- increased hydrogen ions - increasing acidity

Basics exam 3 Flashcards by Amanda D

5 general principles for improving pt outcomes and experiences (M&P chart):

1. (on exam) Regional -general anesthesia technique to improve pt care
2
3.
4
5

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Although a benzodiazepine may be given to prevent anesthesia awareness, little

scientific evidence exists that supports such treatment

M&P

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Oculocardiac reflex is :

pressure on the globe

- pressure on the extraocular muscles

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Pre-op patient is anxious. what dose of diazepam do you give?

2-5mg PO

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Type 1 OR fire is located:

in or on the patient

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BIS monitoring assess:

anesthetic depth

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Patient can follow commands but has no memory. what kind of memory is this:

Implicit memory

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Potential risk factors with various types of anesthesia from Chart in M&P.

-Regional anesthesia =

seizures is a risk

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brainstem anesthesia with regional anesthesia is not associated with:

(chart in m&p)

seizures

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What medication has alpha, minimal beta, and phentolamine is used for infiltration

Phenlephrine

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Strabismus surgery associated with higher risks of:

MH
PONV
OCR

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Maintenance rate for 100lb granny:

85ml/hr

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LMA size for 68kg

size 4

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EBV for full term infant with weight of 7.7lbs

85x 3.5kg = 297.5ml

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Cut length for 4 year old =

16cm

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ETT size for a 4 year old =

4.5, 5.0, 5.5

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Decreasing pH means:

increased hydrogen ions

- increasing acidity

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Patient getting a laminectomy with thoracic outlet. How do you position?

Prone with hands down by side

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Laryngospasm mediated by:

SLN of vagus nerve

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OCR afferent and efferent (2 questions on this):

a. afferent trigeminal; efferent vagal

b. afferent is to CNS; efferent is from the CNS

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Epiglottis is most likely caused by what pathogen?

Haemophilus influenzae type B

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If suspected epiglottitis, what are three things you should do:

do NOT attempt to directly visualize the glottis
have surgeon called/in to assist with intubation
do not administer anesthesia until equipment and team are ready

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O2 levels should be what percentage to avoid OR fires?

< 30%

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High CO2, increased inspiratory pressure, decreased O2 may indicate:

ETT dislodgement

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Concentration of O2 that can cause OR fire in less than 1 sec (cotton huck towel):

95%

A patient that would benefit from prolonged post-op monitoring (T&A??):

3 year old female | < 4 y/o

Pt is 55 yr old with CHF, insulin dependent DM, and a TIA 1 yr ago. Would this pt be appropriate for a stand alone surgical center?

How do propofol and remifentanil benefit hypotension intraoperatively? **need to check wording*

Decrease PONV

What device could potential increase IOP?

face mask

Most common cause of post-op eye pain?

Corneal abrasions

Afferent carries stimulus

to CNS

Efferent carries stimulus

from the CNS

OCR can be abated by:

parasympatholytics (atropine or glycopyrrolate)

Normal IOP pressure is:

10-22mmHg

What would improve pt satisfaction (from chart on m&p):

combined regional and general anesthesia

An adult with URI is scheduled for surgery. How long would you delay the surgery?

6 weeks

A child has a URI. How long would you delay surgery?

2 weeks

What medication should be stopped 10 hours before surgery?

Lisinopril (ACE inhibitors)

A patient with a BMI of 42 is supine for surgery. He has hypoxemia, etc. What would you expect to be a contributing factor?

Decreased FRC

What is true regarding stopping metformin prior to surgery:

- Its controversial | - must be d/c'd 48 hours prior to surgery

HgbA1C --- eryhrocytes have a life span of:

120 days

Lidocaine 0.75% is equal to:

7.5mg

What should you do in regards to an ETT fire:

simultaneously stop gases/o2 , remove ETT, and disconnect circuit

Type 1 OR fires consist of (2)

1. in or on the pt | 2. can include drapes and surgical towels

What is true regarding O2 rich atmospheres in the OR (2):

1. decreases temperature at which the fuel will ignite | 2. the fire will burn more vigorously

Giving a benzodiazepine

is recommend but not clinically proven to benefit

Ensuring the prep is dry completely before placing drapes will:

help to decrease risk of OR fire

If a pt has hx of PONV, what anesthetic gas would you consider NOT using:

N20

A patient with a past experience with PONV that usually requires pain meds 3-7 days post op... You may consider:

triple medication therapy on

What will sevoflurane combine with to form an exothermic reaction in the OR? (2)

1. soda lime | 2. baralyme

An source of ignition is:

bovie

A patient drank water. how long will you delay surgery?

2 hours

Patient had a steak dinner one hour ago. How long will you keep NPO?

7 hours (8 hours total)

in your induction; what medication would you avoid to prevent IOP?

succinylcholine

A patient should d/c metformin 48hrs preop to decrease incidence of:

fatal lactic acidosis

Two major side effects of spinal anesthesia:

1. hypotension | 2. parasympathetic response

What would you give preop to decrease awareness in the OR?

Benzodiazepine

Unconscious memory =

Implicit memory

Conscious memory =

explicit memory

What pt(type of) would you expect to have a greater likelihood of awareness during anesthesia?

- emergent c-section - cardiac surgery *on exam: 35 year old /emergent c-section

Name three elements required to perform Sellick maneuver:

1. 5kg 2. or 30 newtons 3. push esophagus posteriorly

Nerves dealing with anterior 2/3 and posterior 1/3 tongue:

Lingual and glossopharyngeal (in order)

Something about cocaine pledgets for nasal/sinus surgery?

Trigenminal --> opthalmic --> anterior ethmoidal **need to fix this question?

Disadvantage of the peribulbar technique?

slower onset *than the intrabulbar block (think of it as the epidural vs spinal)

correct spinal order via midline approach:

Skin, subq, supraspinous, interspinous, ligamentum flavum, dura mater, arachnoid space

Remifentanil and Propofol combination benefit:

a. Remifentanil reduces middle ear blood flow, creating a dry surgical field for tympanoplasty. b. Propofol may help reduce PONV

Propofol may help reduce

PONV

Remifentanil reduces middle ear blood flow, creating a

dry surgical field for tympanoplasty.

What type of anesthesia has a decreased risk for PONV?

regional