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PMI > Miscellaneous Monitors > Flashcards

Miscellaneous Monitors Flashcards

1
Q

febrile definition

A

> 38 degrees C

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2
Q

hypothermia defintion

A

<36 degrees C

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3
Q

room temp

A

23 degrees C

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4
Q

what is the recommended room temperature for the OR

A

between 20-24 degrees C

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5
Q

what are the 6 temperature monitoring sites?

A 
blood (swan) 
esophageal
rectal
nasal
bladder
skin/ axillary
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6
Q

which temp monitoring location is the best estimate of core temp?

A

swan ganz

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7
Q

which temp monitoring site is the most consistently reliable estimate of core body temp

A

esophageal

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8
Q

when is the esophageal temp probe less reliable?

A

open chest cases

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9
Q

when would the rectal temp probe be less reliable?

A

if rectum isnt clear

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10
Q

What is a good temp probe choice during open heart surgery?

A

nasal bc the chest is open so esophageal will not be accurate

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11
Q

what does the accuracy of the bladder temp probe rely on?

A

urine output being normal

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12
Q

what are the 4 causes of intraop temp loss?

A

IV fluids
vasodilation
blood products
volatile agents

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13
Q

how much does 1 unit of blood or 1 L of crystalloids decrease the mean body temp by?

A

0.25 degrees C

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14
Q

how does vasodilation cause temp loss?

A

redistributes heat from warm central compartments to cooler peripheral tissues

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15
Q

how dose the volatile agents cause temp loss?

A

interferes with hypothalamic thermoregulation

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16
Q

what blood products are stored at cool temps and should be given through a blood warmer?

A

PRBC
cryo
FFP

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17
Q

what blood product is not given through a fluid warmer?

A

platelets

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18
Q

4 adverse cardiovascular effects of hypothermia

A

platelet dysfunction/bleeding
decreased SV
bradycardia/arrhythmia
increased blood viscosity

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19
Q

for every 1 degree C drop in body temp the cerebral blood flow decreases how much?

A

5-7%

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20
Q

what is the adverse neurologic effect of hypothermia

A

increased cerebral vascular resistance

decreased cerebral blood flow

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21
Q

adverse renal effects of hypothermia

A

decreased GFR

impaired renal tubular function

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22
Q

adverse respiratory effects of hypothermia

A

respiratory depression

left shift of the HbO2 dissociation curve

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23
Q

adverse metabolic effects of hypothermia

A

decreased drug metabolism & delayed emergence
decreased wound healing
shivering

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24
Q

how much does shivering increase oxygen consumption?

A

five fold

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25
Q

what pts should we be extremely concerned with shivering?

A

pts with CAD

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26
Q

When is shivering more likely? 3

A

lower intraop temp
longer surgery
higher volatile agent

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27
Q

what are the two treatments for shivering?

A

warm the pt

demerol 25mg

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28
Q

4 types of heat loss in the OR (in order of most heat loss to least, with %)

A

radiation 60%
evaporation 20%
convection 15%
conduction 5%

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29
Q

radiation definition

A

losing heat to the colder temp of atmosphere (requires no contact)
60%

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30
Q

evaporation definition

A

body loses heat through the loss of water
(when the body is opened up)
20%

31
Q

convection definition

A

air flow over exposed surfaces
(moving air currents in OR)
15%

32
Q

conduction definition

A

transfer of heat between adjacent surfaces
(laying on the cold metal table)
5%

33
Q

2 purposes of an esophageal stethoscope

A

measure temp

listen to heart and lung sounds

34
Q

precordial stethoscope function, where is it popular?

A

constant heart/lung sounds

popular in peds

35
Q

BIS monitor reading 65-85 indicates?

A

sedation

36
Q

BIS monitor reading 40-65 indicates?

A

general anesthesia

37
Q

BIS monitor reading <40 indicates?

A

too deeply anesthetized

38
Q

what drug can actually increase the BIS number?

A

ketamine

39
Q

What is a BIS monitor?

