Anaesthesia Flashcards
Predictor for bag an mask
rventilation
OBESE
Predictors of diff
airway
LEMON
rule of 3-3-2
interincisor gap
hyomental distance
Thypohyoid
Patil’s test
TMD
6:5 6
savva’s test
SMD
max .predictive value for a difficult amway
12-5
Mallampatti
Push
nmallampati o
Epiglottis visible
Cormack and Le hane classification
I-
II -
III -
IV-
Ideal position for intubation
Barking dog/ sniffing
ideal position for
obese pts
HELP ( head elevated laryngoscopy position)
Ramp
ear . - suprasternal notch
Eg for secure aisway
ETT
tracheostomy
order of increase in dead space in diff
ariway techniques
FM >SAD >ETT
except long ETT preterm neonate
Why risk of aspiration
gastric insufflation of air
AMBU=
FiO2
vol
Ambulatory manual
breathing unit
100%02
250 N 500 C 1-5L A
GUedal’s airway
OPA
hard plastic
appropriate size of guedel’s awway
vertical distance b/w angle of mandible and central incisor or
blw EAM an angle of mouth
Nasal trumpet
soft silicon
tragus to tip of nose
disadv of nasal trumpet
/ bleeding pts on ants ‘coagulants
basilar skull #
AOC for SAD insertion
Propofol
tip of CMA →
faces esophagus
Examples of 2nd gen LMA
proseal
supreme
I- gel
C/ I to LMA
distorted upper away
emergency surgery)
full stomach pts
most common size
LMA Claussic
M-5
F-4 C- 3 (30.5kg)
man int racuff pressure 60 cms
LMA fastrach
intubating
plunger
Miller Blade
Pediatric intubation
most common injured structure during
laryngoscopy
upper central
incIsor
maneouvre improving
visualisation of vc
BURP
Plan for anticipated difficult arewary
Awake F0B intubation
mantiapitated duff airway
A B c D
Murphy’s eye
types
and opening ETT
Magil - C
Murphys
Ad vantage and disadvantageof how volume
high pressure
cuff
N O risk of aspiration
r/o tracheal stenosis
red rubber
pressure, volume cuff
size
<25 mm Hg
4-8 m I
2.5 10.5
depth 21-23 cm
F-7/7.5
why uncuffed ETT for pediatric
(tell 8 yrs)
P recent post intubation
croup
pediatric ETT size for > lyr
age/ 4 +4
age /2 + 12cm
ETT size for pretum neonate
2-5/3
3Cmx size
surest sign of confirmation of placement of €TT
visualis ation of
vocal colds
fold std for placement of
ETT
FOB - carina
most common method
of confirmation of placement of ETT
Capnography
nasal intubation C/I
in
base of skull#
CS F rhinorr hea
Bleeding tendency
Nasal polyps
Why nasal intubation
C/ I in base of
skull#
weak cribri form plate
intracranial migration
… … has no role in confuming
endo bronchial tube
Cap no
Pregnant female which ASA
II
ASA Iv
sever systemic disease limits activity but not incapacitating
uncontrolled HTM ( DM
chronic smoker
alcohol addict
ESRD on rregular dialysis
11HO CAD TIA stroke MY, stent > 3months
Drugs that need to be continued preoperatively
BB NTG CCB Thiazides
statins
steroids
POP
anti epileptics anti thyroid
ATT ART
stopping aspirin preoperatively
low dose continue
high -3-5d b4
stopping clopidogrel preop
7d b4
stopping warfarin preop
Target PT IMR < 1.5
or 3-5d b 4
stopping heparin preop
UFH- 4-6 hrs
LM WH
proph- 12hrs therapeutic-24 hrs
Which antihypertensives
to bestopped on
day of Sx
ACEI
ARB all diuretics except
thiazides
stopping insulin n 0HA
day of sx
When to stop heebal and Ayurvedic med preop
min 2 weeks by Sx
stopping psychiatric meds
continue all except Li MAO#
Li - 48 hrs(24-48)
MAO ⇒ Irreversible- 2-4wks
reversible day of Sx
s topping OCP preop
4-6 w eeks
except POP
advised duration of
smoking abstinence
4-8 weeks
most commonly used premedication
BZD
anti anxiety, sedation, anterograde amnesia
BZD of choice for premedication
Midaz
most used anti sialogogue
gly copyrrolate
use an technique Preoxygenation
Tidal vol respx 3 mins
8_10 vital capacity breathes
increase safe apnea time
02 req at rest
250 ml) min
96% ischemia detection rate which leads
V5, V4, II
Bispectral index
O
0-20
20-40
40-60
60-80
80-100
