Basics Of Anesthesia

Front 1

Elbow flexion
Compresses ulnar nerve

Back 1

Cubital tunnel retinaculum

Front 2

compression injury at lateral aspect of arm, below lateral epicondyle of the humerus
Loss of sensation b/w thumb & index finger, inability to extend thumb, wrist drop

Back 2

Radial nerve

Front 3

Elbow extension, Iatrogenic trauma to nerve @ antecubital fossa during venipuncture
Symp: inability to extend elbow, numbness over dorsal & palmer areas of distal phalanges of 1st, 2nd fingers

Back 3

Median Nerve dysfunction

Front 4

Branch of median nerve in upper forearm
Compression from a tight arm restraint
Ischemia injury to nerve & median artery resenbles compartment syndrome
Requires surgical decompression

Back 4

Anterior Interosseous nerve

Front 5

Postural hypotension
airembolus
midcervical tetraplegia
edema of face, tongue, neck
pneumocephalus

Back 5

Complications of sitting position

Front 6

Transient, resolves postop day #5
avoid postures that compress/stretch specific nerve
consult neurologist

Back 6

Sensory neuropathy

Front 7

Consult neurologist immediately
does not resolve by itself
EMG studies: to assess location
measures resp. of muscle to stimulation of motor nerve
eval. by degree of muscle contract

Back 7

Motor neuropathy

Front 8

Prolonged spinal procedures
anemia/hemodilution
venous congestion & edema of the head
excessive crystalloid use
massive bld loss
intraop hypotension

Back 8

Risk factors for blindness secondary to prone position

Front 9

inadequate perfusion to extremity
ischemia
edema
rhabdomyolysis from tissue pressure

Back 9

Compartment Syndrome

Front 10

Candy cane's
smokers
low body mass index
long surgeries >2hrs

Back 10

Common peroneal nerve damage

Front 11

peroneal nerve damage
compartment syndrome
digit amputation

Back 11

Complications of Lithotomy

Front 12

postural hypotension
pressure alopecia
ischemic necrosis under bony areas
backache
nerve palsies

Back 12

Complications of Dorsal decubitus position

Front 13

autotransfusion of volume from legs
increase preload & CO
decrease VC, FRC, TV

Back 13

Standard lithotomy

Front 14

nerve sciatic/ femoral damage with extension
high incidence of lower ext. compartment syndrome

Back 14

High lithotomy

Front 15

uphill gradient for perfusion causes autotransfusion, lower ext. compartment syndrome, thighs flexed 90 degrees over trunk

Back 15

Exaggerated Lithotomy

Front 16

nasal congestion, increase ICP,CVP,IOP,preload
prevent venous air emboli, improve surgical access

Back 16

Trendelenburg

Front 17

Compartment syndrome
folding ear
incr. IOP
ischemia to dependent eye
stretch injury to suprascapular nerve(too much rotation)

Back 17

Compl. of Lateral decubitus

Front 18

minimal risk if short procedure, mask ventilation, mild risk via LMA, 10 fold increase via ETT

Back 18

URI

Front 19

Epidural space
sacrococcygeal ligament
b/w unfused S4-S5

Back 19

Caudal block

Front 20

stridor, hoarseness, sternal wall retraction, agitation, lethargy, impending resp. failure, decr. LOC, dusky appearance, barky cough

Back 20

Postop croup

Front 21

What promotes rapid desat. during periods of apnea in pedi pts?

Back 21

limited # of alveoli, incr. compliance of rib cage & weak intercostals & diaphragmatic musculature, promote chest wall collapse resulting in decr. FRC, reducing O2 reserve

Front 22

What ends at S3 for children?

Back 22

Dural sac

Front 23

Thirdspace loss replaced with LR for pedi pts at what rate?

Back 23

0-2ml/kg/hr non-invasive
6-10ml/kg/hr larger abd. procedures

Front 24

Pedi at higher risk for larnygospasm during?

