Anesthesia MONITORING DEVICES | Part I Flashcards
The main value of monitoring central venous and right-heart pressures lies in their ability to approximate or trend in conjunction with the ___
A. left ventricular end-diastolic pressure (LVEDP)
B. pulmonary circulation
C. cardiac output
A. left ventricular end-diastolic pressure (LVEDP)
The CVP is equivalent to right atrial pressure and serve as reflection of:
A. right ventricular preload
B. right atrial pressure
C. left ventricular preload
A. right ventricular preload
The CVP is essentially equivalent to right atrial pressure and serves as a reflection of right ventricular preload
Which wave of the CVP is absent in a patient with Atrial Fibrillation?
A. a wave
B. x descent
C. y descent
A. a wave
Based of POCUS, a full stomach is presence of solid contents or a gastric fluid volume of:
A. >1.5mL/kg
B. > 1mL/kg
C. >2.5 mL/kg
A. >1.5mL/kg
In most studies, the presence of solid contents, or gastric fluid volume >1.5 mL/kg, is defined as “full stomach.”
When performing POCUS of the lung, at least how many areas must be scanned for an optimum assessment?
A. at least 3 areas of the lung
B. at least 2 areas of the lung
C. one area from the apex and one area from the base is acceptable
A. at least 3 areas of the lung
Lung ultrasound can be performed with linear, phased array or curvilinear probes, depending on the patient’s body habitus.
At least three areas must be examined in each patient: anteriorly below the clavicle, anterolaterally in fourth to fifth intercostal space, and posterolaterally in the
seventh to ninth intercostal space.
Which of the following is considered an ABSOLUTE contraindication of TEE?
A. Previous radiation therapy to the neck or mediastinum
B. History of upper GI hemorrhage
C. Esophageal varices
D. Active gastric ulceration
E. Gastroesophageal strictures
E. Gastroesophageal strictures
What is the normal PVR:
A. 100–300 dyne-cm-sec−5
B. 50–150 dyne-cm-sec-5
C. 300 - 450 dyne-cm-sec-5
A. 100–300 dyne-cm-sec−5
What is the normal FRC?
A. 2.4L
B. 1.5L
C. 2L
A. 2.4L
Which is the most sensitive test to diagnose an air embolism?
A. TEE
B. TTE
C. CVP
A. TEE
TEE is most sensitive
‘cannon waves’ seen on CVP waves is most likely due to which pathology?
A. Mitral stenosis
B. Tricuspic stenosis
C. Aortic stenosis
B. Tricuspic stenosis
Which of ECG lead provides the highest sensitivity for monitoring of ischemia?
A. Lead II
B. V5
C. Lead I
D. V2
B. V5
Usually, lead II is monitored for inferior wall ischemia and
arrhythmias, and V5 is monitored for anterior wall ischemia. When only one lead can be monitored, a modified V5 lead provides the greatest sensitivity.
Which of the following is INACCURATE when peripheral nerve stimulator is used for NMB monitoring?
A. The electrode placement should be oriented with the negative electrode more PROXIMAL and the positive electrode more DISTAL.
B. It usually deliver a square wave current of 10 to 80 mA for 100 to 300 microseconds (greater than 300 microseconds may exceed the nerve refractory period).
C. Quantitative monitoring is the only way to objectively measure train-of four ratio.
D. TOF should not be repeated more frequently than every 15 seconds to avoid potentiation or muscle contraction
exaggeration.
A. The electrode placement should be oriented with the negative electrode more PROXIMAL and the positive electrode more DISTAL - **False statement **
Electrode placement should be oriented with the negative electrode more distal (usually black) and the positive electrode more proximal (sometimes red, “red toward the head”).
Rule of thumb:
NEGATIVE - more DISTAL
**POSITIVE - more PROXIMAL **
Which of the following is most effective in decontaminating an anesthesia machine that was splattered with HIV-contaminated blood?
(A) Bleach
(B) Deionized water
(C) Ethylene oxide
(D) Hydrogen peroxide
(E) Isopropyl alcohol
(A) Bleach
Each of the following factors may lead to erroneous readings using pulse oximetry EXCEPT:
(A) electrocautery
(B) high cardiac output states
(C) infrared lights near the sensor
(D) intravenous dyes
(E) severe hemodilution
(B) high cardiac output states
TRUE or FALSE
Desflurane is an inhalational anesthetic agent that has a high vapor pressure and must be stored in a heated, pressurized vaporizer.
TRUE
TEC 6 is HEATED and PRESSURIZED
Which of the following is accurately paired when employing nerve stimulators?
A. Ulnar nerve: Abductor polliccis
B. Facial nerve: Corrugator supercilli
C. Ophthalmic branch of Trigeminal: Corrugator supercilli
D. Radial nerve: Adductor polliccis
B. Facial nerve: Corrugator supercilli
Rule of thumb:
ADDUCTOR is ULNAR
CORRUGATOR is FACIAL
According to BARASH, Residual paralysis is currently defined as a train-of-four ratio less than:
A. 0.7
B. 0.9
C. 0.4
B. 0.9
Regression of drug during NMB reversal will chronologically follow this pattern:
A. T1 return first followed by T2, T3, lastly T4
B. T4 return first followed by T3, T2, lastly T1
C. T4 return first then T1, T2, lastly T3
- As the effects of a nondepolarizing neuromuscular blocking drug deepen, the number of muscle responses will decline, T4 will be lost first, then T3, then T2 and finally T1.
