Anesthesia - Absite | Conjunto de Fichas

Pregunta	Respuesta
What is MAC, minimum alveolar concentrations?	smallest concentration of inhalational agent in which 50% of patients will not move with incision small MAC = more lipid soluble = more potent
what is the fastest inhalation induction agent but low potency	Nitrous Oxide
Effects of inhalation induction agents	unconsciousness, amnesia, and some analgesia Many cause myocardial depression, increased CBF and decreased RBF
Nitrous Oxide	fast, minimal myocardial depression; tremors at induction Avoid in SBO or pneumothorax pts
Halothane	slow onset/offset highest degree of cardiac depression and arrhythmias, least pungent (good for kiddos)
Side Effects of Halothane	Halothane Hepatitis fever, eosinophilia, jaundice, elevated LFTs
Sevoflurane	inhalation induction fast, less laryngospasm and less pungant good for mask induction
Isoflurane	inhalation induction agent good for neurosurgery lowers brain O2 consumption, no increase in ICP PUNGENT
Enflurane can cause what?	seizures
MCC of intra-op bradycardia and its treatment	inhalation anesthesia Tx: Atropine
Propofol Use	IV induction agent, very rapid distribution and on/off; provide anesthesia and amnesia
Side effects of propofol	HoTN, respiratory depression, metabolic acidosis
Patients not to use propofol in	egg allergy, pregnancy or parkinson's
How is Propofol Metabolized?	by liver and plasma cholinesterases
Effects of Ketamine	dissociation of thalamic/limbic systems places patient in cataleptic state (amnesia, analgesia No respiratory depression
Side Effects of Ketamine	hallucinations, catecholamine release (increase CO2, tachycardia) increased airway secretions, increase CBF (don't use in patients w/ head injuries)
Continuous infusions of this inhalation induction agent can lead to adrenocortical suppression	Etomidate
Dexmedetomidine (Precedex)	sedation agent, provide anesthesia and analgesia without blunting hypoxic drive CNS alpha-2 receptor agonist
What is the last muscle to go down and the first muscle to recover from paralysis?	Diaphragm
First muscles to go down and last to recover from paralytics	Neck muscles and Face
Depolarizing Agents	Succinylcholine depolarizes NMJ
Effects of Succinylcholine	fast, short acting, causes fasciculations, increases ICP, degraded by plasma pseudocholinesterases
Side effects of succinylcholine	Malignant Hyperthermia Hyperkalemia
Malignant Hyperthermia	d/t defect in calcium metabolism Calcium release from SR cause muscle excitation-contraction fever, tachycardia, rigidity, acidosis, hyperK, rhabdomyolysis
Tx of Malignant Hyperthermia	Dantrolene 10mg/kg, inhibits Ca release and decouples excitation complex cooling blankets, HCO3, Glucose, Supportive
Patients to NOT use succinylcholine	severe burns, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure, open-angle glaucoma
MoA of Nondepolarizing Agents	inhibit neuromuscular junction by competing with acetylcholine
Cis-atracurium what is it? how is it eliminated? common s/e	nondepolarizing agent Hoffman elimination can be used in liver and renal failure b/c broken down in blood Histamine release (HoTN)
Rocuronium what is it? how it's metabolized	Nondepolarizing Agent Fast Acting Hepatic Metabolism
Pancuronium what is it? how its metabolized MC s/e	nondepolarizing agent slow acting, long-lasting renal metabolism s/e: tachycardia (no HoTN)
Reversing Agents for Nondepolarizing Agents	Neostigmine Edrophonium by blocking AChE, increasing ACh. Also give Atropine and Glycopyrrolate to counteract ACh overdose with treatment
How do Local Anesthetics work?	increases action potential threshold, preventing Na influx
What is the maximum dosing of lidocaine?	4mg/kg or 7mg/kg with epinephrine
What is the maximum dosing of Buprivacaine?	2mg/kg or 3mg/kg with epinephrine
Why are infected tissues more difficult to anesthetize?	Acidosis
Side effects of local anesthesia	perioral paresthesias (1st sign), tremors, seizures, tinnitus, arrhythmias, (CNS symptoms before cardiac)
When should you not use epinephrine with local anesthetics?	arrhythmias, unstable angina, uncontrolled HTN, poor collaterals (penis, ear), uteroplacental insufficiency
List of Amide Local Anesthetics	(all have 'i' in the first part of the name) Lidocaine, Bupivacaine, Mepivacaine
List of Ester Local Anesthetics	Tetracaine, Procaine, Cocaine increased chances of allergic reactions d/t PABA analogue
Opioid Receptors	mu
Effects of opioids	analgesia, respiratory depression, no cardiac effects, blunt sympathetic response
Where are narcotics metabolized?	Liver
Tx for narcotic overdose	Narcan (Naloxone) mu-opioid receptor antagonist
Why shouldn't you use narcotics in patients with MAO-i use?	can cause hyperpyrexic coma, serotonin release syndrome, fever, tachycardia, seizures, coma
Effects of Morphine	analgesia, euphoria, respiratory depression, miosis, constipation, histamine release (causing HoTN), decreased cough
Effects of Demerol	analgesia, euphoria, respiratory depression, miosis, tremors, fasciculations, convulsions
