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Anesthesia based on Nebuchanedzzer II > Basic - General Anesthesia > Flashcards

Basic - General Anesthesia Flashcards

1
Q

Read the 11 non-reassuring findings from ASA as predictors of difficult airway

A
  1. Long incisors
  2. Prominent overbite
  3. Cannot bring mandibular incisors anterior to maxillary incisors
  4. < 3cm inter-incisor distance
  5. Uvula not visible when tongue protruded
  6. High arched or narrow palate
  7. Mandibular space stiff or occupied by mass
  8. < 3 ordinary finger breadth TM distance
  9. Short neck length
  10. Thick neck
  11. Decreased extension or flexion of neck

*Decaying teeth is NOT a predictor

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2
Q

The liver receives ___% of total cardiac output

A

30%

  • 3/4 by portal vein
  • 1/4 by hepatic artery
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3
Q

_____ cells and specialized pathways detoxify substances, rendering them into harmless compounds. This process is the primary reason why ______ metabolism is effective.

A

Kupffer cells

First-pass

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4
Q

Liver synthesizes all of the procoagulants EXCEPT ____

A

Factors III, IV, and VIII

*overlaps with vit K dependent proteins 1972, giving vit K will differentiate if it is a deficiency in Vit K or hepatic procoagulants

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5
Q

Factor VIII is produced in ____

A

endothelial cells and bone marrow

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6
Q

Vit K dependent proteins are ______

A

Factors II, VII, IX, X

1972

*giving vit K will differentiate if pts with prolonged PT has a deficiency in Vit K or hepatic procoagulants

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7
Q

(ALT/AST) is the main cytoplasmic liver enzyme

A

ALT

*AST can be found in other body tissues

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8
Q

What can low albumin indicate?

A
  1. Chronic liver injury
  2. Renal loss
  3. Inc albumin catabolism
  4. Expansion plasma volume
  5. Maldistribution
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9
Q

Laryngospasm is a reflex response that involves the ADDuction of the ______, with motor innervation by the recurrent laryngeal n.

A

true and false vocal cords.

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10
Q

Individual risk factors of post op cognitive dysfunction

A
  1. Adv age
  2. Lower education level
  3. H.o Previous CVA with NO residual impairment

*Independent of type of surgery. ie. NOT cardiac sx

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11
Q

Anyone with a MI without intervention should wait ____ days before elective sx

A

60 days

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12
Q

Emergent vs Urgent surgery

A

Emergent: Life or limb is threatened if not in OR w/in 6 hours

Urgent surgery: Life or limb if not w/in 24 hrs

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13
Q

After an MI, Pts should wait ___ days after balloon angioplasty before elective surgery

A

14 days

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14
Q

2 antidotes for extravasation

A
  1. Hyaluronidase
    - pediatric, TPN
  2. Phentolamine
    - alpha blocker -> vasodilates
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15
Q

How to administer phentolamine if phenylephrine extravasated?

A

Dilute 5 mg of phentolamine to 0.5mg/mL, then inject 1 mL increments into area surrounding extravasation site

Elevate limb

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16
Q

After fentanyl, which med is the most commonly abused opioid amongst anesthesiologist?

A

Sufentanil > Meperidine > Morphine > oral drugs

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17
Q

Inhaled anesthetic induction techniques are (improved/worsened) by benzos and (improved/worsened) by opioid

A

improved

worsened

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18
Q

Stage II excitation is (increased/decreased) with masked induction with sevoflurane

A

decreased

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19
Q

ASA 4 vs 5?

A

4: severe systemic disease, constant threat to life
- Recent < 3 mo TIA or MI
- ESRD NOT on regular dialysis

5: Moribund pt not expected to survive w/o operation
- Massive trauma
- ICH w/ mass effect

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20
Q

Severe aortic stenosis:
Valve area:
Transvalvular pressure gradient:

A

Valve area: < 0.8 cm^2

Transvalvular pressure gradient: > 50 mmHg

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21
Q

Where do you want to keep HR in pts with AR?

A

> 80bpm to decrease diastolic time and decrease time for regurgitation

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22
Q

Factor VII has a the shortest half life of the vit K dep factors, it has a half life of __, and can serve as an early measure of hepatic dysfunction by measuring ____

A

6 hours

PT/INR

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23
Q

Platelets are produced in the _____, and can be sequestered in the ____ secondary to portal hypertension

A

bone marrow

spleen

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24
Q

Factor VIII is produced by _______ (4). It is generally bound to vWF in blood.

