Anesthesia Princ + Monitor/conditions/intracranial too Flashcards

1
Q
  1. Which of the following is true?
    a. Awakening of dogs is from excretion
    b. The body is divided into only 2 groups, the vessel rich group and the vessel poor group.
    c. Anesthetic drug delivery and distribution is dependent on cardiac output
    d. CRIs work via loading dose, and an inhalant does not work this way
A

C correct

A (false redistribution)
B (false- a muscle group intermediate exists)
D false- inhalants are basically a CRI, and CRIs add approximately 5 half lives via maintenance dose)

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2
Q

True or false: As the carrier gas flow increase above 5 L/min or below 0.1 L/min the concentration of vapor may be different from the dial

A

True

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3
Q

KNOW THESE: Color. Pressure (PSI). Volume (L).

a. Oxygen:
b. Medical Air:
c. Nitrous Oxide:
d. Carbon Dioxide:
e. Nitrogen:

A

Color. (PSI). Volume (L).

a. Oxygen: Green 1900 660
b. Medical Air: Yellow 2200 6900
c. Nitrous Oxide: Blue 745 1590
d. Carbon Dioxide: Gray 838 1590
e. Nitrogen: Black 2200 6400

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4
Q

True/False 100% oxygen is NOT flammable but with other mixtures becomes more flammable

A

true

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5
Q

Why is morphine chosen for epidurals?

A

Relatively low lipophilicity- stays in epidural space

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6
Q
  1. Which opiate causes excitement in cats given IV:
A

morphine (inconsistent)

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7
Q
  1. Hypoxia on room air with apnea (TIME A): versus with 100% oxygen (TIME B)
A

A 30 sec

B 5 min

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8
Q

Which is false?
A Hydromorphone has a potency for the μ receptor eight times greater than morphine
B Oxymorphone has a potency 10 times greater than that of morphine
C Meperidine has a potency two times less than that of morphine.
D Fentanyl has a potency approximately 100 times that of morphine.
E Buprenorphine is 40 times more potent than morphine at the μ-receptor

A

C (10x less)

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9
Q

Which of the following statements is FALSE regarding Dissociative agents
• Low-dose CRI of ketamine can be used to decrease dorsal horn wind-up and decrease hyperalgesia and allodynia
• The duration of Telazol is shorter than a typical dose of ketamine and a benzodiazepine
• In cats about 50% of the administered dose of ketamine is excreted unchanged in the urine, the rest is metabolized to norketamine.
• Ketamine may increase salivation, but laryngeal reflexes are typically maintained

A

B (45-60 min versus 15-20 min)

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10
Q

Which of the following is NOT a similarity between Propofol and barbituates (thiopental)
• Both if extravasation occurs will cause significant necrosis
• Both result in rapid and smooth transition to anesthesia
• Both may result in hypotension
• Etomidate also exerts effects at GABA receptor

A

A: (only thiopental, give lidocaine and saline)

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11
Q

Which statement is incorrect?
• MAC is the concentration required to prevent purposeful movement in response to a standard, painful stimulus in 50% of normal patients
• MAC-BAR is the concentration of inhalant that prevents a cardiovascular response (blockade of adrenergic response)
• Hypothermia increases MAC by 5% for each degree in C in people.
• Less soluble agents have faster induction, recovery and change in depth

A

C (false-decreases)

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12
Q

Fill in the blank: Used SQ Lidocaine’s onset of action is ___ and lasts for ____ and bupivicaines onset of action is ____ and lasts for ___.

