Anesthesia Flashcards
Small MAC equals…
More lipid soluble -> more potent, slower induction
Ex: Nitrous oxide-> low potency, fast induction
What does MAC stand for and what does it mean?
Minimum alveolar concentration
Smallest concentration of inhaled agent at which 50% of pts will not move with the first incision
No Nitrous oxide with…
Anywhere with confined spaces- pneumo, SBO
Nitrous oxide
Fast onset
Low potency
LEAST myocardial depression
Inhaled agent with highest degree of cardiac depression
Halothane- good for kids
Halothane hepatitis- fever, increased eos, jaundice, inc LFT’s
Sevoflurane
Less myocardial depression
Fast
Less laryngospasm
$$$
Induction agents
Barbiturate- sodium thiopental
Propofol
Ketamine
Etomidate
Do not use propofol in pts with what allergy?
Egg
What does ketamine cause?
Dissociation of thalmic/limbic system
Hallucinations
Catecholamine release- inc carbon monoxide, tachy
NO in pts with head injury
Good for kids
Etomidate
Fast
Fewer hemodynamic changes
Cont infusions can cause adrenocortico suppression
Paralytics
Succinylcholine- de polarizing Cis-atracurium- Hoffman deg- ok in liver and renal failure Mivacurium Rocuronium Pancuronium - tachy
De polarizing agent
Succinylcholine
Fast, short acting
Causes fasciculations at first- flaccid paralysis
Succinylcholine contraindicated with…
Hyperkalemia- depolarization causes release of K
No in burn pts, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, renal failure, head injury
Complication of succinylcholine
Malignant hyperthermia
Ca released from SR causes muscle excitation/contraction syndrome
1st sign- inc end tidal CO2
Tachy, rigid, acidosis, inc K
Atypical psuedocholinesterases- prolonged paralysis- Asians
Treatment of malignant hyperthermia
Dantrolene 10mg/kg
Inhibits Ca release
Cooling blanket, HCO3, glucose
What nondepolarizing agent can be used in liver or renal failure?
Cis- atracurium
Hoffman degradation
Histamine release
What is the side effect of pancuronium?
Tachycardia
Nondepolarizing mm relaxant/paralyzer
Reversing drugs for nondepolarizing agents
Neostigmine - blocks acetylcholinesterase- more Ach
Edrophonium-blocks
Atropine & glycopyrrolate - have to be given with neo or Edro to counteract Ach overdose
Max dose of 1%lido
5mg/kg
Max dose of lido + epi
7mg/kg
Max dose of bupivicaine
3mg/kg
Amides…
All have i in first part of name
Rare allergic rxns
Esters…..
Increased allergic rxns due to PABA analogue
Demerol complications
Tremors
Fasciculations
Convulsions
In renal failure can cause seizures
Overdose of benzodiazepine is treated with
Flumazenil ( contra in pts with inc ICP)
Tx for acute hypotension and Brady in epidural anesthesia
Stop epidural, fluids, phenylephrine, atropine
Spinal anesthesia injected into what space?
Subarachnoid space
No with hypertrophic cardio, cyanotic heart dz
Treatment spinal headache
Fluids caffeine
>24hrs- blood patch- place 10-20ml blood into epidural space
Due to CSF leaking - brain sags into cranial vault- traction on pain fibers
Complication of neuroaxial anesthesia
Epidural hematoma
ASA classifications
I- healthy II- mild dz without limitation III- severe dz IV- constant threat to life V-moribund- not expected to survive OR VI- donor
Placement of endotracheal tube
2cm above carina