A
  1. Vascular endothelium
  2. Renal tubular and glomerular cells
  3. Megakaryocytes
  4. Hepatic sinusoidal cells
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25
Q

Hemophilia A is d/t a defect in ____

A

genes for factor VIII

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26
Q

Neostigmine ____ mg/kg can be administered to reverse succinylcholine when a phase II block is present.

A
  1. 03 mg/kg
    * neostigmine during a phase I block is ineffective, since postjunctional membrane remains in state of sustained depolarization, that is completely unresponsive to ACh.
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27
Q

Prolonged neuromuscular blockade can occur in pts with abnormal _____. std intubating dose produces depolarizing phase I block ~ 10 min.
But impaired metabolism of succinylcholine can lead to _____.

A

plasma cholinesterase

Prolonged phase I block that can progress to nondepolarizing phase II block (several hours)

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28
Q

Progression from a phase I to a phase II block means the postjunctional membrane has ______, though it is desensitized

A

Become repolarized

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29
Q

During a phase II block, neostigmine can reverse succinylcholine how?

A

it inhibits acetylcholinesterase ->
higher ACh [ ] in the NMJ

*but it also inhibits plasma cholinesterase which is responsible for succinylcholine metabolism, so dose needs to be low

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30
Q

After an MI, pts should wait __ days after a balloon angioplasty, ___ days after a bare metal stent, ___ days if no coronary intervention, and ___ days after a drug eluting stent for elective noncardiac sx

A

14
30
60
180

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31
Q

The oxygen affinity for hemoglobin is (higher/lower) in children/infants than adults. making their P50 (higher/lower)

A

Lower oxygen affinity for hgb

Higher P50

*P50 is the partial pressure of O2 when oxygen sat (SaO2) is 50%

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32
Q

The oxygen affinity for hemoglobin is (higher/lower) in newborns than adults. making their P50 (higher/lower)

A

very much higher

very much lower P50

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33
Q

When the oxyhemoglobin dissociation curve shifts to the Left, the P50 will (increase/decrease)

A

decrease

  • P50 is the partial pressure of O2 when oxygen sat (SaO2) is 50%
  • neonates have very low P50 d/t hemoglobin F
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34
Q

neonates have very low P50 d/t _____

A

hemoglobin F

- useful for oxygen transfer from maternal blood to the fetus

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35
Q

P50 is the lowest in ____, and highest in _____

A

newborns

children > 12 mo old

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36
Q

P50 increases, when the oxyhemoglobin dissociation curve shifts to the right.
What causes a RIGHT shift?

A

(Right) RIse in:
2,3 DPG
H+
Temp

and acidosis

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37
Q

P50 decreases, when the oxyhemoglobin dissociation curve shifts to the left.
What causes a LEFT shift?

A

(Left) Lowered:
Temp
CO2
2,3 DPG

and Alkalosis

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38
Q

LMAs are associated with which nerve palsy?

A
  1. Lingual nerve
    - tongue numbness, no taste
  2. Recurrent laryngeal
    - vocal cord palsy
  3. Hypoglossal
    - tongue edema, diff with phonation

*Higher risk with N2O use

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39
Q

Type of surgery with the highest risk of exacerbating liver disease

A

Cardiothoracic surgery

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40
Q

____ accurately predicts perioperative mortality in pts with cirrhosis

A

MELD scoring system

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41
Q

_____ is the most common postop peripheral neuropathy.

______ can be used to evaluate for motor and sensory deficits

A

ulnar nerve injury

Nerve conduction studies

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42
Q

Electromyograms tell you what?

A

Exact location of injury in the setting of motor deficits

Timing of injury

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43
Q

DOUBLING the distance from radiation sources, decrease exposure by what factor?

A

4
(exposure is 1/4 of the original)

Intensity = Source / Radius ^2

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44
Q

Recommended occupational exposure to radiation / year

A

< 5000 mrem /yr

Each CXR is 10 mrem
CT scan is 5000 mrem

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45
Q

______ flow is reduced when there is systemic hypotension or cardiac output is decreased.

_____ flow is autoregulated and can compensate if the above drops.

A

Portal venous blood flow

Hepatic arterial blood flow

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46
Q

Neck circumference > __cm predicts increased incidence of OSA and difficulty with mask ventilation

A

60 cm

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47
Q

How to calculate BMI?

