Anesthesia

Question 1

Patient getting surgery and has:

• sudden bradycardia
• sudden drop in BP not responsive to fluid
• “mill wheel” sounding murmur
• inferior ST segment changes

Answer 1

Venous air embolism

• can happen with lap cases (cholecystectomy, hysterectomy)
• can happen with rapid infusion of blood products perioperatively

Management is immediate release of pneumoperitoneum (if doing laparoscopy) then steep trendelenburg and left lateral decubitus position to stabilize the entrapped air in the right atrium

Question 2

Intraoperative hypothermia is typically treated by

Answer 2

increasing the ambient anesthesia

Question 3

what is the best sedative to give in a pregnant patient?

Answer 3

propofol at low doses

propofol can cause hypotension and does pass the placenta – can lead to low Apgar scores, muscle hypotonia, depressed neuromusuclar activity (tends to happen with higher doses i.e. 2.8 mg/kg

Question 4

what are the side effects of precedex

Answer 4

bradycardia and hypotension

Question 5

which sedative is relatively contraindicated in pregnancy patients?

Answer 5

benzodiazepines

Question 6

if benzodiazepines need to be given to a pregnant patient with eclamptic seizures which do you give?

Answer 6

lorazepam

• no teratogenic effects on the fetus
• fairly long acting
• very lipid soluble

Question 7

which inhalation anesthetics produces the least myocardial depression?

Answer 7

nitrous oxide

• also has rapid uptake and elimination
• will not produce adequate general anesthesia for surgery as a single agent

Question 8

which inhaled anesthetic is the most cost effective?

Answer 8

halothane

can cause ventricular arrhythmia and rarely hepatic necrosis

Question 9

which inhaled anesthetic has been shown to directly cause myocardial depression?

Answer 9

sevoflurane

Question 10

which inhaled anesthetic is a strong vasodilator?

Answer 10

isoflurane

Question 11

which inhaled anesthetic is peripheral vasodilator and causes myocardial depression?

Answer 11

enflurane

Question 12

what pain medications are best for CKD?

Answer 12

Tylenol
dilaudid
fentanyl
sufentanil

Question 13

which pain medications should be avoided in CKD?

Answer 13

NSAIDs
oxycodone
codeine
morphine

Question 14

which patients should not get ketamine?

Answer 14

relatively contraindicated in patients with myocardial ischemia and space occupying lesions in the brain

it is a direct and indirect stimulator of the sympathetic nervous system which results in increased myocardial oxygen consumption and elevated intracranial pressures

Question 15

what are signs of lidocaine overdose?

Answer 15

numbness
tingling of the face
tinnitus
in severe cases - seizures, coma, respiratory depression, cardiac arrest

Question 16

how to calculate the max dose of lidocaine without epinephrine?

Answer 16

(4.5 mg/kg * weight in kg) / 20 mg/ml = dose

1% lidocaine contains 10 mg of lidocaine per 1 ml