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77 Cards in this Set
- Front
- Back
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Why are inhalation anesthetics avoided in elevated ICP patients?
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They cause peripheral vasodilation and decrease autoregulation, both leading to increased intracranial pressure.
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True or false: ketamine causes an increase in ICP due to vasodilation, but is still useful in hemodynamically unstable patients.
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True
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If you are worried about aspiration, which paralytic drug would you use?
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Succinylcholine (most rapid onset; used for full stomach too)
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What PaCO2 level is desired to control ICP?
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28-32mmHg
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Explain what happens in the brain of a hypovolemic patient with iatrogenic tachypnea.
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Their hypovolemia leads to reflexive cerebrovasodilation to maintain CBF, but the tachypnea blows off the CO2, which leads to decreased CBF and cerebral ischemia.
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What factors are required for successful weaning from mechanical ventilation?
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* Vital capacity > 15 ml.kg-1.
* Alveolar-to-arterial difference for oxygen <350 mm Hg breathing 100% oxygen. * Arterial-to-alveolar PaO2 ratio > 0.75. * PaO2 > 60 mm Hg * pHa > 7.3 * PaCO2 < 50 mm Hg * Maximum inspiratory pressure greater than - 20 cm H2O. * Dead space-to-tidal volume ratio < 0.6. |
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Name some side effects of mu-opoid receptor agonists (e.g. remifentanil, morphine, etc.).
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Decreased sympathetic output (decreased HR & BP), respiratory depression, constipation, pruritis (histamine release), etc.
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What percent of adult patients undergoing anesthesia have some degree of coronary artery disease?
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5-10%
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What is the chance of having perioperative MI if a patient had an MI 3 months ago? 3 - 6 months out?
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30%
15% |
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True or false: a history of a coronary bypass surgery increases your chance of a perioperative MI.
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False
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Name three factors that increase the chance of a perioperative MI.
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Surgery lasting more than 3 hours
Intrathoracic surgeries Intraabdominal surgeries |
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What is the most reliable preoperative finding for predicting postoperative myocardial morbidity?
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CHF
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Technetium is taken up by recently infarcted myocardium and allows for estimation of infarct size
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True
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True or false: Narcotics have no intrinsic negative inotropic effects and are very useful in patients with cardiomyopathy.
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True
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Within what time range should an ESRD patient get dialysis?
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Within 24 hours
Corrects uremia (platelet function and pericardial perfusion) Corrects metabolic acidosis and hyperkalemia Corrects fluid volume |
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What percentage of the general population has IDDM?
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2-3%
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Why would you use rocuronium or cis-atracurium over succinylcholine in an ESRD patient?
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Succinylcholine has the potential of producing hyperkalemia
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Which drug lasts longer at increasing BP: epinephrine or ephedrine?
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Ephedrine (lasts 10x longer)
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Can you give lactated Ringer's to an ESRD patient? Why or why not?
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No. Each liter of LR has 4 mEq of potassium, which should not be given to anuric patients.
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Which class of drugs should not be taken with meperidine (demerol)?
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MAOIs (serotonin syndrome)
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What happens to the minute ventilation during pregnancy?
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It increases by 50%
Tidal volume increases by 40% and breathing frequency increases by 10% |
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What happens to the vital capacity and total lung capacity during pregnancy?
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Stays the same
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What laboratory test should be attained before placement of an epidural?
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Coagulation panel
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What are three side effects of high magnesium levels (during treatment of eclampsia with magnesium sulfate)?
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Severe skeletal muscle weakness, hypoventilation, and cardiac arrest
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True or false: Inhaled concentrations of oxygen should be at least 50% to ensure maximal oxygen delivery to the fetus
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True
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True or false: The risks of laryngospasm and bronchospasm are increased in the patient with an active upper respiratory infection
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True
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True or false: Physostigmine may increase the state of consciousness in patients sedated by diazepam, midazolam or ketamine
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True
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Who was the "first" anesthesiologists? He was also popularized chloroform.
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John Snow
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True or false: GB used ether and US used chloroform.
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False. Direct opposite
Ether stimulates ventilation and maintains BP Chloroform suppresses ventilation |
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Name the effect of anesthetic meds on BP.
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Decreased, except for N2O and ketamine
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Name the effect of anesthetic meds on SVR.
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All decrease
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Name the effect of anesthetic meds on CO.
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No change: Isoflurane & desflurane (COID)
Decrease: halothane & enflurane Increase: N2O |
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Name the effect of anesthetic meds on preload.
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All decrease due to peripheral vasodilation
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Name the effect of anesthetic meds on HR.
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Increased: desflurane (high doses) & enflurane
No change: halothane and N2O |
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Name that drug: ameliorates S/S of opioid withdrawal and tobacco craving
Decreases the MAC of injected and inhaled drugs Attenuates SNS response evoked from laryngoscopy Injected epidurally/intrathecally to produce analgesia w/o causing hypoventilation/pruritis/nausea/vomiting. |
Clonidine
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What effect does fluorination have on inhaled anesthetics?
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Decrease toxicity and increase stability.