Why don't you give Demerol to patients in renal failure?	can cause seizures, build up of normeperidine analogues
Methadone	stimulates morphine, less euphoria, agonist to CNS mu-receptor
Fentanyl	fast acting, 80x strength of morphine doesn't cross react in patients with morphine allergy no histamine release
What is the most potent narcotic?	Sufentanil it is very short acting with a very short half life Remifentanyl also is short acting with very short half-life
Effects of Benzodiazepines	anticonvulsant, amnesic, anxiolytic, respiratory depression, NOT an analgesic
Receptor associated with benzodiazepines	Agonist to GABA in the CNS most prevalent inhibitory brain receptor
Versed other name and contraindication	Midazolam, Benzodiazepine short acting, contraindicated in pregnancy crosses placenta
What is Valium?	Diazepam, a long-acting benzodiazepine
What is Ativan?	Lorazepam, a long acting benzodiazepine
Treatment for Benzodiazepine overdose	Flumazenil its a competitive inhibitor, may cause seizures and arrhythmias c/i in patients with status epilepticus and elevated ICP
How epidural anesthesia works	allows analgesia by sympathetic denervation (sensory blockade) vasodilation
Effects of Morphine in an epidural	Respiratory Depression (use dilaudid to avoid this)
Lidocaine in an epidural	can cause decreased HR and BP
Treatment for a patient who develops acute HoTN and Bradycardia during an epidural	turn epidural down, give fluids, phenylephrine, atropine
Why can't you use an epidural in patients with HCM or cyanotic heart disease?	sympathetic denervation causes decreased afterload
Area to place an epidural for thoracotomy	T6-T9
Area to place an epidural for laparotomy	T8-T10
Spinal Anesthesia	inject into subarachnoid space, spread determined by baricity and patient position inject below L2
Caudal Block	through sacrum, good for pediatric hernias and perianal surgery
Epidural and Spinal Complications	HoTN, HA, Urinary retention, Abscess, Hematoma, Respiratory Depression
What are spinal HAs and how to treat them	caused by CSF leak after spinal/epidural HA worsens with sitting up Tx: rest, fluids, caffeine, analgesics if persists >24hrs, blood patch it
Initial Treatment for Post-op MI	beta-blocker, morphine, oxygen, ASA, sublingual nitrates
What to do for patient with STEMI post-op?	emergent cardiac cath lab for intervention
Patients who need pre-op cardiac work up	angina, prev MI, SOB, CHF, walks <2block d/t SOB/CP, FEV1 <70% predeicted, severe valvular dx, PVCs >5/min, high grade heart block, >70y/o, DM, renal insufficiency, those undergoing major vasc. surgery
ASA Physical Status Class I	Healthy
ASA Physical Status Class II	mild disease without limitation ctrl'd HTN, obesity, SM, smoking hx, older age
ASA Physical Status Class III	Severe Disease (angina, prev MI, poorly ctrl HTN, DM w/ complications, mod COPD)
ASA Physical Status Class IV	Severe Constant Threat to Life unstable angina, CHF, renal failure, liver failure, severe COPD
ASA Physical Status Class V	Moribund (ruptured AAA, saddle pulmonary embolism)
ASA Physical Status Class VI	Donor
ASA Physical Status Class E	Emergency
Biggest Risk Factors for postop MI	uncompensated CHF, recent MI, age >70, DM, previous MI, unstable angina, Cr >2, stroke/TIA
Most effective cardiac med to prevent intra-op and post-op cardiovascular events	Beta-blocker
How long should you wait after an MI before doing an elective surgery?	6-8weeks
What is a high cardiac risk for a noncardiac surgical patient?	cardiac risk >5% emergent operations (esp elderly) aortic, peripheral and other major vascular surgery (except CEA) Long surgeries with large fluid shifts
What is a Intermediate cardiac risk for a noncardiac surgical patient?	Cardiac Risk <5% CEA, head and neck surgery intraperitoneal and intrathoracic surgery orthopedic and prostate surgeries
What is a Low cardiac risk for a noncardiac surgical patient?	cardiac risk <1% endoscopic procedures, superficial procedures, cataract surgery, breast surgery
Best determinant of esophageal vs tracheal intubation	end-tidal CO2 (ETCO2)
Intubated patient undergoing surgery with sudden transient RISE in ETCO2 - most likely cause - treatment - possible other causes	MC: Hypoventilation Tx: increase tidal volume or increase RR other: CO2 embolus or malignant hyperthermia
Causes for an intubated patient with sudden DROP in ETCO2	disconnected from vent pulmonary or air embolism
Symptoms of Air Embolism	sudden drop in ETCO2 HoTN, tachycardia, mill wheel murmur (air lock prevents venous return)
Treatment of Air Embolism	Stop CO2 insufflation if lap procedure Trendelenburg and left lateral decubitus (keeps air from right ventricle) hyperventilate with 100% oxyegn aspiration central line pressors + inotropes, prolonged CPR
ETT placement should be how far above carina?	2cm
MC PACU complication	nausea and vomiting
MCC of post-op hypoxemia	atelectiasis (alveolar hypoventilation)
MCC of postop hypercarbia	poor minute ventilation need to take bigger breaths or increase tidal volumes
Signs of inadequate pain control	tachycardia, diaphoresis, splinting, HTN

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