Anesthesia MONITORING DEVICES | Part II Flashcards
During general anesthesia using a standard circle system, which of the following capnography traces would MOST likely indicate that the carbon dioxide absorbent has been exhausted?
A
Which of the following conditions would result to an abnormally ELEVATED capnograph?
A. Sepsis
B. Hypotension
C. Hypothermia
D. Acidosis
A. Sepsis
INCREASED/ELEVATED capnograph:
Increased EtCo2 may be associated with the following:
Malignant hyperthermia
Septic shock
Shivering
Hypoventilation
Obstructive pulmonary disease such as COPD or asthma
Exhaustion of the CO2 absorbent (in addition to elevation of the phase 1 baseline)
Which TCI model is ideal for a 3 year old if GA TIVA will be utilized?
A. Kataria
B. Schnider
C. Marsh
D. Minto
A. Kataria
The Kataria model can be used in children aged 3–16 years and weighing 15–61 kg, and the Paedfusor in children aged 1– 16 years and weighing 5–61 kg. Teenage children
weighing > 61 kg can be managed using the Marsh adult
model.
1 year old - Paedfusor
3 year old - Kataria
The ideal TCI model for Remifentanil is:
A. Minto
B. Marsh
C. Schneider
D. Kataria
A. Minto
- Propofol = Marsh and Schneider Model
*Dexmedetomidine = Dyck Model
*Ketamine = Domino
- Fentanyl = Bergmann
Which of the following agents have the longest context-sensitive half-time?
A. Fentanyl
B. Propofol
C. Dexmedetomidine
D. Thiopental
A. Fentanyl
Which TCI model is not compatible to a pediatric patient?
A. Schneider
B. Kataria
C. Paedfuser
D. Marsh
A. Schneider
This is because of the V1 compartment that is fixed to 4.7L
Which of the following TCI model is compatible to an Obese patient?
A. Eleveld
B. Minto
C. Marsh
D. Scneider
A. Eleveld
Ideal for obese because it is not based on LBW.
The “Bristol Regimen” uses which maintenance dose if PROPOFOL is utilized?
A. 3mg/kg/hr
B. 6mg/kg/hr
C. 9mg/kg/hr
B. 6mg/kg/hr
Based on the ASA Standards for Basic Anesthetic Monitoring, which of the following statements is MOST likely true:
A. An anesthesiologist may never waive the use of a pulse oximeter during GA
B. Temperature monitoring is required for all anesthetic cases
C. For a patient undergoing moderate sedation, monitoring for exhaled carbon dioxide is recommended
D. During mechanical ventilation, visual alarms alone are adequate to meet the standard
C. For a patient undergoing moderate sedation, monitoring for exhaled carbon dioxide is recommended
- C. For a patient undergoing moderate sedation, monitoring for exhaled carbon dioxide is recommended: Clinical signs, such as chest excursion, can be used to assist with monitoring adequacy of ventilation.
However, in most circumstances, including when moderate or deep sedation is administered, the standards state that monitoring of exhaled carbon dioxide (CO2) should also be used. An exception to the use of CO2 monitoring is permitted when specifics of the patient or procedure do not allow it.
Which of the following is MOST likely the basis for measurement of oxyhemoglobin in the pulse oximeter?
A. Law of Laplace
B. Lambert-Beer Law
C. Haldane Effect
D. Fick principle
B. Lambert-Beer Law
B. Lambert-Beer Law: the intensity of transmitted light is inversely proportional to the concentration of the substance through which the light passes
*INVERSE relationship of light intensity and concentration of substance
It is used to determine the blood flow to an organ and the principle is based on calculation of the oxygen content of blood going to and coming from the organ, coupled with the consumption of oxygen by the organ:
A. Dalton’s law
B. Lambert-Beer Law
C. Haldane Effect
D. Fick principle
D. Fick principle
Fick principle: used to determine the blood flow to an organ. The Fick-based calculation requires knowledge of the oxygen content of blood going to and coming from the organ, coupled with the consumption of oxygen by the organ
Which of the following parameters is MOST likely to be measured by a typical 2 wavelength pulse oximeter?
A. Fractional saturation
B. Functional saturation
C. Arterial Oxygen Saturation
D. Partial Pressure of Oxygen
B. Functional saturation
Functional saturation: A 2-wavelength pulse oximeter utilizes 2 different wavelengths of light (red and near infrared at 660 nm and 940 nm, respectively) to detect oxyhemoglobin (O2Hb) and reduced or deoxyhemoglobin (RHb).
