ANESTHESIA Flashcards
ASA class breakdown
1 = healthy 2 = mild systemic disease (HTN, DM), active smoker, pregnancy 3 = severe systemic disease (stable angina, CHF, hx MI, CKD), morbid obesity 4 = severe systemic disease that is constant threat to life (unstable angina, mod-severe COPD) 5 = not expected to survive wo operation (MOF, sepsis, coagulopathy)
Succinylcholine should be avoided in which pts?
- burn pts
- massive tissue trauma (rhabdo)
- upper and lower motor neuron lesions (spinal cord injuries)
- NM disorders
C/I to nitrous oxide administration includes…
- pneumothorax
- SBO
- w/ air-filled cavity (ie. pneumoperitoneum, increased middle ear pressure)
**bc can diffuse into any air-filled cavity to displace nitrogen
Which inhalation agent has highest incidence of postop nausea and vomiting (PONV)?
prolonged use of nitrous oxide
ACC-AHA cardiac risk stratification for non-cardiac surgery
high risk >5% = any vascular surgery (except CEA)
intermediate 1-5% = CEA, head/neck/C/A surgery, ortho
low <1% = hernia, endoscopic, breast
1 predictor of post-op hospital mortality
renal failure
Steps of RSI
- oxygenation + short-acting induction agent
- muscle relaxant
- cricoid pressure
- intubation
- inhalational analgesic
MCC sudden rise ETCO2…? But should also be concerned for…?
hypoventilation.
malignant hyperthermia.
MCC sudden drop ETO2…? But should also be concerned for…?
tubing malfunction.
CO2 emboli.
Mgmt CO2 emboli
- stop CO2 insufflation, reduce pneumoperitoneum
- Trendelenburg + left lateral decub
- 100% FiO2
- aspirate off central line from RA
- pressors/inotrope + prolonged CPR, if necessary
What is MAC?
minimal alveolar concentration; smallest concentration of gas in which 50% pts will not move to painful stimuli
Low MAC means…?
- more lipid soluble
- more potent
- slow speed induction
High MAC means…?
- less lipid soluble
- less potent
- fast induction
Highest MAC agent is…?
nitrous oxide
Side effect: halothane
- hepatitis
- high degree cardiac depression
- arrhythmia
Best agent for mask-induction for kids
Sevoflurane
Best agent for NSGY procedures
Isoflurane
Side effect: propofol
- metabolic acidosis
- hyperTG
- rhabdo
- propofol infusion syndrome
Best IV anesthesia agent in pts with angina or HF
etomidate (few hemodynamic and cardiac effects)
Which IV anesthesia agent can cause adrenal cortical suppression?
etomidate
Which IV anesthesia agent has no respiratory depression effects?
ketamine
Order of paralysis of muscles vs. recovery from paralysis with paralytic agent
paralyzed from head -> diaphragm.
recovers from diaphragm -> head.
Tx malignant hyperthermia
dantrolene
Paralytic agent that undergoes Hoffman elimination? Best used for pts w/…?
Cisatracurium.
For pts with liver or renal failure.
Rocuronium is metabolized by?
liver
Pancuronium is metabolized by?
kidney
How to reverse non-depolarizing paralytic agents?
ACh-esterase inhibitors
How do local anesthetics work?
blocks transmission signals by stabilizing Na-channels -> increase AP threshold (increases amount of Na needed to create AP)
Longest lasting local anesthetic by longest > shortest
Bupivacaine > lidocaine > procaine
Max dose lidocaine wo epi vs. w epi? How long do they last?
wo epi: 5 mg/kg (up to 60-min)
w/ epi: 7 mg/kg (up to 4-hr)
Max dose bupivacaine? How long does it last?
3 mg/kg (up to 15-hrs)
If give morphine via epidural, can cause…?
respiratory depression
If give lidocaine via epidural, can cause…?
hypotension + bradycardia
Which benzo is C/I pregnancy?
midazolam
