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Surgery & Anesthesia
| Question | Answer |
|---|---|
| Long term toxicity of inhalant anesthetics is thought to be caused by | release of toxic metabolites during liver metabolism |
| The anesthetic most clearly associated with neurologic and adverse reproductive effects is | Nitrous Oxide |
| Which of the following can be used to effectively monitor waste anesthetic gas levels? | passive dosimeter badge |
| to conduct a low pressure test for an anesthetic machine you must | Close the pop-off valve, turn on the flow meter, and occlude the end of the circuit. (all) |
| How often should a test for low pressure leaks be conducted? | Each day that the machine is used |
| The safest way to transport a large high-pressure tank, such as an oxygen tank, is by | using a handcart |
| A technician may reduce the amount of waste gas by | using cuffed endotracheal tubes, ensuring that the anesthetic machine has been tested for leaks, and using an injectable agent rather than a mask or chamber (all) |
| In what units are waste anesthetic gas levels measured? | Parts per million (ppm) |
| which of the following is a source of waste anesthetic gas? | Exhaled by the patient during recovery |
| which of the following is true regarding short term exposure to waste anesthetic gas? | resolve spontaneously when the area of exposure is left |
| Which is not a potential long term side effect of waste gas exposure? | Thyroid cancer |
| What strategy is most effective at reducing waste gas exposure? | Utilizing a scavenging system |
| which of the following inhalant gases is least likely to cause long term side effects | Isoflurane |
| which of the following hospital areas contain the largest concentration of waste gas? | recovery room, surgical suite, and surgical prep room |
| If the pop-off valve is inadvertently left shut, it will | cause a significant rise of pressure within the circuit |
| A geriatric patient is considered to be one that | has reached 75% of its life expectancy |
| How do you check if an ET tube is blocked? | Bag he patient and see if their chest rises |
| How do you decrease the anesthetic risk for a geriatric pt.? | Decrease the IV fluid rate |
| Which is true regarding anesthetizing pediatric pt. | Tend to develop hypoglycemia, anesthetic drugs should be calculated at lower doses, and dextrose can be added to IV fluids to decrease risk (all) |
| Why should brachycephalics be oxygenated prior to anesthesia | It provides a reserve of pure oxygen for them to draw on during induction |
| Obese pts are at increased risk during ax because | it is difficult for them to fully expand their lungs, difficult to accurately dose anesthetic drugs, and anesthetics poorly distribute (all) |
| Who has the highest risk of vomiting or regurgitating while anesthetized? | Pregnant dams |
| How long after impact are HBCs at risk for fatal cardiac arrhythmias? | 72 hours |
| Which of the following is a sign of fluid overload? | Increased respiratory rate |
| what condition makes pt most susceptible to fluid overload? | Cardiac dz |
| What is an indication for an enterotomy? | intestinal foreign body |
| what fracture fixation technique has the highest risk of infection? | External skeletal fixator |
| Drug induced calm, pt is reluctant to move, aware of but unconcerned with surroundings | tranquilization |
| Balanced anesthesia | administration of multiple drugs at smaller doses than would be necessary if given alone |
| anesthetic agents have | narrow therapeutic indices |
| anesthetic accidents may result in | permanent dz or dysfunction, death, legal action against staff (all) |
| O2 tank half full, pressure gauge will read | 1100 psi |
| O2 tank should be replaced at | 500 psi |
| part of anesthetic machine that controls the amount of O2 going to the pt | flow meter |
| anesthetic machines deliver inhalation and | remove respiratory waste products |
| What part of ax machine enables a quick infusion of O2 into the breathing circuit? | Oxygen flush valve |
| non rebreathing | pt under 2.5 kg |
| 2200 psi indicates the tank is | full |
| flow meters with a ball gauge should be read | from the middle of the ball |
| unidirectional valves on ax machine help | control the direction of movement of gases |
| the pop-off valve helps | prevent gas pressure from building up within the breathing circuit |
| spinal cord neurons become hypersensitive and interpret non-painful stimuli as painful | wind-up |
| pop-off valve should only be closed when | giving the patient a breath |
| continuous suture patterns | are not as secure as interrupted patterns, are quicker to place and use less suture, and if one part of the suture line breaks the entire line fails (all) |
| small animal ax, when the pt is bagged the pressure manometer reading should not exceed | 20 cm H2O |
