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77 Cards in this Set

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  • Back
What is the most important monitoring?
vigilance of the anesthetist
What is the arterial bp generated by?
left ventricular contraction
Name 2 complications of NIBP
1. nerve palsies
2. extravasation of IVF
What is the gold standard for monitoring BP?
Art line
What causes inaccurate art line reading?
small catheter size
incorrect calibration
position
TRUE/FALSE

The catheter-tubing-transducer system must respond to the lowest frequency of the arterial waveform.
FALSE

the highest frequency(>200Hz)
What does the upstroke waveform of the art line reflect?
contractility
What does the downstroke waveform of the art line reflect?
peripheral resistance
What is the MAP in the art line waveform?
area under the pressure curve
Name 5 indications for art line monitoring
1. expected large volume loss
2. induced hypotension
3. hemodynamic instability
4. freq blood sampling
5. end organ dz requiring precise and continuous monitoring
When is art line CI?
vascular insufficiency or lack of collateral blood flow
raynaud's
What are se of axillary artery art line?
nerve damage, hematoma, retrograde flushing (air or thrombi access circulation)
Name 4 things mentioned about femoral art lines in the notes.
1. excellent access
2. higher rate of infection and thrombosis
3. pseudoaneurysm and atheroma
4. asepic necrosis of femur head in kids
Complications of art lines
(8)
1. hematoma
2. bleeding
3. vasospasm
4. arterial thrombosis
5. nerve damage
6. emboli
7. loss of digits
8. intra-arterial drug injection
factors that increase risk of art line complication
(6)
1. prolonged cannulation
2. hyperlipidemia
3. repeated attempts
4. female
5. use of vasopressors
6. extracorporeal circ.
What dysrhythmias are monitored in lead II?
inferior wall
What dysrhythmias are monitored in lead V5?
anterior and lateral wall
how do you do modified V5 monitoring with 3 leads only?
place left arm lead at v5 and select lead I on monitor
What is normal CVP according to notes?
4-8 cm H2O
What does CVP determine?
RVEDV
parallel LVDV in healthy hearts
What are uses of CVP?
(5)
1. monitor fluid volume
2. adm. fluids and corroding drug infusions
3. aspiration of air emboli
4. insertion of transcutaneous pacer wires
5. venous access in pts with poor veins
What are C/I of CVP?
(4)
1. renal cell tumor extension into RA
2. tricuspid valve vegitation
3. anticoagulants
4. ipsilateral carotid endartectomy
What are complications of CVP?
(7)
1. pneumothorax
2. infection
3. embolism
4. dysrhthmias
5. hemothorax
6. chylothorax
7. cardiac perf and tamponade
Where should the tip of the CVP catheter sit?
above the junction of SVC and RA
When in the respiratory cycle should CVP be measured?
during expiration
what is the best site for CVP
RIJ