hold std for
monitoring anaesthetic depth
Midale latency auditory evoked potentials
Pulse oximetry is based on
Beer Lambert law
wavelengths used in
pulse oximetry
660 deoxy
940 oxy
False low reading pulse oximetry
meth Itb
methylene blue
indocyanine green
peripheral vasoconstriction
shivering
Badly positioned probe
Nail paints (Blue/ Black/ purple ‘
False high pulse oximetry reading
CO Hb
Capno graphy Normal
35-45 mm hg
cap no graphy
rebreathing
does not touch
base
Curare notch/ cleft
First spontaneous
lescashing effort under muscle relaxant
supplement more
relaxant
Shark fin appearance
Partially obstructed ETT
Obstructive lung
disease
COPD
Broncho spasm
upper amway obstruction
flat cap no
accidental extubation
disconnection ventilator failure
carctic arrest d
source of Co2 in stomach
aerated drinks
Bacterial metabolism
swallowed air
Iv inducers
GABA agonist-4
MMDA antagonist -1
inhaled inducers
h alothane
sevoflurane
AOC inhalational inducers
sevoflurane
Barbiturate used for
induction
Thiopentone
AOL - ECT
Metho hexitone
Eg. of phenecycline
derivative
ketamine
site of action of
Thiopentone
RA S
immediate LOC
site of action of ketamine
Thalamo cortical jn
hence dissociative
anaesthesia
onset of action of Thiopentone
ultrafast 15-20s
I arm brain circulation time
duration of action of
thiopentone
<20 mins
redistribution
Cns effects of Thiopentone
decrease CBF ICP (Max) CMRO2
anti analgesic
anti epileptic
Thiopentone
c| I in
k / C / o AlP and vari gate porphyria
hypovolaemic/
circulatory shock
statUs asthmaticus
Aoc for raised ICP Sx
Thiopentone
uses of thiopentone
Induction
Barbiturate coma
Nemoanalysis
active form of ketamine
Liver- Norketamine
ketamine’s effect on c Vs
indirect sympathomimetic “HR “ BP,,co
ketamine effect on RS
max preservation of
respiration
max preservation of
airway reflexes
Max broncho dilation
Why avoid ketamine in NSx
” ICP
“ CRO2
“ IOP
proconvulsant
ketamine AO C for
acute shock
asthma
full stomach
PPH
feeld anaesthesia
pediatric pts
cganofic CHD
short and painful
- burns
Ketamine c/ I
l HD AA head ingrye caused ICP
open eye sx
NS x
1/0 psychiatric illness
Emergence delirium
associated with
ketamine
E tomidate …… derivative
Imida zole
max pain on injaction with
Why
Eto midare
propylene glycol
Contents of Propofol
EGGS
onset and duration
of action of propofol
15-20 secs
10 mins
AOC for daycare Sx
Propofol
AOC SAD insertion
propofol
cardio stable induction agent
Etomid ate
cars effects of Propofol
cerebral vasoconstrictor ,,ICP
,,cMROz
anti convulsant
antiemetic
anti prucritic?
No muscle relax?
Max decrease in 10P
Proconvulsant inducers
ketamine Etomidate
AOC induction cardiac pts
Etomidate
Propofol infusion
syndrome
> 4 mg/ kgl hr
for > 48 hrs
Mx . propofol infusion
syndrome
hemo dialysis
(PR ECHO
MOA NDMR
competitive Antagonism @ nico tinic Ach receptors
MOA DMR
pasteal agonist at Ach receptors
Suxamethonium I scoline onset a duration
30-605
< 10 minutes
dose scoline
1-1-5 my /kg
Aoc tracheal intubation
S coline
,,plasma cholinesterase
Liner failure
Renal failure
preg
drugs_ Neo stig mine
cyclophosphamide
Echo throophate
scoline phase II block
7-10mg/kg
60 mins
” drwalton of action - s coline
phase II block
hypothermia
,,enzyme
genetic abn@ or altered enzyme
Dibucaine No
scolin e
co-10 40-60 20-40
ADR_ scoline
brady cardia
fasciaaulations (-)
myalgia
“ ICP “10P
Masseter spasm
Trigger for malignant hyperthermia
histamine release
hyper k+
Scolim C/ I
head ingkey malig hypothermia open eye injury, glaucoma heyper kalemia
Myotonica dystrophica pediatric < 8C?) Burns * scinjury, GBS, Tetanus I myopathy chronic dInnervation Stroke massive trauma
curium
Benzyl iso quinnolum derivative
doxa dTC
adra cisatra
Ganta miva
shortrest on longest curium
Ganta
Doxa
Fastest NDMR
Rocuranium
60-90s
long duration steroidal derivatives MDMR
