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DIM Bloc TCP > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What are the patient’s risk factors for nausea and vomiting postoperative?

A
  • Female
  • Young
  • Nonsmoker
  • History of motion sickness or previous PONV
  • Postoperative opioid use
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2
Q

What can trigger malignant hyperthermia?

A
  • Inhalational agents!!!!!!!!
  • Succinylcholine
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3
Q

What is plasma cholinesterase deficiency?

A

Deficiencies in or atypical plasma cholinesterase can result in prolonged neuromuscular blockade after succinylcholine administration (GENETIC)

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4
Q

What are the goals of general anesthesia?

A
  • Analgesia (pain relief)
  • Amnesia
  • Anxiolysis
  • Muscle relaxation
  • Autonomic nervous system control
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5
Q

What are the complications of general anesthesia?

A
  • Dental trauma 1: 4,500
  • Peripheral nerve injury
  • Eye injury
  • Awareness 0.2%
  • Anaphylaxis/anaphylactoid reaction
  • Inability to ventilate/oxygenate
  • Bronchospam, Hypoxia…
  • Death
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6
Q

What are the induction drugs?

A
  • Propofol
  • Ketamine
  • Etomidate
  • Midazolam
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7
Q

What is Succinylcholine?

A

A Depolarizing Neuromuscular Blocker (paralytic agent)

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8
Q

What is Rocuronium?

A

A Non-Depolarizing Neuromuscular Blocker (paralytic agent)

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9
Q

What are the main inhalational agents?

A
  • Sevoflurane
  • Desflurane
  • Nitrous oxide (never used as sole agent)
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10
Q

What are the basic required monitors during general anesthesia?

A
  • 3-lead ECG (lead II and modified V5)
  • Pulse oximetry
  • Non-invasive blood pressure (NIBP)
  • End-tidal CO2
  • End-tidal gas concentration
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11
Q

What are the predictors of difficult bag mask ventilation?

A

BONES

  • Beard
  • Obese
  • No teeth
  • Elderly
  • Snoring (OSA)
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12
Q

What are the risk factors of sleep apnea?

A

STOP BANG

  • Snoring
  • Tired
  • Observed apnea
  • Pressure (HTN)
  • BMI > 35
  • Age > 50
  • Neck circumference > 40 cm
  • Gender (male)
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13
Q

What are the 3 phases of anesthesia?

A
  1. induction
  2. maintenance
  3. emergence
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14
Q

What is Propofol?

A

A white IV induction agent that potentiate GABA receptor activity inhibiting normal neuronal function

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15
Q

What are the side effects or propofol?

A
  • Will depress hemodynamic, decrease contractility, peripheral vasodilation
  • Will depress ventilation and lower airway muscle tone
  • Preparation in fat emulsion, favorable to bacterial contamination
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16
Q

What is the induction agent of choice with status asthmaticus?

A

Ketamine because it is a bronchodilator and preserves spontaneous ventilation

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17
Q

What is Ketamine?

A
  • An IV or IM induction
  • Analgesic and anesthetic agent
  • Is NMDA receptor antagonist
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18
Q

What are the side effects of ketamine?

A
  • Increases transiently intracranial pressure
  • Increase BP, CO
  • No respiratoy effect
  • No neuroprotective effect
  • Psychotomimetic side effects: potential for abuse
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19
Q

What is the main class of anxiolytics used in anesthesia?

A

Benzodiazepines

20
Q

What is the mechanism of action of Benzodiazepines?

A
  • GABA receptor agonist
  • Lipid solubility
  • Metabolized by the liver
21
Q

What is Midazolam?

A

A Benzodiazepine given IV, PO, IN, IM

22
Q

Opioids are metabolized by the liver except which one?

A

Remifentanil (short acting metabolized by plasma esterase)

23
Q

How do we reverse muscle relaxation / neuromuscular blockers?

A
  • Neostigmine (Anticholinesterase)
  • Glycopyrulate (counteract the muscaric effects)
24
Q

What is the mechanism of action of local anesthetics?

A
  • They block voltage-gated sodium channel and prevent depolarization.
  • They must convert to an ionized form to properly bind the receptor
25
Q

What are the contraindications of peripheral nerve blocks?

A
  1. Allergy to local anesthetic
  2. Patient refusal, lack of cooperation
  3. Lack of resuscitation equipment
  4. Lack of IV access
  5. Coagulopathy
  6. Certain types of preexisting neurological dysfunction
  7. Local infection at block site
26
Q

What are the contraindications to central blocks?

