14058263
Description
Flashcards by Jennifer Huber, updated more than 1 year ago
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Created by Jennifer Huber
over 7 years ago
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| Question | Answer |
| What 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 |
| what is the fastest inhalation induction agent but low potency | Nitrous Oxide |
| Effects of inhalation induction agents | unconsciousness, amnesia, and some analgesia Many cause myocardial depression, increased CBF and decreased RBF |
| Nitrous Oxide | fast, minimal myocardial depression; tremors at induction Avoid in SBO or pneumothorax pts |
| Halothane | slow onset/offset highest degree of cardiac depression and arrhythmias, least pungent (good for kiddos) |
| Side Effects of Halothane | Halothane Hepatitis fever, eosinophilia, jaundice, elevated LFTs |
| Sevoflurane | inhalation induction fast, less laryngospasm and less pungant good for mask induction |
| Isoflurane | inhalation induction agent good for neurosurgery lowers brain O2 consumption, no increase in ICP PUNGENT |
| Enflurane can cause what? | seizures |
| MCC of intra-op bradycardia and its treatment | inhalation anesthesia Tx: Atropine |
| Propofol Use | IV induction agent, very rapid distribution and on/off; provide anesthesia and amnesia |
| Side effects of propofol | HoTN, respiratory depression, metabolic acidosis |
| Patients not to use propofol in | egg allergy, pregnancy or parkinson's |
| How is Propofol Metabolized? | by liver and plasma cholinesterases |
| Effects of Ketamine | dissociation of thalamic/limbic systems places patient in cataleptic state (amnesia, analgesia No respiratory depression |
| Side Effects of Ketamine | hallucinations, catecholamine release (increase CO2, tachycardia) increased airway secretions, increase CBF (don't use in patients w/ head injuries) |
| Continuous infusions of this inhalation induction agent can lead to adrenocortical suppression | Etomidate |
| Dexmedetomidine (Precedex) | sedation agent, provide anesthesia and analgesia without blunting hypoxic drive CNS alpha-2 receptor agonist |
| What is the last muscle to go down and the first muscle to recover from paralysis? | Diaphragm |
| First muscles to go down and last to recover from paralytics | Neck muscles and Face |
| Depolarizing Agents | Succinylcholine depolarizes NMJ |
| Effects of Succinylcholine | fast, short acting, causes fasciculations, increases ICP, degraded by plasma pseudocholinesterases |
| Side effects of succinylcholine | Malignant Hyperthermia Hyperkalemia |
| Malignant Hyperthermia | d/t defect in calcium metabolism Calcium release from SR cause muscle excitation-contraction fever, tachycardia, rigidity, acidosis, hyperK, rhabdomyolysis |
| Tx of Malignant Hyperthermia | Dantrolene 10mg/kg, inhibits Ca release and decouples excitation complex cooling blankets, HCO3, Glucose, Supportive |
| Patients to NOT use succinylcholine | severe burns, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure, open-angle glaucoma |
| MoA of Nondepolarizing Agents | inhibit neuromuscular junction by competing with acetylcholine |
| Cis-atracurium what is it? how is it eliminated? common s/e | nondepolarizing agent Hoffman elimination can be used in liver and renal failure b/c broken down in blood Histamine release (HoTN) |
| Rocuronium what is it? how it's metabolized | Nondepolarizing Agent Fast Acting Hepatic Metabolism |
| Pancuronium what is it? how its metabolized MC s/e | nondepolarizing agent slow acting, long-lasting renal metabolism s/e: tachycardia (no HoTN) |
| Reversing Agents for Nondepolarizing Agents | Neostigmine Edrophonium by blocking AChE, increasing ACh. Also give Atropine and Glycopyrrolate to counteract ACh overdose with treatment |
| How do Local Anesthetics work? | increases action potential threshold, preventing Na influx |
| What is the maximum dosing of lidocaine? | 4mg/kg or 7mg/kg with epinephrine |
| What is the maximum dosing of Buprivacaine? | 2mg/kg or 3mg/kg with epinephrine |
| Why are infected tissues more difficult to anesthetize? | Acidosis |
| Side effects of local anesthesia | perioral paresthesias (1st sign), tremors, seizures, tinnitus, arrhythmias, (CNS symptoms before cardiac) |
| When should you not use epinephrine with local anesthetics? | arrhythmias, unstable angina, uncontrolled HTN, poor collaterals (penis, ear), uteroplacental insufficiency |
| List of Amide Local Anesthetics | (all have 'i' in the first part of the name) Lidocaine, Bupivacaine, Mepivacaine |
| List of Ester Local Anesthetics | Tetracaine, Procaine, Cocaine increased chances of allergic reactions d/t PABA analogue |
| Opioid Receptors | mu |
| Effects of opioids | analgesia, respiratory depression, no cardiac effects, blunt sympathetic response |
| Where are narcotics metabolized? | Liver |
| Tx for narcotic overdose | Narcan (Naloxone) mu-opioid receptor antagonist |
| Why shouldn't you use narcotics in patients with MAO-i use? | can cause hyperpyrexic coma, serotonin release syndrome, fever, tachycardia, seizures, coma |
