Anes Finals Flashcards by Josh Sap

At what age does the geriatric period begin?

65 years old.

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What is the difference between physiologic and chronologic age?

Physiologic age refers to functional capacity, whereas chronologic age is the actual time lived.

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What are the effects of reduced arterial elasticity in aging?

Increased afterload, elevated SBP, and left ventricular hypertrophy (LVH).

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What pulmonary function changes occur in the elderly?

Decreased total lung capacity, vital capacity, FEV1; increased residual volume, functional residual capacity, and dead space.

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What factors lead to perioperative hypoxia in the elderly?

Decreased FRC, blunted hypoxic reflexes, and increased ventilation-perfusion mismatch.

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How does aging affect renal function?

Renal mass decreases, GFR declines 1-1.5% annually after age 40, and creatinine clearance decreases.

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Why is creatinine level misleading in the elderly?

Despite reduced renal function, creatinine levels may remain normal due to decreased muscle mass.

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What is the principal pharmacodynamic change with aging?

Reduced anesthetic requirement due to increased brain sensitivity.

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What happens to MAC (Minimum Alveolar Concentration) with aging?

Decreases by approximately 4% per decade after age 40.

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What are perioperative management priorities for elderly patients?

Meticulous monitoring, avoiding hypothermia, managing fluids carefully, and ensuring post-op recovery of mental function.

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What is the most common anesthesia technique for labor pain?

Continuous lumbar epidural anesthesia.

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What are the cardiovascular changes in pregnancy?

Increased blood volume (35-55%), cardiac output (40%), and heart rate (15 bpm).

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What is supine hypotensive syndrome?

Hypotension caused by compression of the aorta and IVC by the gravid uterus in the supine position.

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What is the preferred position for pregnant patients during surgery?

Tilted to the left side with a wedge under the right hip to prevent aortocaval compression.

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What are the respiratory implications of pregnancy?

Increased O2 consumption, decreased FRC, and higher risk of difficult intubation due to airway edema.

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What are the stages of labor and their associated pain pathways?

Stage 1: T10-L1 (visceral pain); Stage 2: T10-S4 (somatic pain).

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What is the main advantage of regional anesthesia in cesarean sections?

Lower maternal mortality and minimal drug transfer to the fetus.

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How does pregnancy affect anesthetic drug requirements?

MAC decreases by 25-40% due to increased sensitivity to inhalation agents.

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What is the major side effect of regional anesthesia during labor?

Hypotension, which must be managed with vasopressors, IV fluids, and oxygen supplementation.

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What are the four processes in the pain pathway?

Transduction, transmission, modulation, and perception.

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What is peripheral sensitization?

Increased excitability of sensory nerve endings in response to tissue injury or inflammation.

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What is central sensitization?

Functional changes in the CNS causing abnormal responses to nociceptive and non-nociceptive stimuli.

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What is the gold standard for pain reporting?

Self-report by the patient.

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What is the Visual Analog Scale (VAS)?

A 10 cm horizontal line where patients mark their pain intensity from 0 (no pain) to 10 (worst pain).

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What are the categories of pain?

Nociceptive, neuropathic, neuralgia, central pain, psychogenic pain, and referred pain.

What is the mechanism of referred pain?

Convergence of visceral and somatic afferent fibers on the same spinal neurons, leading to misinterpretation of pain location.

What are the key principles in cancer pain management?

Use a multidisciplinary approach, administer analgesics by the clock, and avoid placebos.

What is psychogenic pain?

Pain linked to psychological factors without clear organic pathology.

What are the dimensions assessed by the McGill Pain Questionnaire?

Sensory-discriminative, affective-motivational, and cognitive-evaluative.

What cardiovascular changes increase the risk of arrhythmias in the elderly?

Fibrosis of the conduction system and loss of SA node cells.

How does aging affect the response to hypovolemia and hypoxia?

Elderly patients have reduced ability to respond due to diminished cardiac and pulmonary reserves.

What anatomical changes contribute to higher spinal anesthesia spread in elderly patients?

Decreased CSF volume and increased lumbar lordosis.

Why are elderly patients more prone to post-operative hypothermia?

Reduced muscle mass, decreased basal metabolic rate, and lower hypothalamic temperature regulation.

What is the effect of aging on drug distribution for water-soluble drugs?

Higher plasma concentrations due to reduced volume of distribution.

