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26 Cards in this Set
- Front
- Back
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How does an open cholecystectomy affect respiratory function?
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postop diaphragm dysfunction
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What are the serious effects of small bowel obstruction and large bowel obstruction?
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SBO-strangulation, LBO-distention and possible rupture
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If colonic rupture occurs where is the most frequent site?
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cecum
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What are the effects of bowel obstruction?
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strangulation(bacteria and toxin penetration and sepsis) and abdominal dissension(decreased FRC, shunting of blood in the lung); sequestration of fluid(patients loose large amount of fluid that is normally absorbed); sepsis; severe electrolyte/acid base problems(hypokalemic, hypochloremic metabolic alkalemia or academia
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What should you do prior to surgery for bowel obstruction?
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if strangulated proceed and decompress the stomach, if elective correct fluid and electrolyte deficits and decompress the stomach
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How should you intubate a patient undergoing surgery for bowel obstruction?
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RSI, if intubation difficulty is thought to exist then do awake intubation(do not anesthetize below the vocal cords as it will further increase risk for aspiration)
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What is the typical urine Na during dehydration?
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<40mEq/L
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What is normal portal pressure?
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5-7mm Hg
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What is the cause of esophageal varices?
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hepatic fibrosis which leads to intrahepatic vascular obstruction and increased portal pressure
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What is the danger of an esophageal balloon to tamponade a bleeding vessel?
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incorrect placement or dislodgement, causing asphyxiation, exsanguination, or esophageal rupture
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What are preop considerations in patients with liver failure?
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volume optimization, good venous access, blood availability, optimize liver function, consider awake intubation due to aspiration risk, preop sedation is usually not indicated
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When should you decrease the dose of SCh in patients with liver disease?
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in the setting of severe liver failure secondary to decreased pseudocholinesterase
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what are postop problems in patients with liver failure?
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fulminant hepatic and renal failure
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Where do carcinoid tumors most commonly occur?
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appendix-50%, ileum-25%, rectum-20%
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What are symptoms of carcinoid syndrome?
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increased GI motility, hypotension/hypertension, bronchospasm, flushing,
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When do the symptoms of carcinoid become manifest?
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after they have metastasized to the liver(before the hormones are cleared by the liver)
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What are the major hormones released by carcinoid tumors?
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histamine, kinins, serotonin
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What are the major anesthetic problems associated with carcinoid tumors?
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bronchospasm, hypertension, hypotension
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What is the cause of severe htn with carcinoid tumors and what is the treatment?
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serotonin; treat with vasodilators(SNP, NTG)
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What drugs should you avoid in a hypotensive patient with carcinoid syndrome and how should you treat it?
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drugs that release histamine, SCh(increases intraabdominal pressure causing hormone release); fluid replacement(avoid catecholamines)
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What should you do preop in a patent with carcinoid syndrome to prevent bronchospasm?
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pretreatment with H1/2 blockers and steroids, avoid histamine releasing drugs,
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How do you treat bronchospasm in a patient with carcinoid syndrome?
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benedryl, somatostatin, volatile anesthetics, steroids
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What is the most effective way to treat carcinoid syndrome?
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somatostatin analog(octeotide acetate); controls diarrhea, flushing and wheezing in 75% of patients
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How do general anesthetics affect the GI tract?
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relaxes the GI tract
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How do anticholinesterases, morphine, and regional anesthesia?
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cause the gut to contract
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How does spinal anesthesia affect the gut and why is it not used frequently for intraabdominal procedures?
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increases peristalsis, difficulty blocking pain fibers despite a high block
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