A
5
45-60 
and 
45 min
6-8hrs
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13
Q

What drugs are not indicated to address cardiovascular abnormalities during adrenalectomies?
• o A) Lidocaine to control ventricular arrhythmias
• o B) Diltiazem to control tachycardia
• o C) Esmolol to control tachycardia
• o D) Medetomidine to decrease central sympathetic outflow

A

D Medetomidine

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14
Q
What type of drug class is phenoxybenzamine?
•	o   A) Alpha adrenergic antagonist
•	o   B) Beta blocker
•	o   C) Alpha 2 agonist
•	o   D) Calcium channel blocker
A

A

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15
Q

What is FALSE regarding drugs in patients with respiratory compromise?
• o A) Ketamine results in bronchodilation
• o B) Beta blockers cause bronchoconstriction
• o C) Acepromazine causes minimal respiratory depression
• o D) Butorphanol causes worsened respiratory depression compared to hydromorphone

A

D

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16
Q
A nasal oxygen rate of 100ml/kg/min delivers what percentage of inspired oxygen?
•	o   A) 30%
•	o   B) 40%
•	o   C) 50%
•	o   D) 60%
A

B 40%

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17
Q

Which is true concerning laparoscopy?
• The maximum allowable intraabdominal pressure (IAP) is 16 cm H2O.
• Prolonged pressures above 25 cm H2O are associated with acute heart failure.
• Hypoventilation may be exacerbated by absorption of CO2 from the peritoneal cavity into the bloodstream.
• Hypoventilation can be helped by the Trendelenburg positioning.

A

C

A (14)
B (renal failure, anuria)

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18
Q

Which is true?
• The colloid oncotic pressure of 25% human albumin is 200 mm Hg
• The colloid oncotic pressure of 16% canine albumin is 200 mm Hg
• The colloid oncotic pressure of 25% human albumin is 98 mm Hg.
• The colloid oncotic pressure of plasma is 98 mm Hg

A

A is true

Canine alb is 98

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19
Q
The only anesthetic drug that has been shown to adversely affect neonate survival is which of the following?
•	Propofol
•	Morphine
•	Ketamine
•	Xylazine
A

D xylazine

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20
Q
Which of the following medications should be avoided for ophthalmologic procedures?
•	Ketamine
•	Midazolam
•	Propofol
•	Alfaxalone
o	A and B
o	A and D
o	B and C
o	A and C
A

A and C (both cause increase in intraocular pressure)
ketamine
propofol

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21
Q

Which of the following is the correct pairing in regards to heat loss?
• Evaporative loss accounts for approximately 10%
• Convective loss is minimal
• Radiation loss accounts for about 30%
• Conductive loss accounts for approximately 10%

A

D conductive = 10%

Evap = (minimal)
convenc = (30%)
radiation (50%)

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22
Q

Which of the following statements is false?
• Hypoxemia from V/Q mismatch can be treated with a bronchodilator
• High levels of CO2 result in narcosis and eventual circulatory collapse
• Malignant hyperthermia should be treated with Calcium
• Higher ETCO2 values during CPR >15 mm Hg in dogs and > 20 mm Hg in cats may be associated with increased ROSC

A

C (dantrolene)

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23
Q

True or false: Tracheal tears occur in cats most commonly when there is a rotating movement of the tube.

A

True

As well as overinflation of the ET cuff

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24
Q

False regarding atracurim…

a. Depolarizing
b. Hoffman elimination
c. Paralysis m. respiration
d. Can be reversed neostigmine

A

A ? IT’s non-depolarizing) – smoother process
Match cis-atracurium with glycopyrolate
Succinylcholine is depolarizing

25
Q
  1. Which is not a side effect of benzodiazepines?
    a. Muscle relaxation,
    b. Narcosis
    c. Amnesia
    d. Respiratory depression
A

d respiratory depression

26
Q

What are 5 causes hypoxemia?

