Absite 8: Anesthesia

Front 1

define MAC:
how this is associated with solubility

Back 1

minimum alveolar concentration, smallest concentration of inhalation agent at which 50% of patients will not move with surgical stimulus
Small MAC= increased lipids solubility= high potency= slow onset

Front 2

inhalation agent:
Fast, minimal cardiac depression

Back 2

nitric oxide

Front 3

inhalation agent:
slow, highest degree of cardiac depression and arrhythmia,
least pungent, best for children

Back 3

halothane

Front 4

fever, eosinophilia, jaundice, increased LFTs following inhalation anesthetic use

Back 4

halothane hepatitis

Front 5

inhalation agent:
can cause seizures

Back 5

enflurane

Front 6

inhalation agent:
good for neurosurgery, less effect on intracranial pressure

Back 6

isoflurane

Front 7

inhalation agent:
less myocardial depression,
fast onset/offset
Less laryngeal spasm

Back 7

sevoflurane

Front 8

sodium thiopental:
Onset
Side effects

Back 8

fast acting
Decrease cerebral blood flow and metabolic rate, decreased blood pressure

Front 9

propofol
Onset
Advantages
Side effects
Disadvantage
Contraindicated patient's with this allergy

Back 9

very rapid distribution, on/off
Amnesia and sedation
Hypotension, respiratory depression
Not an analgesic
Egg allergy

Front 10

ketamine
Type of amnesia
Advantages
Side effects
Contraindicated in these patients

Back 10

disassociation of the thalamic/limbic system, places patient in cataleptic state
No respiratory depression
Hallucination, catecholamine release, tachycardia, increased airway secretions, increase cerebral blood flow
Contraindicated in head injury

Front 11

induction agent:
fewer hemodynamic changes
Fast acting
Good for intubation

Back 11

etomidate

Front 12

etomidate
Continuous infusions can lead to __

Back 12

adrenocortical suppression

Front 13

5 indications for rapid sequence intubation

Back 13

recent oral intake
GERD
Delayed gastric emptying
Pregnancy
bowel obstruction

Front 14

this is the last muscle to go down and the first muscle to recover from paralytics

Back 14

diaphragm

Front 15

first muscle group could go down and last to recover from paralytics

Back 15

neck and facial muscles

Front 16

malignant hyperthermia
Seen after succinylcholine use
First sign
Additional signs and symptoms
Treatment

Back 16

increase end title CO2
Fever, tachycardia, rigidity, acidosis, hyperkalemia
dantrolene

Front 17

succinylcholine is contraindicated in these 6 patient types

Back 17

burn patient
Neurologic injury
Neuromuscular disorders
Spinal cord injury
Massive trauma
Acute renal failure

Front 18

nondepolarizing paralytic:
Undergoes Hoffman degradation
can be used in the liver and renal failure
Histamine release

Back 18

cis-atracurium

Front 19

nondepolarizing paralytic:
rapid onset, short acting
Degradation by plasma cholinesterase
Histamine release

Back 19

mivacurium

Front 20

most common side effects of pancuronium

Back 20

tachycardia

Front 21

name 2 reversing drugs for nondepolarizing paralytics,
Mechanism of action
Should be given with these to counter act acetylcholine overdose

Back 21

neostigmine and edrophonium
Both block a acetylcholinesterase
give atropine or glycopyrrolate

Front 22

maximum dosage of lidocaine

Back 22

0.5 cc per kilogram of 1% lidocaine

Front 23

when is lidocaine with epinephrine contraindicated

Back 23

arrhythmias
Unstable angina
Uncontrolled hypertension
Poor collaterals, (penis and ear)
Uteroplacental insufficiency

Front 24

which class of local anesthetic increase allergic reaction secondary to PABA analog

Back 24

esters- (one I)

Front 25

morphine
Significant effects

Back 25

decreased cough
Constipation
Histamine release

Front 26

Demerol
Significant effects

Back 26

tremors
Fasciculations
Convulsions

Front 27

Demerol
Advantage over morphine
Avoid in these patients, why

Back 27

no histamine release
Avoid in renal failure. Can get buildup of normeperidine analogue resulting in seizures

Front 28

this benzodiazepine is contraindicated in pregnancy, why

Back 28

Versed (midazolam and pregnancy)
crosses placenta

Front 29

give affect of each in the epidural
Morphine
Lidocaine

Back 29

morphine-respiratory depression
Lidocaine-bradycardia and hypotension

Front 30

treatment for acute hypotension and bradycardia in a patient with epidural

Back 30

turned epidural down
Fluids
Phenylephrine
Atropine

Front 31

6 complications of epidural and spinal anesthesia

Back 31

hypotension
Headache
Urinary retention
abscess/hematoma formation
Neurologic impairment
Respiratory depression (high spinal)

Front 32

treatment for spinal headache

Back 32

breast, IV fluids, caffeine, analgesics
Blood patch if pain persists >24 hours

Front 33

described ASA class I II and III

Back 33

I-healthy
II-mild disease, no limitation (controlled with medication)
III-severe disease (poor medical control)

Front 34

describe ASA class 4, 5 and 6

Back 34

4-severe constant threat to life
5- moribund, expected to die with or without surgery
6- deceased, i.e. donor
add E. for emergency cases

Front 35

5 main risk factors for postoperative MI

Back 35

H. greater than 70
Diabetes
Previous MI
CHF
Unstable angina

Front 36

best determinate of esophageal versus tracheal intubation

Back 36

end-tidal CO2

Front 37

intubated patient undergoing surgery with sudden transient rise in end-title CO2
diagnosis
treatment

Back 37

alveolar hypoventilation
Increase tidal volume or increase respiratory rate

Front 38

3 differential diagnosis for intubated patient with sudden drop in end-tidal CO2

Back 38

disconnection from the vent
Pulmonary embolism
Significant hypotension