ANESTHESIA Flashcards
MC inhalational anesthetic
Sevoflurane
MC IV anesthetic
Propofol
What does a small MAC mean?
More lipid soluble aka more potent. The speed of induction is inversely proportional to solubility
Which anesthetic diffuses into closed spaces?
NO2 – avoid in pts with SBO, PTX
Which inhalational anesthetic has the highest degree of cardiac depression and arrhythmias
Halothane
Halothane hepatitis
Fever, eosinophilia, jaundice, increased LFTs
Which inhalational anesthetic is the least pungent
Halothane
Which inhalational anesthetic is good for mask induction
Sevoflurane
Which inhalational anesthetic is used in neurosurgery
Isoflurane. It lowers brain oxygen consumption and doesnt cause increase in ICP
Which inhalational anesthetic can cause seizures?
Enflurane
MCC of intra-op bradycardia
Inhalational anesthesia. Tx with atropine
3 types of pts that should not get propofol
Egg allergy
Pregos
Parkinsons
Side effects of ketamine
Hallucinations
Catecholamine release (increased CO2, tachy)
Increased airway secretions
Increased cerebral blood flow
Ketamine contraindicated in..
head injury
Which IV induction agent has fewest cardiac side effects?
Etomidate
Sedation agent for intubated patients
Dexmedetomidine (Precedex) – good for early extubation protocols
Last muscle to go down and first to recover from paralytics
Diaphragm
First to go down and last to recover from paralytics
Neck muscles and face
First sign of malignant hyperthermia
Increased end-tidal CO2
Succinylcholine – specific electroylte effect
Depolarization releases K. Don’t use in severe burns, neuro injury, NM disorders, spinal cord injury, massive trauma, or acute renal failure (all have upregulation of ACh receptors which can release significant amts of K)
Most common side effect of pancuronium
Tacycardia (no hypotension)
Two drugs that can be used to reverse non depolarizing agents
Neostigmine
Edrophonium
both block AChase, increasing ACh
Max dose of lidocaine
4 mg/kg (7 mg/kg with epi)
Max dose of bupivacaine
2 mg/kg (3 mg/kg with epi)
Why are infected tissues difficult to anesthetize
Acidosis
List length of action for local anesthetics
bupivacaine > lidocaine > procaine
First sign of local anesthetic OD
Perioral paresthesias – CNS sx occur before cardiac
Amides
All have i in first part of name – lidocaine, bupivacaine, mepivacaine. Rarely cause allergic rxns.
Esters
Tetracaine, procaine, cocaine. Increased allergic reactions due to PABA analogue
Avoid use of narcotics in patients on what kind of drug?
MAOIs. Can cause hyperpyrexic coma (srotonin release syndrome – fever, tachy, sz, coma)
What causes hypotension with morphine
Histamine release
Demerol should be avoided in pts with ..
Renal failure. It can cause a buildup of normedperidine analogues – > seizures
Most potent narcotic
Sufentanil
Which benzo contraindicated in prego
Versed (midazolam) as it can cross placenta
Tx for acute hypotension and bradycardia in epidural anesthesia
Turn it down.
Fluids
Phenylephrine or atropine
Lidocaine in epidural can cause ..
Decreased HR, BP
Epidural contraindicated in ..
HOCM, cyanotic heart dz – sympathetic denervation causes decreased afterload, which worsens these 2 conditions
MC complication of epidural and spinal
Urinary retention
Most post op hospital morality is due to ..
Pre-op renal failure (#1) and CHF
Which abx prolong neuromuscular blockade
Clindamycin