| granule in the CO2 absorber have been depleted when | granules are brittle, hard, and change color (all) |
| Pt. weighing 26.5 lb uses | rebreathing |
| scavenger system attaches to | the pop-off valve |
| first ground drape is placed | on the side closest to the person draping |
| inadequate tissue perfusion during sx is most likely to damage | kidneys |
| reservoir bag not moving well may indicate | ET tube not in trachea, decreased tidal volume, or there is a leak around the ET tube (all) |
| pt attached to machine, pop-off valve should always be | open |
| important to perform instrument/sponge count at beginning and end of sx | to avoid leaving instruments or sponges inside the body |
| during surgical gowning | the hands must remain inside the gown cuffs until the gloves are on |
| to aid in hemostasis | apply firm pressure to site of hemorrhage, pass the appropriate hemostat, and blot, don't wipe, the blood (all) |
| presoaking instruments | prevents blood and other surgical debris from drying on the instruments |
| eyes in ventral position indicate | stage 3/plane 2 of anesthesia |
| exposed tissues are kept moist by | dripping sterile solution onto them |
| the part of ring handled surgical instruments that lock the jaw closed is | the ratchet |
| gentle tissue handling is important | to avoid causing trauma to healthy tissue, avoid complications such as hemorrhage, dehiscence, etc, and avoid further compromising unhealthy tissue (all) |
| what contributes to hypothermia in a healthy pt | anesthetic induced muscle relaxation, water and alcohol used in surgical prep, and administering room temperature IV fluids (all) |
| hypotension can be caused by | cardiac insufficiency |
| when passing ring handled instruments | the instrument should be gently laid in the surgeon's waiting hand |
| minimum pt database for young healthy cat having elective surgery should include | PCV/TP, BUN, ALT, blood glucose |
| reflex that significantly diminishes or is absent in surgical plane of ax | palpebral |
| monitoring device that measures O2 saturation | pulse oximeter |
| how should you pass a scalpel handle? | handle facing surgeon, blade facing away from you |
| untreated pulse deficits lead to | shock |
| blood pressure cuff should be what percentage of limb width to ensure accuracy? | 40% |
| eye position when too deep under anesthesia | central |
| what breeds need to be watched closely under ax to ensure patent airway | brachiocephalic |
| how to monitor respirations | watch the reservoir bag, watch the tube fogging, chest auscultation (all) |
| unconscious pt responds to sx with movement is in what stage of ax? | stage 3/plane 1 |
| instruments on instrument table should be laid out | with the ring handles facing you |
| if the patient is apneic | turn inhalant gas down |
| normal SaO2 for anesthetized pt | >95% |
| tachycardia may indicate | pt is too light |
| ALWAYS an emergency | dyspnea |
| pt is too deep | hypotension |
| towel clamps that penetrate through the drape into the skin | Bakhaus |
| good jaw tone (snapping back) | pt is too light |
| losing consciousness, vocalizing and struggling | stage 2 |
| measure the length of the ET tube to | the thoracic inlet |
| ET tube for brachiocephalic pt | select 1-2 sizes smaller than measured |
| ET tube is too far | pt will breath with abdominal press |
| dog with bcs of 8/9 will require more anesthetic per unit body weight | false |
| overinflation of ET tube cuff results in | tracheal necrosis |
| surgical assistant cannot wear | sandals, nail polish, jewelry (all) |
| jerky abdominal respirations, loose jaw tone, bradycardic, prolonged CRT | stage 3/plane 4 |
| large O2 tanks should be stored | chained to the wall |
| part of the anesthetic machine that does not need to be checked prior to use | oxygen flush valve |
| pt breathing rapidly under anesthesia | turn up inhalant gas |
| what retractor requires more than one person for proper use? | Senn |
| what is the first thing you should do if the SaO2 reading is low? | check your equipment |
| what should you NOT do if pt is bradycardic? | turn up the inhalant gas |
| conscious, struggling, fearful | stage 1 |
| what part of scrubbed in gown are part of the sterile field | front from chest to table |
| how should thumb forceps be held? | like a pencil |
| appropriate breakfast on surgery day? | whole wheat toast with PB |
| nail care practices for surgery day? | clip shorter than fingertips and remove polish |
| surgical mask should cover | nose and mouth |
| if you need to sneeze in surgery while wearing a mask | step back from the table and don't turn your head |
| minimum time for pre-surgical scrubbing? | 5 minutes |
| absence of what equals asepsis? | all pathogenic microorganinsms that cause infection |
| scalpel blade used for declaw? | 12 |
| Unscrubbed assistant | should not step between 2 scrubbed people in the surgical field, should not step between pt and equipment table, always face the surgical field (all) |
