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Flashcards

Anesthesia - Absite

Jennifer Huber Surgery - Absite Review English 93 cards

Cards in this deck (93)

  1. 1What is MAC, minimum alveolar concentrations?smallest concentration of inhalational agent in which 50% of patients will not move with incision
    small MAC = more lipid soluble = more potent
  2. 2what is the fastest inhalation induction agent but low potencyNitrous Oxide
  3. 3Effects of inhalation induction agentsunconsciousness, amnesia, and some analgesia
    Many cause myocardial depression, increased CBF and decreased RBF
  4. 4Nitrous Oxidefast, minimal myocardial depression; tremors at induction
    Avoid in SBO or pneumothorax pts
  5. 5Halothaneslow onset/offset
    highest degree of cardiac depression and arrhythmias, least pungent (good for kiddos)
  6. 6Side Effects of HalothaneHalothane Hepatitis
    fever, eosinophilia, jaundice, elevated LFTs
  7. 7Sevofluraneinhalation induction
    fast, less laryngospasm and less pungant
    good for mask induction
  8. 8Isofluraneinhalation induction agent
    good for neurosurgery
    lowers brain O2 consumption, no increase in ICP
    PUNGENT
  9. 9Enflurane can cause what?seizures
  10. 10MCC of intra-op bradycardia and its treatmentinhalation anesthesia
    Tx: Atropine
  11. 11Propofol UseIV induction agent, very rapid distribution and on/off; provide anesthesia and amnesia
  12. 12Side effects of propofolHoTN, respiratory depression, metabolic acidosis
  13. 13Patients not to use propofol inegg allergy, pregnancy or parkinson's
  14. 14How is Propofol Metabolized?by liver and plasma cholinesterases
  15. 15Effects of Ketaminedissociation of thalamic/limbic systems
    places patient in cataleptic state (amnesia, analgesia
    No respiratory depression
  16. 16Side Effects of Ketaminehallucinations, catecholamine release (increase CO2, tachycardia)
    increased airway secretions, increase CBF
    (don't use in patients w/ head injuries)
  17. 17Continuous infusions of this inhalation induction agent can lead to adrenocortical suppressionEtomidate
  18. 18Dexmedetomidine (Precedex)sedation agent, provide anesthesia and analgesia without blunting hypoxic drive
    CNS alpha-2 receptor agonist
  19. 19What is the last muscle to go down and the first muscle to recover from paralysis?Diaphragm
  20. 20First muscles to go down and last to recover from paralyticsNeck muscles and Face
  21. 21Depolarizing AgentsSuccinylcholine
    depolarizes NMJ
  22. 22Effects of Succinylcholinefast, short acting, causes fasciculations, increases ICP, degraded by plasma pseudocholinesterases
  23. 23Side effects of succinylcholineMalignant Hyperthermia
    Hyperkalemia
  24. 24Malignant Hyperthermiad/t defect in calcium metabolism
    Calcium release from SR cause muscle excitation-contraction
    fever, tachycardia, rigidity, acidosis, hyperK, rhabdomyolysis
  25. 25Tx of Malignant HyperthermiaDantrolene 10mg/kg, inhibits Ca release and decouples excitation complex
    cooling blankets, HCO3, Glucose, Supportive
  26. 26Patients to NOT use succinylcholinesevere burns, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure, open-angle glaucoma
  27. 27MoA of Nondepolarizing Agentsinhibit neuromuscular junction by competing with acetylcholine
  28. 28Cis-atracurium what is it? how is it eliminated? common s/enondepolarizing agent
    Hoffman elimination
    can be used in liver and renal failure b/c broken down in blood
    Histamine release (HoTN)
  29. 29Rocuronium what is it? how it's metabolizedNondepolarizing Agent
    Fast Acting
    Hepatic Metabolism
  30. 30Pancuronium what is it? how its metabolized MC s/enondepolarizing agent
    slow acting, long-lasting
    renal metabolism
    s/e: tachycardia (no HoTN)