inc risks with left sided catheters
What does the A wave represent in the CVP waveform?
atrial contraction
What does the C wave represent in the CVP waveform?
tricuspid valve elevation during early ventricular contraction
What does the V wave represent in the CVP waveform?
venous return against a closed tricuspid valve
What does the X-y wave represent in the CVP waveform?
descents caused by the downward displacement of the tricuspid valve
When is the esophageal steth C/I?
esophageal varices or strictures
What is a mandatory non-invasive monitor of arterial blood oxygenation?
pulse ox
measures tissue perf and HR
What does the pulse ox probe contain?
light source (light-emitting diodes - red and infrared)
light detector (photodiode)
Does HbO2 absorb more infrared or red light?
infrared (960nm)
Does Hb absorb more infrared or red light?
red (660nm)
Name 7 factors that influence accuracy of pulse ox reading.
1. excessive ambient light
2. motion
3. methylene blue
4. low CO, hypothermia
5. profound anemia
6. nail polish
7. bovie
90% sat, what is PaO2?
60 mHg
80% sat, what is PaO2?
50 mmHg
70% sat, what is PaO2?
40mmHg
What are some characteristics of the sidestream ETCO2?
1. aspirates continuously from breathing circuit
2. infrared light absorption
3. low dead space tubing
4. autocalibration
5. prone to H2O precip
Name 4 things that decrease ETCO2 according to lecture notes.
1. air embolism
2. decreased CO
3. decreased BP
4. increase in alveolar dead space
What separates the molecules on the basis of mass to charge ratio?
mass spectrograph
How does the mass spectrometer work?
a gas sample is aspirated into a vacuum chamber where an electron beam ionizes and fragments the components of the sample.
The BIS may reduce?
awareness
amount of GA used
PONV
PACU and hospital stay
What do EP's assess?
neural function
measure electrophysiological responses
EP's record neuronal activity as voltage vs time and further analyze what?
latency - time to response
amplitude - peak of the response
What physiologic factors may delay evoked potentials?
hypotension, moderate hypothermia (32 C)
What are electrical stimulation delivered to a sensory or mixed peripheral nerve to assess integrity of ascending sensory fibers of the dorsal SC?
Somatosensory evoked potentials
(SSEP's)
contralateral scalp electrodes will register response
What are stimulating electrodes placed on scalp with recording electrode on muscle.
Motor-evoked potentials
(MEP's)
assess integity of descending motor patways of the ventral roots of the SC
What MAC can u run with SSEP's?
0.5 MAC
Which drugs effect SSEP's and MEP's?
Barbs, benzos, opioids
also cold effects SSEP's
Which drugs have no effect on SSEP's?
N2O
NMB
What do PIA's do to amplitude and latency of SSEP's and MEP's?
dose related decrease in amplitude and increase latency
What should u avoid with MEP's?
NMB
What has no effect on MEP's?
N2O
How much is PNS decreased by for every 1 degree cent. drop in body temp?
6%
Name 11 deleterious effects of hypothermia.
1. cardiac arrhythmias and ischemia
2. increased PVR
3. left shift of hemoglobin curve - less O2 available
4. reversible coag (plt disfx)
5. postop protein catabolism and stress response
6. AMS
7. impaired renal fx
8. decreased drug metabolism
9. poor wound healing
10. increased infection rate
11. delayed awakening
What is Phase I of temp. loss?
1st hr of anesthesia - vasodilation upon induction - redistribution of blood loss
(decreased temp 1-2 C)
What is Phase II of temp loss?
gradual decline in temp over 3-4 hrs
What is Phase III of temp loss?
state of equilibrium 4 hrs p anesthesia
Where does the probe have to be for esophageal temp monitoring?
lower 3rd of esphagus
is rectal temp accurate measure of core temp?
no
What is UOP reliable indicator of?
renal, CV, fluid volume status
I don't know what this slide means, but it says indications for urine output...
oliguria, prevent reflux and infection, avoid urethral trauma, accuracy of bladder temp -- what does that mean??
What delivers an electric current of variable frequency and amplitude?
Peripheral nerve stimulator
Where are the electrodes placed for peripheral nerve stimulation?
over the nerve pathway, avoid direct muscle stimulation
What is stimulated with the ulnar nerve?
Adductor pollicis
What is stimulated with the facial nerve?
Orbicularis oculi
Which nerve takes longer to recover from muscle paralysis?
Adductor pollicis
Which muscles are the hardest to paralyze?
central
peripheral muscles paralize first, last to come back
When is single twitch response used?
mostly in research
compared to a control preblockade twitch, useful to construct dose response curves
Describe TOF
1. 4 successive stim 200 Hz in 2 seconds
2. twitches fade as relaxation increases
3. measure the ratio b/w the 1st and 4th twitches
4. indicator of paralysis
5. visual observation more accurate than estimating the ratio
With TOF, the depth of blockade is defined by the % of inhibition of the twitch response... how much block with below twitch?
4 twitch
3 twitch
2 twitch
1 twitch
4 twitch = < 75% blockade
3 twitch = 75% blockade
2 twitch = 80% blockade
1 twitch = 90% blockade
What is release of Ach to neuromuscular jx with 50 Hz/sec tetanic stimulation for 5 sec?
Tetanus

sustain muscle contraction indicate adequate reversal
What is a falsly exaggerated single twitch response?
posttetanic facilitation

for 50 hz duration is 1-2 min
Describe the posttetanic count
1. a 50hz tetanus applied for 5 sec
2. wait 3 sec and stim at 1Hz
3. this should facilitate posttetanic twitch
4. the number of twitches correlates with time
(a count of 1 = 10-20 min)
Name 3 indicators of return of muscle fx
1. head lift>5 sec
2. neg inspiratory force of -25cm H2O
3. Forceful hand grip