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Anesthesia Flashcards

1
Q

Laryngospasm is the reflex closure of the … and … vocal cords

A

False and True

It occurs along the descent of the epiglottis over the laryngeal orifice

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2
Q

Appropriate steps to manage a laryngospasm

A

1 - 100 % O2 via face mask, CPAP w/ jaw thrust
2 - Finger pressure laryngospasm notch
3 - Deepen anesthesia

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3
Q

Succinylcholine dosing for laryngospasm

A

.25-.5 mg/Kg IV

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4
Q

Gold standard for diagnosis of OSA

A

Polysomnogram is the gold standard for diagnosing OSA

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5
Q

Quick questionnaire to assess for OSA?

A

Snoring
Tiredness
Observed apneas
Pressure treatment (blood pressure treatments)

BMI >35
Age >50
Neck circumference >40cm
Gender (male)

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6
Q

STOP BANG Scoring criteria

A

0-2 - Low risk
3-4 - Moderate risk
5-8 - High Risk

15% at 3 points
65% at 7-8 points

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7
Q

Systemic inflammatory response syndrome (SIRS) criteria

A

Temperature <36 or >38
Heart rate >90
Respiratory Rate >20/min or PaCO2 <32
WBC >12k or <4K

Must be two criteria to have SIRS

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8
Q

Treatment of hypotension with bradycardia

A

Atropine 0.5mg every 3-5 minutes up to 3.0mg

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9
Q

Treatment of hypotension with tachycardia

A

Phenylephrine 1% 100ug per dose every 5 minutes (alpha agonist with reflex bradycardia)

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10
Q

Main disadvantage of using a laryngeal mask airway

A

Aspiration of gastric contents is not prevented

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11
Q

Preoperative fasting guidelines for nonhuman milk

A

6 hours (nonhuman milk)

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12
Q

Preoperative fasting guidelines for breast milk

A

4 hours (breast milk)

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13
Q

Preoperative fasting guidelines for clear liquids

A

2 hours (clear liquids)

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14
Q

Preoperative fasting guidelines for infant formula

A

6 hours (infant formula)

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15
Q

ASA VII

A

Declared brain dead; planned for organ harvest

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16
Q

ASA V

A

Moribund patient, not expected to survive without surgery

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17
Q

ASA IV

A

Severe systemic disease that is constant threat to life

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18
Q

ASA III

A

Severe systemic disease (controlled and not constant threat to life). Severe systemic disease with constant threat to life is ASA IV

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19
Q

ASA II

A

Mild-moderate systemic disease

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20
Q

Which leads of an ECG are more sensitive to ischemia and are thus the most commonly used

A

Leads II and V5 are more sensitive to ischemia

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21
Q

Noninvasive blood pressure monitoring is more reflective of … as opposed to directly correlating blood pressure

A

Noninvasive blood pressure monitoring is more reflective of blood FLOW

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22
Q

Bispectral index objectively measures the depth of anesthesia.
What instrument is used to measure this and what is the scale

A

Electroencephalogram will read numbers between 0 and 100.

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23
Q

Sources of error occur while utilizing the BSI. Name two medications that will cause paradoxic changes

A

Ketamine and nitrous oxide causes paradoxical changes to EEG readings

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24
Q

At what level of sedation (minimal, moderate, deep, or general) does spontaneous ventilation become inadequate with the potential for airway intervention?

A

Deep sedation - Airway intervention may be required and spontaneous ventilation is inadequate

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25
Q

At what level of sedation is there a purposeful response to repeated noxious stimuli

A

Deep sedation

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26
Q

Describe the first-pass hepatic effect on PO drugs

A

Oral drugs are absorbed by the GI tract and pass through the liver via the portal circulation prior to entering the systemic circulation. Drugs may be variably metabolized

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27
Q

What is the minimum alveolar concentration?

A

The MAC is the partial pressure (concentration) of a volatile anesthetic that prevents movement in 50% of patients during a surgical stimulus.
The higher the MAC, the less potency

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28
Q

MAC of sevoflurane

A

MAC of Sevoflurane - 2.05

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29
Q

Potential renal concerns (production of compound A) are taken into account with which volatile anesthetic?

A

Sevoflurane

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30
Q

Does isoflurane have a faster or slower onset of action then sevoflurane

A

Isoflurane has a slower onset of action than sevoflurane

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31
Q

MAC of isoflurane

A

MAC of isoflurane - 1.15

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32
Q

MAC of Desflurane

A

MAC of desflurane - 6.0

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33
Q

Which volatile anesthetic has coronary steal effect?

A

Isoflurane
Coronary steal affect is a phenomenon where an alteration of circulation patterns leads to a reduction in the blood flow directed to the coronary circulation

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34
Q

MAC of nitrous oxide

A

MAC of nitrous oxide - 105

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35
Q

Anatomic differences of pediatric airway

A
  • Tongue is relatively larger
  • Epiglottis is higher and more floppy
  • Larynx is funnel shaped
  • Narrowest point of the airway is in the subglottic region
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36
Q

What is the formula for selecting the size of an ET tube in a child greater than 2 years old?