  31. 31Reversing Agents for Nondepolarizing AgentsNeostigmine
    Edrophonium by blocking AChE, increasing ACh.
    Also give Atropine and Glycopyrrolate
    to counteract ACh overdose with treatment
  32. 32How do Local Anesthetics work?increases action potential threshold, preventing Na influx
  33. 33What is the maximum dosing of lidocaine?4mg/kg or 7mg/kg with epinephrine
  34. 34What is the maximum dosing of Buprivacaine?2mg/kg or 3mg/kg with epinephrine
  35. 35Why are infected tissues more difficult to anesthetize?Acidosis
  36. 36Side effects of local anesthesiaperioral paresthesias (1st sign), tremors, seizures, tinnitus, arrhythmias, (CNS symptoms before cardiac)
  37. 37When should you not use epinephrine with local anesthetics?arrhythmias, unstable angina, uncontrolled HTN, poor collaterals (penis, ear), uteroplacental insufficiency
  38. 38List of Amide Local Anesthetics(all have 'i' in the first part of the name)
    Lidocaine, Bupivacaine, Mepivacaine
  39. 39List of Ester Local AnestheticsTetracaine, Procaine, Cocaine
    increased chances of allergic reactions d/t PABA analogue
  40. 40Opioid Receptorsmu
  41. 41Effects of opioidsanalgesia, respiratory depression, no cardiac effects, blunt sympathetic response
  42. 42Where are narcotics metabolized?Liver
  43. 43Tx for narcotic overdoseNarcan (Naloxone)
    mu-opioid receptor antagonist
  44. 44Why shouldn't you use narcotics in patients with MAO-i use?can cause hyperpyrexic coma, serotonin release syndrome, fever, tachycardia, seizures, coma
  45. 45Effects of Morphineanalgesia, euphoria, respiratory depression, miosis, constipation, histamine release (causing HoTN), decreased cough
  46. 46Effects of Demerolanalgesia, euphoria, respiratory depression, miosis, tremors, fasciculations, convulsions
  47. 47Why don't you give Demerol to patients in renal failure?can cause seizures, build up of normeperidine analogues
  48. 48Methadonestimulates morphine, less euphoria, agonist to CNS mu-receptor
  49. 49Fentanylfast acting, 80x strength of morphine
    doesn't cross react in patients with morphine allergy
    no histamine release
  50. 50What is the most potent narcotic?Sufentanil
    it is very short acting with a
    very short half life
    Remifentanyl also is short acting with very short half-life
  51. 51Effects of Benzodiazepinesanticonvulsant, amnesic, anxiolytic, respiratory depression, NOT an analgesic
  52. 52Receptor associated with benzodiazepinesAgonist to GABA in the CNS
    most prevalent inhibitory brain receptor
  53. 53Versed other name and contraindicationMidazolam, Benzodiazepine
    short acting, contraindicated in pregnancy
    crosses placenta
  54. 54What is Valium?Diazepam, a long-acting benzodiazepine
  55. 55What is Ativan?Lorazepam, a long acting benzodiazepine
  56. 56Treatment for Benzodiazepine overdoseFlumazenil
    its a competitive inhibitor, may cause seizures and arrhythmias
    c/i in patients with status epilepticus and elevated ICP
  57. 57How epidural anesthesia worksallows analgesia by sympathetic denervation (sensory blockade)
    vasodilation
  58. 58Effects of Morphine in an epiduralRespiratory Depression
    (use dilaudid to avoid this)
  59. 59Lidocaine in an epiduralcan cause decreased HR and BP
  60. 60Treatment for a patient who develops acute HoTN and Bradycardia during an epiduralturn epidural down, give fluids, phenylephrine, atropine
  61. 61Why can't you use an epidural in patients with HCM or cyanotic heart disease?sympathetic denervation
    causes decreased afterload
  62. 62Area to place an epidural for thoracotomyT6-T9
  63. 63Area to place an epidural for laparotomyT8-T10
  64. 64Spinal Anesthesiainject into subarachnoid space, spread determined by baricity and patient position
    inject below L2
  65. 65Caudal Blockthrough sacrum, good for pediatric hernias and perianal surgery
