Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ABSITE > 8 Anesthesia > Flashcards

8 Anesthesia Flashcards

1
Q

Concerning findings on airway exam for anesthesia?

A

BMI >31
Interincisor or intergingival distance >3cm
Class III or IV mallampati classification
Inability to protrude lower incisors to meet or extend past upper incisors
Radiation changes or thick obese neck
Limited extension or possible unstable cervical spine
Presence of full beard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mallampati classification of the airway

A

Class I - Can see everything
Class II - cannot see all of pillars or uvula
Class III - cannot see pillars
Class IV - Cannot see anything

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MAC

A

Minimum alveolar concentration - smallest conc of inhalation agent at which 50% of patients will not move with incision
Small MAC - more lipid soluble = more potent
Speed of induction is inversely proportion to solubility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Common AE for inhaled anesthetics?

A

Unconsciousness, amnesia, analgesia
Blunt hypoxic drive
Myocardial depression, increase cerebral blood flow and decrease renal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nitrous oxide

A

Fast
Minimal myocardial depression
Tremors at induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Halothane

A

Slow onset/offset
Highest degree of cardiac depression and arrhythmias
Least pungent - good for children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Halothane hepatitis

A

Fever
eosinophilia
Jaundice
Increased LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sevoflurane

A

Fast
Less laryngospasm
Less pungent
Good for mask induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Isoflurane

A

Good fro neurosurgery - lowers brain consumption, no increase in ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Enflurane

A

Can cause seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sodium thiopental

A

Barbiturate
Fast acting
AE: decreased cerebral blood flow and metabolic rate; decreased blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Propofol

A

Very rapid distribution and on/off
Amnesia, sedative, NOT analgesic
AE: Hypotension, respiratory depression, egg allergy
Metabolized in liver and by plasma cholinesterases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ketamine

A 
Dissociation of thalamic/limbic systems
Cataleptic state (amnesia, analgesia)
AE: Hallucinations, catecholamine release (increased CO2, tachycardia), increased airway secretions, increased cerebral blood flow
CI: head injury
Good for children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Etomidate

A

Fewer hemodynamic changes
Fast acting
Continuous infusions can lead to adrenocortical suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the last muscle to go down and first muscle to recovery from paralytics?

A

Diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the first muscle to go down and last muscle to recover from paralytics?

A

Neck muscles and face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Succinylcholine

A

Fast, short acting
AE: Fasciculations, increase ICP, malignant hyperthermia
CI: Hyperkalemia, open-angle glaucoma, atypical pseudocholinesterases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Malignant hyperthermia

A

Defect in calcium metabolism
Calcium release from sarcoplasmic reticulum causes muscle excitation-contraction syndrome
AE: increase ETCO2, fever, tachycardia, rigidity, acidosis, hyperkalemia
Treatment: dantrolene, cooling blankelts, HOC3, glucose, supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the first sign of malignant hyperthermia?

A

Increased ETCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dantrolene - MOA, dose

A

Inhibits Ca release and decouples excitation complex

Dose 10mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hyperkalemia and succinylcholine

A

Depolarization release more K

CI: Severe burns, neurologic injury, neuromusclar disorders, spinal cord injury, massive trauma, acute renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Atypical pseudocholinesterases and succinylcholine

A

Causes prolong paralysis

Seen in Asians

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Non-depolarizing paralytic agents

A

Inhibit neuromuscular junctions by competing with acetylcholine
Get prolongation of these agents with myasthenia graves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cis-atracurium

A

Hoffman degradation
Can be used in liver and renal failure
Causes histamine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Rocuronium

A

Fast, intermediate duration

Hepatic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pancuronium

A

Slow acting, long-lasting
Renal metabolism
AE: tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Neostigmine

Edrophonium

A

Blocks acetylcholinesterase, increasing acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Reversing drugs for non-depolarizing agents

A

Neostigmine
Edrophonium
Atropine/glycopyrrolate - given with to counteract the effects of generalized acetylcholine overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

MOA - local anesthetics

A

Works by increasing action potential, preventing Na influx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why are infected tissues hard to anesthetize?

A

Acidosis inactivates it

31
Q

AE of local anesthetics?

A 
Tremors
Seizures
Tinnitus
Arrhythmias 
(CNS symptoms present before cardiac)
32
Q

Epinephrine with local anesthetics?

A

Allows higher doses to be used - vasoconstriction keeps the anesthetic local
CI: arrhythmias, unstable angina, uncontrolled HTN, poor collaterals (penis, ear), uteroplacental insufficiency

33
Q

AE of opioids

A

Profound analgesia
Respiratory depression (decrease CO2 drive)
No cardiac effects
Blunt sympathetic response

34
Q

Morphine

A 
Analgesia
Euphoria
Respiratory depression
Miosis
Constipation
Histamine release (hypotension)
Decrease cough
35
Q

Demerol

A 
Analgesia
Euphoria
Respiratory depression
Miosis
Tremors
Fasciulations
Convulsions
NO histamine release
Can cause seizures - build up of normeperidine analogue (renal failure)
36
Q

Methadone

A

Simulates morphine

Less euphoria

37
Q

Fentynal

A

Fast acting
80x strength of morphine
No histamine release

38
Q

Sufentanil

Remifentanil

A

Fast-acting narcotics

Short half-life

39
Q

Most potent narcotic?

