Boot Camp Week 1 Flashcards
What vertebrae correspond with the adult larynx?
C3 - C6
What vertebrae correspond with the neonatal larynx?
C2 - C4
What is the afferent limb of the laryngospasm?
Internal SLN
What is the efferent limb of the laryngospasm?
External SLN
RLN
What are the borders of Larson’s Maneuver?
Skull Base
RAMUS of mandible
Mastoid process
How should Larson’s be applied?
3-5 seconds on
10 sec off
What is Muller’s Maneuver?
Inhaling against a closed glottis
What is a severely reduced FEV1?
< 35%
What cell communication pathway does the M3 receptor use?
Gq
PLC -> IP3 -> Ca
What cell communication pathway do pulmonary Beta 2 receptors use?
Gs
Adenalyl Cylase -> increased cAMP -> decreased Ca
What cell communication pathway does VIP use?
Non-cholinergic PNS nerves release Vasoactive intestinal peptide onto airway smooth mm which increases NO production
NO stimulates _____
cGMP, which leads to smooth mm relaxation
What pulmonary function test is the MOST sensitive indicator of small airway disease?
Forced Expiratory Flow of 25-75%
ALSO KNOWN AS THE MMEF
What is forced expiratory flow?
Average flow during the middle half of the measurement
ALSO KNOWN AS THE MMEF
What is a normal DLCO?
17-25 ml/min/mmHg
What surgical procedures are independent risk factors for postop pulmonary problems?
- Aortic
- Thoracic
- Ab/Neuro/Peripheral
- Emergency
What duration of anesthesia is associated with poor postoperative outcomes?
> 2 hours
What albumin level is associated with poor postoperative outcomes?
< 3.5
6 weeks of smoking cessation improves:
Airway function
Mucociliary clearance
Sputum Production
Pulmonary Immune Fx
Hep. Enzyme Induction subsides
Which disease type leads to reduced FRC?
Restrictive
Which disease type leads to reduced RV?
Restrictive
What ABG finding in an asthmatic signals impending collapse?
Increased PaCO2
What is the treatment for Alpha 1 Antitrypsin Disease?
Liver Transplant
It’s the most common metabolic disease effecting the liver
What should you avoid while mechanically ventilating a patient with severe COPD?
Getting the CO2 down to normal
They’re in compensated acidosis, so knocking down CO2 can cause severe alkalosis
What lung volumes are increased in COPD?
RV
FRC
TLC
What spirometry readings are diagnostic of restrictive disease?
FEV1 AND FVC < 70%
What are the risk factors for Mendelson Syndrome?
pH < 2.5
Gastric Volume > 25ml (0.4ml/kg)
What is the hallmark sign of Mendelson Syndrome?
Hypoxemia
When can a patient who aspirated but is showing no s/s can be discharged from the PACU?
2 hours
Which symptoms in PACU justify keeping an aspiration patient longer?
New cough or wheeze
+ XRay
>10% reduction in SpO2 on RA from baseline
A-a > 300
In neurosurgical patients, the risk of VAE is highest in which position?
- Sitting
- Lateral
- Prone
- Supine
What PA mean constitutes pHTN?
> 25
What drugs increase PVR?
Nitrous
Ketamine
Des
PVR is reduced by:
Hyperventilation
NO
NTG
PVR is increased by:
Hypoxia
Hypercarbia
Nitrous
Hypothermia
PEEP
100% FiO2 should be administered until CoHgb is:
<5%
What is a normal vital capacity?
65-75 ml/kg
What vital capacity indicates a need for mechanical ventilation?
< 15 ml/kg
What is a normal inspiratory force?
75-100 cmH2O
What inspiratory force indicates a need for mechanical ventilation?
<25 cm H2O
What is a normal Aa gradient on room air?
< 10-15 mmHg
What is a normal Aa gradient on 100% FiO2?
<100
If a patient is on 100% FiO2, what Aa gradient indicates a need for intubation?
> 450 mmHg
What are the BEST predictors of poor outcomes for patients needing pulm sx
FEV1 < 40%
DLCO < 40%
VO2 Max < 15ml/kg
Any of these values warrant split lung testing
What are ABSOLUTE indications for OLV?
Infection
Massive Hemorrhage
Bronchopleural Fistula
What are RELATIVE indications for OLV?
Improved Exposure
Pulm Edema
Severe Hypoxemia d/t lung disease
How does lateral positioning effect the alveolar compliance curve in the anesthetized patient?
Unlike a DLT, a bronchial blocker cannot:
Prevent contamination from a contralateral infection
The lumen of the bronchial blocker can be used to:
Suction AIR
Insufflate O2
An absolute contraindication to mediastinoscopy is:
A previous Mediastinoscopy
PIV for mediastinoscopy should be placed:
in lower extremity in case large vessels are damaged
Oat cell carcinoma is associated with:
ELS
Patients with ELS are sensitive to:
Succ AND non-deps
How do you calculate loading dose?
Vd x (desired Cp/Bio)
If it’s being given IV, the bioavailability is always 1
What is the calculation for total body water in adults?
