Chapter 04 Anesthesia

Chapter 04  Anesthesia

MULTIPLE CHOICE

1. The anesthesia department at Evergreen Medical Center has a total staff of 102 persons. These employees serve in many roles as care providers, technical assistants, materials management, clinical engineers, and clerical staff. Select the list of direct-care anesthesia providers.

1. CRNA, anesthesia tech, anesthesia provider
2. CRNA, CNA, anesthesia scheduler
3. Anesthesia tech, anesthesiologist assistant (AA), anesthesia scheduler
4. Anesthesia provider, AA, CRNA

ANS: D
In the United States, anesthesia care usually is provided by an anesthesiologist, by a certified registered nurse anesthetist (CRNA) working in collaboration with or under the direction of an anesthesiologist or a physician, or by an anesthesia provider’s assistant (AA) working under the direct supervision of an anesthesia provider.

REF: Page 111

2. The potential for intraoperative awareness (IOA) can exist for patients in all modes of anesthesia. Select the anesthesia modality that presents the least likely opportunity for IOA.

1. Regional anesthesia
2. General endotracheal anesthesia
3. Monitored anesthesia care
4. Local anesthesia

ANS: B
IOA is expected during regional anesthesia, local anesthesia, and monitored anesthesia care (MAC), as these modalities do not render the patient unconscious and in a deep sleep state with a managed airway. General endotracheal anesthesia is a modality of unconsciousness with an anesthesia-managed airway. Multiple studies have found IOA to occur in 0.1% to 0.2% of patients undergoing general anesthesia. Research suggests that the two most common risk factors are light anesthesia and a history of awareness.

REF: Pages 113-114

3. At a regional MH testing center Davis Washington is undergoing a muscle biopsy for suspected genetic predisposition to malignant hyperthermia. The anesthesia provider will provide light intravenous (IV) sedation while the surgeon infiltrates the biopsy site with a local anesthetic. This will facilitate Davis’ tolerance of the procedure and minimize his risk for an MH episode. What is the current correct name for this anesthesia modality?

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 4-2

1. Local with anesthesia standby
2. Monitored anesthesia care (MAC)
3. Basal narcosis
4. Moderate sedation

ANS: B
MAC is infiltration of the surgical site with a local anesthetic and is performed by the surgeon. “Local standby” and “anesthesia standby” are older, less accurate terms frequently used interchangeably with MAC. The anesthesia provider supplements the local anesthetic with IV drugs that provide sedation and systemic analgesia, monitors the patient’s vital functions, and may use additional medication to optimize the patient’s physiologic status.

REF: Page 118

4. Sherry Ames is an endoscopy nurse in a busy free-standing ambulatory surgery center. She is an RN with additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies, bronchoscopies, and upper GI endoscopies. This modality will allow this patient population to tolerate potentially uncomfortable procedures while maintaining their own airway and be easily aroused from light sleep. Sherry is competent and legally qualified to provide which modality of anesthesia?

1. Moderate anesthesia care
2. Local infiltration
3. Conscious sedation/analgesia
4. Procedural narcosis

ANS: C
Moderate sedation/analgesia (conscious sedation/analgesia) is defined as “a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.” No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The demand for this modality in the ambulatory surgical setting has resulted in increased use of non–anesthesia providers (usually professional registered nurses with additional training in administering conscious sedation/analgesia medications and monitoring these patients) for these functions.

REF: Page 118

5. The instillation of a local anesthetic into the subarachnoid space is termed:

1. spinal anesthesia.
2. epidural anesthesia.
3. perfusion block.
4. stellate ganglion block.

ANS: A

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 4-3

Common regional anesthesia techniques include spinal anesthesia (subarachnoid block [SAB]), epidurals, caudals, and major peripheral nerve blocks. For epidural anesthesia, the local anesthetic usually is injected through the intervertebral spaces in the lumbar region (lumbar epidural), although it also can be injected into the cervical or thoracic regions. For caudal anesthesia, the local anesthetic also is injected into the epidural space, but the approach is through the caudal canal in the sacrum. For peripheral nerve blocks, the anesthetic is injected along the nerve pathway.

REF: Pages 118, 134, 138

6. Justin, a 4-year-old preschool student, was telling his friend Jacob about his operation. He had a hernia fixed and told Jacob that the nurse put “magic cream on his hand before she stuck the ivy in” and then the doctor “gave him surgery sleep medicine that was like milk in his ivy” and “another doctor put a little needle stick in his back near his butt after he was asleep so he would not hurt when he woke up.” Based on Justin’s self-report of his surgery experience, what three types of anesthesia, in the correct order to his story, did Justin receive?

1. Local, general, spinal
2. Local, regional, general
3. Local, general, caudal
4. Regional, general, caudal

ANS: C
General anesthesia is a reversible, unconscious state characterized by amnesia (sleep, hypnosis, or basal narcosis), analgesia (freedom from pain), depression of reflexes, muscle relaxation, and homeostasis or specific manipulation of physiologic systems and functions. Local anesthesia refers to the administration of an anesthetic agent to one part of the body by local infiltration or topical application, usually administered by the surgeon. Common regional anesthesia techniques include spinals (subarachnoid block [SAB]), epidurals, caudals, and major peripheral nerve blocks.

REF: Pages 117-118