Anesthesia

Question 1

8 P’s of rapid sequence intubation

Answer 1

Prepare, Pretreat (drugs), Position (sniffing position), preoxygenated (POX 100%), Pressure (Sellick), Paralyze (drugs), Placement (tube), Position (of tube, confirm two ways)

Question 2

What drug is important for intubation pretreatment in children?

Answer 2

Atropine to prevent bradycardia

Question 3

Sellick maneuveur

Answer 3

Pressure on cricothyroid cartilage to compress esophagus, minimizing risk of aspiration

Question 4

What drugs are used for sedation/induction of general anesthesia?

Answer 4

Thiopental, etomidate, midazolam, ketamine, methohexital, fentanyl, propofol

Question 5

Thiopental

Answer 5

Can cause hypotension, good for inc ICP. Cannot use in asthma.

think tHIOpental = HIO = hypotension and good for inc ICP

Question 6

Etomidate

Answer 6

Minimal hepatic/renal effects, good for pts with decreased CO. Can precipitate adrenal insufficiency

Question 7

Midazolam

Answer 7

Can cause hypotension. Decrease dose if patient taking a drug that inhibits P450 (e.g. erythromycin).

Question 8

Ketamine

Answer 8

Can cause tachycardia and increased ICP, good for patients with broncospasm. Cannot use in head trauma due to inc ICP effect. Not a lot of hypotensive effect (unless it is someone who is catecholamine deplete)

Question 9

What drugs are used to paralyze the patient for intubation?

Answer 9

Succinylcholine, vecuronium

Question 10

Succinycholine

Answer 10

Can cause hyperkalemia. Duration 5-10 min

Question 11

What things can cause falsely lowered POX reading?

Answer 11

Methylene blue, indigo carmine blue, certain nail polishes

Question 12

What can cause falsely raised POX reading?

Answer 12

Carboxyhemoglobin

Question 13

What can cause a false POX reading of 85%?

Answer 13

Methemoglobin

Question 14

Spinal cord ends at

Answer 14

L1-L2

Question 15

Spinal vs. epidural anesthesia

Answer 15

Spinal anesthesia: stick needle into CSF, lasts for 2-3 hrs. Epidural anesthesia: catheter goes into epidural space and can continuously infuse. Both are indicated for surgeries involving LE’s, lower abdomen, GU and anal region

Question 16

Complications of spinal anesthesia

Answer 16

Hypotension/nausea (from unopposed parasympathetic activity) more common. Less commonly, post-spinal headache from CSF leak. Urinary retention, backache common.

Question 17

Complications of epidural anesthesia

Answer 17

Hypotension/nausea less common than with spinal. Urinary retention, backache common. Rare but serious: epidural abscess or hematoma.

Question 18

Succinylcholine is CI in what patients?

Answer 18

Burns, rhabdo, NM disease, GBS, narrow-angle glaucoma, malignant hyperthermia

Question 19

Propofol

Answer 19

Comes as lipid emulsion, can cause hyperTG over time. Careful aseptic technique to prevent sepsis since emulsion is great growth medium.

Question 20

Methohexital

Answer 20

Do not use in seizures, hypotension, asthma

Question 21

How to reverse effect of neuromuscular blockade?

Answer 21

Anticholinesterases, which prevent breakdown of Ach.

Question 22

Hepatic insufficiency considerations for sedation

Answer 22

Chronic alcohol use increases anesthetic requirements, while acute alcohol intoxication decreases them. Hypoalbuminemia means more unbound drug available. P450 activity may be decreased, so prolonged elimination of many drugs.

Question 23

Pediatric considerations for sedation

Answer 23

Neonates: high metabolic requirements, increased O2 consumption; left shift of O2 curve due to fetal Hg; impaired temp regulation. Functional residual capacity is lower. Succinylcholine assoc with risk of bradycardia and rarely malign hyperthermia in peds. Airway narrowest point is beyond where you can see while intubating!

Question 24

OB patients sedation consideration

Answer 24

Functional residual capacity decreased so more susceptible to hypoxemia. Demerol (meperidine) is better than morphine b/c newborn less sensitive to it. Tx hypotension with ephedrine because it preserves uterine blood flow.

Question 25

Local anesthesia

Answer 25

MOA: blockade of Na channels. Less effective in acidic environment (e.g. infection). Adding epi prolongs duration by inducing vasoconstriction.

Question 26

Toxicity of local anesthetics

Answer 26

Tinnitus, vertigo, seizures, hypotension, PR prolonging, QRS widening, arrhythmias

Question 27

Do not use epi with local anesthesia in what areas?

Answer 27

SPF-10: scrotum, penis, fingers, toes, ears, nose

Question 28

Two classes of local anesthetics

Answer 28

Amides and esters. Recall that amides have “i” before “caine” e.g. lidocaine, bupivacaine, prilocaine.

Question 29

Malignant hyperthermia

Answer 29

Autosomal dominant hypermetabolic syndrome occurring after exposure to anesthetic agent. Cause: impaired reuptake of Ca by sarcoplasmic reticulum in muscle due to ryanodine receptor dysfunciton. Signs: tachy, hypertherm, hypercarb, hypoxic, acidosis, muscle rigidity, ventricular dysrhythmias

Question 30

Treatment of malignant hyperthermia

Answer 30

Benzos (fast). Dantrolene (definitive but takes 30 min)

Question 31

What is tylenol #2, 3, 4?

Answer 31

Acetaminophen with varying doses of codeine

Question 32

Vicodin

Answer 32

Acetaminophen with hydrocodone

Question 33

Ketorolac

Answer 33

Toradol = NSAID

Question 34

Prochlorperazine

Answer 34

Compazine, antiemetic, antidopaminergic

Question 35

Droperidol

Answer 35

antiemetic, antidopaminergic