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149 Cards in this Set

  • Front
  • Back
with a Co2 laser what type of protection should be worn
ordinary eyeglasses with sideguards
with a Nd-YAG laser what type of protection should be worn
opaque green eyewear or clear lenses with special coating
with a KTP laser what type of protection should be worn
special eyewear with a red filter
with a argon laser what type of protection should be worn
special opaque orange goggles/eyewear
what type of damage can occur from a CO2 laser
*tissue destruction is proportional to water content

*corneal injury
what kind of damage can occur from a Nd-YAG laser
retinal damage
what kind of damage can occur from a KTP laser
retinal damage
what kind of damage can occur from a argon laser
retinal damage
what is the order of increasing dead space with ETT, face masks and LMA
face mask > LMA > ETT
what is the order of decreased resistance with ETT, face masks and LMA
face mask < LMA < ETT
what medications should be continued up to time of anesthesia and surgery
*HTN drugs
*meds for angina
*meds for arrythmias
*meds for CHF
*meds for endocrine disorders
when should oral hypoglycemics be discontinued for surgery
withhold day of sx
when shoud ASA and NSAIDs be discontinued for sx
withold for 3-7 days
when should heparin be discontinued for surgery
stop it 4-5 hrs before sx and check PTT
when should coumadin be discontinued before surgery
3-5 days before sx and check PT
when should plt inhibitors like Plavix be discontinued before surgery
7-14 days
what effect on anesthesia drugs can aminoglycosides have
can potentiated neuromuscular block
what effect can MAO inhibitors have on anesthesia drugs
*increase catecholamine stores

*HTN response to pressor agents

*increased response to ephedrine
what is the regimen for steriod therapy for pts who have received corticosteriod therapy for at least 1 month in the last 6-12 months
*admin 25mg of hydrocortisone pre-op then give IV infusion of 100mg over next 12-24 hrs

*100mg hydrocortisone IV before, during and after sx
if the pharmokinetics of an herbal supplement is UNKNOWN how long should the supplement be discontinued prior to sx
2 weeks
what possible s/e does echinacia have
*activation of cell-mediated immunity

*may caused decreased effectivenessof immunosuppresants
what s/e does ephedra have
*increased HR and BP
*may increase risk for myocardial ischemia, stroke and dysrhythmias
*depletion of endogenous catecholamines with long term use
how long prior to sx should ephedra be discontinued
at least 24 hrs
what is garlic used for
to prevent atheroslcerosis, HTN and decrease thrombis formation and lipid levels
what s/e can garlic have
*inibition of plt aggregation, increased fibronolysis and possible antihypertensive activity

*may increase risk of bleeding and potentiate other anti-platelet meds
how long prior to sx should garlic be discontinued
at least 7 days
what is ginkgo bilobo used for
to decrease symptoms of cognitive disorders, tinnitus, erectile dysfunction and altitude sickness
what are the s/e of ginkgo bilobo
*inhibition of plt-activating factor

*may increase risk of bleeding and potentiate other anti-platelet meds
how long prior to sx should ginkgo bilobo be discontinued
at least 36 hrs prior to sx
what is ginseng used for
to prevent stress and improve cognitive function
what are the s/e of ginseng
*lowers blood glucose
*inhibits plt aggregation
*may cause hypoglyemia
*risk of bleeding
*may decrease anticoagulation effect of warfarin
how long prior to sx should ginseng be discontinued
at least 7 days
what is kava used for
to decrease stress and as a sedative
what are the s/e of kava
*sedation and anxiolysis

*may increase sedative effect of anesthetics
how long prior to sx should kava be discontinued
at least 24 hrs
what is saw palmetto used for
symptoms of BPH
what are the s/e of saw palmetto
*inhibition of 5-a reductase and cyclooxygenase

*may increase risk of bleeding
what is st. johns wort used for
mild to moderate depression
what are the s/e of st. johns wort
*inhibition of NT reuptake
*increased induction of CYP450
*delayed emergence
how long prior to sx should st. johns wort be discontinued
at least 5 days
what is valerian used for
sedative and insomnia
what are the s/e of valerian
*sedation
*may increase sedative effects of anesthetics
*BZD-like acute withdrawal (insomia, anxiety, hallucinations, HA)
what is the MAC of halothane
0.76-0.87
what is the blood gas solubility of halothane
HIGH- 2.4
what is the blood gas solubility of sevoflurane
LOW- 0.69
what is the MAC of sevoflurane
1.7 - 3.3
what are the s/e of halothane
*halothane hepatitis

