Akt-6 Keywords

Front 1

What percent of patients exhibit autonomic hyperreflexia after recovery from spinal cord transection?

Back 1

85%

Front 2

Autonomic hyperreflexia is associated with what sort of spinal cord injury?

Back 2

transection at T5 and above

Front 3

Describe the syndrome of autonomic hyperreflexia.

Back 3

Severe paroxysmal HTN with bradycardia, dysrhythmias, cutaneous vasoconstriction below and vasodilation above the level of the injury

Front 4

What triggers an episode of autonomic hyperreflexia?

Back 4

typically distension of the bladder or rectum, but any noxious stimulus can cause it.

Front 5

Many patients with spinal injuries and autonomic hyperreflexia will complain of headaches in the setting of _____.

Back 5

Bladder distention

Front 6

In autonomic hyperreflexia, what is it that's lacking that results in the symptoms and signs?

Back 6

A lack of supraspinal inhibition to the sympathetic outflow below the lesion.

Front 7

How should one treat an episode of autonomic hyperreflexia?

Back 7

remove stimulus, deepen anesthesia, administer direct-acting vasodilators.

Front 8

What end-organ damage can autonomic hyperreflexia cause?

Back 8

seizures, MI, intracranial hemorrhage

Front 9

What type of anesthesia are effective in preventing autonomic hyperreflexia?

Back 9

Spinal > general with gas or epidural

Front 10

How does one treat systemic hypertension in autonomic hyperreflexia?

Back 10

Nitroprusside

Front 11

How does pregnancy affect MAC?

Back 11

it decreases

Front 12

What hormone may contribute to the decrease in MAC during pregnancy?

Back 12

Progesterone due to its sedating effects.

Front 13

What might desiccated soda lime degrade sevoflurane to?

Back 13

carbon monoxide and/or compound A

Front 14

What might moist soda lime degrade sevoflurane to?

Back 14

compound A

Front 15

What four conditions increase production of compound A with soda lime?

Back 15

1) low gas flows 2)higher concentrations of sevo 3)higher absorbent temp 4) absorbent dessication

Front 16

If a carbon dioxide absorbent like Baralyme become desiccated what will happen if used with sevoflurane?

Back 16

a chemical reaction that can lead to spontaneous fires or extreme heat without fire.

Front 17

What is normal and what is elevated ICP?

Back 17

Normal is < 10mmHg and ICP HTN is > 15mm Hg

Front 18

How do volatile anesthetics affect ICP?

Back 18

They increase ICP in a dose-dependent manner.

Front 19

In patients with supratentorial tumors with midline shifts which inhaled anesthetics could be more useful and underwhat circumstance?

Back 19

Isoflurane and desflurane did not significantly affect lumbar CSF pressure in the setting of moderate hypocapnia (PaCO2 = 30)

Front 20

What induction agents are unlikely to increase ICP?

Back 20

thiopental or etomidate (and propofol but this might also result in greater decrease in CBF)

Front 21

What paralytic should be used in the setting of increased ICP?

Back 21

ND NMB because succinylcholine may increase it

Front 22

In a patient with increased ICP, what must be confirmed prior to intubation?

Back 22

skeletal muscle paralysis so that coughing is avoided

Front 23

What IV drugs may be given 1 - 2 minutes prior to DL in a patient with increased ICP and why?

Back 23

To attenuate the increase in SBP that comes with intubation, thiopental, propofol, opioids or lidocaine IV can be given.

Front 24

What level of hypocapnia is helpful in an intubated patient with increased ICP?

Back 24

PaCO2 30 - 35

Front 25

What type of carbon dioxide absorber will not degrade inhaled anesthetics?

Back 25

Amsorb Plus

Front 26

From most likely to least likely which inhaled anesthetics are likely to produce carbon monoxide in desiccated soda lime?

Back 26

desflurane = enflurane > isoflurane >> halothane = sevoflurane

Front 27

What is the metabolic oxygen requirement of patient undergoing general anesthesia?

Back 27

150 - 250mL/min

Front 28

If a sidestream gas analyzer is used in a closed circuit, what must happen to the gas analyzed?

Back 28

It must be returned to the system.

Front 29

If NO is being used in a closed breathing system, what monitor becomes mandatory?

Back 29

an oxygen analyzer on the inspiratory or expiratory or inspiratory limb