Back 24

Emergence

Front 25

muscle rigidity, hypermetabolic state, hypercarbia, metab. acidosis, tachycardia(early sign), hyperthermia(late),rhabdomyolysis, hyperkalemia, cardiac arrest

Back 25

MH

Front 26

hip fracture repair
bil. knee replacement
pre-exist dementia
Parkinson's
sleep deprivation
hearing & visual impairment

Back 26

High incidences of Post op Delirium

Front 27

Fibrosis of the media reduces arterial compliance & causes these 3 things

Back 27

incr. afterload
incr. SBP
L ventricular hypertrophy

Front 28

exercise intolerance, dyspnea, cough, edema, fatigue

Back 28

s/s for diastolic dysfunction

Front 29

Four charcteristics of pulm. aging

Back 29

reduction in muscle mass & power
changes in compliance
reduction in diffusion
decline in control of breathing

Front 30

ability of an organism to maintain a steady state during increased physiological demands

Back 30

Functional reserve

Front 31

released by posterior pituitary gland in response to changes in bld osmolarity
released by stimulation of carotid baroreceptors as a response to a 5-10% decr. in bld. volume
can respond from hypotension, pain, nausea, emotional stress & hypoxia
changes in permeabiity to water at collecting ducts

Back 31

ADH

Front 32

Prevents sodium depletion & hypovolemia
secreted by adrenal cortex
triggered by decr. Na levels ECF/by incr. Na levels in the urine

Back 32

Aldosterone

Front 33

released from cardiac atria in response to incr. atrial stretch. causes vasodilation incr. renal excretion of Na and water

Back 33

ANP

Front 34

reversal of Warfarin
correction of PT, PTT
correction of coagulopathy
correction of microvascular bleeding
fluid portion extracted, frozen
contains all coags except platelets
ABO compatibility required

Back 34

FFP

Front 35

Fraction of plasma that precipitates when FFP is thawed
contains factor VIII, XIII
Von Willebrand factor & Fibrinogen
ABO compatibility not required
Microvascular blding due to massive bld transfusion, consequent decr. in fibrinogen stores, prophylaxis before surgery in pts with congenital dysfibrinogenemias, may be used for hemophilia A disease

Back 35

Cryoprecipitate

Front 36

HCT 70-80%
250-300ml
each unit incr. Hbg 1g/dl, HCT by 3g/dl

Back 36

PRBC

Front 37

indications for transfusion
count<50,000
thrombocytopenia(<150,000)
dysfunctional PLT, maintanence of levels during ongoing blding & transfusion no less than 50,000ul
units contain conc. from 6 single donor units
each unit incr. count by 5-10,000ul
survive 1-7days
ABO compatibility desired
count 10-20,000 spont. bleed

Back 37

Platelets

Front 38

done 4-5wks prior to surgery
required to maintain Hb 11
5-7 days b/w donations
can still have a rxn due to clerical error
Compl: air embolus, hemolysis, dilutional coagulopathy

Back 38

Autologous

Front 39

Delayed awakening from anesthesia, respiratory depression, cardiac irritability, increased pulm. vascular resistance and altered drug responses

Back 39

Hypothermia in pedi pts

Front 40

High affinity for oxygen, so there is a left shift of oxyhemoglobin dissociation curve (P50 18-20) and is compensated by the higher Hgb levels at birth, greater bld volume and increased CO

Back 40

HgF

Front 41

IV dose for neonates and infants of SUCC?

Back 41

3mg/kg IV, 4-6mg/kg IM

Front 42

Reversal agent reverses 90% in 2 min with less muscarinic s/e?

Back 42

Edrophonium

Front 43

#1 reason neonates and infants tend to obstruct easily?

Back 43

proportionately larger head and tongue

Front 44

Pedi oxygen consumption?

Back 44

7-9ml/kg/min (RR 30-50)

Front 45

Bradycardia results in a reduction of CO b/c CO is dependent on this?(pedi)

Back 45

HR

Front 46

spina bifida, myelomeningocele, meningocele, SC injuries, congential abnormalities of urinary tract. 73%pedi population has a high incidence of ?

Back 46

latex allergy

Front 47

antibiodics(PCN, Cephalosporins, sulfonamides, LA's (procaine) insulin produce what type of reaction(anaphylactic/anaphylactoid)

Back 47

anaphylactic

Front 48

Muscle relaxants, opioids,hypnotics(propofol, thiopental, etomidate),Protamine, colloids(dextran, protein fractions, albumin) steroids, vanco, and non-steroidals anti-inflammatory drugs
produce what type of reaction? (anaphylactic/anaphylactoid)

Back 48

anaphylactoid

Front 49

Decr. Bp, tachycardia, cardiac arrhythmias, CV collapse, pulm. HTN

Back 49

cardiovascular manifestations from anaphylaxis during anesthesia

Front 50

Incr. RR, laryngeal edema, bronchospasm, pulm. edema, decr. pulm. compliance, difficult to ventilate, incr. peak airway pressure, resp. failure

Back 50

Pulm. manifestations from anaphylaxis during anesthesia

Front 51

Treatment for anaphylaxis?

