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Stuff and Thangs > BR Anesth > Flashcards

BR Anesth Flashcards

1
Q

While performing surgery the anesthetist tells you he administered Reglan, what is this for?

A

this reduces gastric motility.

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2
Q

Pediatric hypoglycemia is extremely dangerous!

Why is this and what should be given intraop to combat this problem?

A

Pediatric patients do not have large glycogen stores.

Thus D5W should be given IV to these patients to prevent hypoglycemia.

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3
Q

What are the effects of hypocalcemia on an ECG?

A

Widened QRS complex.

Makes up the plateau complex in the contracture wave

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4
Q

What effect does ketamine have on a patient?

A

Amnesia only

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5
Q

What is fetanyl used for?

A

Narcotic analgesia

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6
Q

What drug has largely replaced sodium penthothal?

A

Diprivan

Also known as propofol

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7
Q

What is the first symptom of hyperthermic malignancy?

A

Tachycardia

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8
Q

Describe how esters vs amides are broken down.

A

Amides contain two “I’s” and are broken down via the liver.

Esters are broken down in the blood by pseudocholinesterases.

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9
Q

What is the drug of choice for seizures?

A

Valium

“Diazepam”

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10
Q

What is a Mayo block?

A

A ring block for the MTPJ

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11
Q

What is MAC anesthesia?

A

Monitored Anesthetic Care

It is IV sedation + Local anesthetic.

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12
Q

How does local anesthetic prevent pain?

A

Blocks sodium channels within the nerve preventing the carriage of a pain signal down the nerve.

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13
Q

What are the complications associated with tournaquet use?

A 
Tissue necrosis
Inflammation
Paralysis
Thrombosis
Circulatory volume overload
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14
Q

What would be considered a contraindication to tourniquette use?

A

Previous popliteal - Dorsalis pedis bypass grafting.

Sickle cell disease –> tourniquette causes low oxygen levels possibly making the blood sickle.

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15
Q

How can a tournaquette cause a patients blood “Sickle” with sickle cell anemia?

A

Because the low oxygen levels cause the hemaglobing to conform.

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16
Q

List the five complications of intubation

A 
Sore throat
Tracheal edema
Croup
Laceration
Pneumothorax
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17
Q

When placing a patient in supine position for surgery, what is the most common complication while under anesthesia?

A

Ulnar nerve neuropathy

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18
Q

When placing a patient in a prone position for surgery, what is the most common complication while under anesthesia?

A

Pressure on the orbit as well as the dorsum of the foot.

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19
Q

Where is anesthetic placed in spinal nerve blocks?

A

Within the subarachnoid space, deep to the dura.

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20
Q

What are the four complications of spinal anesthesia?

A

Headache
Hypotension
Cauda Equina syndrome
Infection

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21
Q

What is the most common cause of temperature elevation while under anesthesia?

A

Malignant hyperthermia

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22
Q

What medication is used to treat malignant hyperthermia?

A

Dantrolene IV

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23
Q

What type of allergic reaction is anaphylaxis?

A

Flush, difficulty breathing, wheezing, stridor, laryngeal edema.

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24
Q

What is the treatment for anaphylaxis?

A

Epinephrine 0.3-0.5 mL sub Q of a 1:1,000 solution along with antihistamines.

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25
Q

How do local anesthetics work (MOA)?

A

Local anesthetics prevent conduction of the nerve by decreasing sodium permeability thus increasing the excitation threshold.

26
Q

What is the toxic dose of lidocaine 1% plain?

A

30 mL
or
300 mg

27
Q

what is the toxic dose of lidocaine 1% plain with epinephrine?

A

50 mL
or
500 mg

28
Q

What is the toxic dose of bupivicaine 0.25% plain?

A

70 mL
or
175 mg

29
Q

What is the toxic dose of bupivicaine 0.25% with epinephine?

A

90 mL
or
225 mg

30
Q

List four common amide based local anesthetics

A 
Two "I's"
Lidocaine
Bupivicaine
Mepivicaine
Etidocaine
31
Q

List four common Ester based local anesthetics

A

Procaine
Tetracaine
Chloroprocaine
Hexylcaine

32
Q

When performing tendon transfer type procedures, list the type of potential anesthesia that may be used.