A

(Age/4) +4 = mm diameter of ET tube

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37
Q

In the pediatric population, the cardiac output is driven mostly by what?

A

In the pediatric population, the cardiac output is driven mostly by the heart rate

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38
Q

The physiologic difference in a child’s upper airway as compared to that of an adult…

A

The child’s upper airway is more compliant and thus more prone to compression from negative inspiratory forces. The child’s upper airway is more likely to collapse

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39
Q

Why are pediatric patient’s more prone to abrupt drops in body temperature

A

Decreased fat insulation and having a large surface area to volume ratio make pediatric patients more likely to have a drop in body temperature

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40
Q

In a morbidly obese patient, the singlebiggest predictor for a problematic intubation is what pre-operative assessment?

A

The neck circumference is the single biggest predictor for a problematic intubation in the morbidly obese patient
40 cm neck circumference = 5% chance of problematic intubation
60 cm neck circumference = 35% chance of problematic intubation

41
Q

BMI of morbidly obese patient

42
Q

Pickwickian syndrome

A

Obesity hypoventilation syndrome

43
Q

Symptoms of hyperglycemia

A
  • Tachycardia, tachypneic, abdominal pain, ketone breathe of DMI
44
Q

Symptoms of hypoglycemia

A
  • AMS, diaphoresis, tachycardia, possible seizure disorder
45
Q

Treatment of hypoglycemia with no AMS

A

Oral glucose containing solution

46
Q

Treatment of hypoglycemia with AMS

A

IF IV access: 10-25gm glucose (20-50ml of 50% solution or 40-100ml of 25% solution)
If no IV access: 1-2mg of IM glucagon

47
Q

For asthmatic patients, which two agents inhibit bronchoconstriction

A

Propofol and ketamine both inhibit bronchoconstriction and are thus beneficial for the asthmatic patient

48
Q

Which volatile agents are potent bronchodilators?

A

Enflurane and isoflurane are both bronchodilators

49
Q

Sterile water with added electrolytes describes what solution?

A

A crystalloid

50
Q

LR and normal saline are what type of solution?

A

LR and normal saline are crystalloids

51
Q

A solution that contains large molecular weight substances with less membrane permeability to allow for increased intravascular osmotic pressure, is what type of a solution?

A

A colloid (albumin)

52
Q

Each unit of pRBCs increased hematocrit by what percentage and increases hemaglobin by what percentage?

A

3% increase of hematocrit per 1 unit pRBCs

1% increase of hemaglobin per 1 unit of pRBCs

53
Q

1 unit of platelets will increase the platelet count by…

A

1 unit of platelets will increase the platelet count by 5,000 -10,000 /mm3

54
Q

This may be used for reversal of warfarin and will replace deficient coagulation factors

A

Fresh frozen plasma, contains all coagulation factors and can be used to reverse warfarin

55
Q

Cryoprecipitate is an enriched solution containing

A

fibrinogen, vWF, Factor XII and factor VIII-C

56
Q

What is the maximum score of the Aldrete discharge criteria?

A 
10
Respiration - normal depth and rate 
Oxygen saturation - >92%
Consciousness - A&Ox3
Circulation - BP +/- 20mm HG of anesthetic level
Activity - FC x 4
57
Q

What 5 clinical assessments does the Aldrete discharge criteria take into account?

A 
Respiration - normal depth and rate 
Oxygen saturation - >92%
Consciousness - A&Ox3
Circulation - BP +/- 20mm HG of anesthetic level
Activity - FC x 4
58
Q

If the Aldrete discharge score is <8, can the patient be discharged

A

No - Each assessment is worth 2 points with the below criteria
Respiration - normal depth and rate
Oxygen saturation - >92%
Consciousness - A&Ox3
Circulation - BP +/- 20mm HG of anesthetic level
Activity - FC x 4

59
Q

Scopalamine acts on what receptor?

A

Muscarinic receptors

60
Q

What is the equation for determining the size of the ETT in pediatric populations?

A

(Age/4) + 4

61
Q

What is the maintenance fluid requirement equation for the pediatric population?

A

4-2-1 rule
4ml/kg/hour per kg up to 10kg

2ml/kg/hour for each additional kg up to 20kg

1ml/kg/hour for each additional kg above 20kh

62
Q

Estimated blood volume of a child greater than one year old

A

70ml/kg - estimated blood volume of a child greater than one year old

63
Q

Estimated blood volume of an infant 3months to one year old

A

70-80ml/kg is estimated blood volume of an infant 3 months to 1 year old

64
Q

Estimated blood volume of a term neonate

A

80-90 ml/kg is estimated blood volume of a term neonate

65
Q

Pediatric dosing of albuterol

A

Nebulized albuterol 2.5mg in 3ml every 20 minutes

66
Q

Pediatric dosing of dexamethasone for ponv

A

Pediatric dosing for dexamethasone for ponv 0.1mg/kg IV

67
Q

Pediatric dosing for diphenhydramine

A

Pediatric dosing for diphenhydramine is 0.5-1mg/kg IV q4-6 hours max 50mg dose

68
Q

Pediatric dosing for epinephrine given for arrest

A

10mcg/kg IV

69
Q

Pediatric dosing of fentanyl for analgesia

A

Pediatric dosing for fentanyl for analgesia is 0.5-1.0 mcg/kg IV or 1-2 mcg/kg intranasal

