Anesthesia Mcq Bank.rar
Sanora Ngueyn
There is an unmet need for essential surgical services in Africa. Limited anesthesia services are a contributing factor. Nonphysician anesthesia providers are utilized to assist with providing anesthesia and procedural sedation to make essential surgeries available. There is a paucity of data on outcomes following procedural sedation for surgery in Africa. We investigated the postoperative outcomes following procedural sedation by nonphysicians and physicians in Africa. We hypothesized that the level of training of the sedation provider may be associated with the incidence of severe postoperative complications and death.
Regarding complications from surgery, well-trained surgeons should experience complications in fewer than 5% of cases. Complications include stenosis, bleeding, infection, recurrence, nonhealing wounds, and fistula formation. Urinary retention is directly related to the anesthetic technique used and to the perioperative fluids administered. Limiting fluids and the routine use of local anesthesia can reduce urinary retention to less than 5%.
In tandem with increasing recognition, an array of options have become available for perioperative patient temperature monitoring and warming. A single layer of passive insulation only compensates for 30% of cutaneous heat losses that occur during general anesthesia, and additional layers of insulation have diminishing effectiveness [3]. Adequate temperature management requires methods of active warming, most commonly forced air warming blankets. Multiple randomized trials [8, 9] and systematic reviews [10,11,12] have shown the effectiveness of these options in maintaining normothermia, and hospitals have incorporated them into perioperative protocols [1].
The greatest barrier to compliance appears to be the availability of equipment for perioperative temperature management in all three perioperative phases. A substantial proportion of survey respondents do not have ready access to temperature measuring equipment and active warming devices at critical locations, namely the operating complex reception / induction room, the operating theater, and the anesthesia recovery area. Having active warming equipment readily available in the operating room was associated with ten times the odds of performing intraoperative active warming.
Another significant observation was that compliance rates to intraoperative temperature monitoring during neuraxial anesthesia was half that of general anesthesia (25.6% vs 67.5%), despite the fact that neuraxial anesthesia also impairs thermoregulatory mechanisms to a similar degree as general anesthesia [3]. The importance of intraoperative warming even in patients undergoing neuraxial anesthesia should be further emphasized in subsequent iterations of perioperative temperature management guidelines.
Occlusive balloon placements are performed in the Interventional radiology suite under either regional anesthesia or sedation. General anesthesia is usually not required in elective situations. Use of epidural anesthesia provides an opportunity for transition to a cesarean delivery, using an in-situ epidural if needed [66]. Typically, after establishing a regional anesthetic, the vascular occlusive catheters are placed by the interventional radiologists in the interventional radiology suite. Regional anesthesia has the advantage of limited exposure of the fetus to general anesthesia. Care should be exercised when balloon catheters are inflated in the IR suite, because these maneuvers can reduce uterine artery blood flow resulting in fetal compromise necessitating emergent delivery.
In our institution, general anesthesia is preferred for patients with hemodynamic instability who need emergent cesarean deliveries. In elective scenarios, general anesthesia is limited to women who may have a difficult airway or to cases where intraoperative conversion to general anesthesia may not be ideal, e.g., maternal obesity. When MOH is expected, massive transfusion can cause airway edema exacerbating difficulty with airway management. Ureteral stents are often placed before the cesarean section to help avert ureteral injury. Invasive monitoring and large-bore venous access is established. In our center, we electively opt for central venous access before the patient develops intraoperative coagulopathy.
After your exam, your surgeon will review the findings with you and will discuss a treatment plan. Many anorectal disorders are treatable without surgery, but your surgeon may determine that an exam under anesthesia is necessary for further work-up. It is also possible that further testing, such as an MRI or colonoscopy, will be necessary. You may be given instructions on taking fiber powder to address the problem or be prescribed other medication. You will be given an opportunity to ask as many questions as you like about your treatment plan.
If your cat is 12 years or older, has all of its teeth, and no sign of resorptive lesions, it may qualify to have a free dental cleaning and full mouth radiographs to confirm. If healthy, we would collect a small blood sample while your cat is under anesthesia.
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