A
  1. V/q mismatch * most common
  2. Decrease FiO2
  3. Hypoventilation
  4. Anatomic shunts (arteriovenous, R–>L PDA)
  5. DIffusion impairment (e.g. ARDS)
27
Q

Cerebral blood flow=

a. Cerebral vascular resistance/CPP
b. CPP/ cerebral vascular resistance
c. CPP/MAP
d. MAP-(ICP or CVP)

A

b. CPP/ cerebral vascular resistance

MAP-(ICP or CVP) = CPP

28
Q
Humans w/ severe head injuries have a higher mortality rate when CPP is  
•	a.    80mmHg
•	b.    70mmHg
•	c.    60mmHg
•	d.    50mmHg
A

c. 60mmHg – Correct

29
Q

True/false
a. A decrease in PaCO2 will cause vasoconstriction of cerebral blood vessels and will cause a rapid decrease in cerebral blood flow and decrease in intracranial pressure

A

True

30
Q
What drug increases cerebral blood flow?
•	a.       Ketamine
•	b.       Benzodiazepines
•	c.       Etomidate
•	d.       Thiopental
A

A ketamine

31
Q

What is true regarding propofol?

a. It increased cerebral blood flow
b. It reduces intracranial pressure
c. It does not preserve autoregulation of the brain
d. It does not preserve vascular reactivity of the brain

A

B dec. ICP

32
Q

What is true about Etomidate?

a. It increased cerebral metabolic rate
b. It increased cerebral blood flow
c. It increases intracranial pressure
d. It has been shown to increased ischemic neuronal injury

A

d. It has been shown to increased ischemic neuronal injury

33
Q

What is the difference between 0.5 MAC and 1.0 MAC in regards to cerebral perfusion?

a. At 0.5 there is suppression of cerebral metabolic rate
b. At 0.5 MAC vasodilation and therefore minimal blood flow changes are noted
c. At doses 1.0 MAC and greater, the vasodilatory effects predominate and cerebral blood flow increases.
d. All of the above are true

A

All of them true

34
Q

Which of the following is FALSE regarding anesthetic maintenance of neurologic patients?
• Inhalant concentration should be <1 MAC
• Patients undergoing MRI alone should have the same protocol as those going through surgery
• Neuromuscular blockers should be considered for craniotomies
• Dexmedetomidine of 1-2ug/kg/hr for invasive and 0.5ug-1ug/kg/hr for non-invasive procedures

A

B (false, lighter plane and reduced analgesics)

35
Q

Which of the following is false regarding anesthetic monitoring of the neurologic patient?
• Direct/arterial blood pressure is ideal for monitoring
• Capnography for EtCO2 can be used to assess for changes to cerebral blood flow and intracranial pressure
• Mild hypoventilation is ideal with a target EtCO2 of 38-40 mmHg
• Increases in esophageal temperature can correlate with increments in CMRO2 (cerebral metabolic rate for oxygen)

A

C (false, mild hyperventilation, ETCO2 of 28-32mmHg)

36
Q

Which of the following is true regarding recovery from anesthesia in the neurologic patient
• Recovery should be delayed to ensure safety
• Shivering can increase oxygen requirement by up to 200%
• Hypothermia can lead to slowed metabolism and recovery, with hyperthermia increasing CMRO2
• Opioids should be used for the potent analgesic effects

A

C

(false, should be rapid with minimal discomfort to assess neuro status)
(false, up to 400%)
(False, d/t secondary sedation, nausea, and hypoventilation)

37
Q

Which of the following is false regarding treatment of increased intracranial pressure and brain protection?
• Mannitol is a treatment of increased ICP in humans, it expands intravascular volume, decreases hematocrit and blood viscosity thereby improving cerebral blood flow and oxygenation
• Hypothermia decreases oxygen requirements to support cerebral cellular integrity, with true hypothermia there is a high incidence of bacteremia
• Barbiturates are a mainstay of treatment to decrease cerebral metabolic rate with minimal to no negative effects
• Lidocaine should be considered as it is a Na+ channel blocker, thereby having neuroprotection due to blocking the first step in the ischemic cascade

A

C (false, controversial studies for barbituates and there are negative effects including cardiovascular depression and immunosuppression)

Mannitol: osmotic effects delayed and last 1-6 hrs, hypertonic saline less permeable through intact BBB but better brain protection

38
Q

What is the Monro-kellie doctrine

A

cranium is noncompliant: brain + blood + CSF

39
Q

What percentage total body oxygen requirement for cerebral metabolic rate?

