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Med School Rotations > Anesthesia: Tips, Techniques and Drugs > Flashcards

Anesthesia: Tips, Techniques and Drugs Flashcards

1
Q

What should the blood pressure be regulated to while under anesthesia

A

+/- 20% of baseline

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2
Q

What drugs are commonly used to induce anesthesia

A
  1. Remifentanyl
  2. Lidocaine
  3. Propofol (Etomidate is more cardiac stable)
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3
Q

Zemeron

A

Rocuronium

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4
Q

What is rocuronium

A

A short acting muscle relaxant

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5
Q

when is succinylcholine indicated

A

during difficult intubations

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6
Q

When is succinylcholine contraindicated

A

with crush injuries

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7
Q

What helps sevoflurane to be better tolerated.

A

Start the patient on sevoflurane and then switch them desflurane

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8
Q

What is the ballpark End Tidal desflurane needed to wake a patient

A

0.5 - 0.6

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9
Q

When is neostigmine indicated

A

A nondepolarizing neuromuscular blockade reversal.

Add 0.2 Robinul per 1mg of neostigmine

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10
Q

What is the lead placement for anesthesia monitoring

A

Patients Right
- Snow over Grass (White over Green)

Patients Left
- Smoke over fire (Black over brown)

Midline
- Brown

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11
Q

What is a key thing to remember when using rocuronium

A

Ventilate the patient first for about a minute

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12
Q

What is the train of four (TOF)

A

Measures the effectiveness of a Neuromuscular blockade (rocuronium/succinylcholine)

Four consecutive stimuli are delivered along the path of a nerve, and the response of the muscle is measured in order to evaluate stimuli that are blocked versus those that are delivered. Four equal muscle contractions will result if there is no neuromuscular blockade, but, if nondepolarizing blockade is present, there will be a loss of twitch height and number, which will indicate the degree of blockade.

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13
Q

Toradol

A

Ketorolac (NSAID)

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14
Q

While the patient is recovering from anesthesia, what is physical indication of their level of pain

A

Number of respirations. If their respirations are 25 give 0.25mg Dilaudid

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15
Q

After intubation be sure to check for 3 things

A
  1. Breath sounds (R - L - R)
  2. Look for condensation of the tube
  3. Check for high End Tidal CO2
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16
Q

What should be given to the patient of the Heart rate decreases rapidly

A

Atropine

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17
Q

What can be given to the patient if the heart rate is decreasing slowly

A

glycopyrolate

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18
Q

Zemeron

A

Rocuronium

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19
Q

Robinul

A

Glycopyrolate

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20
Q

Describe the ocular cardiac reflex

A

HR will decrease when the eye muscles are pulled. Can lead to asystole

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21
Q

What size tube should you generally start with when intubating a patient

A

Women: 7.0
Men: 8.0

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22
Q

What options should you consider when a PTs blood pressure drops

A

Decrease Remifentanyl
Decrease Desflurane
Giving phenylephrine

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23
Q

Trandate

A

Labetalol

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24
Q

What is a bis-monitor

A

Bispectral index

  • used to monitor the depth of anesthesia
  • Generally speaking, look for 40-60
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25
Q

What additional medications should be given towards the end of an anesthesia case

A
  1. Zantac
  2. Dexadron (do not use with DM pt’s)
  3. Zofran
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26
Q

zantac

A

Ranitidine

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27
Q

Zofran

A

ondansetron

28
Q

Dexadron

A

dexamethasone

29
Q

Pepcid

A

Famotidine

30
Q

When ventilating a patient, generally what is the max Tidal volume and Tidal pressure you want to see

A

Max tidal volume: 750

Max tidal pressure: 35

31
Q

What may happen if you use PEEP on a pt with COPD

A

may rupture a bleb

32
Q

What is the mechanism of Ketamine

A

NMDA receptor antagonist

Provides a dissociative amnesia

33
Q

What are the cardiovascular effects associated with ketamine

A

Increase in HR and BP

34
Q

Neosynephrine

A

Phenylephrine

35
Q

What is the mechanism of phenylephrine

A

a1 adrenergic receptro agonist

- Should not increase HR

36
Q

When is phenylephrine indicated in anesthesia

A

Used to increase the BP when the HR is greater than 70

37
Q

What is the preoperative dosage of ancef

A

< 80 kg - 1gm

>80 kg - 2 gm

38
Q

What is a good technique to intubate a kiddo that does not like needles

A
  1. N20 - 8.0 max
  2. O2 - 4.0
  3. Add sevoflurane at 8.0 for a few minutes and take away the N2O so that you can start the IV
39
Q