| when opening a pack and checking it for sterility | check the sterile indicator on the package |
| surgical instrument "box locks" | absorb the greatest stress during use |
| liquid seeping through the sterile drape is | strike-through |
| if mucous membranes are blue, first | check for obstruction of the ET tube |
| scalpel blade used for most dog/cat surgical procedures | 10 |
| sleeplike, non-responsive to verbal stimulus, aroused by painful stimulus | stuporus |
| why are needle holders the only surgical instruments that should be used to hold metal? | it is unsafe to use other instruments, it will wear the jaws of other instruments, it will place too much stress on the box lock of other instruments (all) |
| how long should small animals be fasted prior to surgery? | 12 hours |
| atraumatic surgical instruments | cause little damage to tissue |
| very young/small pt should be fasted ____as other animals | not as long |
| healthy 6 month old puppy according to ASA physical status classification system | P1 |
| HBC w/internal bleeding (ASA) | P5 |
| signalment | age, breed, gender |
| premature suture loss and surgical site opening | dehiscence |
| debridement of infected scratch on dog's hind limb should be done | in the prep room |
| needle holders with built in scissors | Olson-Hegar |
| vessels in the skin | halstead mosquito hemostat |
| what room should the autoclave go in? | Scrub room |
| nonmovable equipment of surgery room | overhead lights |
| moveable equipment of surgery room | suction unit |
| after turning off the anesthetic vaporizer | leave pt on oxygen for 5 minutes |
| pt is most likely to die during | induction and recovery |
| postanesthetic pt is recovered when | physiologic parameters have returned to normal |
| hemostats with serrations extending half way up the tip | Kelly hemostats |
| recover period: thrashing, crying out, paddling limbs | emergence delirium |
| Pt to be given reduced concentrations of anesthetic agents | neonates, sighthounds, pt with liver or kidney dz (all) |
| terminal cleaning | cleaning surgery and prep rooms and equipment at the end of a surgery day |
| never use to clean surgery room | dry dusting |
| scissors to use to cut gastrocnemius muscle | Mayo scissors |
| deactivate the effects of chlorine-based disinfectant | fecal matter |
| significant finding in calm canine pt with regard to anesthetic risk | increased respiratory effort |
| Surgical scissors with long, thin blades used to cut delicate tissue | Metzenbaum scissors |
| hemorrhage from surgical incision | apply direct pressure 5-10 minutes |
| seroma at surgical site due to | overactivity |
| treatment for seroma | warm compresses |
| operating scissors used | to cut inanimate objects |
| treatment for emergence delirium | hold pt, talk quietly to pt, ask vet to administer tranquilizer (all) |
| pt experiencing pain after surgery can be given | both an opioid and an NSAID |
| instrument milk is for | lubrication |
| can only be mixed with ketamine | diazepam |
| system targeted by anesthetic agents | brain |
| most general anesthetics provide analgesia | false |
| why administer pre-meds | sedation, calm excited animals, analgesia, muscle relaxation, make induction and recovery smoother (all) |
| not an appropriate route of preanesthetic agents | PO |
| primary effect of anticholinergics (atropine, glycopyrrolate) | increased heart rate |
| drug that provides analgesia | dexmeditomidine |
| preanesthetic drug, causes hypotension, reduces seizure threshold | Acepromazine |
| safe for high risk, geriatric animals | diazepam |
| antibiotics | should not be needed if sterile and aseptic technique were followed |
| side effect of propofol | apnea |
| induction agents that cause sensitivity to light, sound, and touch | dissociatives |
| best anesthetic gas for mask inductions | sevoflurane |
| stage that smooth induction should bypass | stage 2 |
| what can kill a cat during anesthesia | laryngospasm from improper intubation, leaving pop-off valve closed, incorrect calculation of pre-anesthetic drugs (all) |
| ring handled instrument rings should be held with | thumb and ring fingers |
| pulse oximetry allows accurate estimation of | SaO2 or percent saturation of hemoglobin with oxygen |
| bradycardic | turn vaporizer down |
| hypotensive | turn vaporizer down |
| fully dilated pupils, no PLRS | turn vaporizer down |
| tachypnic | turn vaporizer up |
| palpebral reflex | turn vaporizer up |
| amount of oxygen animal is receiving is indicated by | the flow meter |
| device that measures CO2 levels | capnometer |
| surgical plane of anesthesia, pt eyes are | ventral |
| Jaw with no tone "flapping in the breeze" indicates | Pt is too deep |
| Cats and dogs should be fasted how long prior to surgery | 12 hours |
| ASA classification- mildly anemic or moderately dehydrated | P3 |