What is the impact of increased body fat on lipid-soluble drug pharmacokinetics in the elderly?

Increased volume of distribution, prolonged elimination half-life, and delayed recovery.

What is the main reason pregnant patients are at increased risk for aspiration during surgery?

Decreased lower esophageal sphincter competency and delayed gastric emptying.

What changes in pregnancy increase oxygen consumption during labor?

Metabolic demand increases oxygen consumption by 100% during active labor.

What is the primary nerve pathway involved in second-stage labor pain?

Somatic pain conducted via the S2-S4 nerve roots, forming the pudendal nerve.

What are the clinical implications of increased minute ventilation in pregnant patients?

Faster uptake of inhalational agents and decreased minimum alveolar concentration (MAC).

Why is epidural anesthesia preferred for preeclamptic patients?

It provides stable hemodynamics and reduces the risk of severe hypertension.

What precautions should be taken during general anesthesia for cesarean delivery?

Minimize uterine incision-to-delivery time to reduce fetal exposure and ensure maternal oxygenation.

What is the role of central modulation in pain pathways?

It suppresses or inhibits pain transmission through endogenous opioids or descending pathways.

What causes peripheral sensitization?

Release of inflammatory mediators at the site of injury, lowering the activation threshold of nociceptors.

What is the typical presentation of neuropathic pain?

Burning, tingling, or shooting pain often associated with nerve injury or dysfunction.

What distinguishes nociceptive pain from neuropathic pain?

Nociceptive pain arises from tissue damage and is proportional to the stimulus, while neuropathic pain stems from nerve damage.

How is referred pain explained neurologically?

Convergence of visceral and somatic inputs onto the same dorsal horn neurons leads to misinterpretation of pain origin.

What is the most common side effect of opioids, and how is it managed?

Constipation; managed with concurrent laxative use.

What are the recommended pain assessment tools for children?

Wong-Baker Faces Pain Scale or other visual scales adapted for pediatric patients.

What is the purpose of a patient pain diary?

To track the relationship between pain and daily activities for better treatment planning.

["What is the impact of myocardial fibrosis on elderly patients?"

"Increased stiffness of the heart

["How does decreased baroreceptor sensitivity affect elderly patients during surgery?"

"Increased risk of orthostatic hypotension and impaired response to blood pressure changes."]

["What contributes to prolonged circulation time in elderly patients?"

"Decreased cardiac output and slower blood flow."]

["Why is there a delayed onset of IV drugs in elderly patients?"

"Prolonged circulation time due to reduced cardiac output."]

["What are the perioperative risks of decreased pulmonary elasticity in elderly patients?"

"Collapse of small airways

["What is the significance of elevated norepinephrine levels in the elderly?"

"Compensatory mechanism for decreased adrenergic receptor sensitivity

["What are the risks of failed intubation in pregnant patients?"

"Airway edema

["How does pregnancy affect venous return?"

"The gravid uterus compresses the IVC

["What is the clinical significance of decreased functional residual capacity (FRC) in pregnancy?"

"Lower oxygen reserve

["Why are lipid-soluble opioids like fentanyl preferred in labor epidurals?"

"They cross the placenta minimally and provide effective pain relief with low systemic impact."]

["What is the role of vasopressors in managing regional anesthesia-induced hypotension during labor?"

"To restore maternal blood pressure and prevent fetal compromise."]

["What is a pudendal block used for?"

"To block somatic pain during the second stage of labor by anesthetizing the pudendal nerve."]

["What is the function of A-delta and C fibers in pain transmission?"

"A-delta fibers conduct sharp

["What is the role of endogenous opioids in pain modulation?"

"They mimic exogenous opioids by binding to opioid receptors to suppress pain perception."]

["What differentiates hyperalgesia from allodynia?"

"Hyperalgesia is exaggerated pain to a noxious stimulus

["What causes structural reorganization in chronic pain?"

"Sprouting of low-threshold fibers to areas that normally process nociceptive signals

["How does disinhibition contribute to chronic pain?"

"Loss of inhibitory control (e.g.

["What are common descriptors for psychogenic pain?"

"Pain that is inconsistent with anatomy

["What are the primary goals in managing central pain syndromes?"

"Reducing pain to an acceptable level and improving quality of life

["How does the McGill Pain Questionnaire assess pain?"

"Through sensory

]