ACE Flashcards
Most common complication of OB paracervical block
-fetal bradycardia
U/S PNX
lung point
Intra-aortic ballon pump
- he primary purpose of IABP therapy is to improve myocardial perfusion during diastole by improving coronary blood flow. It also reduces left ventricular afterload, thus decreasing left ventricular work.
- The most accurate way to correctly time IABP counterpulsation is to initiate inflation immediately as the dicrotic notch is detected. Deflation of the IABP balloon should take place just before the systolic upstroke
- helium in balloon
Peds, % blood loss before hypotension
40%
Shortest half life of benzos (versed, lorazepam, diazepam, alprazolam)
versed
Methylphenidate perioperative concerns
increased cardiovascular instability, altered anesthesia requirements, and lowering of the seizure threshold. Methylphenidate use is associated with an increased minimum alveolar concentration (MAC) and thus a decreased sensitivity to volatile anesthetics. Time to emergence from general anesthesia is not increased in patients taking methylphenidate
Carcinoid heart disease
Carcinoid heart disease typically produces tricuspid regurgitation and mixed pulmonic stenosis and regurgitation, resulting in right heart failure.
OI associations
-platelet dysfunction, easy trauma, pectus excavatum, heat intolerance, increases thyroid hormone
Dementia drugs interactions
-Anticholinesterase medications are also frequently used in the treatment of dementia (eg, donepezil). These medications may prolong paralysis from succinylcholine and impact nondepolarizing muscle relaxants by decreasing or reversing their effects
Most predictve on unsuccessful mask
-neck radiation changes
Fractional flow reserve
< .8 likely to improve with PCI or stent
Pregnancy s/p renal transplant
However, some complications of pregnancy are higher in transplant recipients, such as preeclampsia (27.0% vs 3.8%) and gestational diabetes (8% vs 3.9%). Also higher are the rates of cesarean delivery (56.9% vs 31.9%) and preterm delivery (45.6% vs 12.5%
presedex context sensitive halflife for 40 yo
50 minutes
post ROSC hypothermia
32°C to 34°C and 34°C to 36°C
MH susceptibility
There is a wide range of disorders associated with mutations in the RYR1 gene (eg, central core disease, King–Denborough syndrome, periodic paralysis, and idiopathic hyperCKemia).
Stellate ganglion block
- In 80% of patients, the stellate ganglion is formed by the inferior cervical and the first thoracic ganglion. The anterior approach is most commonly used for SGB
- Left-sided SGB has been noted to be more effective at managing ventricular arrhythmias. If left SGB fails, a right SGB can be added, but this should be restricted to intubated patients, as bilateral phrenic nerve paralysis is possible
- LA injected anterior to longus colli muscle
TIPS procedure
shunt between hepatic vein and portal vein
Aortic coarctation
headache, epistaxis, lower extremity claudication, and hypertension. Upper extremity systolic hypertension (with normal diastolic pressure) and lower extremity hypotension are also common. These individuals exhibit extensive collateral circulation
cancer drugs that interact with pseudochilinesterase
nitrogen mustards
eg, mechlorethamine, cyclophosphamide, melphalan, and chlorambucil
treatment for heparin resistance
administration of recombinant human antithrombin, additional heparin, or fresh frozen plasma (FFP)
thorasic scoliosis PFTs
- follow restrictive pattern
- decrease in FVC
PONV acupuncture
Pericardium-6
- 4 cm proximal to the distal wrist crease, between the palmaris longus and flexor carpi radialis tendons
Parkinsons and PONV
Haloperidol, metoclopramide, and promethazine are all dopamine antagonists and have proved efficacious in treating PONV. However, dopamine antagonists may exacerbate symptoms in patients with Parkinson disease and should therefore be avoided in such patients.
cerebral edema in tumor
- Vasogenic cerebral edema occurs when tight endothelial junctions of the blood–brain barrier are compromised, such as with tumor growth
- Intravenous steroids, such as dexamethasone, selectively target vasogenic cerebral edema by stabilizing the blood–brain barrier
Most appropriate way to report drug dosage
mean drug dose +/- SEM
elective procedure s/p stroke
wait 6 weeks
Serotonin syndrome
Signs and symptoms of altered mental status include: Agitation Disorientation Anxiety Visual hallucinations
Signs of neuromuscular overactivity include: Myoclonus Tremor Hyperreflexia Muscle rigidity Positive akathisia Nystagmus Trismus
Signs of autonomic instability include: Hypertension Tachycardia Hyperthermia Mydriasis
button battery
honey 10ml q 10 minutes
Epsilon waves on EKG
Epsilon waves on 12-lead electrocardiogram are considered characteristic of rrhythmogenic right ventricular cardiomyopathy (ARVC)
-The disorder is often familial and typically autosomal dominant with variable expressivity
Vd in old people
The volumes of distribution for drugs change with age, depending on whether they are fat soluble or water soluble. The volume of distribution of fat-soluble drugs is increased in the elderly, leading to a longer elimination half-life compared to younger patients. For water-soluble drugs, the volume of distribution is decreased in the elderly, leading to higher plasma concentrations compared to younger patients.
gabapentin MOA
Gabapentin and pregabalin are best described as calcium-channel antagonists
caudal block landmarks
PSIS for equilateral traingle with the sacral hiatus
cirhotic cardiomyopathy
CCM is characterized by diastolic dysfunction, impaired contractile response to β-adrenergic stimulation, prolonged QT interval (>440 ms), and other evidence of autonomic dysfunction such as a decreased ability to increase heart rate in response to exercise.
most common side effect of precedex infusion
hypotension
interferes with hormononal birth control
suggamadex, rifampin, aprepitant
heparin resistant associations
Thrombocytosis (platelet count above 300,000 to 450,000 per microliter)
Release of platelet factor 4, often due to subclinical thrombotic processes
Sepsis
Preoperative heparin infusion
Hypereosinophilia
Consumptive coagulopathy
Horners syndrome
Ptosis
Miosis (Figure 2)
Bloodshot conjunctiva (due to vasodilation)
Pseudoenopthalmos (the eye appears sunken, but has not actually changed position in the orbit)
Nasal congestion
Anhidrosis
drugs that interfere with DBS placemetnq
beta blockers
methylergonovine avoided in
CAD, HTN
prostagladin avoided in
asthmatics
superior hypogastric nerve block
uterus and lower pelvic tissue
Celiac plexus
The celiac plexus is the largest autonomic plexus located in the retroperitoneum. It is composed of the left and right celiac ganglia, the superior mesenteric ganglia, and the aorticorenal ganglia, with fibers from presynaptic sympathetic nerves carried by the greater, lesser, and least splanchnic nerves.
tumescent liposuction
The safe dose of lidocaine using the tumescent technique (with epinephrine) has been reported to be 35 mg/kg, with some advocating as high as 55 mg/kg
-The dilute epinephrine dose causes a constriction of the blood vessels, leading to a peak lidocaine dose occurring 12 to 14 hours after the procedure.
Xenon anesthesia
does not trigger MH, doesnt destroy ozone, , no hepatic damage. Increase in PONV and cost
Tramadol
Tramadol is a weak μ-opioid receptor agonist and a serotonin and norepinephrine reuptake inhibitor. Due to the latter effects, tramadol has additional risks not associated with other opioids, including serotonin syndrome and seizures.