What can happen during a laproscopic inflation of the abdomen

A

Can cause a cardiac reflex leading to asystole

40
Q

What should you consider when you see a pt’s End Tidal CO2 rise and body temperature Increase

A

Malignant hyperthermia

41
Q

What is TIVA

A

Total IV anesthesia

42
Q

When should you use TIVA

A

Use with patients that have a h/o malignant hyperthermia

43
Q

What is soda lime used for

A

to remove CO2 from the lines

44
Q

What is in the SODA cannister

A

Calcium hydroxide
Water
Sodium hydroxide
Potassium hydroxide

45
Q

What is the inspiratory to expiratory time ratio

A

1: 2 for normal patients

1. 25 for patients with COPD

46
Q

If a patient starts to wake up during anesthesia, what should you consider doing

A

Increase desflurane and remifentanyl while increasing the O2 flow.

Higher O2 flow decrease the onset time of the Desflurane

47
Q

When is toradol contraindicated

A

Patients with a creatinine clearance greater than 1.2

Less than 1.2 you can use 30mg toradol

48
Q

What is the mechanism of glycopyrrolate

A

anticholinergic

49
Q

What are the indications for glycopyrrolate

A

Preoperative: reduces secretions and blocks intubation/drug-induced cardiac vagal reflexes

Intraoperative use: Blocks procedure/drug induced cardiac vagal reflexes and associated arrhythmias

Nueromuscular blockade reversal: Blocks peripheral muscarinic effects of cholinergic agents

50
Q

When is it a good idea to use pressure control while ventilating

A

Low Tidal Volume and Increased peak pressure

Especially when abdominal pressure is increased.

51
Q

What is MAC

A

Monitored Anesthesia Care

52
Q

what is typically used for MAC

A

Propofol and Ketamine

53
Q

What are the NPO Guidelines for a typically healthy patient

A

2 hours: No clear liquids
4 hours: No breast milk
6 hours: No Infant formula or light meal or non human milk
8 hours: No Solid foods (fatty/fried/meat)

Normal medications can be taken with a minimal amount of water

Chewing gum may increase gastric volumes and is treated as clear fluids

Low pH and particulates make matters worse

54
Q

What are the ways to control the epidural

A
  1. Choice of Agent
  2. Spinal catheter
  3. Add epinephrine
55
Q

Why is morphine not frequently used

A

it has a delayed respiratory suppression

56
Q

What should be considered when conducting a parotidectomy

A

minimize the regional anesthetic and NMB so that the nerve can be stimulated and avoid severing the CN VII through out the procedure

57
Q

What types of surgeries do you not want to use a paralytic

A

Parotidectomy
Thyroidectomy
Total masectomy

58
Q

What are some causes for bradycardia or asystole

A 
Carotid pressure
ICP (cushings triad)
Occular cardiac reflex
Increased abdominal pressure
Vagal response
Hypoxia
Cardiac issues (MI, conduction blocks etc)
59
Q

What should you always suspect in children that are brady

A

hypoxia until proven otherwise

60
Q

What do you do when you notice the patient is Brady during anesthesia

A
  1. Undo what you did to get into the situation
  2. Drugs:
    a. Glycopyrrolate (does not cross BBB)
    b. Atropine (quicker onset)
61
Q

If a patient has had a heart transplant, how does this effect the response to brady during anesthesia

A

The heart will not respond to the parasympathetic (atropine) will need to consider Epi (I think)

62
Q

What are the problems with over breathing for a patient when you are bagging them

A
  1. Left shift of the hemoglobin dissociation curve (hard to off load O2)
  2. Increased intrathoracic pressure ( increase PVR, Decrease Preload, decrease CO)
63
Q

How can you minimize the possibility of over breathing for a patient during CPR

A
  1. Maintain breathing at a rate of 5-6 seconds between breaths
  2. Continuous, rapid and deep chest compression
64
Q

What joules should be used for a patient should you need to defibrilate them

65
Q

When should you try to chemical cardiovert a patient during ACLS for a shockable rhythm

A

after 3 failed shock attempts

  1. Use a 300 bolus for VFIB
  2. Use 150 bolus for pulseless V Tach
66
Q

What are the H’s and T’s for ACLS

A

H’s: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypoglycemia, Hypothermia.

T’s: Toxins, Tamponade(cardiac),Tension pneumothorax, Thrombosis (coronary and pulmonary), and Trauma.

67
Q

What should you do to correct hyperkalemia

A

Use bicarb to drive K+ back into the cells.
Use Calcium chloride to stabilize the cardiac membrane

If using insulin, give 10 units of insulin with an amp of D50 (25 grams in a 50 ml solution - like syrup)

Med School Rotations (26 decks)

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