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63 Cards in this Set
- Front
- Back
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what is the minimum alveolar concentration MAC?
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the smallest concentration of inhalation agent that is needed to achieve sedation
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how is lipid solubility related to MAC?
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more lipid soluble medications have a smaller MAC
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does nitrous oxide have a high or low MAC?
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High
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which inhalational agent has the highest degree of cardiac depression and arrhythmias?
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Halothane
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which inhalational agent is associated with hepatitis (fever eosinophilia jaundice and elevated liver function test)?
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halothane
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which inhalational agent can cause seizures?
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enflurane
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which induction agent should be avoided in patients with egg allergies?
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Propofol
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what is the mechanism of action of ketamine?
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Disassociation of the thalamic/limbic systems
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which induction agent is contraindicated in patients with head injury?
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Ketamine due to increased cerebral blood flow
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which induction agent is associated with hallucinations and catecholamine release?
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Ketamine
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continuous infusion of which induction agent can lead to adrenocortical suppression?
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Etomidate
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which induction agent does not cause cardiorespiratory depression?
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ketamine
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which are the muscles first affected with paralytic's?
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muscles of the face and neck
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what is the last muscle to be affected by paralytics?
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diaphragm
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what is the first muscle to recover from paralytics?
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diaphragm
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what is the last muscle to recover from paralytic?
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Muscles of the face and neck
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what is the only clinically used depolarizing paralytic?
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Succinylcholine
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which induction agent has the least cardio suppressive effects?
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Etomidate
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what is the half-life of succinylcholine?
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5 min.
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what can cause a prolonged paralysis with succinylcholine?
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Decreased cholinesterase activity, seen mostly in Asians
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what is the first sign of malignant hyperthermia?
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Increase in end tidal CO2
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what is the treatment of malignant hyperthermia?
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Dantrolene which blocks calcium release, cooling, bicarbonate, and glucose
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what electrolyte abnormality is associated with succinylcholine?
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Hyperkalemia
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succinylcholine is contraindicated in which patients?
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Burn patients, spinal cord injury patients, renal failure patients, and trauma or brain injury patients
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what effect does succinylcholine have on glaucoma?
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It can turn open angle glaucoma into closed angle glaucoma by causing striated muscle contractions in the eye thereby increasing ocular pressures
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what is the mechanism of action of non-depolarizing paralytic agents?
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Compete with acetylcholine in neuromuscular junctions
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what is the effect of hypothermia on nondepolarizing paralytic agents?
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Prolonged paralytic effect, because low temperatures affect Hoffman degradation
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what is the effect of hypercapnia, acidosis on nondepolarizing paralytic agents?
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Prolonged paralytic effect, because acidosis affects Hoffman degradation
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which nondepolarizing paralytic agents can be used in hepatic and renal failure?
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atracurium, because it mainly undergoes Hoffman degradation
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which nondepolarizing paralytic agents have the shortest half-life?
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Mivacurium
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which nondepolarizing paralytic agent has the longest half-life?
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Pancuronium
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which nondepolarizing paralytic agent is eliminated by the liver?
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Rocuronium
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which nondepolarizing paralytic agent is eliminated by the kidneys?
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Pancuronium
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how can we reverse the effects of nondepolarizing paralytic agents?
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Acetylcholinesterase inhibitors such as neostigmine and edrophonium
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what is the mechanism of action of local anesthetics?
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Increase the action potential threshold, thereby prevent sodium influx and blocking the propagation of nerve pain impulses
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what are the two main groups of local anesthetics?
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Esters and amides
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which is more allergenic, esters or amides?
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Esters, because they are broken down to PABA, which is highly allergenic
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what is the maximum dose of lidocaine 1%?
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0.5 mL per kilogram or 5 mg per kilogram
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why are infected tissues hard to anesthetize?
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Due to the acidosis
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which local anesthetic have the longest length of action?
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Bupivicaine
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in which body parts is lidocaine with epinephrine avoided?
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In places with poor circulation, such as the penis, the ear, fingers, etc. because it can cause ischemia
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what is the first sign or symptom of lidocaine toxicity?
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Tongue numbness/perioral paresthesias, followed by visual/hearing disturbances, muscle twitching, loss of consciousness, and seizures. Cardio respiratory symptoms occur after the neurological symptoms and can include arrhythmias and cardiac arrest, usually V-fib.
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What is the mechanism of action of opioid narcotics?
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Mu receptor antagonists
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what is the antidote to opioids?
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Naloxone
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how are opioids eliminated?
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Metabolized by the liver, and excreted by the kidneys. Toxic metabolites can therefore build up in renal failure.
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Why do we get papillary constriction with opioids?
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Inhibition of the Edinger-Westphal nucleus in the brain
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why do we sometimes get hypotension with opioids?
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Some opioids can cause histamine release, which causes peripheral vasodilation
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why do we sometimes get bradycardia with opioids?
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Direct inhibition of the vaguest nucleus in the medulla
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with which other class of medications should opioids be avoided?
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MAO inhibitors, due to risk of hyperpyrexic coma
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why is fentanyl more potent than morphine?
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It is more lipophilic
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what is the mechanism of action of benzodiazepines?
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GABA-A receptor agonists
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what is the antidote to benzodiazepines?
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Flumazenil, a competitive GABA-A inhibitor
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what are the side effects of flumazenil?
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Seizures and arrhythmias, so avoid in a patient with epilepsy or elevated ICP because it might trigger a seizure
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which benzodiazepine is contraindicated in pregnancy?
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Versed, midazolam, because it crosses the placenta
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what is the etiology of post-spinal anesthesia headache?
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most commonly due to CSF leak from the puncture site in the dura, causing compensation of the loss of intracranial volume by vasodilation. It therefore presents the dull headache aggravated by sitting up
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how is post-spinal anesthesia headache treated?
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Rest, increased fluids, and caffeine or theophylline to vasoconstrict intra-cerebral vessels. it is usually a self-limiting problem, but if it persists, a blood patch can be used at the puncture site
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in what kind of heart conditions are spinal's and epidurals contraindicated?
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Hypertrophic cardiomyopathy and cyanotic heart disease, because finals and epidurals can cause peripheral vasodilation and patience with those cardiac problems cannot increase their cardiac output to overcome the hypotension caused by the peripheral vasodilation
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why is fentanyl preferred and thoracic epidurals?
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because it has less cardiovascular side effects than morphine
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what is the most common PACU complication?
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Nausea and vomiting
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how far should an endotracheal tube be in relation to the Carina?
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2 cm above the Carina
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what is the best way to confirm placement of an endotracheal tube?
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End tidal CO2
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what is the most common cause of a sudden drop in endotracheal CO2?
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Most commonly due to disconnection from the ventilator. Although it can be a PE or severe hypotension
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what is the most common cause of a sudden rise in the endotracheal CO2?
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alveolar hypoventilation. Treat by increasing the title volume or respiratory rate
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