A

weight kg / height in meters ^2

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48
Q

Methgb (Fe3+ feric, icky) is unable to bind new O2, and the oxygen dissociation curve is shifted to the _____

A

left.

  • PREVENTS release of O2 into tissues
  • HIGHER affinity to O2
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49
Q

Ischemic optic neuropathy presentation

A

painless sudden vision loss following long spine surgeries in prone position

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50
Q

Respiratory effects of laparoscopic surgery

  • lung compliance
  • V/Q
  • Inspiratory pressures
  • Partial pressure CO2
  • blood pH
A
  1. Decreased lung compliance
  2. Increased V/Q mismatch
  3. Increased inspiratory pressures
  4. Increased partial pressure of CO2
  5. Decreased blood pH
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51
Q

Pneumothorax presentation in GA

A
  1. Desaturation
  2. Increased Airway pressure
  3. Decreased breath sounds
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52
Q

Lethal dose of CO2 for obstructive embolism?

A

5x that of air bc of diffusibility of CO2

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53
Q

Subcutaneous emphysema presentation in GA

A
  1. Swelling or crepitus
  2. no change in pulse ox
  3. no change in airway pressure
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54
Q

Pneumoperitoneum is typically created in laparoscopic surgeries. What do you expect happens to ETCO2?

A

CO2 will be absorbed and equilibrate with CO2 in blood

- After 15-30 min it plateaus

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55
Q

In laparoscopic surgeries, If pts have a sudden increase in ETCO2 after the 15-30 min plateau period, what conditions do you suspect?

A
  1. Subcutaneous emphysema
  2. Early pneumothorax
  3. MH
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56
Q

Accidental endobronchial intubation would SLOW the relative rate of induction of which volatile anesthetic?

A

Desflurane > sevo > iso
- one lung ventilation creates a R-> L pulmonary shunt, which has greatest effect on less soluble inhalational anesthetics

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57
Q

One lung ventilation creates a R-> L pulmonary shunt, which has greatest effect on (more/less) soluble inhalational anesthetics

A

Less

- ie: desflurane, an insoluble agent

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58
Q

The faster the alveolar fraction (FA) of inhaled agent approaches the fraction of inspired (FI) agent, the (faster/slower) the agent will reach equilibrium.
Why?

A

faster

- the anesthetic partial pressures of the alveolus, blood, and CNS become equal

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59
Q

Insoluble agents like desflurane and nitrous oxide have (higher / lower) blood: gas partition coefficient

A

low
- partial pressure quickly builds in the alveoli

*The faster the alveolar fraction (FA) of inhaled agent approaches the fraction of inspired (FI) agent, the (faster) the agent will reach equilibrium.

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60
Q

More soluble agents like halothane and isoflurane will diffuse across the alveoli and into alveolar capillary bed more readily, thereby INCREASING the time needed to reach this equilibrium.
- What equilibrium is this referring to?

A
  • the anesthetic partial pressures of the alveolus, blood, and CNS become equal
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61
Q

More soluble agents like halothane and isoflurane have (higher / lower) blood: gas partition coefficient

A

higher

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62
Q

What should you use to treat PONV if dexamethasone and zofran does not work?

A

Droperidol 0,625 mg IV

- dopamine 2 receptor antagonist

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63
Q

Vomiting center is stimulated by which areas?

A
  1. Chemotactic trigger zone in medulla
  2. GI tract
  3. Pharynx
  4. VIsual centers
  5. Mediastinum
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64
Q

Unique LMA 4 and 5 will fit up to what size ETT?

What about Aura-i Size 4 and 5?

A

Unique 6.0, 7.0

Aura-i 7.5, 8.0

65
Q

Top 3 Anesthetic factors leading to death and permanent brain damage in order

A
  1. Cardiovascular events (PE, Stroke, MI, arrythmia)
  2. Respiratory events
  3. Equipment issues (failure, misuse)
66
Q

When should aspirin be held for surgery?