*cardiac depression

*myocardial dysrhythmias
what are the s/e of sevoflurane
*small increase in HR
*20-30% decrease in BP
*delirium & excitement on emergence
*increase in Fl ions
what is the formula for proper size UNCUFFED ET tube
age (years) +16/4= ETT size
what is the formula for distance of insertion for ET tube
depth of insertion =
age / 2 + 12
what is the blood gas solubility for nitrous
0.47
when should nitrous be AVOIDED
*tympanoplasty & mastoidectomy sx
*pneumothorax/pulmonary blebs
*abd/bowel sx
*cyanotic heart dz
*venous air embolism
what is blood gas solubility for isoflurane
1.4
what is MAC for isoflurane
1.2 - 1.6
isoflurane has what effect on the myocardium
minimum
isoflurane has what effect on baroreceptor reflexes
decreases them so decrease in arterial BP
which inhalation agent has favorable cerebral hemodynamics
isoflurane
what is the blood gas solubility of desflurane
0.42
what is the MAC of desflurane
6.6 - 9.2
induction dose for propofol for peds
2-5 mg/kg
maintenance dose for propofol for peds
100-250 mcg/kg/min
induction dose for CHILDREN of thiopental
5-6 mg/kg
induction dose for NEONATES of thiopental
3-4 mg/kg
dose for children for methohexital
1 to 2.5 mg/kg
ketamine IV induction dose for peds
2 mg/kg
etomidate induction dose for peds
0.2 to 0.3 mg/kg

(0.2)
fentanyl dosage for GENERAL surgery for peds
1 - 5 mcg/kg
fentanyl dosage for CARDIAC surgery for peds
75 - 150 mcg/kg
remifentanil dosage for peds
0.05 - 0.1 mcg/kg/min

0.25 -0.5 mcg/kg/min
sufentanil dosage for peds
0.2 - 0.5 mcg/kg/hr
dose of morphine for peds
0.1 - 0.2 mg /kg
what age group in pediatrics have greater sensitivity to morphine
neonates
dose for demerol for peds
1 -1.5 mg/kg
IV dose of succinylcholine for peds
2 mg/kg
IM dose of succinylcholine for peds
4 mg/kg
what is given with succinylcholine in the pediatric population
atropine 0.02 mg/kg
dose of atracurium for peds pt
0.3-0.5 mg/kg
dose of cisatracurium for peds
0.15 - 0.2 mg/kg
dose of vecuronium for peds
0.1 mg/kg
onset of action for atracurium
2-4 min
duration of action for atracurium
20-45 min
duration of action for succinylcholine
<2-5 min
onset of action for cisatracurium
2-4 min
duration of action for cisactracurium
20-45 min
onset of action for vecuronium
2-4 min
duration of action for vecuronium
20-45 min
dose of rocuronium for peds
0.5 - 1 mg/kg
onset of action for rocuronium
2-4 min
duration of action for rocuronium
20-45 min
what is an alternative to succinylcholine for RSI
rocuronium
what is the dose for pancuronium in peds
0.05 - .1 mg/kg
onset of action for pancuronium
3-5 min
duration of action for pancuronium
45-60 min
dosage for ketorolac in peds
o.5 mg/kg not to exceed 15 mg for wt less than 50 kg
dose for zofran for peds
.1- .15 mg/kg

(.15)
dose of metoclopramide in peds
0.15 mg/kg
what is the amt of ml/kg needed for a sacral block
0.50ml/kg
what is the amt of ml/kg needed for a lower thoracic block
1.00/ml/kg
what is the amt of ml/kg needed for a mid thoracic block
1.25 ml/kg
what is the dosage of bupivacaine used for a caudal block
0.125-0.25%

1ml/kg
what is the dosage of ropivacaine used in a caudal block
0.20%

1ml/kg
what is the dosage of duramorph used in a caudal block
50 to 100 mcg/kg

1ml/kg
what is the dosage of clonidine used in a caudal block
1-2 mcg/kg

1ml/kg
how is fluid replacement calculated based on the 4/2/1 system
4cc/kg/hr = 1-10 kg

