7. ERAS/Transplant Flashcards
1
Q
ERAS
A
enhanced recovery after surgery
2
Q
ERAS was first designed for
A
colorectal surgery
3
Q
FIVVE therapy is used for
A
anemia correction
4
Q
FIVVE therapy
A
Folate
Iron
Vit B12
Vit C
Erythropoetin
5
Q
alcohol usages incr incidence of
A
cardiomyopathy
infection
arrythmias
6
Q
alcoholism incr risk of post-op complications
A
50-200%
7
Q
alcoholism consumption
A
> 36 gm/day
or
3 drinks/day
8
Q
COMA BAC
A
0.4-0.5 g/dL
9
Q
sleep/stupor BAC
A
0.25-0.4 g/dL
10
Q
confusion/impaired balance BAC
A
0.15-0.3 g/dL
11
Q
euphoria/decr judgement BAC
A
0.05-0.1 g/dL
12
Q
mild euphoria/decr inhibitions BAC
A
0.01-0.05 g/dL
13
Q
1 drink =
A
1.5 oz 40% liquor
5 oz 12% wine
12 oz 5% beer
14
Q
alcoholism labs
A
hypokalemia
hypomagnesemia
hypocalcemia
hypophosphatemia
15
Q
alcoholism treatment
A
thiamine
benzos
16
Q
cough med alcohol
A
16-25%
17
Q
vanilla alcohol
A
35%
18
Q
glass cleaner alcohol
A
10%
19
Q
hand sanitizer alcohol
A
62%
20
Q
mouthways alcohol
A
25%
21
Q
perfume alcohol
A
80%
22
Q
nictoine is used for
A
smoking cessation
23
Q
20 mins smoking cessation
A
decr effects of nicotine on BP
vasoconstriction
24
Q
8 hrs smoking cessation
A
CO levels halved
25
12 hrs smoking cessation
CO levels normalized***
26
24 hrs smoking cessation
chances of MI decreased
27
48 hrs smoking cessation
mucus expulsion increased
incr risk of surgery
28
2 weeks smoking cessation
lung inflammation starts to decr
29
e-cigs can cause
EVALI
30
NPO
nil per os
31
NPO standard
8 hrs
clear liquids up to 2 hrs prior
32
pre-op goals
normoglycemia
normothermia
multi-modal analgesia
33
opioids
meds that mimic papaver somniferum (opium poppy)
34
opioid mechanism
pure mu agonist
mixed mu agonist/antagoionist
35
opioid SE
pruritus
resp depre
histamine release
urinary retention
N/V
ileus
36
which opioids causes histamine release
morphine
meperidine
37
Multi-modal anesthesia
use more than one class of analgesic med
38
MMA goal
improve analgesia
decr SE
39
MMA dosing
smaller doses of more meds
40
what is gabapentin best for
neuropathic pain
41
what is mg best for
nerve stabilization
42
what is esmolol good for
prevents HR/BP windupw
43
which meds inhibit pain perception
opioids
alpha 2 agonist
TCAs
SSRIs
SNRIs
44
which meds inhibit ascending pain transmission
LAs
opioids
alpha 2 agonists
45
which meds facilitate descending pain modulation
TCAs
SSRIs
SNRIs
gabapentinoids
46
which meds inhibit pain transduction
LAs
alpha 2 agonists
gabapentinoids
acetaminophen
NSAIDs
glucoroticoids
47
physiological pain
acute
nociceptive
protective
48
pathological pain
neuropathic
fibromyalgia
disesase is pain
49
psychogenic pain
phantom limb
50
neuropathic pain types
allodynia
hyperalgesia
OIH
opioid tolerance
51
allodynia
pain due to stimulus that does not usually provoke pain
52
hyperalgesia
incr pain from simulus that usually provokes pain
53
OIH
exposure to narcotic that induces hyperalgesia
54
opioid tolerance
incr narcotic need to illicit similar analgesia
due to incr metabolism
55
OIH pain stimulus
incr
56
in OIH, opioids _____ pain
incr pain
57
opioid tolerance pain stimulus
no change
58
what helps with OIH
NMDA antagonisms
59
which opioid has higher risk of OIH
remi
(shorter acting = higher risk of OIH)
60
which drug can help reset pain perception
ketamine
61
ketamines effect on opioids
ketamine makes smaller doses of opioids more effective
62
CTZ activation results in
vomiting center response
63
CTZ
mu
kappa
dopa-2
neurokinin-1
serotonin type 3
enkephalin
histamine 1/2
64
factors that incr PONV risk
female
non smoker
history of PONV/motion sickness/migrane
young
anxiety
65
does the dose or the agent of opioids correlated with incr PONV risk?
