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Flashcards in Induc & Emergence Deck (25)
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1
Q

Anesthetic plan = 8

A

Chart review. H&P. Interpret lab tests. ASA status. Anesthetic plan development: comorbidities, preop labs/dx, surgical consid

2
Q

Anesthetic plan includes details on which things: 8

A

Preop consid, monitoring, induction, a/w management, maintenance technique, fluid plan, emergence. Alternative anesthetic plan

3
Q

MSMAIDP

A

M (monitors on, alarms set), S (suction on and near), M (PPV/machine check), A (ett and lma), I (IV&fluids), D (drugs, emergency and basic), P (pt position)

4
Q

Airway set up: 11

A

Appropriate sized face mask, PPV (ambu, jet vent, vent checked), suction on and near, tongue depressor, appropriate sized oral/nasal airways, LMA, laryngoscope handle, 2 blades, 2 ETT, stylet, syringe, tape

5
Q

ETT sizes male and female

A

Male 7.5-8, female 6.5-7

6
Q

Blade sizes male and female

A

Male Mac 4 miller 3-4. Female Mac 3 miller 2

7
Q

Standard induction: positioning to pre-oxygenation

A

Pt supine and in sniffing position. Place monitors and get pre-induction vitals. Pre 02: 5 min 100% fio2 @ 6 LPM flow, 10 safe min. 4 VC breaths in 30 sec= 5 min safe time

8
Q

Induction: med considerations, sequence

A

Antianxiety meds (benzos), narcotic (sns response), lidocaine, induction agent

9
Q

What to do after induction meds given

A

Confirm LOC w eyelash reflex. Test ventilate: reposition, use oral a/w, 2 hands on mask, difficult a/w alg, plan b a/w

10
Q

Steps after induction for NMB and intubation

A

Apply PNS, check baseline twitch. Give NMB, monitor effective ness w PNS. Ventilate while NMB kicks in, tape eyes. Then attempt laryngoscopy and confirm ett placement, tape

11
Q

What to do after ETT secured

A

Ventilate w machine or by hand. Adjust flows. Add air/n20. Start propofol, add volatile anesthetic

12
Q

Effects of tracheal intubation: 5

A

Htn, tachycardia, laryngospasm, bronchospasm, MI risk

13
Q

How to prevent effects of tracheal intubation

A

Deepen plane of anesthesia, use lidocaine/narcotics/additional induction agent. Consider bronchodilator prophylactically

14
Q

Standard induction review 21

A
  1. Pt supine, sniffing pos. 2. Turn on 02 flow 3. Pre-oxygenate 4. Monitors on and vs taken 5. Suction on and ready at HOB 6. Pre-induction meds 7. Lidocaine +/- induction agent 8. Lash reflex 9. Test vent 10. Check PNS 11. Ventilate by mask 12. NMB 13. Vent w mask 14. Tape eyes 15. Vent until twitches lost 16. Intubate 17. Inflate cuff 18. Confirm ett 19. Tape 20. Vent w bag/machine 21. Maintenance anesthetic
15
Q

How RSI different from standard induction

A

Add sellicks maneuver, removes ventilation

16
Q

RSI sequence 19

A

ID need for RSI 2. Pre-op aspir prophylaxis 3. Anxiolytic 4. Narcotic 5. Monitors on 6. Suction at hOB 7. Sniffing position and supine 8. Pre-o2 9. Sellicks maneuver 10. Induction agent 11. Sux or roc, wait 60 sec 12. Intubate 13. Confirm placement 14. Have assistant release cric pressure 15. Secure ett 16. Vent 17. Tape eyes 18. Adjust flows 19. Maintenance anesthetic

17
Q

Choices for maintenance anesthesia

A

IA, TIVA, short or long acting narcotic, intubating NMB or continued paralysis

18
Q

Extubation criteria 6

A

TV >6ml/kg, VC >10 ml/kg, RR <30 on own, Sao2 >90 on <60% fio2, etco2 <50, no fade on pns

19
Q

Nearly fully awake extubation

A

Muscle relaxant reversed, confirm w pns. Extubation criteria met. Anesthetic meds and volatiles off. Suction. Pt responsive. 5 sec head lift. Pt can protect own a/w. ETT removed while PPV given

20
Q

Deep extubation steps

A

NMB reversed and confirmed w pns. Suctioned. Oral or nasal a/w placed. ETT removed while PPV given. Agents and infusions off. Mask a/w while spontaneously venting. Vigilance until pt responsive.

21
Q

Laryngospasm: what it is, signs

A

Prolonged glottic closure. High pitch squeak to total silence. Supra sternal and Supra clavicular in-drawing, inc diaphragmatic excursions, flailing of lower ribs (rocking horse)

22
Q

Laryngospasm: what its caused by, when its often seen

A

Contraction of LCA, thyroarytenoids, and cricothyroid from stim of vagus. Induction and emergence

23
Q

Laryngospasm triggers: 6

A

Secretions, foreign body, pain, pelvic/abd visceral stim, stim glottis in light plane of anesthesia, reactive a/w disease

24
Q

Laryngospasm prevention 4

A

Deep plane of anesthesia reached before surgical stim, either fully awake or deep before extubation, suction oropharynx before extubation, remove ett w PP breath

25
Q

Laryngospasm tx 6

A

Remove offending stim, Larson maneuver (retro mandibular notch pressure 3-5 sec), 100% fio2 and cont pos pressure, deepen w propofol, 20-40 mg sux