Questions and Answers
Which component is NOT typically present in general anesthesia?
What is a key consideration when choosing an anesthetic technique for a patient?
Which of the following statements about the phases of general anesthesia is true?
Which type of anesthesia provides sedation but not necessarily immobility?
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What is the primary focus of standard one in the AANA standards for nurse anesthesia practice?
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Which of the following is a requirement under standard two for obtaining informed consent?
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What is the purpose of standard four in the AANA standards?
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According to standard five, what must be ensured when using physiological monitoring devices?
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What is a critical monitoring action for ventilation stated in the AANA standards?
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Which option is a key component that is present in general anesthesia but may not be in sedation?
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Which of the following is NOT a consideration influencing the choice of anesthetic technique?
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Which type of general anesthesia is preferred for patients with severe refractory post-operative nausea?
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What phase of general anesthesia involves the onset of drug effects leading to loss of consciousness?
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Which of these types of anesthesia might be contraindicated in neuro spine surgery due to potential increases in intracranial pressure?
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Study Notes
Introduction to Anesthesia
- Anesthesia specialty areas include Obstetric, Pediatric, Cardiothoracic, Neuro, Outpatient care, Pain management, and Critical Care.
- Key types of anesthesia: General, Monitored Anesthesia Care (MAC), Regional, and Local Anesthesia.
Ideal Anesthetic Technique
- Prioritizes optimal patient safety and satisfaction.
- Aims for excellent surgical conditions and rapid recovery with minimal postoperative side effects.
- Should be cost-effective and facilitate early patient discharge from the Post Anesthesia Care Unit (PACU).
Factors Influencing Anesthetic Technique Choice
- Consider patient safety, comfort, and personal preferences.
- Account for coexisting conditions, surgical site, patient positioning, and urgency (elective vs emergency).
- Evaluate airway management needs, surgery duration, patient age, recovery time, and PACU discharge criteria.
General Anesthesia Overview
- Defined by a drug-induced loss of consciousness and responsiveness to stimuli.
- Comprises multiple components: unconsciousness, amnesia, analgesia, immobility, autonomic response attenuation.
- Phases include Induction, Maintenance, and Emergence.
Types of General Anesthesia
- Inhalation anesthesia is prevalent for children and dental procedures.
- Total Intravenous Anesthesia (TIVA) is preferred for certain conditions, particularly in neuro spine surgeries due to potential contraindications with inhalation drugs.
AANA Standards for Nurse Anesthesia Practice
- Perform a thorough preanesthesia assessment and document findings.
- Ensure informed consent is obtained and documented properly.
- Develop a patient-specific anesthesia care plan.
- Continuously adjust anesthesia based on patient's physiological status and response during the procedure.
- Monitor and document physiological conditions with the use of variable pitch and threshold alarms for safety.
Oxygenation and Ventilation Monitoring
- Continuous monitoring of oxygen levels and ventilation is essential.
- Confirm intubation via auscultation and confirm expired carbon dioxide levels.
- Prevent hypothermia and maintain vigilance on vital signs and anesthetic depth throughout the procedure.
Fluid Management
- The 4-2-1 Rule is used for calculating hourly maintenance rates for fluid management, particularly for patients over 20 kg.
Stages of General Anesthesia
- Stage 1: Analgesia begins with induction agents and ends with loss of consciousness.
- Stage 2: Delirium featuring irregular respirations and potential for excitation; avoid extubation during this phase.
- Stage 3: Surgical anesthesia; depth and parameters must be assessed before extubation.
Emergence Protocols
- Develop an individualized plan for emergence based on patient's health and surgical needs.
- Critical to confirm consciousness, neuromuscular recovery, and airway protective reflexes before extubation.
- Ensure proper pain management with opioids, adjust based on respiratory rates, and provide oxygen post-nitrous oxide use.
Monitored Anesthesia Care (MAC)
- Involves diagnosis and management of complications, vital function support, and administration of sedatives/analgesics as required for patient safety.
- Psychological support and comfort during procedures are emphasized, with readiness for conversion to general anesthesia if needed.
Local Anesthesia Considerations
- Factors include drug choice, dosing characteristics, maximum and recommended doses, and the effect of preservatives.
- Caution with patients: children and those unable to cooperate or follow commands may not be suitable candidates for local anesthesia.