| Effects of Morphine | analgesia, euphoria, respiratory depression, miosis, constipation, histamine release (causing HoTN), decreased cough |
| Effects of Demerol | analgesia, euphoria, respiratory depression, miosis, tremors, fasciculations, convulsions |
| Why don't you give Demerol to patients in renal failure? | can cause seizures, build up of normeperidine analogues |
| Methadone | stimulates morphine, less euphoria, agonist to CNS mu-receptor |
| Fentanyl | fast acting, 80x strength of morphine doesn't cross react in patients with morphine allergy no histamine release |
| What 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 |
| Effects of Benzodiazepines | anticonvulsant, amnesic, anxiolytic, respiratory depression, NOT an analgesic |
| Receptor associated with benzodiazepines | Agonist to GABA in the CNS most prevalent inhibitory brain receptor |
| Versed other name and contraindication | Midazolam, Benzodiazepine short acting, contraindicated in pregnancy crosses placenta |
| What is Valium? | Diazepam, a long-acting benzodiazepine |
| What is Ativan? | Lorazepam, a long acting benzodiazepine |
| Treatment for Benzodiazepine overdose | Flumazenil its a competitive inhibitor, may cause seizures and arrhythmias c/i in patients with status epilepticus and elevated ICP |
| How epidural anesthesia works | allows analgesia by sympathetic denervation (sensory blockade) vasodilation |
| Effects of Morphine in an epidural | Respiratory Depression (use dilaudid to avoid this) |
| Lidocaine in an epidural | can cause decreased HR and BP |
| Treatment for a patient who develops acute HoTN and Bradycardia during an epidural | turn epidural down, give fluids, phenylephrine, atropine |
| Why can't you use an epidural in patients with HCM or cyanotic heart disease? | sympathetic denervation causes decreased afterload |
| Area to place an epidural for thoracotomy | T6-T9 |
| Area to place an epidural for laparotomy | T8-T10 |
| Spinal Anesthesia | inject into subarachnoid space, spread determined by baricity and patient position inject below L2 |
| Caudal Block | through sacrum, good for pediatric hernias and perianal surgery |
| Epidural and Spinal Complications | HoTN, HA, Urinary retention, Abscess, Hematoma, Respiratory Depression |
| What are spinal HAs and how to treat them | caused by CSF leak after spinal/epidural HA worsens with sitting up Tx: rest, fluids, caffeine, analgesics if persists >24hrs, blood patch it |
| Initial Treatment for Post-op MI | beta-blocker, morphine, oxygen, ASA, sublingual nitrates |
| What to do for patient with STEMI post-op? | emergent cardiac cath lab for intervention |
| Patients who need pre-op cardiac work up | angina, 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 |
| ASA Physical Status Class I | Healthy |
| ASA Physical Status Class II | mild disease without limitation ctrl'd HTN, obesity, SM, smoking hx, older age |
| ASA Physical Status Class III | Severe Disease (angina, prev MI, poorly ctrl HTN, DM w/ complications, mod COPD) |
| ASA Physical Status Class IV | Severe Constant Threat to Life unstable angina, CHF, renal failure, liver failure, severe COPD |
| ASA Physical Status Class V | Moribund (ruptured AAA, saddle pulmonary embolism) |
| ASA Physical Status Class VI | Donor |
| ASA Physical Status Class E | Emergency |
| Biggest Risk Factors for postop MI | uncompensated CHF, recent MI, age >70, DM, previous MI, unstable angina, Cr >2, stroke/TIA |
| Most effective cardiac med to prevent intra-op and post-op cardiovascular events | Beta-blocker |
| How long should you wait after an MI before doing an elective surgery? | 6-8weeks |
| What 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 |
| What 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 |
| What is a Low cardiac risk for a noncardiac surgical patient? | cardiac risk <1% endoscopic procedures, superficial procedures, cataract surgery, breast surgery |
| Best determinant of esophageal vs tracheal intubation | end-tidal CO2 (ETCO2) |
| Intubated patient undergoing surgery with sudden transient RISE in ETCO2 - most likely cause - treatment - possible other causes | MC: Hypoventilation Tx: increase tidal volume or increase RR other: CO2 embolus or malignant hyperthermia |
| Causes for an intubated patient with sudden DROP in ETCO2 | disconnected from vent pulmonary or air embolism |
| Symptoms of Air Embolism | sudden drop in ETCO2 HoTN, tachycardia, mill wheel murmur (air lock prevents venous return) |
| Treatment of Air Embolism | Stop 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 |
| ETT placement should be how far above carina? | 2cm |
| MC PACU complication | nausea and vomiting |
| MCC of post-op hypoxemia | atelectiasis (alveolar hypoventilation) |
| MCC of postop hypercarbia | poor minute ventilation need to take bigger breaths or increase tidal volumes |
| Signs of inadequate pain control | tachycardia, diaphoresis, splinting, HTN |
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