Pan
Pipe
max ragolytic action
among NDMR
pan
MDMR- vago+
histamine -
Rocu ro nium
Hist +
vago -
MDMR
Atra
Miva
Bile/ urine excretion
ND MR
Rocuranium
NDMR “ potency of
antibiotics - strep
Amikacin
Amino glycosides
Danteolene
Des> lso> sevo> Halo
Mgso4
forosemide
MDMR,,potency of
antiepileptics
Ca20
cholinesterase inhibitors
Indication NDMR
intubation
defasciccuelation
maintenance
Laudon osine
metabolite of
ateacurium hoffman
elimination
THEORETICAL seizure induction
NDMR that can replace
scolere for inthenation
but can cause pain on
inj
Rocu
1sT MR used clinically
DTC
max hist amine release
most potent
vagolytic MDMR
pan
old- Gallamine
only MMDR metabolised
ley pseudo cholineesterase
MIVA
Aoc for day care Sx
muscle relaxants that don’t need
dings for reversal
scoline
MIva
atra
cisatra
MR that need drugs for reversal
cholinestuas inhibitors
anticholinergic
sugamma dex
Roc vec reecesal agent
most common nerve-muscle
combo tested in NM monitoring
ulnar
Adductor Pollicis
2nd_ facial
orbicullis oculi
Gold std of recording N MJ monitori ngresponse
MM G
but m/c AmG
use of 1 twitch
supra maxi mal
strength
mc need pattern of
stimulation
Train of 4
4→ 2s 2HZ
Duration b/w 2 stimulation in a TOF
0-5s
duration b/w 2 TOF
10 S
continuous stimulation or tetany
50-200 Hz
assess deeper levels of block
TOF- R NDMR
0.4
TOF R DMR
I- 1.0
I - 0:4
intubate on what TOF count
0 / 1
TOR- R 0-4 action
0.3-0-7 wait and watch
reveesal and extubation on which TO_R
0.7
0.9
PTC= O
intense block
clinical signs of recovery
sustained head left
sustained leg lift
sustained hand grip
positive tongue depressor
test
Meg inspiratory pressure of
-40to-50 cms. water
TIVA AOC for
maintenance
Propofol+ opiod
Remi fentanyl> Alfentanil > tentamyI
Pure gases used for
maintenan ce
N20
Xe
Fastest onset and recovery
Xenon 0.15
slowwest onset and
recovery
Methoxy flurane
increasing order of BG PC
Xe
Des
M20
sevo
1so
halo 2-4
Fastest volatile agent
Des
heast potent inhaled agent
NzO
housest MAC) highest potency
Methoxy fleurane
Decreasing order of MAC
NO (104)
Xe (70)
Des (6)
sevo (2)
1so (1.1)
temperature potency
temperature <42 potency”ses
>42,,ses
max MAC @
6 months
liffect of electrolyte
on potency
Na decreases potency increases
Ca2 increases potency increases
preg, all LA, all
anesthetic except cocaine
MAC decreases
Effect of T S H on MAC
No role
Metabo li sm sevo iso halo
5 %
0.2%
25 %
all inhaled agents are myocardial depressants except
N20
Effect of inhaled agents on
RS
“ses HR
,,ses Tidal volume
~ fast and shallow breaths
seffect of inhalational
agents C N S
I’ses ICP
,,ses CMRO2 except NzO
muscle relax except N20
trigger malignant hyper exept NzO
N20
’
..
-
hong term exposun of
M20 causes
peripheral neuropathy
megaloblastic anemia
SACD
tera togens
maximum level of agent in OT
M20 - <2 5 ppm
volatile agent w/o M20 - 2 ppm
W N20 0-5 ppm
structures parsing through
SOF
3,4,6
V1
Fink effect
During recovery from the anesthesia, when nitrous oxide is discontinued – large concentration of nitrous oxide diffuses back to the alveoli from the blood. This is due to low blood solubility of nitrous oxide (N2O) and results in:
Dilution of the inspired oxygen concentration and hypoxia.
Dilution of inspired carbon-dioxide concentration and subsequent decrease in arterial carbon dioxide concentration leading to reduction in respiratory drive.
First 10-15 mins
Least potent
NzO
Entonox
50%02
50% M20
dental anaesthesia
habour analgesia
c/ i N zO
pneumothorax
pulm htm
air embolism
Intraocular
Tympanic
membrane
graft ….
why xe ideal
Fastest onset and recoverBGC 0.15
inert analgesic
neuro cardio protective
No metabolism
No malignant
hyperthermia
no pollution
halothane preservative
thymol
only agent causing
brady
halothane
inhalational agent
causing max
bronchochelation
halothane