0.6 L/kg
A drug with a Vd that exceeds TBW is assumed to be:
lipophilic
A drug with a Vd below TBW is assumed to be:
Hydrophilic
Generally, how does ionization dictate drug effect?
Ionized = not active, unable to cross any membrane, and more likely to be eliminated
Local anesthetics are weak _____
bases
Which LAs are most and least likely to cause ion trapping?
Most: lidocaine
Least: Chloroprocaine
Albumin primarily binds with _____ drugs
acidic
Alpha 1 primarily binds with ______ drugs
basic
Basic bitches are Alphas
The plasma concentration of alpha 1 is INCREASED in:
Old age and Bad things:
surgical stress, MI, pain, RA
The plasma concentration of albumin is increased by
NOTHING
The plasma concentration of alpha 1 is DECREASED in:
neonates
pregnancy
In the elderly, how do plasma proteins change?
Albumin (acidic binding) decreases
Alpha 1 (basic binding) increases
How is protein binding related to volume of distribution?
inversely
the more protein binding, the lower the volume of distribution
When do zero order kinetics occur?
When the enzymes are saturated
What are the three phases of drug metabolism?
What drugs are dependent on liver perfusion for clearance?
Drugs that have a high hepatic extraction ratio (>0.7)
Fentanyl, sufentanil, morphine, ketamine, propofol
What drugs are dependent on the liver’s extraction capacity for clearance?
Drugs that have a low hepatic extraction ratio (<0.3)
Rocuronium, diazepam, methadone
THESE ARE THE DRUGS MOST EFFECTED BY CHANGES IN ENZYME PATHWAYS
Name two drugs that undergo enterohepatic circulation
diazepam and warfarin
Which opioid isn’t a good choice for someone taking SSRIs?
Codeines. Interferes with converting codeine to morphine
Name three enzyme inducers
tobacco
phenytoin
ETOH
Name three enzyme inhibitors
SSRIs
Omeprazole
Grapefruit
Ammonia makes urine:
acidotic
Acetazolamide makes urine:
Alkalotic
Name four drugs metabolized by nonspecific esterases
esmolol
remifentanil
atracurium (+ hoffman)
clevidipine
Which drugs are broken down by hoffman elimination?
Atracurium (+ nonspec)
Cisatracurium
Which paralytics are broken down by pseudocholinesterase?
Succ and Mivacurium
An example of potentiation is Penicillin + _________
Probenecid
How do you calculate therapeutic index?
Divide the lethal dose by the effective dose
What creates chirality?
A carbon atom bonded to four DIFFERENT atoms
In terms of bupivicaine and ketamine, which enantiomer is better?
S
Which drugs are NOT supplied as racemic mixtures?
Levobupivacaine
Ropivacaine
What is a normal CaO2?
20 ml/dl
Concentric =
parallel
What side effect is unique to fospropofol?
Anal burning
What are the CNS effects of etomidate?
Decreased CBF
Decreased ICP
CPP remains stable
How is etomidate metabolized?
Liver and plasma esterases
What is the drug class of thiopental?
Thiobarbituates
Name two oxybarbituates
Methohexital
Pentobarbitol
Name four features of Thiopental
- Not a DIRECT myocardial depressant
- Causes histamine release
3.Causes reflex tachycardia because baroreceptors are unaffected
- Produces less HoTN than propofol
What are the CNS effects of Thiopental?
Decreases everything
Thiopental protects against ______ ischemia
focal. NOT global.
Acute Intermittent Porphyria is made worse by:
- Dehydration
- ALA synthase
- Stress
- CYP450 INDUCTION
What drugs should be avoided with porphyria?
IV anesthetics
CCBs
Toradol
Amio
Birth control
How do you treat inadvertent arterial thiopental injection?
Phenoxybenzamine
Phentolamine
Sympathectomy (SGB)
How are barbiturates metabolized?
Liver, except phenobarbitol which is excreted unchanged in the urine
Where does precedex produce analgesia?
Decreases substance P and Glutamate release in the dorsal horn of the spinal cord
Which benzo has the longest half life?
Diazepam
Which benzo is most potent?
Lorazepam
Diazepam =
Valium
Lorazepam =
Ativan
Which inhaled agent decreases SVR the LEAST?
SEvo
Which halogenated agents increase HR?
Iso and Des do
Sevo does not
“sevo is stable”
List the inhaled agents in order of coronary dilation
Iso highest
Then des
Sevo is lowest
Which agent impairs the hypoxic ventilatory response the LEAST
Des
It’s METABOLITES that interfere with hypoxic ventilation, so it makes sense Des has the least effect
Des is the best choice for patients with what breathing conditions?
Emphysema or severe sleep apnea
Which volatile agent increases CSF absorption?
Iso
What volatile agent increases CSF production?
Sevo
You should be concerned about nerve ischemia when what SSEP changes are noted?
Amplitude DECREASES by 50%
Latency INCREASES by 10%
Which evoked signals are MOST resistant to the effects of anesthetics?
BAEP
Which evoked signals are MOST sensitive to effects of anesthetics?
VEP