70
Q

Pediatric dosing for an antisialogogue effect when utilizing glycopyrrolate

A

Pediatric dosing for an antisialogogue effect when utilizing glycopyrrolate is 0.05-0.2mg IV/IM

71
Q

Pediatric induction dosing of IV ketamine

72
Q

Pediatric IM induction dosing of ketamine

73
Q

Pediatric dosing of IV ketorolac

A

0.5-1mg/kg IV/IM

74
Q

Pediatric dosing of labetalol

A

0.1 mg/kg IV increments q5-10 minutes per BP

75
Q

Pediatric dosing of ondansetron

A

0.15mg/kg with max dose of 4mg

76
Q

Pediatric dosing for propofol induction

77
Q

Pediatric dosing of remifentanil

A

IV bolus 0.5-1 mcg/kg IV

78
Q

Pediatric dosing of rocuronium

A

0.6-1.2 mg/kg IV paralysis

20-40 minutes until reversible (80% hepatic)

79
Q

Pediatric dosing of verses

A

PO: 0.25-0.5 mg/kg max 20mg
Intranasal: 0.2-0.3 mg/kg
IM: 0.25mg/kg
IV: 0.05-0.1mg/kg with max of 0.25 mg/kg

80
Q

Reversal agent for benzodiazepines and dosages

A

Flumazenil 0.2mg q1min with max dose of 1mg

81
Q

Reversal agent of opioids

A

Narcan 0.4mg q2-3 minutes to max dosage of 10mg

82
Q

Patient is bradycardic and hypertensive. You only want to decrease blood pressure. Which medication should be given?

a. Esmolol
b. Labetolol
c. Hydralazine

A

C. Hydralazine

83
Q

Treatment for hypotension and tachycardia?

A

Phenylephrine - alpha agonist with reflex bradycardia

84
Q

Treatment for hypotension with normal heart rate?

A

Ephedrine (alpha and beta agonist)

85
Q

Treatment for hypotension and bradycardia?

A

Atropine 0.5mg

86
Q

Modified Aldrete Score categories

A

Respiration, Oxygen saturation, consciousness, Circulation, Activity with maximum of 10. Patient should not be discharged if score is less than 8

87
Q

Which of the following are targets for antiemetic therapy?

a. Serotonin antagonism
b. Histamine
c. Dopamine
d. Muscarinic
e. Corticosteroids

A

All of these are targets for antiemetic therapy

a. Serotonin antagonism
b. Histamine
c. Dopamine
d. Muscarinic
e. Corticosteroids

88
Q 
Pulmonary capillary wedge pressure indirectly estimates what?
right atrial pressure
left atrial pressure
right ventricular pressure
left ventricular pressure
A

Right atrial pressure

89
Q

Which antiemetic is okay in a patient with parkinson’s disease?

  • Zofran
  • Metocopramide
  • Droperidol
  • compazine
A
  • Zofran

the other’s are anti-dopaminergics

90
Q

What lab marker is present for someone who is a carrier of hepatitis B?

  • HbsAg
  • anti-HbC
  • HBeAG
91
Q

A patient has a cocaine positive uranalysis. How long should you wait before operating?

a. 2 hours
b. 4 hours
c. 6 hours
d. 8 hours

92
Q

Which is an absolute contraindication in MAO-I use?

a. epinephrine
b. norepinephrine
c. Levonordephrine
d. Ephedrine

A

D. Ephedrine

93
Q

What is one major effect of propofol?

a. Bronchoconstriction
b. Bronchodilation

A

B. Bronchodilation

94
Q

SVT refractory to vagal maneuvers is treated with which medication?

a. adenosine
b. propofol
c. ativan
d. amiodarone

A

A. Adenosine

95
Q

What lab value must you check for pre-operatively in ESRD patients?

a. Hyperkalemia
b. Hypercalcemia
c. Hyperphophatemia

A

A. Hyperkalemia

96
Q

What is the safest paralytic agent to use in myotonic muscular dystrophy?
A. succ
b. Rocuronium
c. Pancuronium

A

B Roc - short acting depolarizing agents (Vec, Roc, Cis)

97
Q

What is the alpha-2/alpha-1 ratio of precedex?

a. 800:1
b. 400:1
c. 1600:1
d: 2000:1

98
Q

Which inhalation anesthetic should not be used in a patient with renal disease?
A. Iso
B. Sevo
C. Des

A

B. Sevo

Use iso, which is also preferred for chronic liver disease patients

99
Q

What level is the larynx at in children?

a. C2-C3
b. C3-C4
c. C4-C5

OMFS (14 decks)

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