A

Sufentanil

40
Q

Effects of benzodiazepines

A 
Anticonvulsant
Amnesic
Anxiolytic
Respiratory depression
NOT analgesia
Liver metabolism
41
Q

Versed

A

Midazolam
Short acting
CI: pregnancy (crosses placenta)

42
Q

Valium

A

Diazapam

Intermediate acting

43
Q

Ativan

A

Lorazepam

Long acting

44
Q

Benzo overdose

A

Flumazenil
Competitive inhibitor
AE: seizures, arrythmia
CI: elevated ICP, status epilepticus

45
Q

AE of morphine in epidural

A

Respiratory depression

46
Q

AE of lidocaine in epidural

A

Decreased heart rate and hypotension

47
Q

Treatment of acute hypotension and bradycardia in patient with epidural?

A

Turn epidural down
Fluids
Phenylephirine, atropine

48
Q

CI for epidural

A

Hypertrophic cardiomyoptahy
Cyanotic heart disease
(Sympathetic denervation causes decreased afterload, which worsens these conditions)

49
Q

Spinal anesthesia

A

Injection into subarachnoid space - spread determined by baricity and patient position
- Neurological blockade is above motor blockade
CI: hypertrophic cardiomyopathy, cyanotic heart disease

50
Q

Caudal block

A

Through sacrum

Good for pediatric hernias and perianal surgery

51
Q

Epidural and spinal complications

A 
Hypotension
Headache
Urinary retention (require catheter)
Abscess/hematoma formation
Respiratory depression (with high spinal)
52
Q

Spinal headache

A

Caused by CSF leak after spinal/epidural
Headache gets worse with sitting up
Tx: rest, fluids, caffeine, analgesics; blood patch to site if it persists >24 hours

53
Q

What pre-op conditions are associated with the most post-op hospital mortality?

A

Renal failure*

CHF

54
Q

Symptoms of post-op MI

A

May have no pain or EKG changes

Sx: hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia

55
Q

What patients need pre-op work up?

A 
Angina
Previous MI
SOB
CHF
Walk <2 blocks secondary to SOB or CP
FEV1 <70% predicted
Severe valvular disease
PVCs >5/min
High grade heart block
Age <70
Dm
Renal insufficiency
Major vascular surgery
56
Q

ASA class 1

A

Healthy

57
Q

ASA class 2

A

Mild disease without limitations (controlled HTN, obesity, DM, sig smoking history, older age)

58
Q

ASA class 3

A

Severe disease (angina, previous MI, poorly controlled HTN, DM with complications, mod COPD)

59
Q

ASA class 4

A

Severe constant threat to life (unstable angina, CHF, renal failure, liver failure, severe COPD)

60
Q

ASA class 5

A

Moribund (ruptured AAA, saddle PE)

61
Q

ASA class 6

A

Donor

62
Q

ASA class E

A

Emergency

63
Q

Aortic, major vascular and peripheral vascular surgeries are ___ risk?

A

High

64
Q

Carotid endarterectomy is ____ risk?

A

Moderate

65
Q

Biggest risk factors for post-op MI?

A 
Age >70yo
DM
Previous MI
CHF
Unstable angina
66
Q

High cardiac risk Stratification for non-cardiac surgical procedures?

A

Cardiac risk >5%

  • Emergent operations (esp elderly)
  • Aortic, peripheral and other major vascular surgery (except CEA)
  • Long procedure with large fluid shifts
67
Q

Intermediate cardiac risk Stratification for non-cardiac surgical procedures?

A

Cardiac risk <5%

  • CEA
  • Head and neck surgery
  • Intraperitoneal and intrathoracic surgery
  • Orthopedic surgery
  • Prostate surgery
68
Q

Low cardiac risk Stratification for non-cardiac surgical procedures?

A

Cardiac risk <1%

  • Endoscopic procedures
  • Superficial procedures
  • Cataract surgery
  • Breast surgery
69
Q

Best determinant of esophageal vs. tracheal intubation?

A

ETCO2

70
Q

Intubated patient undergoing surgery with sudden transient rise in ETCO2

A

Most likely hypoventilation

Tx: increase TV or increase RR

71
Q

Intubated patient with sudde drop in ETCO2?

A

MC: disconnected from the vent

PE - when associated with hypotension

72
Q

MC PACU complication

A

Nausea and vomiting

73
Q

High volume hospitals are associated with lower mortality for:

A

AAA repair

Pancreatic resection

ABSITE (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions