Non-Operating Room Anesthesia
(NORA) questions well answered
T/F: non-operating room anesthesia requires the same standards of care as OR anesthesia -
correct answer ✔✔ true
What are the most common complications of NORA? - correct answer ✔✔ airway/respiratory
events leading to brain damage/death
What are the anesthetic considerations for neuro-interventional radiology procedures? - correct
answer ✔✔ -MAC for neuro assessment or GETA for more invasive/less tolerable procedures
-Standard induction (hyperventilate for inc ICP/ normocapnia if ICP normal)
-Blunt SNS for layrngoscopy/intubation
-RSI w/ ETT for most bc usually emergent*
-Standard maintenance +/- NMR
-Emergence: rapid neuro assessment
-Maintain euvolemia, euglycemia, and BP control
*if heparin and protamine needed in vascular cases, baseline ACT drawn + heparinize 2-3x
baseline
During anurysm coiling, the patient begins showing signs of increased ICP, is hypertensive,
bradycardia and the interventional radiologist says there is extravastion of the constrast media,
what has happened? - correct answer ✔✔ -aneurysm rupture and hemorrhage
-place EVD and book OR for craniotomy
, What are some other complications of neuro-interventional radiology procedures? - correct
answer ✔✔ -aneurysm rupture and hemorrhage
-intracranial vascular injury/dissection
-displacement or embolization of embolic material
-vasospasms
-contrast sensitivity and/or anaphylaxis
-injury to groin/access site injury
Endovascular thrombectomy/thrombolysis will require _______ of the patient's baseline ACT? -
correct answer ✔✔ heparinization 2-3x baseline
What is the TIPS procedure? - correct answer ✔✔ -Transjugular intrahepatic portosystemic
shunt (TIPS) treats ascites by threading a catheter into the portal vein by the transjugular route
and placing a shunt from the portal vein to one of the hepatic veins and bypassing the liver.
-Purpose is to decompress portal circulation in patients with portal HTN and decrease variceal
bleeding
-often last effort to bridge to transplant
What are the 2 major complications during the TIPS procedure? - correct answer ✔✔ -
arrhythmia because we are working so close to the heart and hemorrhage due to the
vascularity of the liver
-also, carotid/jugular puncture, pneumothorax, brachial plexus injury, ascites/ increased IGP,
severity of encephalopathy and airway protection abilities
Absolute contraindications of a TIPS procedure? - correct answer ✔✔ -heart failure
-severe tricuspid regurgitation
-severe pulmonary HTN (mean PAP > 45)
-sepsis
(NORA) questions well answered
T/F: non-operating room anesthesia requires the same standards of care as OR anesthesia -
correct answer ✔✔ true
What are the most common complications of NORA? - correct answer ✔✔ airway/respiratory
events leading to brain damage/death
What are the anesthetic considerations for neuro-interventional radiology procedures? - correct
answer ✔✔ -MAC for neuro assessment or GETA for more invasive/less tolerable procedures
-Standard induction (hyperventilate for inc ICP/ normocapnia if ICP normal)
-Blunt SNS for layrngoscopy/intubation
-RSI w/ ETT for most bc usually emergent*
-Standard maintenance +/- NMR
-Emergence: rapid neuro assessment
-Maintain euvolemia, euglycemia, and BP control
*if heparin and protamine needed in vascular cases, baseline ACT drawn + heparinize 2-3x
baseline
During anurysm coiling, the patient begins showing signs of increased ICP, is hypertensive,
bradycardia and the interventional radiologist says there is extravastion of the constrast media,
what has happened? - correct answer ✔✔ -aneurysm rupture and hemorrhage
-place EVD and book OR for craniotomy
, What are some other complications of neuro-interventional radiology procedures? - correct
answer ✔✔ -aneurysm rupture and hemorrhage
-intracranial vascular injury/dissection
-displacement or embolization of embolic material
-vasospasms
-contrast sensitivity and/or anaphylaxis
-injury to groin/access site injury
Endovascular thrombectomy/thrombolysis will require _______ of the patient's baseline ACT? -
correct answer ✔✔ heparinization 2-3x baseline
What is the TIPS procedure? - correct answer ✔✔ -Transjugular intrahepatic portosystemic
shunt (TIPS) treats ascites by threading a catheter into the portal vein by the transjugular route
and placing a shunt from the portal vein to one of the hepatic veins and bypassing the liver.
-Purpose is to decompress portal circulation in patients with portal HTN and decrease variceal
bleeding
-often last effort to bridge to transplant
What are the 2 major complications during the TIPS procedure? - correct answer ✔✔ -
arrhythmia because we are working so close to the heart and hemorrhage due to the
vascularity of the liver
-also, carotid/jugular puncture, pneumothorax, brachial plexus injury, ascites/ increased IGP,
severity of encephalopathy and airway protection abilities
Absolute contraindications of a TIPS procedure? - correct answer ✔✔ -heart failure
-severe tricuspid regurgitation
-severe pulmonary HTN (mean PAP > 45)
-sepsis
