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OMFS ANESTHESIA > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Glycopyrrolate
-other name
-mech of action
- used for
-mg/ mL

A

-Robinul
-anti muscarinic, does not cross BBB (no CNS effects)
-used to tx bradycardia and dry up airway secretions/ saliva
- 0.2 mg/ mL

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2
Q

Phenylephrine
-other name
-mech of action
- used for
-mg/ mL

A

-NeoSynephrine
- alpha-1 agonist
-used to tx hypotension, may cause reflex bradycardia
-100 mcg/mL

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3
Q

Ephedrine
-other name
-mech of action
- used for
-mg/ mL

A
  • N/A
  • stimulates NE release (alpha 1, alpha 2 beta 1 agonist
    -tx hypotension, increase BP, HR and contractility
  • 5 mg/mL
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4
Q

Hypotension and requires medication? Rule of thumb

A

If HR <70, give ephedrine (no reflex brady).
If HR>90, give phenylephrine (reflex brady as side effect)
If HR 70-90, either will work

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5
Q

Rocuronium
-other name
-mech of action
- used for
-mg/ kg

A

-Zemuron
- Non-depol NM blocker (antagonist)
- paralytic, do not use in renal failure pt. Has no CV effect
-0.6 mg/kg intubation, 1.2 mg/kg for RSI

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6
Q

Sugammadex
-other name
-mech of action
- used for
-mg/ mL or typical dose

A

-Bridion
-Cyclodextrin encapsulates and binds Rocuronium or Vecuronium rendering it unable to bind to acetylcholine receptors at NMJ
- reversal agent for paralytics
- may reduce effects of BC
- typical dose 2mg/kg with max of 16 mg/kg

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7
Q

Succinylcholine
-other name
-mech of action
- used for
-mg/ mL or typical dose

A

-N/A
-depolarizing NM agent (agonist)
- paralytic/ breaking laryngospasms
- will trigger malignant hyperthermia. May cause bradycardia
- intubating dose 0.6-1 mg/kg

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8
Q

Propofol
-other name
-mech of action
- used for
-mg/ mL or typical dose

A

-Diprivan
- potentiates GABA activity
- sedative hypnotic, rapid in and rapid out
- profound depression of RR, TV, causes bronchodilation and vasodilation, decreases upper airway reflexes and tone
- 2-3 mg/kg for IV induction, 50-150 mcg/kg/min for TIVA

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9
Q

Ketamine
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • N/A
  • NMDA receptor (glutamate) antagonist, dissociative anesthetic, dissociates thalamus from limbic system, may lead to hallucinations/ dysphoria
  • works well in opioid tolerant pt
  • closest to “complete” anesthetic (analgesia, amnesia and unconsciousness)
  • SNS stimulator: increases BP, HR and CO as well as bronchodilator. Negative inotrope (decrease contractility). causes increased salavation
  • Dart 4 mg/kg otherwise ?
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10
Q

Midazolam
-other name
-mech of action
- used for
- typical dose

A
  • Versed
  • Benzo, enhances GABA activity
  • Anxiolytic, sedative, hypnotic, anti-convulsant, amnestic
  • 0.01 - 0.1 mg/kg
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11
Q

Dexmedetomidine
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Precedex
  • Alpha 2 agonist
  • hypnotic, analgesic
  • no suppression of respiratory drive. Large blous can cause HTN. Side effects: bradycardia, hypotension, heart block and nausea
  • loading dose 1 mcg/ kg over 10 min. TTE 0.2 - 1 mcg/kg/hr
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12
Q

Fentanyl
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Sublamaze
  • mu opoiod receptor agonist
  • decrease RR and tV. Blunts SNS response
  • 50-100 mcg for induction; 1-2 mcg/ kg adjunct
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13
Q

Remifentanyl
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • ## Ulitva-strong narcotic with very rapid off set
  • 0.05- 2 mcg/ kg/ min for TIVA; 50 mcg/ mL
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14
Q

Toradol
-other name
-mech of action
- used for
-mg/ mL or typical dose

A

-Ketorolac
-NSAID
- good to give at end of surgery for simulating procedures. Only <65 yo (decreased clearance in elderly). Do not give to renal or liver pts. Increased risk of bleeding and decreased bone healing. When given IV, more analgesic than anti-inflammatory
- 30 mg/mL

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15
Q

Lidocaine
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Xilocaine
    -local anesthetic, anti-arrhythmic, Na+ channel blocker
  • can numb larynx if given in high dose (IV 1-2 mg/kg)
  • 40 - 100 mg IV prior to Propofol
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16
Q

Hydralazine
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • N/A
  • direct arteriolar vasodilation
  • used for HTN
  • dose 2-5 mg q15 min, TTE
17
Q

Morphine
-other name
-mech of action
- used for/ side effects
-mg/ mL or typical dose

A
  • N/A
  • mu opioid receptor agonist
  • pain/ watch for depressed respiratory effect
18
Q

Hydromorphone
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Dilaudid
  • semi-synthetic opiod
  • pain longer duration that Fentanyl
  • 0.2-1 mg/ kg
19
Q