By definition the value reported by a typical 2-wavelength pulse oximeter is termed functional saturation or SpO2. SpO2 = [ O2Hb ÷ (O2Hb + RHb) ] x 100%
A 60yo woman is tachypneic and has marked dyspnea on exertion. Her oxygen saturation is 97% via pulse oximeter (SpO2) on her finger. Is it possible for this patient to be hypoxic?
A. No; since the pulse oximeter reads 97%, she cannot be hypoxic
B. No; because pulse oximeters are just as reliable as measurement of SaO2 in the laboratory
C. Yes; pulse oximeters may differ by as much as 25% when compared to actual measurement of SaO2
D. Yes; the patient may have been exposed to carbon monoxide
E. Yes; her white nail polish may result in an elevated SpO2 reading
D. Yes; the patient may have been exposed to carbon monoxide
- If a patient was exposed to a significant amount of carbon monoxide, the pulse oximeter would not be able to differentiate COHb from HbO2, because each absorbs approximately the same amount of light at 660 nm. Therefore, it is possible to falsely assume there is adequate oxygenation when a patient is exposed to carbon monoxide
Which of the following is MOST likely to cause an erroneously low reading in the 2-wavelength pulse oximeter?
A. Injection of methylene blue dye
B. Injection of indigo carmine
C. Red fingernail polish
D. Cardboxyhemoglobin levels of 40%
A. Injection of methylene blue dye: Blue dyes, such as methylene blue and isosulfan blue dyes, have been shown to significantly decrease the pulse oximeter readings due to increased absorbance at 660 nm.
Which of the following is PRESSURE CONTROL?
A. column A
B. column B
A. column A
- In pressure control, mode with set INSPIRATORY PRESSURE and tidal volume is based on compliance.
- In volume control, mode with set TIDAL VOLUME and mode GUARANTEES a minute ventilation
TRUE OR FALSE
RED FINGERNAIL polish significantly cause erroneous SpO2 readings.
FALSE
RED is good
BLUE, PURPLE, and BLACK is bad!
Red fingernail polish: Red fingernail polish has little effect on pulse oximeter readings. Blue, purple or black fingernail polish causes erroneously low readings of the SpO2
Identify the most plausible cause of this capnograph?
A. Spontaneous respiratory efforts
B. Incompetent expiratory valve
C. Leak in the sampling line
D. Bronchospasm
B. Incompetent expiratory valve: Elevated CO2 during Phase 1
The most common culprits?
- rebreathing of CO2
- incompetent expiratory valve
- exhausted absorbent
Which of the following is MOST likely to cause a falsely elevated end-tidal CO2 as measured by absorption spectrophotometry?
A. Water blocking the capnography sampling line
B. Air entrainment into the capnography sampling line
C. A decrease in ambient pressure
D. High N2O concentration
D. High N2O concentration
High N2O concentration: CO2 exhibits peak absorbance at 4.3 μm, N2O at 4.5 μm, and NO at 4.7 μm. Because they are similar wavelengths, there is some overlap in the absorption spectrums. Thus, N2O and NO can absorb some infrared light in the CO2 spectrum and falsely elevate CO2 levels. Most current monitors compensate to partially decrease the effect of this distortion.
During transport of a patient from the operating room to the surgical intensive care unit, you are no longer able to monitor lead II or V5 on the five-lead ECG. Lead I can only be monitored. What best explains this finding?
A. The ECG cable is not properly seated into the monitor
B. A 12-lead ECG cable is being used instead of a 5-lead ECG cable.
C. The RA lead connection in faulty
D. The LA lead has been placed on the right lower limb
E. The LL lead is making poor contact with the patient.
E. The LL lead is making poor contact with the patient: Lead II is formed by the positive LL electrode and the negative RA electrode.
Disruption of any one of the 3 bipolar limb leads will consequently disrupt Einthoven’s triangle, leaving one lead intact.
In the case disruption of the LL electrode will leave lead I intact as RA and LA potential is intact. it will also affect all the unipolar limb leads (aVL, aVR, aVF), as well as the precordial leads (V1-V6).
The systolic blood pressure in a noninvasive blood pressure measurement corresponds to:
A. Return of blood flow through the artery during cuff inflation
B. Return of blood flow through the vein during cuff inflation
C. Return of blood flow through the artery during cuff deflation
D. Return of blood flow through the vein during cuff deflation
E. The point of maximal cuff pressure fluctuation
C. Return of blood flow through the artery during cuff deflation
