4.6.2013(anesthesia) 27 Flashcards
Biggest anesthesia cylinder
H
smallest : AA
Most commonly used cylinder in anesthesia machines
E
Color of oxygen cylinder
Black body with white shoulder
2,5
Color of N2O cylinder
Blue
3,5
Color of CO2 cylinder and pin index
Grey
Pin index: 2,6 if CO27.5%
Color of air cylinder and pin index
Gray body with black and white shoulder
1,5
Color of cyclopropane cylinder and pin index
Orange
3,6
Color of Entonox cylinder and pin index
Blue body with blue and white shoulders
7
Color of helium cylinder and pin index
Brown
He80.5% 4,6
Pressure of oxygen cylinder
2000psi
Same as air
Pressure of N2O cylinder
760psi
Same with CO2
Liquid oxygen is stored at temperature of
-119 degrees
Longest acting LA
Dibucaine
most potent and most toxic
Color of halothane vaporiser
Red
Color of vaporiser for Isoflurane
Purple
Color of vaporiser for sevoflurane
Yellow
Most volatile anesthetic agent? I.e very high SVP
Desflurane
Color of desflurane vaporiser
Blue
Dibucaine number
Normal:80
Heterozygous:60
Homozygous:20
Differentiation of genetic and non genetic causes of scoline apnea
Plasma cholinesterase
Dibucaine number
Shortest acting LA
Chlorprocaine
Longest acting LA
- dibucaine
- tetracaine
- bupivacaine
Delhi To Bombay
Potency of LA
Dibucaine>etidocaine=tetracaine=bupivacaine
Normal CO2 in capnography
32-42mmHg(3-4mm less than arterial PCO2)
High baseline of ETCO2
Exhausted absorbent
Incompetent expiratory valve
Insufficient fresh gas flows into mapleson system
Problems with inner tube of bains system
Curare notch is seen during
Spontaneous ventilation PNEUMOTHORAX Cervical transverse lesion Flail chest Hiccup
It is due to asynchrony btw diaphragm and intercostal muscles
LA systemic toxicity is increased by
Hypoxia Hypercarbia Acidosis Renal failure Extreme age
Cardiodepressant effect of bupivacaine is aggravated by
Acidosis Hypoxia Hypercarbia Pregnancy IHD conduction blocks
Rx of systemic local anesthetic toxicity
20% lipid emulsion
Anti arrhythmic of choice in systemic LA toxicity
?Bretylium
Wrights respirometer
False high,false low values
False high-high flow rates
False low-low flow rates
Respirometers are used to monitor
Anemometer
Expiratory volume
It can be used to calculate flows also
First sign of LA toxicity
CNS
Drugs not to be used in bupivacaine cardiotoxicity
Lidocaine
Amiodarone
Systemic effect of inhaled NO
Least
No systemic vasodilation
Potency of xenon anesthesia
Low
Xenon weight compared to air
4.5 times Heavier than air
Management of chronic pain
Intrathecal hyperbaric phenol Anterolateral cordotomy Epidural fentanyl PCA(patient controlled analgesia) Anticonvulsant drugs Antidepressant drugs TENS sympathetic Cryoanalgesia
Systemic effect of NO is reduced due to
Binding of NO by Hb
Heliox
21%O2
79%helium
Entonox
50% N2O
50% oxygen
Viscosity and density of heliox
Viscosity is similar to air but low density
Use of heliox
COPD,asthma
SCUBA divers
To reduce WOB in mechanically ventilated pts
Desflurane reacts with dry sodalime to produce
CO
Anticonvulsants used in chronic pain
GABApentin Valproate Pregabalin Lamotrigine Topiramate
Antidepressants used for Rx of chronic pain
Amitryptiline(spinal cord injury pain)
Duloxetine(diabetic painful neuropathy)
Egg lecithin allergy contraindicated use of
Propofol
Anesthetic agents CI in porphyria
Barbiturates Ketamine(Harrison) Etomidate Pentazocine Ropivacaine
Safest IV induction agent in porphyria
Propofol
Antibacterial substance in propofol emulsion
Disodium edetate
Antiemetic intravenous agent
