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OMSITE > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What is MAC

A

concentration at which 50% of patients won’t respond to skin incision.

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2
Q

Methohexital properties

A

GABAnergic, suppresses reticular activating system. May potentiate seizures.

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3
Q

What lung capacity is decreased in a pregnant patient and obese patient?

A

FRC is decreased.

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4
Q

Pediatric larynx position compared to adults?

A

Anterior and superior.

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5
Q

Propofol + which HTN medication = hypotensive.

A

Propofol causes vasodilation.
ACE/ARBs- block RAS.
Patient cannot compensate.

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6
Q

Edrophonium/Tensilon test

A

Test for suspected Myasthenia Gravis. Edrophonium = acetylcholinesterase inhibitor. Looking for approx 5min improvement in muscle strength.

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7
Q

When to give adenosine?

A

Antiarrythmic for tachycardia/SVT conversion if narrow complex and stable. 6mg rpaid push.

0.05-0.1mg/kg in kids.

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8
Q

When to give Atropine?

A

Bradycardia.
0.5mg for Bradycardia.
1mg if asystole/PEA arrest.

In kids atropine is 0.02mg/kg for brady.

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9
Q

Dopamine effects on the body

A

Stimulates alpha, beta-1, and dopaminergic receptors. Pleasure, cognition, memory.

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10
Q

Treatment of myotonic dystonia with laryngospasm

A

Roccuronium + Positive Pressure O2. Avoid Succinylcholine.

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11
Q

Ketamine mechanism

A

NMDA antagonist

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12
Q

Malignant hyperthermia is via what enzyme

A

Creatine phosphokinase.

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13
Q

How is MH treated?

A

IV Dantrolene 2.5mg/kg every 5 mins until reversal. Or up to 10-20mg/kg total. CK should be trended.

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14
Q

Nitrous teratogen mechanism

A

Inhibits methionine synthase and vit B12.

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15
Q

Do barbiturates cause seizures?

A

No. Except for methohexital. Otehrs are seizure treatment.

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16
Q

What is the main complication with prolonged intubation?

A

Tracheal stenosis.

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17
Q

Why use a cuff-less tube in pedo patients?

A

Narrowest portion is at cricoid cartilage. Avoid excess pressure on tracheal tissues and reduce post-extubation stridor.

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18
Q

Desflourane has rapid onset and offset due to?

A

Very low blood gas partition co-efficient. Relatively insoluble in fat making emergence fairly rapid after a long case.

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19
Q

Infants blood pressure is dependent on what?

A

Heart rate.

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20
Q

How doe benzodiazepines affect sleep?

A

Reduce time to sleep onset and increase total sleep time.

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21
Q

How much REM sleep at night?

A

20-25% of total sleep

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22
Q

Which narcotic is metabolized by plasma cholinesterases?

A

Remifentanyl

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23
Q

How is articaine metabolized.

A

Plasma (primarily) and liver. Due to ester side chain.

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24
Q

All amide local anesthetics are metabolized in the liver except?

A

Articaine. Plasma + liver.

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25
Q

Compound A

A

Product of Sevoflourane.
Causes Kidney damage.

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26
Q

Local anesthetic with lowest pKa

A

Mepivicaine/Carbacain= .6
Lido,prilo, articaine= 7.8

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27
Q

What determines potency of local anesthetics?

A

Lipid solubility

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28
Q

What determines duration?

A

Protein binding

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29
Q

What determines onset

A

pKA

30
Q

Lidocaine Max dose

A

4.5mg/kg w/o epi. w epi 7mg/kg

31
Q

Articaine Max dose

A

7mg/kg

32
Q

Bupivicaine Max dose

A

1.3mg/kg

33
Q

Carbocaine max dose

A

4mg/kg

34
Q

Which local anesthetic can significantly prolong succcinylcholine?

A

Procaine

35
Q

What test can be used to determine is someone has an atypical plasma cholinesterase

A

Dibucaine number
>80 is normal
,80 may have prolonged effects of succs.

36
Q

What happens to lungs as they age?

A

reduced alveolar surface area.

37
Q

Etomidate side effects?

A

PONV and adrenal suppresion.

