Anesthesia

Question 1

4 goals of anesthesia

Answer 1

Analgesia
Amnesia
Paralysis
Unconsciousness/hypnosis

Question 2

ASA standards

Answer 2

Oxygenation
Ventilation
Circulation
Consistent presence
Temperature

Question 3

ASA class 1

Answer 3

Healthy normal

Question 4

ASA class 2

Answer 4

Well controlled systemic dz (mild asthma)
Smokers automatically at least class 2

Question 5

ASA class 3

Answer 5

Moderately controlled systemic dz (severe asthma)

Question 6

ASA class 4

Answer 6

Dz that is constant threat to life (organ failure)

Question 7

ASA class 5

Answer 7

Need surgery in order to survive (ruptured AAA)

Question 8

ASA class 6

Answer 8

Basically being sustained chemically or on vent for organ donation.

Question 9

3 critical questions to ask pts before anesthesia

Answer 9

1. Last eat or drink (must be more than 6 hrs)
   - Big meal - at least 8 hrs
2. Allergies
3. Problems w/ anesthesia in past

Question 10

Drug to block sympathetic response for ET tube placement

Answer 10

Lidocaine

Question 11

Drugs for induction

Answer 11

1. Fentanyl
2. Propofol (with lido 1 mg/kg)
3. Rocuronium (takes 60 seconds)

Question 12

What may help with someone who has a big fat neck?

Answer 12

Pillow under shoulders

Question 13

Standard size ET tubes

Answer 13

7. 5 for men

7. 0 for women

Question 14

Fentanyl duration

Answer 14

30 - 60 mins

Question 15

Propofol duration

Answer 15

5 - 10 mins

Question 16

Rocuronium duration

Answer 16

45 - 60 mins

Question 17

Maintenance meds

Answer 17

Nitrous oxide (104%)
Sevoflurane (2%)
Desflurane (65%)
Dilaudid for narcotic maintainance

Question 18

Narcotic potency

Answer 18

Merperidine:  .1
Morphine: 1 (standard)
Hydromorphone: 5x
Alfentinil: 10x
Fent: 75 - 100x
Remifentanyl: 500x
Sufentanyl:  1,000x

Question 19

Morphine ans hydromorphone duration

Answer 19

Effect around 15 mins
Peak at 60 mins
Duration of 3-4 hrs

Question 20

Perioperative pain control serves what purpose?

Answer 20

Decreases sympathetic surge and reduces risk of:

PE, MI

Question 21

Very high amounts of IV propofol maintenance is ideal for what type of surgery?

Answer 21

Aneurysm repair

Lowers o2 demand of brain

Question 22

What reverses muscle relaxants (paralytics).

Answer 22

ACTH esterase inhibitors
Neostigmine
Edrophonium

Question 23

ACTH esterase inhibitors are always given in conjunction with

Answer 23

Antocholinergics
Glocopyrolate (preferred)
Atropine

Question 24

Most common antiemetic

Answer 24

Zofran (serotonin 5HT receptors)

Question 25

Dose needed to control pain for conscious patient on floor post-op?

Answer 25

18 times less than loading dose needed in surgery

Question 26

During surgery, vitals should be within ___% of baseline

Answer 26

20%

Question 27

Stop taking plavix __ days before spinal block

Answer 27

7 days

Question 28

ASA, NSAIDS and spinal blocks

Answer 28

Generally not a big enough concern to stop them from doing a block.

Question 29

<p>INR cut off for spinal block</p>

Answer 29

<p>1.5 is maximum</p>

Question 30

Local anesthetics 2 classes

Answer 30

Amides (lidocaine, bupi, ropi)

Esters (cocaine)

Question 31

Amides are metabolized by?

Answer 31

Metabolized by liver

Question 32

Esters have greater risk of?

Answer 32

Allergic rxn

Amides have VERY low risk

Question 33

Epinephrine decreases the uptake of?

Answer 33

Lidocaine etc.

Question 34

Steroids make the block last?

Answer 34

Twice as long

Question 35

Lidocaine vs Bupivocaine

Answer 35

Lido has fast onset, short duration (1-2 hrs)

Bupi has slow onset, longer duration (4-8 hrs)

Question 36

Bupivocaine w/ dex in a spinal = how long of duration?

Answer 36

24 hrs

Question 37

Most interscalene blocks also block which nerve?

Answer 37

Phrenic

Causes hemodiaphragmatic paralysis