A
  1. Intracranial neurosurgical procedure
  2. Intramedullary spine
  3. Posterior eye
  4. Middle ear
  5. Prostate

*disastrous neurologic/neurovascular complications

67
Q

Major type of heat loss in OR

Second most?

A
  1. Radiation
    - loss to environment
  2. Convection
    - air in OR is exchanged q15 min
68
Q

Which phase 1 or 2 is associated with DECREASE contraction in response to a single twitch stimulus?

A 
both
Phase I: TOF > 70%
(all 4 twitches feel equal but diminished)
Phase II: resembles NDMB
(twitches fades)
69
Q

Common monitoring sites for NMB

A

Facial nerve (CN VII)

  • Corrugator supercilii
  • Orbicularis occuli

Adductor pollicis

Flexor hallucis brevis

70
Q

Dibucaine number 20 indicates ______

Dibucaine number 40-70 indicates ______

A

Pseudocholinesterase deficiency

20: homozygous atypical

40-70: heterozygous

71
Q

What causes a phase 2 block? how to reverse it?

A

Repeated doses of succinylcholine

Unpredictable reversibility

72
Q

What happens to PAO2 under hypothermic conditions?

A

Increase

- water vapor pressure decreases, allowing more parts per breath to consist of oxygen

73
Q

By comparing PAO2 and PaO2 (A-a gradient), a determination of oxygenation can be made.
Normal A-a gradient is ___

74
Q

Most common complication with brachial artery catheterization?

A

Thrombosis

75
Q

Brachial artery can cause which nerve damage?

A

Median nerve
*medial to brachial artery.

*rare

76
Q

The axillary sheath contains which nerve?

A

Median
Ulnar
Radial

*musculocutaneous is OUTSIDE the sheath

77
Q

How does use of nitrous oxide in a pt with a SBO risk small intestine ischemia?

A

Expansion of the mucosal area of the bowel ->

decrease blood supply

78
Q

Nitrous oxide can worsen Venous air embolism, but the risk is not increased in which type of surgery?

A

intestinal surgery

79
Q

Nicotinic receptors are ____ channels that are typically found at the _____.

Muscarinic receptors are _____ receptors and are mostly found in the ______

A

ligand-gated, NMJ of skeletal muscle

G-protein coupled, peripheral visceral organs

80
Q

Antimuscarinic drugs used in anesthesia:

A

atropine
glycopyrrolate
scopolamine

81
Q

Aldrete score

  • top score
  • criteria
A

Out of 10, needs at least a 9 to bypass

Activity
Breathing
Circulation
Consciousness
Oxygen saturation
82
Q

Pts with allergies to cosmetics are at risk for reactions to _____

A

Rocuronium, vecuronium, and pancuronium

Share similar quaternary ammonion ion

83
Q

Pts with allergies to which fruits may have allergy to latex?

A 
Banana
Avocado
Kiwi
Pineapple
Mango
*and spina bifida
84
Q

Any pathology that causes hyperthermia is generally associated with an (increase/decrease) in ETCO2

85
Q

Drastic drop in ETCO2 in OR can be d/t what processes?

A
  1. Impaired elimination CO2
  2. Decreased production
  3. Circuit/sampling disconnect
86
Q

Acute processes that can cause Impaired elimination CO2

A
  1. Cardiovascular collapse: significantly reduced Cardiac index
  2. Massive VAE: increased End tidal nitrogen
  3. Large PE: S1-Q3
  4. Dislodged/Kinked ET: low and rapidly falling SpO2
87
Q

Acute processes that can cause decreased production of CO2

A
  1. Hypothermia
  2. Hypothyroidism
  3. Neuromuscular blockade
88
Q

The most common cause of sudden increase in physiologic dead space (impaired or absent perfusion of alveoli enhancing V:Q mismatch) is _________

A

a sudden drop in cardiac output

89
Q

(True/False) Cholinesterase inhibitors (anticholinesterases) increases resistance to both depolarizing and nondepolarizing blockade

A

False
- they inc the amount of ACh available and therefore makes nondepolarizing muscle blockade more difficult/resistant

  • They partially inhibit pseudocholinesterase and therefore potentiates depolarizing blockade
90
Q

Burn injuries (>24 hours) results in increase RESISTANCE to which type of muscle relaxant?

