3.6.2013(anesthesia) 26 Flashcards by rakesh durai

Mechanism of action of Etomidate

GABA receptors

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Etomidate causes endocrine suppression by

11 beta hydroxylase

17 alpha hydroxylase

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Steroid inhibitors

Metyrapone
Aminoglutithimide
Trilostane
Ketoconazole 
Etomidate
Mifepristone(glucocorticoid antagonist)

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Metyrapone inhibits steroid synthesis by

Inhibiting 11 beta hydroxylase

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Adverse effects of Etomidate

Myoclonus
Hiccups
Adrenal suppression 
Pain on injection
Thrombophlebitis
Postoperative nausea and vomiting

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IV anaesthetic causing pain on arterial injection

Thiopentone

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IV anaesthetic agent causing thrombophlebitis on intravenous injection

Etomidate

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IV anaesthetic agent cause pain without thrombophlebitis on intravenous injection

Propofol
Methohexital
Thiopental

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Antidote for Etomidate induced adrenal suppression

Vitamin C

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Highest incidence of nausea and vomiting among induction agents

Etomidate

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Pain relief in thoracotomy

Neuraxial block(epidural is gold standard)

2. opioids

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Intrathecal opioid of choice after thoracotomy

Morphine

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High dose of Sch

7-10mg/kg

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Risk of phase 2 block with Sch

Prolonged exposure(30-60min)
Large dose

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CI for nasotracheal intubation

Severe mid facial trauma

CSF rhinorhea

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Ideal airway procedure in a pt with mid facial trauma

cricothyroidectomy

2. orotracheal intubation

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Inhalation anaesthetic agent causing coronary steal

Isoflurane

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Best uterine relaxant among inhalational anaesthetics

Halothane

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Best muscle relaxant among inhalational agents

Ether

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Irritant inhalational agents

Desflurane
Isoflurane
Ether
Enflurane

DIE

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Volatile agent of choice in liver disease

Isoflurane(least decrease in portal blood flow)

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Induction agents that can be used in liver failure

Propofol

Etomidate

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Benzodiazepine that can be used in liver failure

Lorazepam(undergoes only phase 2 glucuronidation)

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Opioid that can be given in liver failure

Remifentanyl

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Inhalational anaesthetics that can be used in liver failure

Desflurane Sevoflurane Isoflurane N2O

Portal flow is maximally reduced by

Halothane

Type of anesthesia contraindicated in boy with sickle cell trait

IV regional anesthesia

Contraindications for IVRA

Sickle cell disease Raynaud Scleroderma

Agents used in IVRA

0. 5% prilocaine | 0. 5% lignocaine

Drugs causing methhemoglobinemia

``` Nitrites/nitrates Benzocaine,prilocaine Dapsone Primaquine and related antimalarials Sulfonamides ```

Mill wheel murmur heard in

Air embolism

Local anaesthetic first used clinically

Cocaine

Muscle relaxants independent of kidney and liver function

Atracurium Cis atracurium Mivacurium

Minimum histamine release among muscle relaxant

Vecuronium

Amount of air necessary to produce significant injury in air embolism

5ml/kg

Most sensitive NONINVASIVE method to detect air embolism

Doppler ultrasound

Most sensitive method to detect air embolism

Transesophageal echocardiography

First sign in air embolism

Low end tidal Co2

Methods to detect air embolism

1. TEE 2. PAC 3. mass spectrometry for end tidal nitrogen(sa sensitive as PAC)

Dead space is increased by

Old age Jaw protrusion Increased lung volume Standing

Decreased dead space is caused by

Hyperventilation

Most common complication of celiac plexus block

Hypotension

Indications of celiac plexus block

Pancreatitis | Ca pancreas

Complications of celiac plexus block

``` Hypotension Hematoma Retroperitoneal hemorrhage(rare) Injury to aorta,IVC Diarrhoea Paraplegia and transient motor block Aortic dissection ```

Baroreceptor reflexes are inhibited by which induction agent

Propofol

Indication for CPAP

All preterm infants <35wks with any sign of respiratory distress

Indications for CPAP in children

``` RDS If paO2<50mm on a FiO2 of .40 pulmonary Edema Atelectasis Apnea of prematurity Recent extubation Tracheomalacia Transient tachypnea of newborn ```

Metabolite of prilocaine responsible for methhemoglobinemia

Orthotoludene

Principle of capnogram

Co2 absorbs IR rays

Phases of capnograph

Phase 1: dead space- baseline of capnograph Phase 2: expiratory upstroke-mixture of dead space and alveolar Phase3: expiratory plateau-mostly alveolar gas Phase 4: inhalational phase End tidal : end of expiratory plateau

Adequacy of CPR based on ETCO2

Level should return to 10mm Hg or more after 20min of CPR

capnograph in bronchial asthma

Shark fin appearance

Systemic absorption of LA

Intrapleural>intercostal>pudendal>caudal>epidural>brachial plexus>sciatic femoral>infiltration

Components children hospital eastern Ontario pain scale(CHEOPS)

``` Cry Facial Child verbal Torso Touch Legs ```

A child is said to be in pain if(according Cheops)

In children 1-7yrs,score greater than 4 indicates pain

Air collections that can be expanded by N2O

``` Pneumothorax Air embolus Obstructed middle air Obstructed loop of bowel Intracranial air Pulmonary bleb ```

CI for N2O anesthesia

Vitro retinal Sx Middle ear Sx Micro laryngeal Sx

Effect of N2O anesthesia in middle ear Sx

Serous otitis media Disarticulation of stapes Impaired hearing

Most commonly used gases in vitro retinal Sx

Filtered room air Sulphur hexafluoride Perfluropropane

Side effect of rapacuronium

Intense bronchospasm

Shortest acting NDMR

Mivacurium

Fastest acting NDMR

Rocuronium

Shortest and fastest acting NMB

Sch

Pancuronium unique features

Least histamine release | Maximal vagal block and tachycardia

Vagal and ganglionic stimulation caused by which NMB

Sch

Most potent muscle relaxant

Doxacurium

Least potent muscle relaxant

Sch

Least potent NDMR

Rocuronium

Maximum ganglionic blockade is caused by which MR

d-tubocurarine

Most common cause of postoperative renal failure

Decreased renal perfusion

Sodium carbonate is added to which induction agent to increase solubility

Thiopentone

Substance added to increase lipid solubility

Sulphur

Effect of ketamine on CVS

Direct myocardial depressant action Vasodilatation But it is a reuptake inhibitor

Renally eliminated muscle relaxant

Doxacurium Tubocurarine Pancuronium

Muscle relaxant eliminated hepatically

Rapacuronium

Muscle relaxants with both Renal and liver elimination

Pipecuronium Vecuronium Rocuronium

Side effects of oxygen therapy

Hypoventilation Absorption atelectasis Pulmonary toxicity ROP

Muscle observed commonly for neuromuscular blockade

Adductor pollicis Most commonly monitored nerve- ulnar

Muscle to show earliest reversal following neuromuscular blockade

Orbicularis oculi

Drawbacks of nasotracheal intubation

Sinusitis Mucosal damage Restricted movement of endotracheal tube