| Most common reason veterinary staff are sued? | lack of communication |
| common adverse affect of induction agents | apnea |
| safe technique to prevent hypothermia in SA surgical pt | circulating hot water blanket |
| two most important practices to prevent surgical infection | aseptic and sterile technique |
| strike through renders drapes | contaminated |
| only scrubbed in, sterile personnel should | reach over the surgical field |
| regarding the surgical field | excessive talking and movement among personnel is unacceptable |
| unscrubbed personnel should never face the surgical field | false |
| surgical assistant is responsible for | monitoring the patient, maintaining sterility, and maintain hemostasis (all) |
| unscrubbed personnel enter or touch the sterile field | it is no longer considered sterile |
| the space above and around an open sterile pack is considered | part of the surgical field |
| scrubs can be worn for surgery more than one day as long as no blood is on them | false |
| fingernail polish protects against microbial growth | false |
| consent forms for surgery/anesthesia are | legally required |
| caps and masks are put on | before scrubbing, gowning, and gloving |
| pt who is underweight will appear ___ dehydrated than they are | more |
| necklaces can be worn when scrubbing in for surgery | false |
| postoperative recovery period begins | on discontinuation of anesthesia |
| what contributes to prolonged recovery from anesthesia? | hypoglycemia, liver dz, kidney dz (all) |
| what can hasten recovery? | physical stimulation, oxygen supplementation, warming measures (all) |
| when moveable equipment is removed from the surgery room | it should be thoroughly cleaned and disinfected before being returned |
| if there are no instructions how do you clean stethoscopes, BP cuffs, and other non-critical items for the surgery room? | clean then disinfect with alcohol |
| how often should surgery room floor be cleaned? | daily |
| difference between antiseptics and disinfectants? | antiseptics used on living tissue, disinfectants use on inanimate objects |
| contact time | time required for disinfectant to be in contact with the microorganism to achieve intended effect |
| correct order to disinfect surgical instruments | clean, sanitize, sterilize |
| neuroleptanalgesic | combination of opioid and tranquilizer |
| opioid reversed with | naloxone |
| to avoid transient apnea with propofol | titrate in several boluses |
| problem associated with recovery from teletamine-zolzepam in dogs | excitement |
| severe bradycardia caused by dexmedetomidine is treated with | atipamezole |
| surgical instruments should only be used for their designated purpose | to avoid damaging them, to protect their useful life, high quality instruments are expensive and should be handled with care (all) |
| part of anesthesia machine that converts liquid anesthetic to gas anesthetic | vaporizer |
| what do you use to place scalpel blade in scalpel handle? | needle holders |
| idiopathic pain is defined as | pain of unknown cause |
| pathologic pain is | pain caused by tissue injury |
| spay has what components of pain? | both somatic and visceral |
| in multimodal analgesic therapy | the dose of each drug is decreased when multiple drugs are used |
| how does treating pain affect wound healing? | treating pain improves wound healing |
| an animal enduring pain is | suffering |
| how do we prevent windup? | adding analgesic to premeds prior to surgery |
| behavioral responses to pain | vary depending on species, breed, age, and temperament, presence or absence of humans, and cats tend to hide, dogs seek owner attention (all) |
| when in perioperative period is analgesia needed? | preanesthetic period, surgical period, postoperative period (all) |
| which analgesics also provide anti-inflammatory action, can cause GI unlers, and can be sent home with owners | NSAIDs |
| which analgesics cannot be used with NSAIDs? | corticosteroids |
| good nursing care includes | keeping cages clean and dry, making sure pt surroundings are quiet, supplying a toy or blanket from home (all) |
| skipping patient prep | may result in life-threatening complications |
| after administering pre-meds by IM injection | place pt in quiet, dark cage where you can constantly observe them |
| most dangerous type of induction | chamber induction |
| what type of induction allows anesthetist to control both increases and decreases in depth? | inhalant induction |
| tracheal rupture caused by | overzealous intubation |
| pt is significantly too deep | turn off vaporizer |
| before repositioning pt | disconnect ET tube from anesthetic machine |
| during recovery from anesthesia | physiologic parameters should be monitored every 5 minutes until they return to normal |
Created by:
Molmae
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