Anesthesia

Question 1

What rule describes anesthetic dosing for children?

Answer 1

Clark’s rule

Childs weight in pounds divided by 150 and then multiplied by the adults weight.

Question 2

What is the rule that describes anesthetic dosing for infants?

Answer 2

This is the Frieds rule.

Infants age in months divided by 15 and then multiplied by the adult dose.

Question 3

What is the maximum dose for lidocaine 1%?

Answer 3

30 mL/ or 300 mG

Question 4

What is the max dose for lidocaine with epi?

Answer 4

50 mL or 500 mg

Question 5

What is the maximum dose for bupivicaine 1%?

Answer 5

175 mg or 17.5 mL

Question 6

What is the maximum dose for bupivicane 1% with epi?

Answer 6

225 mg or 22.5 mL

Question 7

What route does general anesthesia follow?

Answer 7

Cerebral cortex (Amnesia/analgesia)
Basal ganglia (Delerium)
Cerebellum (Surgical anesthesia/paralysis)
Medula (Respiratory depression/death)
Brain stem/spinal cord

Question 8

What are the four stages of anesthesia?

Answer 8

Stage 1: Amnesia/Analgesia (3 planes)
Stage 2: Delerium
Stage 3: Surgical Anesthesia (Four planes)
Stage 4: Medullary Paralysis (2 planes)

Question 9

What are the planes of stage 3 anasthesia?

Answer 9

Termed “Surgical Anesthesia”
Plane 1: Sleeping, residual lid reflex, normal pupils and breathing.

Plane 2: Pupils dialate, full analgesia, HR and BP are normal.

Stage 3: Partial intercostal paralysis, tachycardic, hypotensive, hypotonic

Stage 4:Complete intercostal paralysis and respiratory arrest requiring ventilation

Question 10

Eflurane, isoflurane, and halothane are all?

Answer 10

These are all inhalation agents used to achieve general anesthesia.

Question 11

What do enflurane and isoflurane have in common?

Answer 11

Both of these agents are inhalation agents that can be hepatotoxic.

Both support heart rate and can be used with epinephrine.

Question 12

This inhalation agent can be negative ionotropic leading to arythmias and cause shivering post surgery.

Answer 12

Halothane.

Also commonly associated with malignant hyperthermia.

Question 13

What are the two scary associations seen with prolonged nitrous oxide use?

Answer 13

Can cause
Fatal agranulocytosis
Or
Spontaneous abortion

Question 14

What should be given to patients after receiving nitrous oxide?

Answer 14

Post surgical O2 deliverance to prevent postanesthetic delayed diffusion hypoxia.

Question 15

Why is fetanyl a useful sedative/hypnotic agent?

Answer 15

Fetanyl is a short acting narcotic sedative reversed by naloxone.

Question 16

What is fetanyl?

Answer 16

A sedative/hypnotic narcotic drug.

Question 17

What is propofol (diprivan)?

Answer 17

IV sedative hypnotic agent used for induction and maitenance.

Question 18

What is midazolam (Versed)?

Answer 18

A short acting benzo typically used with an analgesic for short term conscious sedation.

Question 19

Waht are phenergan and compazine?

Answer 19

These are both phenothiazine tranquilizers.

Question 20

Which two meds can be used as premedications to minimize post surgical respiratory secretions while blocking parasympathetic overtone (block the vagus) to allow for positive chronotropic heart effects

Answer 20

Atropine and Scopalamine

Question 21

How does Zofran (Ondansetron) work?

Answer 21

It is a 5-HT3 receptor antagonist with strong antiemetic properties.

Originally used in patients undergoing chemo and now used following general anesthesia.

Question 22

What does succinycholine do?

Answer 22

Paralytic agent used for intubation with a fast onset skeletal muscle blockade.

Question 23

What should one watch out for when using succinycholine?

Answer 23

Intragastric and intraocular pressure rise with a rise in serum potassium as well (arrythmic)

Question 24

Why would you want to avoid using succinycholine in patients undergoing a trauma, burn, uremia or lower motor neuron disease?

Answer 24

These patients are predisposed to be hyperkalemic.

Succinycholine raises potassium levels even more potentially causing arythmias.

Question 25

What are the three major contraindications to spinal anasthesia?

Answer 25

Anticoaguation therapy
Bleeding diathesis (peridermal hematoma or spinal swelling)
Hypovolemia

Systemic infection, neuromuscular disease, COPD, obesity or lumbosacral disk disease are all included as well.

Question 26

What spinal level is safe for epidurals?

Answer 26

Below L2

Can be maintained 24-48 hours for ongoing anesthesia.

Question 27

What is the most common acute complication of spinal anesthesia?

Answer 27

Hypotension secondary to sympathectomy.

Dont forget spinal migrane.