  66. 66Epidural and Spinal ComplicationsHoTN, HA, Urinary retention, Abscess, Hematoma, Respiratory Depression
  67. 67What are spinal HAs and how to treat themcaused by CSF leak after spinal/epidural
    HA worsens with sitting up
    Tx: rest, fluids, caffeine, analgesics
    if persists >24hrs, blood patch it
  68. 68Initial Treatment for Post-op MIbeta-blocker, morphine, oxygen, ASA, sublingual nitrates
  69. 69What to do for patient with STEMI post-op?emergent cardiac cath lab for intervention
  70. 70Patients who need pre-op cardiac work upangina, prev MI, SOB, CHF, walks <2block d/t SOB/CP, FEV1 <70% predeicted, severe valvular dx, PVCs >5/min, high grade heart block, >70y/o, DM, renal insufficiency, those undergoing major vasc. surgery
  71. 71ASA Physical Status Class IHealthy
  72. 72ASA Physical Status Class IImild disease without limitation
    ctrl'd HTN, obesity, SM, smoking hx,
    older age
  73. 73ASA Physical Status Class IIISevere Disease (angina, prev MI, poorly ctrl HTN, DM w/ complications, mod COPD)
  74. 74ASA Physical Status Class IVSevere Constant Threat to Life
    unstable angina, CHF, renal failure, liver failure, severe COPD
  75. 75ASA Physical Status Class VMoribund (ruptured AAA, saddle pulmonary embolism)
  76. 76ASA Physical Status Class VIDonor
  77. 77ASA Physical Status Class EEmergency
  78. 78Biggest Risk Factors for postop MIuncompensated CHF, recent MI, age >70, DM, previous MI, unstable angina, Cr >2, stroke/TIA
  79. 79Most effective cardiac med to prevent intra-op and post-op cardiovascular eventsBeta-blocker
  80. 80How long should you wait after an MI before doing an elective surgery?6-8weeks
  81. 81What is a high cardiac risk for a noncardiac surgical patient?cardiac risk >5%
    emergent operations (esp elderly)
    aortic, peripheral and other major vascular surgery (except CEA)
    Long surgeries with large fluid shifts
  82. 82What is a Intermediate cardiac risk for a noncardiac surgical patient?Cardiac Risk <5%
    CEA, head and neck surgery
    intraperitoneal and intrathoracic surgery
    orthopedic and prostate surgeries
  83. 83What is a Low cardiac risk for a noncardiac surgical patient?cardiac risk <1%
    endoscopic procedures, superficial procedures, cataract surgery, breast surgery
  84. 84Best determinant of esophageal vs tracheal intubationend-tidal CO2 (ETCO2)
  85. 85Intubated patient undergoing surgery with sudden transient RISE in ETCO2 - most likely cause - treatment - possible other causesMC: Hypoventilation
    Tx: increase tidal volume or increase RR
    other: CO2 embolus or malignant hyperthermia
  86. 86Causes for an intubated patient with sudden DROP in ETCO2disconnected from vent
    pulmonary or air embolism
  87. 87Symptoms of Air Embolismsudden drop in ETCO2
    HoTN, tachycardia, mill wheel murmur
    (air lock prevents venous return)
  88. 88Treatment of Air EmbolismStop CO2 insufflation if lap procedure
    Trendelenburg and left lateral decubitus
    (keeps air from right ventricle)
    hyperventilate with 100% oxyegn
    aspiration central line
    pressors + inotropes, prolonged CPR
  89. 89ETT placement should be how far above carina?2cm
  90. 90MC PACU complicationnausea and vomiting
  91. 91MCC of post-op hypoxemiaatelectiasis
    (alveolar hypoventilation)
  92. 92MCC of postop hypercarbiapoor minute ventilation
    need to take bigger breaths or
    increase tidal volumes
  93. 93Signs of inadequate pain controltachycardia, diaphoresis, splinting, HTN

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Surgery - Absite Review Flashcards on Anesthesia - Absite, created by Jennifer Huber on 05/06/2018.
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Jennifer Huber
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