2cc/kg/hr = 10-20 kg

1cc/kg/hr = 20 kg & more
crystalloid replacement for blood loss should be approximately what
3 ml/kg
what is the formula for max allowed blood low (MABL)
MABL=
EBVx(pts hct-min accept hct)
--------------------------------------------
pts hct
what is the value for hypoglycemia in neonates
< 30 mg/dl
what is the value for hypoglycemia in children
< 40 mg/dl
what is the estimated blood volume of a premature infant
90 to 100 ml/kg
what is the estimated blood volume of a full term infant
80 to 90 ml/kg
what is the estimated blood volume of an infant 3 mo to a 1 y/o
70 to 80 ml/kg
what is the estimated blood volume of a child > 6 y/o
65 to 70 ml/kg
in the 1980's what was identified as an early sign of malignant hyperthermia
end tidal CO2
1990's found what receptor is responsible for almost all cases of swine MH and perhaps 50% of human MH
ryanodine receptor
MH is transmitted as what kind of trait
autosomal dominant trait
MH is most common in what age group
older children and young adults
MH is primarily a mutation of what receptor
ryanodine receptor (RYR1)
mutations of the RYR1 gene are responsible for a form of the MH condition known as what
MHS1
what is the most common form of MH (accounts for most cases)
MHS1
MH susceptibility has been linked to what chromosome primarily
chromosome 19
what is the ryandodine receptor the site for
it is the site at which Ca++ stored in the SR is released into the sarcoplasm to initiate muscle contraction
what are the consequences of hypermetabolism
*muscle rigidity
*increased ATP production and usage
*increased O2 consumption
*increased production of lactate, Co2, lactic acid & heat
*leakage of K, Ca, CK & myoglobin from muscle cells as ATP is depleted
*increase in catecholamine levels
*DIC
what are the clinical signs of MH
*increasing ETCo2
*unexplained tachycardia, vent arrythmias
*masseter muscle spasm or generalized rigidity
*tachypnea
*metabolic & resp acidosis
*increased temp 1-2 C q 5 min
*myoglobinuria
*DIC
what is the appropriate treatment regiment with dantrolene for MH
2.5 mg/kg IV and repeat as needed to control signs of MH
what is the appropriate treatment regiment with NaHCO3 for MH
1-2 mEq/kg to control metabolic acidosis as guided by ABG
what is the mnemonic for treatment of MH
Some-stop all triggering agents
Hot- hyperventilate w100% 02
Dude- dantrolene 2.5 mg/kg
Better- bicarb 1-2 mEq/kg
Get- glucose & insulin
Iced- IV fluids/cooling blanket
Fluids- furosemide,mannitol
Fast- tachycardia, arrythmias
dantrolene does what to calcium
blocks the release of calcium from the sarcoplasmic reticulium
what is the onset of action for dantrolene
2-3 min
what is the half life for dantrolene
4-6 hrs
what is the elmination time for dantrolene
12 hrs
how is dantrolene absorbed from the GI tract
poorly
what effect does dantrolene have on cardiac and smooth muscle
little effect
how does dantrolene come packaged
20 mg vial of lyophylized powder
how is dantrolend prepared
reconstituted with 60 ml STERILE WATER

**do NOT reconstitute with D5W or normal saline** they can hinder dissolution
what are the side effects of datrolene
*muscle weakness

*pain/phlebitis at injection site

*nausea
what is the shelf life of dantrolene
36 months
what is the "gold standard of testing for MH
caffeine-halothane contracture test
where is the APL located
on the EXPIRATORY limb
what do you attach the PEEP valve to
the EXPIRATORY limb
where is the fresh gas inlet located
*UPstream of INSPIRATORY unidirectional valve

*DOWNstream of absorber
where is the reservoir located
*DOWNstream of EXPIRATORY unidirectional valve

*UPstream of the absorber
where are the unidirectional valves located
on the absorber column
where is the oxygen monitor located
on the INSPIRATORY limb
where is the respirometer located
EXPIRATORY limb
where is the airway pressure sensor located
*close to pt connection

*to measure PEEP it should be on the same side of the EXPIRATORY undirectional valve as the PEEP valve
with a circle system the PaCO2 depends on what
VENTILATION

(not FGF)
how is Co2 gotten rid of in a mapelson system
it must be "washed out" with FGF
what is absent in a mapelson system
*unidirectional valves

*Co2 absorber
which system circle or mapelson is there no clear separation of inspired and expired gases
mapelson