Clinical Procedures and Protocols Flashcards
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Read the first 7 Clinical Procedures and Protocols flashcards as text
When a spinal anesthetic is administered with isobaric bupivacaine 0.5% in a patient placed in the lateral decubitus position, how does patient positioning affect spread?
Answer: Spread is gravity-independent; the block is symmetric
Isobaric solutions have the same density as CSF, so their spread is largely independent of gravity and patient positioning.
A patient develops high-output cardiac failure after creation of an arteriovenous fistula for hemodialysis. Which invasive monitoring modality best guides fluid and vasopressor management intraoperatively?
Answer: Transesophageal echocardiography
TEE provides real-time assessment of biventricular function, volume status, and cardiac output, which is most informative in high-output heart failure states.
During one-lung ventilation, the dependent lung develops refractory hypoxia. After confirming correct bronchial blocker position, what is the FIRST additional maneuver?
Answer: Apply continuous positive airway pressure (CPAP) 5–10 cmH2O to the non-dependent lung
Low-level CPAP to the non-dependent (operative) lung recruits alveoli and reduces shunt fraction without significantly impairing the surgical field.
A patient undergoing total knee arthroplasty under spinal anesthesia develops a systolic blood pressure of 75 mmHg with heart rate of 58 bpm. Which vasopressor is most appropriate?
Answer: Ephedrine 10 mg IV
Ephedrine has both alpha and beta agonist effects, making it ideal when hypotension is accompanied by bradycardia, as occurs with sympathectomy from spinal anesthesia.
Which criterion in the modified Aldrete score specifically evaluates a patient's readiness for discharge from the post-anesthesia care unit?
Answer: SpO2 ≥92% on room air or baseline oxygen
The modified Aldrete score includes SpO2 ≥92% on room air as an oxygenation criterion alongside activity, respiration, circulation, and consciousness domains.
After an uncomplicated cesarean delivery under spinal anesthesia, a patient develops pruritus. Which agent is MOST effective for treating opioid-induced pruritus?
Answer: Nalbuphine 5 mg IV
Nalbuphine, a mixed opioid agonist-antagonist, effectively treats neuraxial opioid-induced pruritus by antagonizing mu receptors responsible for itching without fully reversing analgesia.
A surgeon requests intraoperative controlled hypotension during functional endoscopic sinus surgery to minimize bleeding. What is the target mean arterial pressure range?
Answer: 50–65 mmHg
A MAP of 50–65 mmHg is the accepted target range for deliberate hypotension, balancing surgical field improvement with organ perfusion safety.