A

General
Spinal
Epidural
(Because each of these modalities will temporarily eliminate lower extremity muscular activity)

33
Q

why do you want general anesthesia to be used when performing tendon transfers?

A

Because you want complete paralysis of muscle bellies during surgery.

34
Q

What type of block is most commonly used in a healthy patient undergoing bunion surgery?

A

MAC with a local Mayo Block.

35
Q

What nerve lies within the first intermetatarsal space?

A

The deep peroneal nerve supplying the second and third dorsal digital nerves.

36
Q

What nerve lies anterior to the medial malleolus?

A

The saphenous nerve

37
Q

Cervical spine radiographs should be obtained in a patient with a history of?

A

Rheumatoid arthritis

38
Q

When using a high thigh tourniquet, which types of anesthesia would be unwise?

A

MAC and local types

High thigh tourniquet causes too much discomfort and generally requires general anesthetic.

39
Q

What is the reccomended pressure for a thigh tourniquette?

A

200 mmHg over the systolic pressure due to the large soft tissue mass in the thigh.

40
Q

What stage of anesthesia should the tourniquette be brought up?

A

Stage II

General delyrium/excitement phase.

41
Q

When comparing a spinal block to a epidural block, which would allow greater control?

A

Epidural

Spinal blocks are only injected once, epidurals utilize a catheter in which anesthetic can be delivered continuously.

42
Q

When a patient is coming out of general anesthesia and is violently shaking as if cold, which medication will releive these symptoms?

A

Demerol (meperidine)

Lowers the shivering threshold.

43
Q

Why is the toxic dose of anesthetic increased with the use of epinephrine?

A

It slows the absorption of the anesthetic and therefore allows more to be used.

44
Q

Factors that affect the concentration of a drug at a site of action, as a function of time is referred to as?

A

Pharmokinetics.

45
Q

Succinylcholine is primary used to achieve?

A

Muscle relaxation through depolarization

Can be used to treat myasthenia gravis

46
Q

Succinylcholine can cause what adverse reaction?

A

Fasciculations as well as hyperkalemia!!

Used to paralyze/relax muscles

47
Q

What are the adverse reactions caused by the drug toradol?

A

Peptic ulcers

Ketolac NSAID

48
Q

Do ester type anesthetics have a higher or lower allergic potential than amides?

A

higher!!

49
Q

The protein binding characteristics of a drug will affect what?

A

Duration of action.

50
Q

Is eating within 6 hours prior to general anesthetic a cause to cancel the surgery?

A

YES!

Due to the risk of regurgitation and aspiration.

51
Q

During a local feild block what sensation is lost first?

A 
Pain
Temp
Touch 
Proprioception
Motor
52
Q

Why is a local block injected into an infected area less effective?

A

The acidic anesthetic converts the structure of the local anesthetic deminishing its effect.

53
Q

What nerves are blocked in an ankle block?

A 
Tibial nerve
Saphenous nerve
Deep peroneal nerve
Superficial peroneal nerve
Sural Nerve
54
Q

When performing various types of anesthesia on pediatic patients what is the common conern during anesthesia?

A

Hypothermia!
Dont forget they dont have much glycogen stores either, use D5W.

they also have quick fluid shifts!

55
Q

What are the immediate steps to perform when a patient undergoes syncope?

A

Oxygen
Trendelenburg positioning
Monitor Vitals

56
Q

When using halothane what vasoconstrictive drug is contraindicated?

A

Epinephrine!!

Can cause ventricular arrythmias.

57
Q

What are the adverse effects of narcotic use?

A

Emisis
Repsiratory depression
Dependence

58
Q

Why do esters have a higher risk of causing allergic potential?

A

They float around in the vasculature for longer as they are hydrolyzed by pseudocholinesterases in the blood.

59
Q

During surgery if a patient becomes hyperkalemic what might you observe?

A

Muscle weakness

Cardiac conduction changes

60
Q

What has a longer duration Marcaine or lidocaine?

A

Marcaine (Bupivicane)

Stuff and Thangs (37 decks)

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