Back 51

stop adm. of antigen, airway maintanence, 100% O2, d/c all anesthetic agents, rapid intravascular vol. expansion, Epi 5-10mcq IV titrate(hypotension), EPI .1-1.0mg IV (CV collapse).
antihistamines, catecholamine infusions, amynophylline, corticosteroids, sodium bicarb

Front 52

Two types of latex allergy reactions

Back 52

Type IV contact dermatitis
Type I anaphylactic rxn IgE mediated

Front 53

After 24 hrs following an anaphylaxis crisis, s/s may persist up to?

Back 53

32hrs

Front 54

What would you use for rapid IV volume expansion in the setting of hemorrhagic shock?

Back 54

Colloids

Front 55

signs of hypervolemia

Back 55

pitting edema, tachycardia, crackles, wheezing, cyanosis, and pink frothy secretions

Front 56

1/2 NS, D5W

Back 56

Hypotonic

Front 57

D51/4NS,NS,LR,Isolytes/Plasmalytes

Back 57

Isotonic

Front 58

D51/2NS,D5NS,D5LR,3%saline, 5%saline, 7.5%NaHCO3

Back 58

Hypertonic

Front 59

In the prone position what do you want to make sure is positioned correctly b/c will have alot of hemodynamic changes with venous pooling and decr. preload?

Back 59

iliac crest

Front 60

Stretching from head turning, prone position,abduction of arm >90 causes what injury?

Back 60

Brachial plexus

Front 61

venous pooling,hypotension, decr. atrial filling activates RAAS, MAP reading at circle of willis more accurate

Back 61

Hemodynamic effects of sitting position

Front 62

BIG complication causes dysrhythmias,and cardiac arrest, compromises gas exchange, pulm. HTN, inefficient CO, air mixed with bld creates a foam,problem with patent foramen ovale

Back 62

air embolus from sitting position

Front 63

Ventral decubitus
positions

Back 63

prone, prone jackknife,prone kneeling

Front 64

Dorsal decubitus positions?

Back 64

supine (trendelenburg, reverse t-burg), frog leg, lithotomy

Front 65

Lateral decubitus positions?

Back 65

semiprone, flexed lateral (jackknife)

Front 66

Thighs flexed 90 degrees over trunk
sciatic, femoral damage with extension, can have autotransfusion

Back 66

High Lithotomy

Front 67

Thighs flexed over trunk
lower legs aimed skyward
symphysis pubis parrallel to floor
uphill gradient, may restrict ventilation
assoc. with high incidence of lower ext. compartment syndrome

Back 67

Exaggerated Lithotomy

Front 68

Why under GA do you have better perfusion to the dependent lung, but better ventilation to the non-dependent lung?

Back 68

Anesthesia takes away HPV response, all the perfusion is going to dependent lung b/c of gravity & body is unable to vasoconstrict & send some to non-dependent lung.
Loss of muscle tone-have abd. contents pushing against diaphragm decr. lung volume and FRC

Front 69

Intendend to widen intercostal spaces to fascilitate a thoracotomy incision, pts down side iliac crest over the hinge b/w back and thigh sections of table
table is flexed so the thighs become lateral to the trunk, chassis of table re-oriented so that pts flank and thorax becomes horizontal

Back 69

Lateral jackknife

Front 70

Management goal:slow HR, maintain NSR,control HTN,optimized bld & fluid volume,maintain oxygenation & coronary bld flow to decrease risk of MI

Back 70

Diastolic dysfunction

Front 71

Impaired chronotropic & inotroptic responsiveness of the heart in the elderly. Increases in CO are a result of an increase in?

Back 71

SV NOT HR, with less tachycardia in response to stress

Front 72

Due to changes in the lung secondary to aging and contributing to similar symptoms of mild COPD?

Back 72

Increased residual capacity(air trapping), increased closed capacity, & gas exchange problems VC decr. + RV incr. = TLC decr.

Front 73

Ventricle is not filling enough and effects EF and CO. Name dysfunction

Back 73

Diastolic dysfunction