A

Nondepolarizing

- d/t inc in extrajunctional ACh receptors

91
Q

Acute and chronic phenytoin and carbamazepine affect on muscle relaxants

A

Acute:

  • augments NMBs
  • Maybe due to acute reduction of stimulus-induced ACh release from prejunctional neuron

Chronic:

  • resistance to nondepolarizing blockade
  • decreases sensitivity at receptor sites
  • prolongs succinylcholine
  • increase end plate anticholinesterase activity
92
Q

Damage to the _______ can impair Thermoregulation and temperature homeostasis

A

preoptic anterior nuclei in the hypothalamus

93
Q

Damage to the _______ nuclei can impair production and secretion of oxytocin and vasopressin

A

Paraventricular and supraoptic nuclei

*if vasopressin is impaired -> hypotension and diuresis

94
Q

The Broca area is supplied by the _____, if this is compromised, pt can have expressive aphasia (understand language, but unable to speak fluently)

A

Middle cerebral artery

95
Q

Blood to the cerebellum is provided by the ______, which branches from the _____ arteries.

A
  1. Superior cerebellar a.
  2. Anterior inferior cerebellar a (AICA)
  3. Posterior inferior cerebellar a (PICA)

_______
Vertebral and basilar arteries

96
Q

Intraop awareness or recall risk factors

A
  1. Cocaine or BDZ use
  2. Prior intraop awareness
  3. Diff intubation (planned/unplanned)
  4. Chronic pain pt
  5. ASA IV or V
97
Q

Twitch characteristics of Phase I block with sux?

A
  1. Single twitch height is decreased
  2. No TOF fade
  3. TOF ratio > 0.7
  4. Continuous (tetanic) electrical stim usually results in SUSTAINED muscle contraction
98
Q

Twitch characteristics of Phase II block with sux?

A
  1. Single twitch height is decreased
  2. Yes TOF fade
  3. TOF ratio > 0.3
  4. Continuous (tetanic) electrical stim usually results in UNsustained muscle contraction
99
Q

How does neostigmine affect a phase I block (std induction of sux)?

A

Augments it

  • Increases the ED95
  • inhibits plasma cholinesterase (resp for sux degradation)
100
Q

How does neostigmine affect a phase II block of sux?

A

Antagonizes it

*but unpredictable

101
Q

Std intubating doses of succinylcholine may create a phase II block in pts with _____.

A

Pseudocholinesterase deficiency

- dramatic inc in duration (hours) of “succinylcholine apnea”

102
Q 
FIO2 correlation:
RA: 
2L/min:
4L/min:
6L/min:
A

RA: 21% O2
2L/min: 29%
4L/min: 37%
6L/min: 45%

*NC <6L does not go above 50%

103
Q

Why is Lactated ringer avoided in pts with severe liver failure?

A

lactate is metabolized by liver to bicarb

104
Q

Why does the ASRA guideline recommend that pts receiving heparin for > 5 days should have a PLATELET count checked prior to epidural placement?

A

Risk of HIT

*note: should still hold prophylactic heparin 4-6 hours prior to epidural placement

105
Q

Diff btwn ASA 2 and 3?

A

systemic illness without vs with functional limitation

106
Q

SIMV is often used to transition pts from controlled to spontaneous breathing. How?

A

Attempts to sync the mandatory breaths with a pts spont inspiratory effort

  • disadvantage is inc work of breathing during non-mandatory breaths
  • SIMV can be used with or without PS
107
Q

Theoretically, why is hydroxyethyl starches (HES) useful?

A

Volume expansion

- significantly longer intravascular half-lives > crystalloid

108
Q

What type of fluids are Categorized based on substitution ratio
- Higher the number, the greater the substitution

A

Hetastarches: 0.7 substitution ratio
Tetrastarches: 0.4 substitution ratio

*Max daily doses of hetastarches are generally LESS than tetra

109
Q

(True/false) Hetastarches are associated with reduction in Factor VIII and vWF

A

True

- by 50-80%

110
Q

What is better for laminar flow (and preventing turbulent flow)?

  • flow
  • radius
  • viscosity
A
  1. Slow deep breathing with low flow rates
  2. Lower radius
  3. Increased viscosity (syrup vs water)
111
Q

Most common reliable sign of cyanide toxicity

A

Anion gap metabolic acidosis
- impairs aerobic respiration

*note that PaO2 and SvO2 will be increased, it just cant be utilized

112
Q

Specificity eq.

