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31 Cards in this Set
- Front
- Back
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In obesity hypoventilation syndrome (Pickwickian Syndrome), what leads to hypoxia and hypercarbia?
What happens to respiratory drive responsiveness to hypercarbia?
What happens that compensates for the acidosis? |
OSA and restrictive lung disease
it decreases
Bicarb is retained by the kidneys eventually. pH is normalized creating a worsening feedback loop and symptoms continue to worsen. |
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What changes regarding pulmonary pressures are expected in obesity hypoventilation syndrome?
WHat are the late manifestations of the pHTN? |
pHTN
Hypoxic pulmonary vasocontriction due to hypoxia and hypercarbia
Hepatomegally and peripheral edema. (No left heart failure or pulmonary edema) |
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In a patient with obesity hypoventilation syndrome, should a patient be sent home on opioids to cover post op pain for a outpatient procedure? |
No, they are on the verge of death at all times. Opioids can send them over the edge and they should be kept as an inpatient while they need them. |
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What type of lung disease does obesity cause?
This capacity is decreased?
....As a result of this volume being decreased? |
Restrictive
FRC
Expiratory reserve volume |
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Obesity associated change in CO?
What volume is increased to accomplish this?
What morphologic change does this lead to? |
Increased to perfuse the increased body mass.
LVEDV
LVH |
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Vertebral level of the glottis in neonates?
Adults? |
C4
C6 |
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Why does obesity increase the risk of aspiration? |
Increased abdominal pressure. |
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Is an OSA patient who has UPPP cured of OSA? |
Not usually, as it involves obstruction at multiple points in the airway, not always addressed by UPPP. Probably will still be difficult to mask ventilate. |
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What is the most common point of airway obstruction in a patient with OSA? |
posterior tongue |
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Normally lipophillic drugs in obese people have a large volume of distribution, this lipophilic opioid is an exception and should be dosed closer a patient's ideal body weight (like how hydrophillic drugs should be dosed)? |
Remifentanyl |
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Should propofol induction dose be based on ideal or total body weight?
What about continuous infusion |
Ideal (its elimination is by redistribution more so than clearance which depends on volume of distribution)
Total |
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In the Elderly:
1) How is adrenergic receptor sensitivity changed?
2) Heart rate?
3) SVR and afterload? |
1) Decreased
2) Decreased due to increased vagal tone
3) Increased due to decreased arterial compliance (leads to diastolic dysfunction and LVH) |
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What is an elevated E/e^1 ratio on TEE indicative of? |
Diastolic dysfunction (just like normalization or reversal of the E/A ratio) |
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What is TAPSE? |
On TEE, tricuspid annular plane systolic excursion. It is a good measure of right heart function. |
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What is the coumadin ridge |
On TEE, it is a muscular ridge between the left atrial appendage and the left upper pulmonary vein and is a normal finding |
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What happens to the elasticity of the lungs in the elderly.
What does this lead to?
This leads to a change in what volume? |
It is decreased
Emphysematous changes
Increased residual volume |
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What happens to closing capacity in the elderly?
This results in what change to V/Q mismatch? |
It is increased (to well within normal TV) due to decreased elasticity. Increased collapse of small airways.
Increased |
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What happens to PaO2 in the elderly?
Dead space? |
It is decreased. PaO2 = 110 - age (0.4)
Increased |
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What is post operative delirium? (POD)
What is post operative cognitive dysfunction? (POCD)
Does regional decrease the incidence of POCD or POD over general? |
Delirium after surgery that is not related to emergence from anesthesia.
More of a long term sequelae from surgery and anesthesia
No |
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What 2 types of surgeries put patients at greatest risk for post operative cognitive dysfunction?
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Cardiac and major ortho
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What are some risk factors for post operative delirium? |
Increased age, inpatient, decreased preoperative cognitive reserve, opioids, benzos, alcohol use, surgical complications, organ failure. |
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How do the results of an epidural change in the elderly?
Spinals? |
Increased cephalad spread with a faster set up, but similar duration and motor block ot normal.
Spinals last longer in the elderly |
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How does MAC change in the elderly? |
It decreases (4% per decade after 40) |
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Do pharmacodynamics or pharmacokinetics account for longer duration and increased potency of drugs in the elderly? |
Pharmacodynamics. In other words it is not because of changed volume of distribution, compartments, etc. |
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What are the first 2 things that should be worried about with agitation in the PACU? |
Hypoxia and hypercarbia |
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What is the Aldrete recovery score?
What things does it look at? |
A score that determine's which patients can be moved from phase I to phase II recovery.
Color, BP, respirations, consciousness, and activity. |
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These complications all increase with increasing ASA scores? |
Prolonged mechanical ventilation, operative duration, length of hospitalization, pulmonary infection, urinary infection, wound infection, blood loss, and mortality. |
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What is ASA IV
V?
VI? |
Severe systemic disease that is a constant threat to life
Will die without immediate surgery
Brain dead organ doner |
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Does ASA V predict intraoperative mortality? |
No just perioperative. Most patients can be kept alive in the OR with a dedicated physician working on them, but it is a different story once they get to the ICU. |
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How much more common are cardiac complications in an ASA IV patient compared to ASA I? |
180 x more common |
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Name the level of anesthesia:
1) Patient responds normally to verbal commands, no airway or hemodynamic effects.
2) Depressed consciousness, but will respond appropriately with verbal commands or light tactile stimulation.
3) Depressed consciousness, arrousable only to painful or repeated stimulation. May require airway support. Hemodynamic effects are minimal. |
1) minimal sedation
2) moderate sedation
3) deep sedation |
