Chapter 11 Choice of Anesthetic Technique
1. What should be accomplished in the preoperative evaluation and visit by the anesthesiologist according to the standard adopted by the American Society of Anesthesiologists?
2. What are some important aspects that should be included in the preoperative medical evaluation of the surgical patient?
Anesthetic technique
3. What are the several anesthetic options available to the anesthesia provider?
4. Name some considerations that influence the choice of anesthetic technique.
5. What are some of the unpleasant side effects associated with anesthesia?
6. Describe some of the optimal conditions to be achieved with the ideal anesthetic technique.
7. What should be included in the discussion of informed consent for anesthesia by the anesthesiologist? Is it required that the anesthesiologist discuss with the patient all the remote risks of anesthesia, including death?
8. How is the induction of general anesthesia often achieved?
9. What is preoxygenation? What is its purpose?
10. What are some methods by which preoxygenation can be achieved?
11. What are some methods by which the proper placement of an endotracheal tube can be confirmed?
12. What is a rapid sequence induction?
13. Describe a rapid sequence induction.
14. When is a rapid sequence induction indicated?
15. Describe an inhalation induction of anesthesia.
16. When is an inhalation induction indicated?
17. What are some objectives during the maintenance of general anesthesia?
18. What are some advantages of nitrous oxide for general anesthesia? What are some advantages of volatile anesthetics for general anesthesia? Why are the two often administered in combination?
19. Why might neuromuscular blocking drugs be used intraoperatively?
20. What are some of the advantages of injected opioids for general anesthesia? What is a disadvantage of injected opioids for general anesthesia?
21. What are some regional anesthetic techniques?
22. What surgical procedures are regional anesthetics often administered for?
23. What are some advantages of spinal anesthesia when compared with epidural anesthesia?
24. What are some advantages of epidural anesthesia when compared with spinal anesthesia?
25. What are some of the conditions that may increase the risk associated with spinal or epidural anesthesia?
26. When is intravenous regional anesthesia or Bier block used?
27. What are some advantages of peripheral nerve blocks for surgical anesthesia?
28. What are some disadvantages of peripheral nerve blocks for surgical anesthesia?
29. What is monitored anesthesia care?
30. What are some anesthesiologist responsibilities during monitored anesthesia care?
31. What are some of the advantages of using monitored anesthesia care?
Answers*
1. According to the standard adopted by the American Society of Anesthesiologists, preoperatively the anesthesia provider is responsible for determining the medical status of the patient: obtaining and reviewing tests and consultations necessary for the conduct of anesthesia, developing a plan of anesthesia care, and reviewing with the patient or a responsible adult the proposed anesthesia care plan. (190)
2. Important aspects that should be included in the preoperative medical evaluation of the surgical patient include data gathering and the imparting of information to the patient. The anesthesiologist needs to gather information regarding the patient’s history and physical examination and current drug therapy regimen, as well as the ordering and interpretation of laboratory data. In turn, the anesthesia provider must present the patient and the patient’s family with information regarding the events of the day of surgery, preoperative instructions regarding medicines and fasting, the anesthetic, and the potential risks of anesthesia. In addition, informed consent for the procedure must be obtained. The overriding goal of the preoperative medical evaluation of the surgical patient is to decrease perioperative morbidity and mortality. (190-191, Table 14-1)