dose
66
which opioid may benefit pONV
alfentanil
67
which opioids is a poor choice for pONV
morphine
68
which VA is best for PONV
all are equal
69
surgical factors incr PONV
vestibular stimulation
swallowing blood/secretions
emotional distress
peritoneal irritation
serotonin releae
vagal stimulation
strabismus surgery
70
primary PONV treatments
4 mg zofran
4-8 mg decadron
71
secondary PONV treatment
haloperidol
phenergan
aprepitant
scopolamine
TIVA
P6 acupuncture
72
Apfel risk factors
female
non-smoker
post-op opioids
hx PONV
73
haloperidol dose
0.5-2 mg IM/IV
(end of surgery)
74
phenergan dose
6.25-12.5 mg IV
(induction)
75
aprepitant
40 mg PO
(1-3 hrs pre-op)
76
scopolamine
1.5 mg Topical patch
(> 1 hr pre-op)
77
dopa antagonisms
metoclopramide
droperidol
78
metoclopramide dose
10 mg
79
droperidol dose
0.625-1.225 mg
80
which pts should not receive dopa antagonists
parkinsons pts
81
which dopa antagonist prolongs QT
droperidol
82
histamine antagonists
diphenhydramine
phenergan
83
diphenhydramine dose
25-50 mg
84
diphenhydramine SE
sedation
urinary retention
extrapyramidal
85
diphenhydramine CI
dementia
86
phenergen (promethazine) dose
12.5-25 mg
87
when is atropine an antiemetic
if use with neostigmine
88
scope patch lasts
72 hours
89
scope patch coverage
vestibular PONV
90
zofran SE
QT prolongation
91
5-HT3 antagonists
ondansetron
granistron
palonosetron
remosteron
92
neurokinin-1 antagonist
aprepiatant
93
aprepitant location of action
nucleus tractus solitarius
94
which is more effective aprepitant or zofran
aprepitant
95
decadron location of action
nucleus tractus solitarius
96
1 gm ancef
< 60 kg
or
reduced renal function
97
2 gm ancef
60-120 kg
98
3 gm ancef
> 120 kg
99
when do you repeat ancef
3-4 hrs
or
EBL > 1 L
100
hypothermia SE
arrythmias
ischemia
Left shift curve
coagulopathy
plt dysfunction
protein catabolism
decr renal function
decr drug metabolism
poor wound healing
incr infection
incr cortisol
101
lung protection vent settings
lower TV (4-6 ml/kg)
PEEP 5-10 cmH2O
102
blood loss volume replacement crystalloids
3:1
103
blood loss colloid replacement
1:1
104
bowel prep fluid deficit
1L
105
PPV fluid responsive
>12
(some sources say 15)
106
intraop glucose
80-180 mg/dL
107
brain dead tests
comatose
lack of brainstem replexes
apnea test
108
what is crucial for prevention of donor organ damage
perioperative HD stabilization
109
organ donation SBP
> 100 mmHg
110
organ donation MAP
70-110 mmHg
111
organ donation PO2
> 100 mmHg
112
organ donation UOP
> 100 mL/hr
(1-1.5 mL/kg/hr)
113
organ donation Hgb
> 10 g/dL
114
organ donation CVP
5-10 mmHg
115
organ donation FiO2
< 40%
(if tolerated)
116
organ donation glu
< 200 mg/dL
117
should you use pressors in organ donation
no
118
why avoid phenylephrine in organ donation
acidosis risk
119
which drug is given prior to organ retriveal
heparin
120
which drugs help stabilize HD
VA
naroctics
121
can you give versed to elective organ donors
no
122
which transplant case is one of the most involved
hepatic
123
hepatic transplant lines
central
arterial
large bore IV
124
preanhepatic SE
blood loss
hyponatremia
hyperkalemia
citrate tox
125
anhepatic effects
no drug metabolism
126
neohepatic effects
reperfusion syndrome
hepatic ischemia
127
reperfusion syndrome
cold
acidotic
hyperkalemic
emboli
128
hepatic donation
Right lobe
129
what immunosuppresant is given in renal transplant
antithymocyte globulin rabbit
130
SE of immunosuppressant
hypotension
immune reaction
131
treat immune response prophylactically
diphenhydramine 50 mg
solu-medrol 250 mg
132
how do you give thymocyte
centrally
(with filter)
133
renal transplant goal CVP
15 mmHg
134
fluids for renal transplant
NS (SLH)
mannitol
lasix