Propofol
Bain is type __________ of mapleson system
D
Most efficient mapleson system for controlled ventilation
D
Efficiency of Mapleson circuits in controlled ventilation
D>B>C>A
Dog Bites Can Ache
Efficiency of mapleson systems in spontaneous ventilation
A>D>C>B
All Dogs Can Bite
Flow rates in mapleson system
Spontaneous: 2-3times minute ventilation
Controlled: 1-2 times minute ventilation
Flow rate in mapleson A
Flow rate = MV
Other name for mapleson A
Magill
Mapleson system of choice in postoperative recovery room
C(waters to and fro)
Mapleson system used in infants and children
E(ayres T piece)
Mapleson F
Jackson Rees modification
LMA protects against
Pharyngeal secretions(partial) Not against gastric secretions
Contraindications for LMA
Pharyngeal pathology(abscess) Pharyngeal obstruction Full stomach(pregnancy,hiatal hernia) Low pulmonary compliance
Role of LMA
Alternative to ET tube not a substitute
LMA size to be used in neonates
1
LMA is available in
8 sizes
LMA sizes used in adults
4,5,6
LMA sizes used in children
1(neonates) 1.5 2 2.5 3
Pin is found on
Anesthetic machine
Onset of effect of epidural
15-20min
Pin index for nitrogen
1,4
Critical intra gastric pressure for aspiration
> 20cm of H2O
Contraindications in RSI(rapid sequence intubation)
Bag and mask ventilation
Induction agent of choice for cerebral protection
Thiopentone
Propofol also protective
Agents that increase ICP
Halothane
Ketamine
ether
Bevelling in ET tubes
Oral tubes:45degrees
Nasal tubes: 30 degrees
ET tube used in thoracic surgery
Double lumen tube for one lung ventilation
ET tube with narrow distal end used in children
Coles tube(narrow subglottis)
ET tube used in head and neck surgeries where acute neck Flexion is required
Spiral embedded or flexometallic armored tube
ET tubes used for lip surgeries
RAE(ring,Adair ,elwyn)
South facing- used for upper cleft lip and cleft palate Sx
North facing- used for lower lip Sx
Hypotension anesthesia
BP reduced by 1/3rd of Preoperative value
Systolic 80-90mm Hg
MAP 50-65mm Hg
Indications of hypotensive anesthesia
Cerebral aneurysm or AV malformation Sx Coarctation of aorta or PDA repair Nasopharyngeal angiofibromas Pheochromocytoma Jehovah witness
Inhalational agent of choice for hypotensive anesthesia
Isoflurane
Others:
Halothane
Enflurane
Ligamentum nuchae is formed by
Supraspinous and interspinous ligaments
Mechanical complications of central line
Cardiac tamponade
Arrythmias
Most common complication of subclavian central line
Pneumothorax
Delayed complications of central line
Venobronchial fistula
Carotid artery-IJV fistula
Pseudoaneurysm
Aortoarterial fistula
Critical temperature
The temperature above which distinct liquid and gas phases don’t exist.
Above critical temp a liquid cannot be formed by increase in pressure.
But with enough pressure a solid can be formed
Critical temperature of Oxygen
-119degrees
Critical temperature of N2O
36.5
Critical temperature of air
-140.6degrees
Critical temperature of nitrogen
-146.9degrees
Critical temperature of CO2
31.04degrees
Confirmation of positioning of DLET
Flexible Fibrooptic bronchoscope
Most commonly used DLT
Robert shaw type
Sizes of DLT
39F for men
37F women
28F pediatrics
Methods to ensure correct positioning of ET tube
Ascultation Chest radiography Use of underwater seal Characteristic feeling of bag Fluoroscopy Selective capnography(cannot detect bronchial intubation) Chest inflation on positive pressure
Earliest signs of MH
MMR
Unexplained tachycardia
ETCO2 rise