- Regression of drug effect (i.e., during recovery) will follow the same pattern in reverse, where T1 will return first
followed by T2, then T3, and finally T4.
Rule of thumb:
Blocking = T4 > T3 > T2> T1
Regression = T1> T2> T3 > T4
In terms of variability, which of the following is MOST SENSITIVE to muscle blockade?
A. Diaphragm
B. Corrugator supercilii
C. Adductor pollicis
D. Orbicularis oris
C. Adductor pollicis
Variability in muscle blockade (most resistant TO most sensitive):
vocal cords > diaphragm > corrugator supercilii > abdominal muscles > adductor pollicis > pharyngeal muscles
- most sensitive = pharyngeal muscles
- most resistant = vocal cord
To assess return of function of pharyngeal muscles (i.e. readiness for extubation): monitor adductor pollicis*
Which of the following conditions can potentially INCREASE the spO2 reading in pulse oximetry?
A. Hypotension – decrease
B. Anemia – decrease
C. Polycythemia – No effect
D. Carboxyhemoglobinemia
D. Carboxyhemoglobinemia
What is the MOST plausible explanation for the given capnograph above?
A. presence of a leak in a sidestream sample line
B. cardiogenic oscillations at the end of exhalation
C. rebreathing of CO2
D. faulty inspiratory valve
B. cardiogenic oscillations at the end of exhalation
- Which labeled point is the best reflection of alveolar CO2 partial pressure?
A. A
B. B
C. C
D. D
E. E
POINT D
RATIONALE:
Point D is the end-tidal CO2 (E CO2), which best reflects PaCO2.
A-B is phase I of expiration and reflects anatomic dead space.
B-C is phase II of expiration and reflects a mixture of both dead space and alveolar gas.
C-D is phase III of expiration (alveolar gas plateau) and reflects alveolar gas.
D-E is due to inspiration.
Which of the following ECG placement is INACCURATELY paired?
A. V3: Midway between V2 and V4
B. V4: 5th ICS-MCL
C. V5: 5th ICS-MAL – 5th ICS-AAL is the correct anatomical placement
D. V6: 5th ICS-MAL
C. V5: 5th ICS-MAL – 5th ICS-AAL is the correct anatomical placement
READ
- The normal PR interval of a 70 kg ASA I adult is:
A. 0.12 – 0.20 secs
B. 0.10 – 0. 20 secs
C. 0.12 – 0.25 secs
D. 0.10 – 0.20 secs
A. 0.12 – 0.20 secs
The normal QT interval is:
A. <0.38 secs
B. <0.35 secs
C. <0.25 secs
D. <0.20 secs
A. <0.38 secs
The standard definition of a fully recovered neuromuscular blockade in terms of TOF count and/or TOF ratio is?
A. TOF count of 4 or TOF ratio of 0.9 or higher
B. TOF count of 4 or TOF ratio of 0.7 or higher
C. TOF count of 3 or TOF ratio of 0.9 or higher
D. TOF count of 3 or TOF ratio of 0.7 or higher
The most important level of block is “recovered,” where the train-of-four count is 4 and the train-of-four ratio is ≥0.9.
After intubating a 20 y.old ASA I patient, you noticed that the value of your TOF count is 0 and PTC(post-tetanic count) >1. Qualitatively, this is considered as:
A. Deep blockade
B. Complete blockade
C. Moderate blockade
D. Shallow blockade
A. Deep blockade
PTC 0 Complete blockade
PTC >1 Deep blockade
Moderate depth of blockade corresponds to a TOF count of 1-3. What is the estimated receptor occupancy when moderate blockade is achieved?
A. 50 - 60%
B. 70 - 90%
C. 40 - 60%
B. 70 - 90%
Differentiate PHASE I versus PHASE II block?
Dr. Asum is planning to extubate his patient after an uneventful MRM however the only reversal agent available is ENDROPHONIUM. The quantitative monitoring revealed a TOF ratio of 0.5. What is the recommended dose he is allowed to give as a reversal agent?
A. 0.5mg/kg
B. 1mg/kg
C. 1.5mg/kg
A. 0.5mg/kg
Dr. Rataban is planning to extubate his patient after an uneventful thyroidectomy under GETA - TIVA using Propofol. She considering a reversal agent before extubation. The nerve stimulator revealed a TOF count of 4 WITHOUT fade. According to BARASH, what is the recommended dose of drug for her patient’s depth of blockade?
A. 30 mcg/kg of Neostigmine
B. 40 mcg/kg of Neostigmine
C. 10 mcg/kg of Neostigmine
D. 4 mg/kg of Sugammadex
A. 30 mcg/kg of Neostigmine
REMEMBER:
This is a TIVA case and the depth of blockade at this point is ‘MINIMAL’ which means, a lower dose of neostigmine is needed to achieve an acceptable recovery without pulmonary complications.
With FADE = 40 - 50 mcg/kg
Without FADE = 15 - 30 mcg/kg
