Preoperative Evaluation and Fasting Guidelines

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?

Diuretics for hypertension Signup and view all the answers

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

They should be discontinued Signup and view all the answers

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

At least 24 hours Signup and view all the answers

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

Garlic Signup and view all the answers

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

Sympathomimetic, cardiac, vascular, and endocrine toxicity Signup and view all the answers

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

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

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

Diacetyl Signup and view all the answers

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

Increased requirements due to withdrawal syndrome Signup and view all the answers

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

At least 36 hours Signup and view all the answers

Which constitutes a significant risk factor for perioperative complications?

A smoking history of more than 20 pack years Signup and view all the answers

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

At least 24 hours Signup and view all the answers

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

Valerian Signup and view all the answers

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

Continue all except ACEIs and ARBs on the day of surgery Signup and view all the answers

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

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

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

Only short-acting insulin should be discontinued Signup and view all the answers

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

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

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

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

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

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

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

Short-acting insulin Signup and view all the answers

What should be documented regarding allergies before surgery?

Responses to past medications and contact allergies should be documented Signup and view all the answers

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

Anabolic steroids Signup and view all the answers

What does the acronym LEMON stand for in airway evaluation?

Look, Evaluate, Mallampati, Obstruction, Neck Signup and view all the answers

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

Patient history review Signup and view all the answers

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

Length of the upper incisors Signup and view all the answers

Obesity is defined in relation to what measurement?

Ideal body weight Signup and view all the answers

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

To detect abnormalities not evident in history Signup and view all the answers

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

Obesity Signup and view all the answers

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

Uvula Signup and view all the answers

What is the primary goal of the preanesthetic evaluation?

To optimize patient conditions and mitigate risks Signup and view all the answers

Which component is NOT typically included in a preanesthetic evaluation?

Patient’s socioeconomic status Signup and view all the answers

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

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

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

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

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

Ensuring adequate fasting prior to surgery Signup and view all the answers

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

Collecting comprehensive airway, cardiac, and pulmonary information Signup and view all the answers

Which best describes an outcome of inadequate preoperative planning?

Higher rates of surgical delay and complications Signup and view all the answers

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

Intra- and postoperative care expectations Signup and view all the answers

How does the preanesthetic evaluation help with surgical efficiency?

By individualizing management plans based on patient assessment Signup and view all the answers

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

Last dosage and timing of all medications Signup and view all the answers

Why is preoperative fasting important?

To minimize the risk of aspiration during anesthesia Signup and view all the answers

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

Medical history, fasting guidelines, and past anesthetic experiences Signup and view all the answers

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

Past anesthetic experiences and risk factors Signup and view all the answers

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

Availability of surgical tools Signup and view all the answers

What is the primary characteristic of general anesthesia?

Loss of response to all external stimuli Signup and view all the answers

Which anesthesia type is typically preferred for pediatric cases?

Inhalation only Signup and view all the answers

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

Avoid postoperative complications Signup and view all the answers

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

Type of anesthesia coverage required 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?

Unconsciousness Signup and view all the answers

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

Length of surgery Signup and view all the answers

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

Development of nurse anesthesia training Signup and view all the answers

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

Uncooperative behavior Signup and view all the answers

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

Moderate sedation/analgesia Signup and view all the answers

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

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

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

Monitoring physiological functions and maintaining homeostasis. 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?

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

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

Support of vital functions and diagnosis of clinical problems Signup and view all the answers

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

Sevoflurane Signup and view all the answers

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

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

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

Ensuring the circuit is properly primed. Signup and view all the answers

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

Maintaining euvolemia and ensuring stable MAP. Signup and view all the answers

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

Assessing the loss of lid reflex and maintaining ventilation. Signup and view all the answers

What defines the 'Valley of Anesthesia' period?

Time after induction but before surgical incision. Signup and view all the answers

What is NOT a goal of anesthesia maintenance?

