques

    • Single injections in the subarachnoid space allow rapid onset and effective surgical anesthesia.
    • Needle types: Pencil point tips (less traumatic) vs Cutting point tips (more traumatic).

    Needles for Spinal Blocks

    • Pencil point needles (Sprotte, Whitacre) are less traumatic than cutting-tip needles (Quincke, Atraucan).

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    Description

    This quiz covers essential components of preoperative anesthetic assessments, including patient classification and informed consent. It addresses the ASA classification system and the impact of co-morbidities on anesthesia administration. Test your understanding of these critical preoperative processes.

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