Anesthesia & Disease Flashcards
What pre med can be used with cardiac dz?
opioids (unless conduction abnormality present/pacemaker), benzodiazepine (minimal CV effect), low dose acepromazine
In what pt with cardiac DZ would dexmeditomidine be used?
HCM; Generally avoid premed causing large change in HR or stroke volume
What acid- base disturbance is commonly seen with vomiting?
hypochloremic metabolic alkalosis
Your pt becomes hypercalcemic under anesthesia; what fluid therapy should be administered?
0.9% Saline
What premeds should you not use with hepatic DZ?
Acepromazine (decreases hepatic blood flow & not reversible) & benzodiazepine (heavy liver biotransformation)
What anesthetic should be used with Hepatic DZ?
o DO use propofol (undergoes extra-hepatic metabolism) & modern inhalants minimally metabolized by the liver (iso better than sevo)
What should you be mindful of with intracranial DZ?
can herniate brainstem; important to maintain cerebral perfusion but NOT increase blood flow too much
What is Cushing’s triad?
observe hypertension with reflex bradycardia & irregular breathing
What are signs of increased ICP?
Cushing’s Triad
TX for increased ICP?
Hyperosmolar agents (unless BBB compromised)- Mannitol/Hypertonic Saline
What adverse event can occur during hyperventilation?
ETCO2 low range this can cause cerebral vasoconstriction & ischemia
What adverse event can occur during hypoventilation?
increase PaCO2, which increases cerebral blood flow & can cause brainstem herniation
Why should inhalant anesthetics be kept low with neurologic disease?
Can cause cerebral vasodilation at dose >1.0 MAC (keep low+ PIVA OR avoid with TIVA)
What is an ideal premed for neurologic patients?
Gaba agonist~ propofol, benzo~because decreases cerebral metabolic rate
What is oculo-cardiac reflux?
vagal reflex occurs with pressure on eyeballs- which can result in sinus arrest.
TX: anti-cholinergic
