Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
67 Cards in this Set
- Front
- Back
|
Propofol MOA Metabolism Special properties |
-Enhancement of GABA at receptors -Hepatic metabolism, but quick emergence due to redistrubution -No analgesia |
|
|
Thiopental MOA Metabolism Special properties |
-Similar to propofol -Hepatic metabolism, but quick emergence from redistribution -Used for burst suppression in neurosurg |
|
|
Etomidate MOA Metabolism Special properties |
-Similar as propofol, enhances GABA -Hepatic metabolism, but redistribution causes quick emergence -myoclonus and adrenal suppression -Relative hemodynamic stability |
|
|
Ketamine MOA Metabolism Special Properties |
NMDA antagonist Hepatic metabolism Analegesia and anesthesia Side effects: hallucinations, ICP, IOP, increased salivation, bronchodilation -INCREASE BP/HR |
|
|
Short to long acting Benzos |
Midaz Diaz Loraz |
|
|
DOC for post-op shivering |
Meperidine |
|
|
Contraindications to Succinylcholine |
H/o MH Hyperkalemia Burns Denervation Increased IOP |
|
|
Nondepolarizing neuromuscular blockers |
Benzylisoquinolones Atracurium, cisatracurium Aminosteroids Vecuronium, rocuronium, pancuronium |
|
|
Metabolism of atracurium |
Spontaneously via hofman rxn (same as cisatracurium) -prefered in renal failure |
|
|
Metabolism of rocuronium |
Renal excretion (use atra/cisatra in renal failure) |
|
|
Metabolism of Succinylcholine |
PLASMA cholinesterase |
|
|
Physiologic changes seen with volatile anesthestics |
Decreased BP via SVR, increased RR, decreased TV |
|
|
Nitrous Oxide |
Hemodynamic stability Increased RR, decreased TV May increase PONV Commonly used as part of peds inhalation induction |
|
|
Slowest to fastest volatile anesthetic agent |
Isoflurane (MAC 1%) - slowest on and off Sevo (MAC 2%) Des (MAC 6%) |
|
|
Toxic dose of lidocaine and bupivicaine |
Lido: 5/7 mg/kg Bupi: 2/3 mg/kg |
|
|
Calculation of 1% lidocaine |
1% = 10 mg/mL |
|
|
Which induction agent increased ICP? |
Ketamine -also increased CBF |
|
|
Which induction agent increased SVR? |
Ketamine |
|
|
Which induction agent increases BP? |
Ketamine |
|
|
Which induction agent increases HR? |
Thiopental, ketamine and sometimes etomidate |
|
|
Ephedrine |
B1>a1 effects, also releases NE Increases HR, BP, SVR |
|
|
Dopamine |
Dose dependent effects -renal dose is small -medium mostly beta, increased contractility -high mostly alpha, increases BP/pulse |
|
|
Norepinephrine |
A and B effects (a>B) |
|
|
Epinephrine |
A and B effects, more increased contractility and heart rate, modest increase in BP -effects metabolism resulting in hyperglycemia |
|
|
Nitroglycerin |
Venodilation>arteriolar dilation -reduces myocardial oxygen consumption |
|
|
Nitroprusside |
More arterial dilation than nitroglycerine |
|
|
Labetalol |
Selective a1 and nonselective B receptor antagonist -decreases BP and HR |
|
|
Esmolol |
Selective B1 antagonist -decrease HR with some decrease in BP |
|
|
Calculate allowable blood loss |
Can let hgb get to 7 (original Hgb - 7)/original hgb x (70mL/kg x weight) |
|
|
How to treat post-dural puncture headache |
Hydration and caffeine -or tramadol -or blood patch (injection of blood into the back) |
|
|
Signs of local anesthetic toxicity |
Perioral numbness, metallic taste, tinnitus, seizure (at very high doses) |
|
|
Tx of local anesthetic toxicity |
Lidocaine: short acting, support for 15 minutes until it passes Bupivicaine: much longer reaction - tx is FAT EMULSION |
|
|
5 reasons to add EPI to local anesthetic |
1. prolongs action of local anesthetic 2. blunts systemic uptake and limits systemic toxicity 3. decreases bleeding at injection site 4. marker of intravascular injection (increased HR) 5. Improves quality of spinal blockade via alpha receptors |
|
|
Dexmetomidine |
alpha2 agonist (reduces adrenergic activity) -sedative and analgesic -strong bradycardia, hypotension and hypothermia seen -only given in slow infusion -very long halflife -no respiratory depression |
|
|
Differences between peds and adult airway |