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How does halothane differ from the other anesthetics with respect to lowering MAP?
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Halothane decreases CO, whereas the rest decrease SVR
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True or false: propofol reduces wheezing and decreases response to hypoxia and hypercapnia.
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True
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What two brain centers are dissociated by ketamine?
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Limbic and thalamus
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Name that drug: highly selective alpha-2 adrenergic agonist; awake fiberoptic tracheal intubation; resembles physiologic sleep state w/o respiratory depression.
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Dexmedetomidine
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True or false: neuraxial opioids are specific for visceral rather than somatic pain.
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True
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Name that drug: causes increased intragastric pressure, increased intraoccular pressure, hyperkalemia, bradyarrhythmia, myoglobinuria, trismus, etc.
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Succinylcholine
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True or false: aminoglycosides potentiate neuromuscular blockade.
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True
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True or false: Ca-channel blockers and hypokalemia potentiate neuromuscular blockade.
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True
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True or false: hypothermia and decreased pH potentiate NM-blockade.
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True
Hypothermia (vecuronium and atracurium) Decreased pH (atracurium) |
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What % of receptors can be occupied and still have normal appearing neuromuscular function on nerve stimulator?
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75-80%
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True or false: there is more systemic hypotension if epinephrine is not added to the epidural anesthetic solution.
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False. There is less systemic hypotension
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Which age group has the highest risk of dural puncture headache?
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Teenagers (also more common in pregnant women, history of dural headache)
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Name the level of anesthesia for the following surgeries:
C-section Perineal Foot Lower abdominal Upper abdominal |
C-section: T-4
Perineal: T-10 Foot: L2/3 Lower abdominal: T-6 Upper abdominal: T-4 |
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True or false: you have decreased pulmonary compliance and impairment jugular venous drainage in the prone position.
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True
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What are complications of glucose-containing fluids given intraoperatively?
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Osmotic diuresis, cerebral acidosis, hyperglycemic-induced hyperosmolality, and hypoglycemia with abrupt discontinuation of glucose-containing solution.
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Which of the following has a greater capacity to remain in IV space and is a more efficient volume expaneder: colloid or crystalloid?
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Colloid
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Give three examples of a colloid solution.
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Albumin, hydroxyl ethyl starch, and dextran
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True or false: phenylephrine improves coronary perfusion pressure but increases heart oxygen requirement.
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True
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What is the grading system for posoperative outcome for COPD?
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BODE
BMI Obstruction (airflow) Dyspnea Exercise capacity |
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What are some predictive PFTs for post-thoracic surgery morbidity (e.g. FEV1, FEV1:FVC, VC, max)
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FEV1 < 2L
FEV1:FVC < 0.5 VC < 15mL/kg Max breathing < 50% predicted |
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True or false: there is a decrease in CVP in pregnancy.
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False, there is no change in central venous pressure.
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When would a spinal anesthetic be preferred to an epidural in labor?
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Advanced stages of labor
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What is the timeline for development for abruptio placenta and preeclampsia/ecclampsia?
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After 20 weeks for all three.
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What increases the risk of elective surgery on a patient with an URI?
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Endotracheal tube (10X risk)
LMA (<10X risk) Younger age |
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True or false: the APGAR score predicts longterm outcome.
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False
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Compare and contrast effect of barbiturates and propofol on ventilation, SBP and HR.
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Barbiturates: ventilation decreases, SBP decreases, HR increases
Propofol: ventilation decreases, SBP decreases, HR same or decreases |
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Is there a depression of ventilation with ketamine?
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No
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Name a medical condition where ketamine would be a helpful anesthetic.
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Asthma (bronchodilates due to its sympathetic activity)
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Name the effect of benzos on HR and SBP.
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No change for either
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What effect does morphine have on SBP and why?
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Decreases SBP due to histamine release
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Which physiological state increases ones sensitivity to the cardiotoxicity of bupivicaine?
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Pregnancy
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What are the side effects of pancuronium?
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Increased HR and CO
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Which chemical compound is released in rapid administration of nearly every nondepolarizing NMBD?
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Histamine (decreased BP with reflexive increased HR)
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Which lung variable increases with age?
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FRC (amount of air in lung after normal expiration.
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What is the MI risk perioperatively at the following times post-MI:
3 months 3-6 months 6 months |
3 months: 37%
3-6 months: 15% 6 months: 5% |
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Why is sevoflurane a better induction agent in the pediatric population as compared to isoflurane?
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Sevoflurane has a better taste than isoflurane
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Which inhalation anesthetic is the most arrhythmogenic?
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Halothane
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True or false: the ventilatory pattern of inhaled anesthetics and opioids are opposite.
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True. Opioids cause slow and deep respirations, whereas inhaled anesthetics causes fast and shallow respirations.
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How long does it take for a smoker's carboxyhemoglobin levels to return to normal?
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12-24 hours
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How do you calculate cerebral perfusion pressure?
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CPP = MAP - (RAP or ICP)
Use the higher of RAP or ICP |
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In which circumstances should you not use N2O?
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Closed penumothorax
Bowel obstruction Air embolism |
