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**FINAL REVIEW > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Allergic rxns are more common with (ester / amide) anesthetics

A

ESTER

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2
Q

Sxs of allergic rxn to local anesthetic

A

dermatologic manifestations to anaphylaxis

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3
Q

How common is a true allergic rxn to local anesthetic?

A

unlikely w/ preservative-free lidocaine

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4
Q

intraneural injection of anesthetic:

sxs

A

pain, paresthesias, subsequent local damage to nerve

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5
Q

intravascular injection of local anesthetic:

sxs

A
  • (lower doses) circumoral numbness, lightheadedness, tinnitus
  • (higher doses) seizures, coma, respiratory arrest
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6
Q

mortality of ASA Class III,

mortality of ASA Class IV

A

4% mortality in class 3

25% mortality in class 4

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7
Q

pulseless electrical activity

A

any organized rhythm w/o a palpable pulse; most common rhythm after defibrillation

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8
Q

how is pulseless electrical activity (PEA) treated?

A

administer epinephrine in 1 mg doses IV every 3-5 minutes

  • treated like asystole
  • NOT a shockable rhythm bc electrical system in heart is working properly
  • do NOT use atropine
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9
Q

stress-induced adrenal insufficiency:

effects

A

hypotension or cardiac arrest

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10
Q

stress-induced adrenal insufficiency:

cause

A
  1. chronic steroid use
  2. trauma patients w/ adrenal hemorrhage
  3. septic patients w/ adrenal infarcts
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11
Q

stress-induced adrenal insufficiency:

TREATMENT

A

IV bolus of hydrocortisone 100 mg or dexamethasone 4 mg is administered if adrenal shock is suspected, esp if pt is not responding to initial resuscitation efforts →

if therapeutic dose of glucocorticoid is not administered, patient may die

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12
Q

calcium sulfate:

use and characteristics

A
  • vehicle for local Abx delivery
    • not even a fraction of exothermic rxn as PMMA
    • peak @ 3 hours, elutes over 72 hours
  • *ABX MUST BE IN POWDER FORM
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13
Q

main mechanism of local anesthetics

A

block voltage-gated sodium channels on the neuronal cell membrane

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14
Q

which nerve fibers are most sensitive to local anesthetics?

A

Type B fibers (sympathetic tone)

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15
Q

nerve fibers, by most sensitive → least to local anesthetics

A
  • Type B (sympathetic tone) - most sensitive
  • Type C (pain)
  • Type A delta (temp)
  • Type A gamma (proprioception)
  • Type A beta (sensory touch & pressure)
  • Type A alpha (motor)
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16
Q

why are Type B fibers more sensitive to local anesthetics than Type C?

A

Type B fibers are myelinated, so they are more sensitive even though than are thicker than the thin, unmyelinated C fiber

17
Q

propofol:

systemic effects

A
  • dose-dependent respiratory depression
  • systemic reduction in blood pressure
  • anticonvulsant properties
18
Q

propofol:

mechanisms

A
  • direct effect on myocardium
  • direct on vascular smooth muscle
  • decrease in sympathetic activity

(decreased vascular resistance in arterial and venous smooth muscle)

19
Q

spinal anesthesia:

relative contraindications

A
  • anti-coagulation
  • sepsis
  • local cellulitis
  • hypovolemia or shock
  • increased intracranial pressure
  • MI < 6 months prior to surgery
20
Q

what type of hemostasis is recommended in an actively bleeding post-op patient?>

A

mechanical hemostasis (e.g. intermittent pneumatic compression);

pharmacologic chemoprophylaxis is CONTRAINDICATED in actively bleeding patients

21
Q

abx that can be mixed with PMMA

A

tobramycin

erythromycin

vancomycin

cephalosporins

22
Q

why would LA block be delayed or fail on severely infected paronychia?

A

ST in area of infection are ACIDIC → fractionates the drug largely to its cationic form, creating a marked decrease in transport across the cellular membrane

23
Q

all local anesthetics are:

[acids / bases]

A

weak bases; two forms

  1. lipid-soluble uncharged
  2. hydrophilic charged
24
Q

how does pKa of LA affect use?

A

closer the pKa of the LA is to the pH of the soft tissues, the more e_fficient, effective, and quicker_ the block will be

25
Q

why is it important to clarify duration of

prior corticosteroid therapy

A

any pt receiving equivalent of 20 mg/dL of prednisone for 5+ days is at risk of suppression of hypothalamic pituitary axis

26
Q

how long does risk of HPA suppression last after 1 month of corticosteroid therapy?

A

6-12 months

27
Q

if patient is at risk of HPA suppression, what should you do the day of surgery

A

Administer 50-75 mg of hydrocortisone the day of surgery, for a moderate stress procedure such as bunion

28
Q

types of post-op fluid management

A

maintenance and replacement;

both are based on temperature (febrile), diet, and activity level

29
Q

malignant hyperthermia:

symptoms

A

increased CPK, high fever, muscle rigidity, and EKG changes;

can be life-threatening

30
Q

effects on adjacent digits after

digital amputation

A

one digit amputation → tendon imbalance in adjacent digits → contracture

this is a concern bc this contracture causes retrograde pressure and new ulceration can develop under adjacent met head

31
Q

coumadin:

how many days to dc in advance

A

dc 3-5 days prior to sx

32
Q

appropriate INR for surgery in patients

NOT on coumadin

A

~1

33
Q

single most important prognostic factor for surgical outcomes

(specifically for smokers)

A

smoking cessation

34
Q

perioperative cardiopulmonary arrest

sxs and tx

A

IMMEDIATE INITIATION OF ADVANCED CARDIOPULMONARY LIFE SUPPORT AND CALLING OF INTRAOPERATIVE CODE

  • asystole
  • nonpalpable carotid pulse
  • no pulse oximetry plethysmography
35
Q

symptoms of true opiate allergy

A
  • sxs:
    • hives
    • maculopapular rash
    • erythema multiforme
    • pustular rash
    • severe hypotension
    • bronchospasm
    • angioedema
  • rare and seems to be IgE-mediated or T-cell mediated
36
Q

hyperlipidemia drug that can cause rhabdomyolysis

A

statin medications (HMG-CoA Reductase Inhibitors)

  • rare cases → assoc w/ severe myotoxicity that can result in rhabdomyolysis
    • risk is increased when taking other medication that interact w/ cytochrome P3A4 (increases levels of statins)
  • more often assoc w/ mild musculoskeletal sxs and myalgia

**FINAL REVIEW (13 decks)

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