Floppy epiglottis (use straight blade) Larynx higher in neck (laryngoscopy looks relatively anterior) Cricoid cartilage is narrowest point of airway (unlike adult in which vocal folds are smallest) |
|
|
NPO deficit |
Hours NPO x hourly maintenance rate -give half in an hour, then a quarter the next hour and a quarter the next hour, in addition to maintenance! |
|
|
How long do you keep infants after surgery? |
Term -44 week post-conceptual: need 24 hour stay Preterm: need 24 hour stay up to 55 weeks PCA |
|
|
Important history for a child |
Medical history Medications Allergies Recent URI? |
|
|
NPO guidelines |
clear liquids: 2 hrs Breast milk: 4 hrs Formula, cows milk, light meal: 6 hrs Solids: 8 hrs |
|
|
4 anatomic airway differences in kids |
-Proportionally larger head (occiput and tongue) -More anterior and cephalad larynx -Long, floppy, omega-shaped epiglottis -Short trachea and neck |
|
|
Rapid sequence intubation steps |
Preoxygenate Apply cricoid pressure Give fast acting anesthetic and analgesic Intubate Confirm w/capnography Release cricoid pressure |
|
|
When is the largest increase in CO during birth? |
After delivery of the placenta |
|
|
Where are pain receptors located in the spinal cord? |
Dorsal horn |
|
|
What are a2 receptors in the dorsal horn of spinal cord? |
Inhibitory modulators |
|
|
Who needs a preop EKG? |
Men over 50 Women and diabetics over 40 |
|
|
Who needs a preop hgb? |
Menstruating women |
|
|
Who needs a CXR preop? |
Smokers
|
|
|
Dobutamine |
B1 agonist with some B2 and a effects -increases CO without change in HR -decreases preload |
|
|
Isoproterenol |
B1 and B2 agonist, no a activity -Increases HR and contractility -decreases SVR |
|
|
Amrinone/Milrinione |
Phosphodiesterase (PDE) inhibitors -increase cAMP in cardiac and vascular smooth muscle, leading to increased intracellular calcium and increased contractility, decreased SVR and increased CO -action independent of B-adrenergic receptors -Milrinone shorter halflife, amrinone onset faster |
|
|
Ester anesthestics |
Only 1 "i" Procaine Tetracaine 2-chloroprocaine Metabolised to PABA, that can cause allergy |
|
|
Metabolism of ester anesthetics |
Plamsa pseudocholinesterase |
|
|
Amides |
(Have 2 "i"s in names) Mostly what we use today Lidocaine Bupivicaine Mepivicaine Prilocaine Ropivacaine |
|
|
Result of intravascular injection of bupivacaine |
Cardiac asystole |
|
|
3 CV physiologic changes of pregnancy |
Increased intravascular fluid volume Increased CO Decreased SVR |
|
|
Pulmonary changes in pregnancy |
Upper airway has vascular edema, bleed more easily Relative hyperventilation, minute ventilation increases RV and FRC decrease (reserve is diminished, anesthetized more easily with volatile agents) |
|
|
GI changes in pregnancy |
Decreased gastric emptying and motility Increased gastric reflux, more prone to aspiration |
|
|
HOw much blood do you transfuse into a child? |
10 mL/kg will raise hgb about 2 points |
|
|
CV differences in peds patients |
Higher CO HR dependent (fixed stroke volume) Respond to stress by becoming bradycardic Higher HR and lower BP |
|
|
Pulm differences in peds patients |
Increased minute ventilation and RR Desat rapidly due to increased oxygen consumption/kg Decreased FRC under anesthesia due to small alveoli and compliant chest wall |
|
|
Replacement of blood loss in children |
3 mL of crystalloid for each mL blood lost |
|
|
Tx laryngospasm |
CPAP -if not successful, propofol to deepen anesthesia -ultimately succinylcholine for refractory laryngospasm |
|
|
Management of can't intubate, can ventilate |
Wake up Fiberoptic scope Eschmann stylet Other airway (LMA) |
|
|
Management of can't intubate, can't ventilate |
Call for help, figure something out -LMA, combitube -surgical airway if needed |
|
|
Why do you use rapid sequence intubation? |
TO decrease risk of aspiration -it avoids bag masking |
|
|
Moderate sedation |
Drug-induced level of consciousness during which patients respond appropriately to verbal commands -maintain ventilatory and CV function |
|
|
Deep sedaton |
Patient responsive only to more profound stimulus -(reflex withdrawl from pain is NOT considered purposeful, and would be considered general anesthesia) |
