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Anaesthesiology
Nonoperating Room Anesthesia
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
12 sections · 177 slides
Overview
- Scope of this topic
- What this deck covers
General Principles
- Challenges of working away from the operating room
- Three-step approach to nonoperating room anesthesia
- The patient
- Patient factors that require sedation or anesthesia for nonoperating room procedures
- The procedure
- Common nonoperating room anesthesia procedures
- Common nonoperating room anesthesia procedures (continued)
- Common nonoperating room anesthesia procedures (continued)
- The environment
- ASA standards for nonoperating room anesthetizing locations
- Anesthesia equipment and monitors in remote sites
Patient Safety
- Adverse events in nonoperating room locations
- Where and in whom adverse events cluster
- Oversedation as the dominant hazard
- Complications of nonoperating room anesthesia
- Complications of nonoperating room anesthesia (continued)
- Preprocedural checklists
- Standards of care for nonoperating room anesthesia
- Transfer of the critically ill patient
- Equipment and planning for patient transport
Sedation and Anesthesia
- Definitions of sedation and anesthesia
- The continuum of anesthesia
- Why a patient drifts deeper than intended
- Levels of sedation and general anesthesia
- Definitions of general anesthesia and levels of sedation and analgesia
- Cardiovascular function across the sedation continuum
Environmental Considerations
- How x-rays are produced
- Fluoroscopy
- Equipment density in a radiology suite
- Deterministic and stochastic effects of ionizing radiation
- Magnitude of patient radiation exposure
- Patient exposure during imaging
- Common terms used in radiation exposure: definitions
- Common terms used in radiation exposure: notes
- Direct exposure and scattered radiation
- Occupational radiation risk to anesthesiologists
- Three principles of radiation protection
- Protective shielding in practice
- Occupational dose limits and monitoring
- Classification of intravenous contrast agents
- Contrast-induced nephropathy
- Risk factors and prevention of contrast-induced nephropathy
- Immediate and nonimmediate hypersensitivity reactions
- Clinical manifestations of immediate and nonimmediate hypersensitivity reactions to radiocontrast agents
- Clinical manifestations of immediate and nonimmediate hypersensitivity reactions to radiocontrast agents (continued)
- Clinical manifestations of immediate and nonimmediate hypersensitivity reactions to radiocontrast agents (continued)
- Prevention and treatment of contrast hypersensitivity
- Reactions to gadolinium-based contrast agents
Radiology Procedures
- Anesthetic considerations for angiography
- Vascular access and discomfort during angiography
- Positioning hazards on a moving gantry
- Interventional neuroradiology: occlusive and opening procedures
- Occlusive endovascular techniques
- Evidence for coiling versus surgical clipping
- Opening procedures in acute ischemic stroke
- Vascular access and anticoagulation in neuroradiology
- Choice of anesthetic technique in interventional neuroradiology
- Sedation techniques and physiologic manipulation
- The Wada test and superselective anesthesia functional examination
- Complications of interventional neuroradiology
- Computed tomography
- Anesthetic hazards in the CT scanner
- Radiofrequency ablation
- Anesthetic assessment and technique for radiofrequency ablation
- Transjugular intrahepatic portosystemic shunt
- Considerations in patients presenting for the transjugular intrahepatic portosystemic shunt procedure
Magnetic Resonance Imaging
- Physical principles of magnetic resonance imaging
- Magnetic field strength
- Biologic effects of the MRI environment
- Ferromagnetic hazards in the MRI suite
- Noise and thermal hazards during MRI
- Monitoring inside the magnetic field
- Duration, temperature and emergencies in the scanner
- Anesthetic technique for MRI in adults
- Why children need sedation for imaging
- Sedation only versus general anesthesia in children
- Choosing between sedation and anesthesia in children
- SOAPME checklist
- Sedative agents for pediatric imaging
Radiation Therapy and PET
- External beam radiation therapy in children
- Common radiosensitive tumors in children
- Preanesthetic assessment before radiotherapy
- Practical conduct of anesthesia for radiotherapy
- Immobilization and vascular access in radiotherapy
- Positron emission tomography
Gastroenterology
- Sedation practice in the endoscopy suite
- Controversy over nonanesthesiologist propofol
- Agreed indications for anesthesia involvement in endoscopy
- Indications for upper gastrointestinal endoscopy
- Airway management for upper endoscopy
- Positioning and pressure care during endoscopy
- Endoscopic retrograde cholangiopancreatography
- Drug interactions and comorbidity in ERCP
- Bacteremia and antispasmodics during endoscopy
Cardiology and Interventional Cardiology
- Growth of interventional cardiology and electrophysiology
- Percutaneous coronary intervention
- When the anesthesiologist is needed in the cath lab
- Complex percutaneous coronary intervention
- Percutaneous ventricular assist devices
- The Impella device
- Percutaneous closure of septal defects
- Air embolism risk during septal defect closure
- Alcohol septal ablation
- Calcific aortic stenosis and transcatheter aortic valve replacement
- Deployment technique and evidence for TAVR
- Transcatheter valve designs
- Anesthetic technique for TAVR
- Monitoring and access for TAVR
- Emergence planning after TAVR
- Mitral regurgitation and transcatheter edge-to-edge repair
- Prolapsing mitral valve on three-dimensional echocardiography
- Mitral valve after transcatheter edge-to-edge clip deployment
- Advantages and outcomes of mitral edge-to-edge repair
- Left atrial appendage occlusion
- Indications, outcomes and anesthesia for appendage occlusion
- Anesthesia in the electrophysiology laboratory
- Cardiac implantable electronic devices
- Indications for implantable cardioverter defibrillators
- Cardiac resynchronization therapy
- Anesthetic challenges during resynchronization device implantation
- Electrophysiology studies with ablation
- Arrhythmia classification
- Arrhythmia classification (continued)
- Arrhythmia classification (continued)
- How catheter ablation is performed
- Energy sources and fluid load during ablation
- Phrenic nerve injury and neuromuscular blockade
- Anesthetic technique for ablation procedures
- Indications for laser lead extraction
- Risks and anesthetic management of lead extraction
- Cardioversion and diagnostic transesophageal echocardiography
- Technique for sedation during transesophageal echocardiography
- Indications and contraindications for elective transesophageal echocardiography
Electroconvulsive Therapy
- Role and schedule of electroconvulsive therapy
- Physiologic response to electroconvulsive therapy
- Seizure duration and cardiovascular consequences
- Adverse sequelae of electroconvulsive therapy
- Monitoring and comorbidity in ECT
- Anesthetic considerations for electroconvulsive therapy
- Anesthetic considerations for electroconvulsive therapy (continued)
- Anesthetic considerations for electroconvulsive therapy (continued)
- Induction agents for electroconvulsive therapy
- Adjuncts and ketamine in electroconvulsive therapy
Summary and References
- Summary of nonoperating room anesthesia
- Key takeaways
- References
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- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition