BR Anesth Flashcards
While performing surgery the anesthetist tells you he administered Reglan, what is this for?
this reduces gastric motility.
Pediatric hypoglycemia is extremely dangerous!
Why is this and what should be given intraop to combat this problem?
Pediatric patients do not have large glycogen stores.
Thus D5W should be given IV to these patients to prevent hypoglycemia.
What are the effects of hypocalcemia on an ECG?
Widened QRS complex.
Makes up the plateau complex in the contracture wave
What effect does ketamine have on a patient?
Amnesia only
What is fetanyl used for?
Narcotic analgesia
What drug has largely replaced sodium penthothal?
Diprivan
Also known as propofol
What is the first symptom of hyperthermic malignancy?
Tachycardia
Describe how esters vs amides are broken down.
Amides contain two “I’s” and are broken down via the liver.
Esters are broken down in the blood by pseudocholinesterases.
What is the drug of choice for seizures?
Valium
“Diazepam”
What is a Mayo block?
A ring block for the MTPJ
What is MAC anesthesia?
Monitored Anesthetic Care
It is IV sedation + Local anesthetic.
How does local anesthetic prevent pain?
Blocks sodium channels within the nerve preventing the carriage of a pain signal down the nerve.
What are the complications associated with tournaquet use?
Tissue necrosis Inflammation Paralysis Thrombosis Circulatory volume overload
What would be considered a contraindication to tourniquette use?
Previous popliteal - Dorsalis pedis bypass grafting.
Sickle cell disease –> tourniquette causes low oxygen levels possibly making the blood sickle.
How can a tournaquette cause a patients blood “Sickle” with sickle cell anemia?
Because the low oxygen levels cause the hemaglobing to conform.
List the five complications of intubation
Sore throat Tracheal edema Croup Laceration Pneumothorax
When placing a patient in supine position for surgery, what is the most common complication while under anesthesia?
Ulnar nerve neuropathy
When placing a patient in a prone position for surgery, what is the most common complication while under anesthesia?
Pressure on the orbit as well as the dorsum of the foot.
Where is anesthetic placed in spinal nerve blocks?
Within the subarachnoid space, deep to the dura.
What are the four complications of spinal anesthesia?
Headache
Hypotension
Cauda Equina syndrome
Infection
What is the most common cause of temperature elevation while under anesthesia?
Malignant hyperthermia
What medication is used to treat malignant hyperthermia?
Dantrolene IV
What type of allergic reaction is anaphylaxis?
Flush, difficulty breathing, wheezing, stridor, laryngeal edema.
What is the treatment for anaphylaxis?
Epinephrine 0.3-0.5 mL sub Q of a 1:1,000 solution along with antihistamines.
How do local anesthetics work (MOA)?
Local anesthetics prevent conduction of the nerve by decreasing sodium permeability thus increasing the excitation threshold.
What is the toxic dose of lidocaine 1% plain?
30 mL
or
300 mg
what is the toxic dose of lidocaine 1% plain with epinephrine?
50 mL
or
500 mg
What is the toxic dose of bupivicaine 0.25% plain?
70 mL
or
175 mg
What is the toxic dose of bupivicaine 0.25% with epinephine?
90 mL
or
225 mg
List four common amide based local anesthetics
Two "I's" Lidocaine Bupivicaine Mepivicaine Etidocaine
List four common Ester based local anesthetics
Procaine
Tetracaine
Chloroprocaine
Hexylcaine
When performing tendon transfer type procedures, list the type of potential anesthesia that may be used.
General
Spinal
Epidural
(Because each of these modalities will temporarily eliminate lower extremity muscular activity)
why do you want general anesthesia to be used when performing tendon transfers?
Because you want complete paralysis of muscle bellies during surgery.
What type of block is most commonly used in a healthy patient undergoing bunion surgery?
MAC with a local Mayo Block.
What nerve lies within the first intermetatarsal space?
The deep peroneal nerve supplying the second and third dorsal digital nerves.
What nerve lies anterior to the medial malleolus?
The saphenous nerve
Cervical spine radiographs should be obtained in a patient with a history of?
Rheumatoid arthritis
When using a high thigh tourniquet, which types of anesthesia would be unwise?
MAC and local types
High thigh tourniquet causes too much discomfort and generally requires general anesthetic.
What is the reccomended pressure for a thigh tourniquette?
200 mmHg over the systolic pressure due to the large soft tissue mass in the thigh.
What stage of anesthesia should the tourniquette be brought up?
Stage II
General delyrium/excitement phase.
When comparing a spinal block to a epidural block, which would allow greater control?
Epidural
Spinal blocks are only injected once, epidurals utilize a catheter in which anesthetic can be delivered continuously.
When a patient is coming out of general anesthesia and is violently shaking as if cold, which medication will releive these symptoms?
Demerol (meperidine)
Lowers the shivering threshold.
Why is the toxic dose of anesthetic increased with the use of epinephrine?
It slows the absorption of the anesthetic and therefore allows more to be used.
Factors that affect the concentration of a drug at a site of action, as a function of time is referred to as?
Pharmokinetics.
Succinylcholine is primary used to achieve?
Muscle relaxation through depolarization
Can be used to treat myasthenia gravis
Succinylcholine can cause what adverse reaction?
Fasciculations as well as hyperkalemia!!
Used to paralyze/relax muscles
What are the adverse reactions caused by the drug toradol?
Peptic ulcers
Ketolac NSAID
Do ester type anesthetics have a higher or lower allergic potential than amides?
higher!!
The protein binding characteristics of a drug will affect what?
Duration of action.
Is eating within 6 hours prior to general anesthetic a cause to cancel the surgery?
YES!
Due to the risk of regurgitation and aspiration.
During a local feild block what sensation is lost first?
Pain Temp Touch Proprioception Motor
Why is a local block injected into an infected area less effective?
The acidic anesthetic converts the structure of the local anesthetic deminishing its effect.
What nerves are blocked in an ankle block?
Tibial nerve Saphenous nerve Deep peroneal nerve Superficial peroneal nerve Sural Nerve
When performing various types of anesthesia on pediatic patients what is the common conern during anesthesia?
Hypothermia!
Dont forget they dont have much glycogen stores either, use D5W.
they also have quick fluid shifts!
What are the immediate steps to perform when a patient undergoes syncope?
Oxygen
Trendelenburg positioning
Monitor Vitals
When using halothane what vasoconstrictive drug is contraindicated?
Epinephrine!!
Can cause ventricular arrythmias.
What are the adverse effects of narcotic use?
Emisis
Repsiratory depression
Dependence
Why do esters have a higher risk of causing allergic potential?
They float around in the vasculature for longer as they are hydrolyzed by pseudocholinesterases in the blood.
During surgery if a patient becomes hyperkalemic what might you observe?
Muscle weakness
Cardiac conduction changes
What has a longer duration Marcaine or lidocaine?
Marcaine (Bupivicane)