A

20%

generating ATP and maintaining cellular integrity

40
Q

What are the recommended targets for monitoring a neurosx patient? ICP? CPP? MAP? ETCO2?

A

normal ICP 5-12
target CPP ≥70mm Hg
MAP 80 mmHg recommended
ETCO2 28-32

41
Q

What vessel is a sphincter vessel?

Capacitance vessel?

A

arteriole = 80% pressure drop occurs here
venules
Venous system = Major blood reservoir 60-70% of blood volume during resting conditions

42
Q

Which is true?
A General anesthesia occurs when a critical dose of a drug reaches the brain and spinal cord, causing decrease output
B Drugs that are lipid soluble take less time to achieve a steady-state concentration
C Diazepam is able to be diluted in bags of saline
D For GA action organs are divided into two groups: vessel-rich and vessel-poor

A

A true
Drugs that are lipid soluble take MORE time to achieve a steady-state
Diazepam is (only one that can’t) be in plastic
vessel-rich and vessel-poor (also muscle)

43
Q

T/F Awakening from anesthesia is caused by metabolism/excretion of drug

A

false REDISTRIBUTION

44
Q
which is NOT a classification of vaporizer?
A. Regulation of output
B. Method of vaporization 
C. Location in the anesthetic circuit
D. Temperature compensation 
E. Carrier specific
A

E its AGENT specific

45
Q

True?
A. Nonrebreathing systems prevent rebreathing of CO2 by using constant fresh gas flow rates.
B. The recommended fresh gas flow rate for a non-rebreathing system is at least equal to the patient’s respiratory minute volume.
C. MV = resp rate x tidal volume. Estimated tidal volume = 25 mL/kg
D. Patients weighing less than 5 kg are best anesthetized using a nonrebreathing system rather than a rebreathing system.

A

A Nonrebreathing systems –> (high flow rates)
B The recommended fresh gas flow rate for a non-rebreathing system is at least equal to the patient’s respiratory minute volume. (3x resp MV)
C MV = resp rate x tidal volume. (15 mL/kg)
D true

46
Q

True?

a. Most endotracheal tubes have a Martins eye near the tip, which allows for continued airflow should the tip of the tube become obstructed.
b. In a patient breathing room air, hypoxemia will develop within 30 seconds of apnea or airway obstruction, whereas a patient previously breathing 100% oxygen may not become hypoxemic for upward of 5 minutes after onset of apnea
c. Use of 100% oxygen may result in relatively more alveolar collapse than 40% oxygen because the carbon dioxide contained in air/oxygen mixtures is not readily absorbed from the alveoli.
d. Helium may be combined in a 60:40 ratio with oxygen to protect against fires caused by laser ignition of anesthetic carrier gas, although this requires a specially calibrated additional flowmeter

A

a murphy’s eye

b. true
c. Use of 100% oxygen may result in relatively more alveolar collapse than 40% oxygen because . (nitrogen - stabilizes alveoli but gets displaced by O2)
d. Helium may be combined in a (70:30)

47
Q

True or false? The oxygen flush valve should not be used with a rebreathing system because of the risk of significant barotrauma

A

False
The oxygen flush valve should not be used with a NONrebreathing system because of the risk of significant barotrauma
Shouldn’t be used with a rebreathing system b/c it will decreased the concentration of inhalant anesthetic

48
Q

true?
A Nitrous oxide has the lowest PSI tank with a volume of 1590 L when full
B Medical air has a PSI of 838 and comes in a gray cylinder
C Activated charcoal absorbents are a form of active scavenging
D Descending bellows are superior and they descend during expiration

A

A true NO: (745) with a volume of 1590 L
B Medical air has a PSI of 2200 = yellow in NA and white/black international, volume = 6550
CO2 comes in a gray cylinder PSI 838, volume 1590
C Activated charcoal absorbents are a form of PASSIVE scavenging
D Descending bellows are INFERIOR and they descend during expiration

49
Q

T/F? Pressure- cycled ventilators are better for patients who may have changing pulmonary compliance or very small patients

