Anesthesia: Tips, Techniques and Drugs Flashcards by B -

What should the blood pressure be regulated to while under anesthesia

+/- 20% of baseline

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What drugs are commonly used to induce anesthesia

Remifentanyl
Lidocaine
Propofol (Etomidate is more cardiac stable)

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Zemeron

Rocuronium

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What is rocuronium

A short acting muscle relaxant

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when is succinylcholine indicated

during difficult intubations

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When is succinylcholine contraindicated

with crush injuries

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What helps sevoflurane to be better tolerated.

Start the patient on sevoflurane and then switch them desflurane

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

0.5 - 0.6

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When is neostigmine indicated

A nondepolarizing neuromuscular blockade reversal.

Add 0.2 Robinul per 1mg of neostigmine

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What is the lead placement for anesthesia monitoring

Patients Right
- Snow over Grass (White over Green)

Patients Left
- Smoke over fire (Black over brown)

Midline
- Brown

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What is a key thing to remember when using rocuronium

Ventilate the patient first for about a minute

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What is the train of four (TOF)

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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Toradol

Ketorolac (NSAID)

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

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

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After intubation be sure to check for 3 things

Breath sounds (R - L - R)
Look for condensation of the tube
Check for high End Tidal CO2

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

Atropine

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

glycopyrolate

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Zemeron

Rocuronium

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Robinul

Glycopyrolate

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Describe the ocular cardiac reflex

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

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

Women: 7.0
Men: 8.0

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What options should you consider when a PTs blood pressure drops

Decrease Remifentanyl
Decrease Desflurane
Giving phenylephrine

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Trandate

Labetalol

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What is a bis-monitor

Bispectral index

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

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

1. Zantac 2. Dexadron (do not use with DM pt's) 3. Zofran

zantac

Ranitidine

Zofran

ondansetron

Dexadron

dexamethasone

Pepcid

Famotidine

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

Max tidal volume: 750 | Max tidal pressure: 35

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

may rupture a bleb

What is the mechanism of Ketamine

NMDA receptor antagonist | Provides a dissociative amnesia

What are the cardiovascular effects associated with ketamine

Increase in HR and BP

Neosynephrine

Phenylephrine

What is the mechanism of phenylephrine

a1 adrenergic receptro agonist | - Should not increase HR

When is phenylephrine indicated in anesthesia

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

What is the preoperative dosage of ancef

80 kg - 2 gm

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

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

What can happen during a laproscopic inflation of the abdomen

Can cause a cardiac reflex leading to asystole

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

Malignant hyperthermia

What is TIVA

Total IV anesthesia

When should you use TIVA

Use with patients that have a h/o malignant hyperthermia

What is soda lime used for

to remove CO2 from the lines

What is in the SODA cannister

Calcium hydroxide Water Sodium hydroxide Potassium hydroxide

What is the inspiratory to expiratory time ratio

1: 2 for normal patients | 1. 25 for patients with COPD

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

Increase desflurane and remifentanyl while increasing the O2 flow. Higher O2 flow decrease the onset time of the Desflurane

When is toradol contraindicated

Patients with a creatinine clearance greater than 1.2 Less than 1.2 you can use 30mg toradol

What is the mechanism of glycopyrrolate

anticholinergic

What are the indications for glycopyrrolate

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

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

Low Tidal Volume and Increased peak pressure Especially when abdominal pressure is increased.

What is MAC

Monitored Anesthesia Care

what is typically used for MAC

Propofol and Ketamine

What are the NPO Guidelines for a typically healthy patient

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

What are the ways to control the epidural

1. Choice of Agent 2. Spinal catheter 3. Add epinephrine

Why is morphine not frequently used

it has a delayed respiratory suppression

What should be considered when conducting a parotidectomy

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

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

Parotidectomy Thyroidectomy Total masectomy

What are some causes for bradycardia or asystole

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

What should you always suspect in children that are brady

hypoxia until proven otherwise

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

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

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

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

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

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

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

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

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

MAX

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

after 3 failed shock attempts 1. Use a 300 bolus for VFIB 2. Use 150 bolus for pulseless V Tach

What are the H's and T's for ACLS

H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypoglycemia, Hypothermia. T's: Toxins, Tamponade(cardiac),Tension pneumothorax, Thrombosis (coronary and pulmonary), and Trauma.

What should you do to correct hyperkalemia

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)