38
Q

Why can succ be used w/out issue in myasthenia gravis

A

fewer funcitonal receptors. These patients require more succ than normal. MG patients ARE more sensitive to non-depolarizing neuromuscular blockers.

39
Q

What anesthetic agents are NOT thought to cause acute intermittent porphyira?

A

Nitrous and Narcotics.

40
Q

What is the initial dose of Dantrolene for MH?

A

2-3mg/kg

41
Q

How is dantrolene mixed

A

60ml steriile water/20mg bottle. Then, the appropriate 2.5mg/kg dose is
injected rapidly after reconstitution. Should have 36 bottles on hand for MH crisis if using triggering
drugs.

42
Q

What durgs can cause methemmogloinemia?

A

Articaine, Benzocaine, prilocaine, Bactriim, sulfonamides, dapsone.

43
Q

What is the treatment of methemoglobinemia

A

O2 and methylene blue 1% solutin dosed at 1-2mg/kg given over 5 minutes.

44
Q

How to treat Torsades?

A

1-2g Magnesium over 5-60 minutes.

45
Q

Fentanyl Dose

A

Wide range. Intraop 2-50mcg/kg.

46
Q

Meperidine + MAOIs=

A

Serotonin Syndrome

47
Q

cardiac instability HTN and hypotension, hyperpyrexia, coma, respiratory arrest

A

Serotonin syndrome

48
Q

Dilaudid Dose

A

0.01-0.02mg/kg
Can cause histamine release

49
Q

Morphine Dose

A

0.1mg/kg
5-10% excreted by kidney. Renal failure may prolong duration.

50
Q

Naloxone Dose

A

Generallysmall doses: 0.1-0.2mg q2-3min. Full reversal is 0.4-2mg

51
Q

Sevoflurane

A

Blood/gas coefficient is 0.65
MAC is 2.
Low solubility and non-pungency

52
Q

Isoflurane

A

Blood gas coefficient is 1.4.
MAC is 1.2.

53
Q

Desflurane

A

Blood gas coefficient 0.42
MAC is 6
Low solubility in both blood and body tissues
causes a very rapid induction and emergence. Rapid increases can lead to transient but significant
increases in HR, BP, and catecholamine levels

54
Q

Nitrous

A

Blood gas coefficient 0.47
MAC 105

55
Q

Prolong exposure to Nitrous causes

A

Bone Marrow suppression.
Megaloblastic anemia.

56
Q

Nitrous in Pregnancy?

A

Oxidizes Vit B12 so affects B12 dependent
enzymes, including methionine synthetase.

57
Q

Halothane

A

Rare but associated with halothane hepatitis.
MAC is 0.75

58
Q

Propofol Dose

A

1-2mg/kg induction dose.

59
Q

Propofol infusion syndrome

A

long infusions can cause lipemia, metabolic acidosis,
and death = propofol infusion syndrome

60
Q

Etomidate Dose

A

Induction 0.3mg/kg.

61
Q

Cisatracurium

A

Hoffman Elimination.

62
Q

Reglan in Parkinsons

A

Blocks dopamine receptors. Extrapyramidal effects.

63
Q

Ondansetron

A

5HT3 blocker- can cause QT prolongation.

64
Q

Droperidol

A

Caution in Parkinsons patients. Also causes prolongation of QT interval.

65
Q

Metoprolol

A

Beta 1 selective. Given as bolus of 2.5-5mg over 2 minutes in A-fib and RVR.

66
Q

Vasopressin

A

acts as ADH- Directly stimulates smooth muscle V1 receptors casing vasoconstriction.

67
Q

Levophed

A

NE. Mostly alpha and beta.1 effects. Usually given as 2-20mcg/min infusion but can bolus 0.1mcg/kg.

68
Q

Epi

A

Anaphylaxiss usually in 100mcg increments. As a pressor run from 2-20mcg/min.Ph

69
Q

phenylephrine

A

Primarily an alpha 1 agonist. Can cause rebound bradycardia.

70
Q

Aprepitant

A

Neurokinin-1 receptor antagonist. Antiemetic.

71
Q

Diltiazem

A

CCB, inhibits calcium influx into vascular smooth msucle, relaxes smooth msucle. Decraseses SVR, dilates coronaries, and prolongs AV node refractory period. 0.25mg/kg IV for afib with rvr.

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