A

TRue
(e.g. severe respiratory disease with prolonged periods of time)
Reasonable starting peak inspiratory pressure is 12 mm Hg

50
Q

True?
A. Medium-deep depth is ideal for most procedures with ventromedial eye position, slightly low Heart rate/blood pressure, and an even respiratory rate
B. Stage II is divided into planes of anesthesia
C. Stage I is all awake states of awareness, from obtundation to loss of consciousness
D. Profound hypoexemia is more important than hemoglobin concentration in dictating oxygen content of arterial blood

A

A. Medium-deep depth is OK but more than necessary for most procedures with ventromedial eye position, slightly low Heart rate/blood pressure, and a SLOW respiratory rate
B. Stage III is divided into planes
C. true
D. Profound hypoexemia (sigmoidal) LESS dramatic effect than hemoglobin concentration (linear)

51
Q

Which of the following is true?

a. The width of the blood pressure cuff should be 40-60% the diameter of the appendage
b. In cats the doppler tends to underestimate the systolic arterial pressure by up to 25mmHg
c. In oscillometric BP measurement, oscillations with the largest amplitude are interpreted as the systolic arterial pressure
d. Oscillometric BP measurement in cats is most precise in determining the systolic and mean arterial pressure

A

A. 40-60% the (circumference)

b. true
c. In oscillometric BP measurement, oscillations with the largest amplitude are interpreted as MAP
d. Oscillometric BP measurement in cats is most precise in determining the MEAN + diastolic

52
Q

Which of the following is FALSE?

a. Hypercarbia does not cause significant adverse consequences in the anesthetized patient until it is consistently greater than 65mmHg
b. Alveolar CO2 closely approximates arterial CO2
c. When using a rebreathing circuit, the CO2 can read artificially low due to dilution with incoming fresh gas
d. A patient breathing 100% oxygen should have a PaO2 of 500mmHg and hemoglobin concentration of 100%

A

c. When using a NON-rebreathing circuit, the CO2 can read artificially low due to dilution with incoming fresh gas

53
Q

List some reasons why the pulse oximeter may be inaccurate (9)

A
Vasoconstriction
Low cardiac output
Hypothermia
Pain
Alpha-agonists (dexmed)
Movement
Pigment
Anemia
Hypoxemia
54
Q

T/F: Anemia, which causes a significant decrease in oxygen content of arterial blood but will not affect the pulse oximetry reading until its <25%

A

→ False, it has to be below 10%

55
Q

Find the false?

a. Opioids act at any of three receptors—μ, κ, and δ—located throughout the central nervous system and peripheral tissues
b. All opioid receptors are G protein–coupled receptors that have endogenous ligands, including endorphins, enkephalins, and dynorphins.
c. μ-agonist opioids are Schedule II, buprenorphine is Schedule III, and tramadol and butorphanol are Schedule IV
d. Analgesia supplied by opioids can reduce the inhalant anesthesia requirement by 65-85% depending on the drug used

A

false: D

Analgesia supplied by opioids can reduce the inhalant anesthesia requirement by → 40-60%

56
Q
Times as potent as morphine...?
Hydromorphone
Methadone
Oxymorphone
Buprenorphine
Meperidine
Fentanyl
A
Hydromorphone - 8x
Methadone - 2x
Oxymorphone - 10x
Buprenorphine - 40x
Meperidine - 10x less
Fentanyl - 100x
57
Q
Which of the following opioid(s) can cause histamine release?
Fentanyl
Buprenorphine 
Morphine
Oxymorphone 
Hydromorphone
A

Morphine : particularly if given rapidly intravenously, which can result in hypotension and tachycardia.

Meperidine :

58
Q

Which alpha-2 agonist has an α2:α1-receptor selectivity of 1600 : 1?

A

dexmedetomidine

xylazine is α2:α1-receptor selectivity of 160 : 1

59
Q

how does trazodone work?

A

serotonin antagonist and reuptake inhibitor