A

bispectral index monitor that uses EEG to monitor awareness

40
Q

3 common situations for the BIS monitor

A

paralyzed pt
pt undergoing TIVA that are paralyzed
sick pts that require less anesthesia

41
Q

Are sick pts always able to mount a sufficient sympathetic response to alert anesthetist of light anesthesia?

A

NO, this is why BIS should be used on these pts, may not be HTN and tachy

42
Q

when are the two exceptions of when we cannot trust vital signs to monitor awareness?

A

beta blockers were not given

pts arent healthy enough to mount normal sympathetic response

43
Q

should an anesthetist need a BIS monitor if the patient is not paralyzed?

A

if a patient is deep enough to not move, they should be deep enough to not have awareness
probably no BIS

44
Q

what is urine output an indicator of?

A

adequate cardiac output and renal perfusion

45
Q

what is the common goal for urine output?

A

> 0.5-1.0 mL/kg/hr

46
Q

What is a TEE?

A

transesophageal echocardiography: ultrasound of cardiac structures with probe resting in the esophagus posterior to heart

47
Q

what can a TEE estimate?

A

EF
CO
patency of heart valves (stenosis/regurg)
PAP

48
Q

What is the best monitor for diagnosing venous air embolism?

A

TEE

49
Q

Evoked potentials definition

A

monitor nerves that are close to the surgical site

monitor waves are warn if nerve is ischemic or damaged

50
Q

evoked potentials method 2

A

1 nerve is electrically stimulated and produce waveform

2 ischemic/damaged nerve abnormal wave

51
Q

evoked potential wave amplitude

A

height of the wave

52
Q

evoked potential wave latency

A

time from the onset of the wave to the peak of the response

53
Q

effect of nerve damage and ischemia on waves

A

decreased amplitude and increased latency

54
Q

when can the surgeon be lad to believe that ischemia is present when it is not?

A

when our anesthetics also cause a decrease in amplitude and increase in latency

55
Q

how can an anesthetist intervene if the amplitude decreases or latency increases?

A

increase the patients BP

56
Q

which two drugs increase amplitude?

A

ketamine

etomidate

57
Q

which two drugs cause no change to latency?

A

nitrous oxide

versed

58
Q

what effect do opiods have on amplitude and latency?

A

minimal effect

59
Q

which drugs have the greatest effect on SSEPs?

A

volatile agents and nitrous oxide

60
Q

4 types of evoked potentials?

A

somatosensory evoked potentials (SSEPs)
motor evoked potentials (MEPs)
brainstem auditory evoked potentials (BAEPs)
visual evoked potentials (VEPs)

61
Q

which type of evoked potential can you not use a muscle relaxant?

A

motor evoked potentials

62
Q

what do SSEPs monitor?

A

the integrity of sensory nerves

peripheral nerve stimulated and travel through dorsal nerve roots

63
Q

Can you use a muscle relaxant during SSEP?

A

yes

64
Q

What do MEPs monitor?

A

integrity of motor nerve

65
Q

where do the motor nerves travel through in spinal cord?

A

anterior and lateral pathways

66
Q

are MEPs or SSEPs more sensitive to volatile agents?

A

MEPs

67
Q

what do BAEPs monitor?

A

integrity of the vestibulocochlear (CN7) and brainstem

uses earphones

68
Q

which evoked potential is least affected by anesthetics?

A

BAEPs

69
Q

what do VEPs monitor?

A

the integrity of the optic nerve

70
Q

when are VEPs used?

A

during pituitary tumor resection

71
Q

What EP is most effected by anesthetics?

A

VEPs

72
Q

3 steps to anesthetic management with EPs

A

<0.5 MAC
keep anesthetic level constant
avoid muscle relaxant if MEPs

73
Q

what are the two supplements for the volatile agent on cases with EPs?

A 
propofol drip
narcotic drip (remi)
74
Q

does bolused or infused propofol have a larger effect on EPs?

A

bolused propofol

PMI (21 decks)

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