A
  1. Thrombocytopenia (PLT<100000)
  2. Coagulation disorders (eg. Hemophilia) anticoagulants
  3. Cardiac insufficiency (low CO syndrome)
  4. Hypovolemic shock
  5. Aortic stenosis (moderate-severe)
  6. Local infection
  7. Sepsis
  8. Neurologic/psychiatric diseases
  9. Allergies to local anesthetics
  10. Patient refusal
27
Q

What are the advantages to use spinal central block?

A
  • Easier to perform
  • Smaller dose of L.A. required (usually < toxic IV dose)
  • Rapid blockade (onset in 2-5 minutes)
  • Very effective blockade
  • Hyperbaric L.A. solution - position of patient important
  • Single injection therefore may wear off. If surgery prolonged
28
Q

What are the types of local anesthetics?

A
  1. Esters: procaine, tetracaine
  2. Amides: lidocaine, bupivicaine
29
Q

At what level of consiousness do you lose your ability to protect the airway against aspiration (vomiting, bleeding)?

A

GCS < 8

30
Q

What are the indications for intubation?

A
  • Swelling or Mass
  • ↓ LOC (GCS <8)
  • PaO2 < 60 mmHg
  • RR > 35 (excessive work of breathing)
  • PaCO2 > 60 mmHg
31
Q

What are the types of respiratory failure?

A
  1. Type 1 (Hypoxemic): PaO2 < 60 mmHg
  2. Type 2 (Hypercapnic): PaCO2 > 50 mmHg
32
Q

What are the symptoms of obstructive sleep apnea?

A

STOP BANG

  • Snoring
  • Tired
  • Observed episodes of apnea
  • Pressure (HTN)
  • BMI > 35
  • Age > 50
  • Neck circumference > 40 cm
  • Sex (male)
33
Q

What are the surgical risk factors for nausea and vomiting postoperative?

A
  • Gynecological or major breast surgery
  • Laparotomy or laparoscopy
  • Plastic surgery
  • ENT procedures
  • Craniotomy
  • Strabismus surgery
34
Q

What is the equipment required for safe management of patient’s airway in the OR?

A

STATICS

  • Suction
  • Tube
  • Airway (oral and/or nasopharyngeal)
  • Tape
  • Introducer
  • Circuit or bag
  • Scope
35
Q

What are the steps of upper airway examination guiding airway management?

A
  1. Assess temporomandibular joint mobility
  2. Assess mouth opening + Mallampati Classification
  3. Assess tyromental distance and mandibular protusion
  4. Assess ROM of c-spine
36
Q

What drugs can be administered through endotracheal tube?

A

NAVEL

  • Naloxone
  • Atropine
  • Ventolin
  • Epinephrine
  • Lidocaine
37
Q

What is the sequence of rapid induction?

A
  1. Preoxygenation
  2. Crycoid pressure
  3. IV anesthetics and muscle relaxant
  4. Endotracheal intubation
  5. Confirmation of placement of the intubation
38
Q

What is the antagonist of benzodiazepines?

A

Flumazenil

39
Q

What is the antagonist of opioids?

A

Naloxone

40
Q

In neonatal resuscitation, when the chest expansion is inadequate, what can you do?

A

MR SOPA

  • Mask (reapply)
  • Reposition (head)
  • Suction (any secretion)
  • Oral airway and Open mouth
  • Pressure (increase)
  • Airway (intubation or other)
41
Q

In neonatal resuscitation, when do you start chest compressions?

A

HR < 60 after 30 seconds of effective ventilation

42
Q

In neonatal resuscitation, when should you give epinephrine?

A

HR < 60 after 30 sec effective ventilatiion + 60 sec chest compressions

43
Q

What are the complications of blood transfusion?

A
  • Infection
  • Hemolysis
  • Non-hemolytic febrile reactions
  • Allergy
  • TRALI: transfusion-related actue pulmonary injury
  • TACO: transfusion-related circulatory overload
  • Hypothermia
  • Electrolytes abnormalities
  • Coagulopathy
  • Acid-base abnormalities
  • Embolism
44
Q

What type of fibres conduct rapid, sharp, localised pain?

A

Að

45
Q

What type of fibress conduct slow, diffused, dull pain?

A

C fibres

46
Q

What are the extubation criteria?

A
  • RR > 8 breaths/min and < 35 breaths/min
  • PaO2 min 60 mmHg
  • FiO2 < 50 mmHg
  • Vital capacity <15 ml/kg
  • Tidal volume > 5 ml/kg
  • NIF > -25 cm H20

DIM Bloc TCP (4 decks)

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