Sensitivity eq

A

Spec: TN / (TN + FP)
*SPIN - rules in

Sens: TP / (TP + FN)

113
Q

Which antineoplastic agent is at risk for cardiomyopathy?

Interstitial pneumonitis?

A

Doxorubicin

Bleomycin

114
Q

Why is low tidal volume of 6 mL/kg beneficial in preventing renal injury?

A

Decreases cytokine release

*high PPV can hurt kidneys

115
Q

The rate of induction of which inhaled anesthetic is MOST affected by changes in cardiac output?

A

Isoflurane

116
Q

Low cardiac output states readily allow uptake of which type of volatile anesthetics?

  • How does this affect gas diffusion into the blood?
  • How does this affect FA:FI?
  • How does this affect induction?
A

All of them, but mostly Blood-soluble agents

  • ie. Isoflurane
  • Slow diffusion of gas into blood (more delivery to brain)
  • Speeding rise of FA:FI ratio
  • Faster induction
117
Q

High cardiac output states

  • How does this affect gas diffusion into the blood?
  • How does this affect FA:FI?
  • How does this affect induction?
A
  • Less delivery of gas to the brain, slows rate of induction
  • Fast diffusion of gas into blood (less delivery to brain)
  • Slowing rise of FA:FI ratio
  • Slower induction
118
Q

A R-to-L intracardiac shunt (speeds/slows) the rate of INHALATIONAL anesthetics

A

slows

- anesthetic is shunted and not involved in gas exchange w/in alveoli

119
Q

A R-to-L intracardiac shunt (speeds/slows) the rate of INTRAVENOUS anesthetics

A

Speeds

- portion of the drug bypasses lungs and enters directly into L side of heart and quickly delivered to brain

120
Q

Equation for SVR (in dynes)

A

[80 * (MAP - RAP)] / CO

*80 is the conversion factor from woods unit to dynes

121
Q

Equation for PVR (in dynes)

A

[80 * (MAP - PAOP)] / CO

122
Q

Components of a Child-Pugh Score for liver transplant

A 
PT
Albumin
Bilirubin
Ascites
Encephalopathy

*Pour Another Beer At Eleven”

123
Q

Components of a MELD score for liver transplant

A 
INR
Creatinine
Sodium
Bilirubin
Dialysis

I Crush Several Beers Daily

124
Q

How much sodium is in 5% albumin? 25%?

A

145 mEq/L for both

125
Q

Most common cause of litigation during MAC?

A
  1. respiratory depression from over sedation
  2. Equipment failure/malfunction
  3. CV events
126
Q

What is the benefit of using an airway exchange catheter instead of elastic bougie?

A

Ability to use oxygen jet ventilation

- both are small enough to allow air passage around them

127
Q

How frequently does negative pressure pulmonary edema occur in anesthesia?

128
Q

How soon does negative pressure pulmonary edema result following obstruction?

A

Immediately -2 hours

129
Q

What happens to preload and afterload in negative pressure pulmonary edema?

A

LV afterload is increased

Negative intrathoracic pressure causes an increase in preload

*Both contributes to increased pulmonary hydrostatic pressures

130
Q 
Antidopaminergic drugs (droperidol, metoclopramide, prochlorperazine) can cause extrapyramidal symptoms (EPS)/acute dystonic reactions - 
How to treat?
A

Anticholinergic medication

  • balance out the cholinergic-dopaminergic balance
  • benztropine or diphenhydramine
131
Q

What is ASA 5?

A

Moribund pt who is not expected to survive w/o operation

132
Q

What ASA are these pts:

  • Symptomatic CHF
  • MI/CVA w/in last 6 mo
  • Unstable angina
  • Hepatorenal disease
A

ASA 4

- severe systemic disease that is a constant threat to life

133
Q

When is heliox (70% helium, 30% oxygen) useful?

A

When airway radius is decreased with resultant turbulent gas flow

134
Q

When is turbulent flow more likely?

  • velocity
  • diameter
  • density
  • viscosity
A

Greater velocity, in larger diameter tubes with a dense gas with low viscosity

135
Q

Inhaled agents with a HIGH FA/FI value are associated with (high/low) solubility.