Meperidine
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Demerol
  • synthetic opioid. Action at mu receptor (analgesia) and kappa receptor (shivering)
    -used to combat post op shivering
  • 12.5 -25 mg dose IV
20
Q

Esmolol
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Brevibloc
  • beta- blocker
  • fast acting, short duration
  • 10 mg/mL, TTE
21
Q

Labetalol
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • N/A
  • blocks alpha1, beta 1, beta 2
  • used when pt has HTN and tachycardia. Avoid in pts with asthma
  • 5 mg/mL
22
Q

Metoprolol
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Lopressor
  • cardio selective beta 1 blocker
  • lasts longer than esmolol
  • 1 mg/mL,
23
Q

Sevofluorane
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Ultane
  • enhance activity at GABA receptors and act as NMDA antagonists
  • increase RR and decrease tV. Bronchodilator. Does not cause tachycardia
  • all volatile agents cause some form of CV depression making dysrhythmias more noticeable and all will decrease SVR
  • MAC is 2.1%
  • Compound A causes toxicity
24
Q

Desfluorane
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Suprane
  • enhance activity at GABA receptors and act as NMDA antagonists
  • increase RR and decrease tV. Quick on/ off. Good for short cases and obese pts. CO2 is biproduct. Increased risk of bronchospasm in smokers on wake up. Turning on too quickly may cause tachycardia.
  • MAC is 6%
  • be ready to manage pt because when you turn off gas they are going to wake up quick
25
Q

Isofluorane
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • N/A
  • enhance activity at GABA receptors and act as NMDA antagonists
  • increase RR and decrease tV. Most soluble (slow on and slow off). Good for ICU pt due to not waking them up/ extubating prior to heading back to floor.
  • good bronchodilator
  • MAC is 1.1%
26
Q

PONV risk factors

A

female, hx of PONV or motion sickness, non-smoker, <50 yo, use of volatile gas / N2O, narcotics, long surgeries, type of surgery (laparoscopic or gynecological)

27
Q

Dexamathesone
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Decadron
  • PONV, causes gluconeogenesis so caution when giving to diabetics
  • 4 mg/ mL; 4-8 mg given at induction
28
Q

Ondansetron
-other name
-mech of action
- used for
-mg/ mL or typical dose

A
  • Zofran
  • PONV, given to everyone over 2 yo unless severe hepatic disease or prolonged QT (Torsades)
  • 2 mg/ mL; 4 mg given (time it out, given near end of procedure)
29
Q

Apfel score for PONV

A

scoring system of 0-4. Higher points = greater risk of nausea.
- opioids +1
- non-smoker +1
- female +1
- Hx of PONV/ motion sickness +1
Total = 0-4

Prevalence of PONV: 0=9%; 1=20%; 2=39%; 3=60%; 4=78% risk of PONV

Tx with drugs that have different mechanisms of action

30
Q

Signs of difficult:
A) ventilation
B) intubation

A

A) Hx of difficulty, facial hair, obesity, Hx of snoring, OSA, edentulous, males, airway mass/ tumor

B) Hx of difficulty, pathology, decreased neck range of motion, thyromental distance <3 fingers, short/ thick neck, long incisors, decreased MIO, prominent overbite, high/ narrow palate, mallampati

31
Q

Local anesthetic toxic doses

A

“3, 5, 7”
3 mg/kg= marcaine
5 mg/ kg= plain lidocaine (really 4.5 mg/kg)
7 mg/kg lidocaine with Epi
May cause seizures, potentially arrhythmias and cardia arrest

32
Q

Train of Four (TOF)
- break it down
- # of twitches = number of receptors blocked

A
  • 4 electrical stimuli at 2 Hz delivered every 0.5s
  • # of twitches= % of receptors blocked0=100%; 1= 90%; 2=80%; 3=75%; 4=0-75%
33
Q

Tx of anaphylactic rxn to abx

A

call for help
epi (0.3 mg) sub Q
Benadryl (25 mg IV)
Steroids (100 mg Hydrocortisone)

34
Q

Tx of Bronchospasm

A

Signs: will notice drop in O2 sats and tV and a “shark fin” etCo2 wave form.

Management:
100% O2, ventilate, deepen anesthetic (prop)
albuterol into ETT
lidocaine into IV (1mg/kg)
if prolonged with no improvement give epi (10-50 mcg bolus)

35
Q

Tx of laryngospasm

A

Signs: inspiratory stridor (crowing noise), increased work of breathing, chest/ abdomen flailing

Management:
chin lift/ jaw thrust
suction (possible secretions on to glottic opening)
positive airway pressure
succinylcholine (kids 0.5 mg/kg IV and 4 mg/kg IM; Adults 0.5-1 mg/kg)

36
Q

Tx of MH

A

Triggers: volatile gasses and succinylcholine

Signs: elevated temp, HR, respirations, etCo2, arrhythmias, BP; masseter spasms, rigid muscles and cola colored urine

Tx: stop offending agent
dantrolene 2.5 mg/kg IV, repeat Q5-10 min with max of 10 mg
cool pt, lasix, mannitol, 100% O2 with high flow, correct metabolic acidosis, hyperkalemia

OMFS ANESTHESIA (2 decks)

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