Sedation Levels
- Minimal Sedation (Anxiolysis): Patients maintain airway reflexes and respond to verbal commands despite impaired cognitive function.
- Moderate Sedation/Analgesia: Patients respond purposefully to commands and do not require intervention for airway maintenance.
Introduction to Anesthesia
- Specialty areas include obstetrics, pediatrics, cardiothoracic, neuro, outpatient, pain management, and critical care.
- Types of anesthesia: general, monitored anesthesia care (MAC), regional, and local.
Ideal Anesthetic Technique
- Prioritizes optimal patient safety and satisfaction, excellent surgical conditions, rapid recovery, minimal postoperative side effects, low cost, and prompt discharge from PACU.
Anesthetic Technique Considerations
- Influenced by patient safety, comfort, personal preferences, coexisting conditions, surgical site, positioning, urgency (elective vs. emergency), airway concerns, surgery duration, patient age, recovery time, and discharge criteria.
General Anesthesia
- Defined as drug-induced CNS depression leading to loss of consciousness and reaction to external stimuli.
- ASA continuum defines varying levels of sedation, with general anesthesia characterized by unarousable states even with painful stimuli.
Components of Anesthetic State
- Includes unconsciousness, amnesia, analgesia, immobility, and attenuated autonomic responses.
- Anesthetic state involves all components, while sedation may lack some, especially immobility.
Phases of General Anesthesia
- Induction, maintenance, and emergence mark transitions within general anesthesia.
General Anesthetic Types
- Inhalation only: common in pediatric and dental procedures.
- Intravenous (TIVA) indicated for patients with severe post-op nausea, in neuro spine surgery situations, and when a breathing system is used.
Pre-induction Considerations
- Preoxygenation replaces nitrogen in the lungs, crucial for patients with difficult intubation scenarios.
- Room air contains 21% oxygen; preoxygenation typically involves breathing 100% O2 for 3-5 minutes to enhance safety during induction.
Induction Process
- Involves administering anesthetic drugs to establish anesthesia, usually resulting in unconsciousness.
Intravenous Induction
- Propofol is widely regarded as an ideal induction drug, transitioning patients through defined stages.
- Stage 3 (surgical anesthesia) characterized by regular breathing patterns before losing spontaneous respiration, spans four distinct planes.
Stages of Surgical Anesthesia
- Stage 3: Plane 1: Loss of lid reflex, regular deeper respirations, normal pupil response.
- Stage 3: Plane 2: Concentrically fixed eyeballs, regular but less tidal volume respirations, muscle tone decreases.
- Stage 3: Plane 3: Loss of intercostal muscle activity, diaphragmatic breathing predominates, pupil dilation begins.
- Stage 3: Plane 4: Complete intercostal loss, fully dilated pupils, loss of muscle tone, indicates depth of anesthesia might be excessive.
- Stage 3: Plane 5: Respiratory paralysis occurs, signaling the need for immediate reduction in anesthesia levels.
Emergence
- Transitioning from general anesthesia to consciousness involves careful monitoring in patients with difficult intubation or regurgitation risks.
Monitored Anesthesia Care (MAC)
- Describes anesthesia service allowing for patient stability and comfort but requires readiness to convert to general anesthesia if necessary.
- Involves administering medications for pain, anxiety, and relaxation while maintaining vital functions, cognitive capability, and the capacity to communicate during the procedure.
Local Anesthesia
- Must be managed carefully regarding drug choice, dosage, concentration, and potential patient risks, particularly avoiding use in children and uncooperative individuals.
Key Concerns in MAC
- Oversedation leading to respiratory collapse is a significant risk highlighted in the ASA claims project.
Sedation Levels
- Minimal Sedation (Anxiolysis): Patients respond normally to verbal cues, though cognitive and motor functions may be impaired.
- Moderate Sedation (Conscious Sedation): Drug-induced state allowing purposeful response to verbal commands, maintaining patent airway and adequate spontaneous ventilation.
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Description
This quiz covers the key concepts from the first week of the Principles of Anesthesia course. Topics include various specialties in anesthesia, types of anesthesia, and the ideal anesthetic techniques aimed at ensuring optimal patient safety and satisfaction. Test your knowledge and understanding of these foundational principles in anesthesia care.