Performing rapid sequence intubation. Signup and view all the answers

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

Pulse oximetry primarily. Signup and view all the answers

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

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

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

Thiopental Signup and view all the answers

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

Close the esophagus to reduce aspiration risk Signup and view all the answers

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

Arterial line Signup and view all the answers

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

Rapid onset and minimal respiratory depression Signup and view all the answers

Which reflex is considered a protective reflex during anesthesia induction?

Eyelid reflex Signup and view all the answers

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

To assess cerebral blood flow and oxygenation Signup and view all the answers

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

Patient-specific comorbidities and situational needs 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?

Applying cricoid pressure until sufficient oxygenation occurs Signup and view all the answers

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

To ensure a safe and effective transition to unconsciousness Signup and view all the answers

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

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

Which criterion is essential for 'Awake Extubation'?

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

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

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

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

Regular respiration with reduced tidal volume and lost sensation. Signup and view all the answers

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

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

What denotes the end of Stage IV in general anesthesia?

Cessation of spontaneous respiration leading to circulatory collapse. Signup and view all the answers

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

Verification of adequate NMBA reversal and stable hemodynamics. Signup and view all the answers

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

Regular assessment of vital signs and anesthetic depth. Signup and view all the answers

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

Presence of slight muscle tone. Signup and view all the answers

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

The patient loses consciousness and the ability to respond purposefully. Signup and view all the answers

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

To replace nitrogen in the functional residual capacity Signup and view all the answers

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

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

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

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

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

Temperature monitoring Signup and view all the answers

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

Applying cricoid pressure Signup and view all the answers

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

Brevital Signup and view all the answers

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

Patient medication review Signup and view all the answers

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

Standard monitors are mandatory regardless of location Signup and view all the answers

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

Sevoflurane Signup and view all the answers

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

Ease of ventilation Signup and view all the answers

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

Use of nitrous oxide Signup and view all the answers

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

Below L1 Signup and view all the answers

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

Constant monitoring of vital signs Signup and view all the answers

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

Increased heart rate Signup and view all the answers

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

Dura mater Signup and view all the answers

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

To ensure oxygen delivery effectively Signup and view all the answers

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

Anterior artery Signup and view all the answers

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

Ongoing anesthesia management Signup and view all the answers

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

Local anesthetic acts primarily on the nerve roots. Signup and view all the answers

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

Increased risk of aspiration Signup and view all the answers

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

Bradycardia Signup and view all the answers

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

Improving oxygen saturation Signup and view all the answers

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

Laryngeal mask airway Signup and view all the answers

What is the primary purpose of neuroaxial anesthesia?

To block signals to and from the nerve adjacent to the spinal cord Signup and view all the answers

Which of the following statements about ETCO2 monitoring is correct?

A sealed mask is needed for accurate ETCO2 monitoring Signup and view all the answers

What does the original application of modern local anesthesia involve?

Topical anesthesia of the eye with cocaine Signup and view all the answers

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

Continuous sedation for all surgical procedures Signup and view all the answers

How do local anesthetics primarily function on nerve fibers?

By interrupting conduction through sodium channels Signup and view all the answers

Which of the following is a characteristic of spinal anesthesia?

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

Which surgeries are typically contraindicated for neuroaxial anesthesia?

Surgeries that may impair ventilation and may require an ETT Signup and view all the answers

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

It is typically maintained during procedures Signup and view all the answers

Who is credited with the development of spinal anesthesia?

Augustus Bier and Theodore Tuffier 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?

Stage III: Surgical Anesthesia 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?

Stage II: Delirium Signup and view all the answers

What is necessary for adequate spontaneous ventilation during awake extubation?

Patent airway and responding to commands Signup and view all the answers

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

Stage II: Delirium Signup and view all the answers

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

Adequate reversal of neuromuscular blocking agents. Signup and view all the answers

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

Muscle relaxation level. Signup and view all the answers

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

Hypoxia due to displacement of nitrogen. Signup and view all the answers

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

Estimate the remaining surgical procedure time. Signup and view all the answers

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

Regular, deep breathing. Signup and view all the answers

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

Ability to lift their head off the table. 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.

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.