136
Q

Inhaled agents with a LOW FA/FI value are associated with (high/low) solubility.

137
Q

Higher blood:gas partition coefficients (or blood solubilities) correspond with (greater/lower) degrees of volatile agent uptake, and SLOWER onset of action

138
Q

Blood:Gas partition coefficient of:
Isoflurane
Sevoflurane
Desflurane

A

Isoflurane: 1.5
Sevoflurane: 0.65
Desflurane: 0.42

*Des has the LOWEST

139
Q

In the lithotomy position, what nerves pass beneath and through the inguinal ligament that could be injured?

A
  1. Lateral femoral cutaneous
  2. Femoral
  3. Obturator

Beneath:

  1. Branches of sciatic nerve
    - Tibial n
    - Common peroneal n
    - —Sural n.
    - —Superficial peroneal n.
140
Q

How does cimetidine and famotidine (H2 blocker) and metoclopramide affect:

  • Gastric pH
  • Gastric volume
A

cimetidine / famotidine
- Gastric pH: increase
- Gastric volume: decrease
(does NOT speed clearance)

metoclopramide

  • Gastric pH: no effect
  • Gastric volume: decrease
141
Q

Which gas augments NMB the most?

A

Desflurane

  • directly (relaxes skeletal muscle)
  • indirectly (synergistic)
142
Q

Large quantities of albumin is lost through burned skin.

- What anesthetic drugs need to be REDUCED with hypoalbuminemia?

A
  1. Benzos

- hypoalbuminemia increases free fraction of drugs (since it normally binds them)

143
Q

Large quantities of albumin is lost through burned skin.

- What anesthetic drugs need to be INCREASED with hypoalbuminemia?

A
  1. LA
  2. BBs
  3. Opioids (rapid development of tolerance)
144
Q

How do burns > 30 % TBSA affect NONdepolarizing NMBs?

A

Resistance starting 1 week following burn - peaking 6 weeks.

- d/t increase in number of ACh receptors, inc renal excretion, protein binding

145
Q

High flow tends to be (more/less) turbulent

146
Q

Low density means (more/less) turbulent flow

147
Q

Helium has an extremely LOW density and thus has an increased tendency for _____

A

laminar flow

* not turbulent flow

148
Q

Efferent limb of the laryngospasm reflex

A

Recurrent laryngeal nerve

149
Q

What does using a vasoconstrictor do during nasal fiberoptic intubation?

A

increases diameter of the nasal passage and reduce bleeding

- it does NOT eliminate trauma

150
Q

Why does use of succinylcholine increase the risk of pacemaker failure?

A

Fasciculations -> high frequency electrical signals interpreted as cardiac activity

151
Q

Risk of electromagnetic interference causing inappropriate shock from AICD is significantly decreased when ______ electrocautery is used

A

bipolar
- electrical energy is delivered between the two electrodes at the tip of the instrument

*monopolar delivers electricity to the tissues, and the path is connected to the grounding pad

152
Q

Is obesity or BMI a risk factor for difficult intubation?

A

No

- Inc neck circumference is

153
Q

Which CO2 absorbents are most at risk for Compound A and fire production during Sevoflurane administration?

A

Barium hydroxide

- carbon dioxide absorbent

154
Q

Which CO2 absorbents are LEAST at risk for Compound A and fire production during Sevoflurane administration?

A

Soda lime

- Calcium hydroxide absorbent

155
Q

_____ is the pH indicator used in CO2 absorbents (colorless when fresh), becomes purple when pH falls < 10, indicating absorbent exhaustion

A

Ethyl Violet

156
Q

Non human milk (soy, formula) requires ___ hours of NPO time

157
Q

Breast milk requires ___ hours of NPO time

158
Q

Is ketamine contraindicated in pts with known ischemic heart disease?

A

Yes

- increase myocardial oxygen demand (HR, BP, CO)

159
Q

Which nerve fibers are associated with pain, temp, touch?

A

Type A delta

  • large myelinated
  • Epicritic pain (sharp, immediate, well localized)

Type C dorsal root

  • small unmyelinated
  • protopathic pain (dull, achy, not well localized)

Anesthesia based on Nebuchanedzzer II (38 decks)

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