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ANESTHESIA : Hall > CH6 GENERAL ANESTHESIA > Flashcards

CH6 GENERAL ANESTHESIA Flashcards

1
Q

longest acting sulfonylurea

A

CHLORPROPAMIDE

DURATION 72 hrs

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2
Q

duration of regular insulin

A

peak 2-3 hrs

duration 6-8 hrs

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3
Q

a QUALITATIVE assesment of pseudocholinesterase

A

DIBUCAINE TEST

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4
Q

amide type LA

inhibit normal pseudocholinesterase by 80%

A

DIBUCAINE

amide ( 2 i)
ester (1i)

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5
Q

Normal PO2 in mixed venous blood is?

A

40mmHg

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6
Q

inc Venous arterial oxygen due to ?

A 
inc CO
sepsis
left to right shunt
impaired peripheral uptake
dec o2 consumption
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7
Q

Tracheal capillary arteriolar pressure

A

25-35mmHg

if cuffed greater > ischemia> tracheomalacia

ET low pressure cuff recommended for intubation> 48 hrs

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8
Q

LMWH like enoxaparin dalterapin and ardeparin should be stop for __hrs prior to neuraxial.

A

at least 24 hrs

LMWH is 2-4 x longer than standard heparin

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9
Q

The most common peripheral nerve injury under GA?

A

ULNAR NERVE

compressed between medial epicondyle of the humerus

sharp edge of the operating table

leading to ISCHEMIA

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10
Q

CODEINE is metabolized to morphine by

A

CYP2D6

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11
Q

CYP2D6 metabolize (3 drugs)

A

oxycodone to oxymorphone
hydrocodone to hydromorphone
codeine to mso4

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12
Q

s/p pca or pci when to schedule elective case

A

2 week - baloon ca
6 weeks - BMS( bare metal)
12 mons - DES( Drug eluting)

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13
Q

DUAL THERAPY
ASPIRIN AND CLOPIDOGREL

when to stop?

A

continue aspirin

clopidogrel 7 days

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14
Q

emergency case on clopidogrel ? what to give?

A

platelet conc effective 4hrs after last dose but much better 24 hrs after

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15
Q

NALOXONE

A

competitive inhibitor all opioid receptors
greater affinity to mu receptor

duration :1hr
short can cause renarcotization

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16
Q

NALTREXONE

A

N cyclopropylmethyl of oxymorphone

long half life 8-12 hrs
oral form only

block euphoric effect

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17
Q

NALMEFEME

A

opiod antagonist
extremely long duration of action

oral and iv

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18
Q

most common cause postoperative hypoxemia

A

uneven v/q mismatch

atelectasis

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19
Q

AIRWAY obstruction after thyroidectomy cause by

A 
hypocalcemia
RLN damage
tracheomalacia 
compression
hematoma
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20
Q

airway symptoms of hypocalcemia can develop

A

as early as 1-3 hrs up to 24-72 hrs post op

laryngeal muscle is sensitive to hypocalcemia

tx
cal gluconate
ca chloride

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21
Q 
weakness in abduction of the thumb
inability to extend to metacarpophhalangeal joints
wristbdrop
numbness in the webbed space 
between thumb and index

what nerve?

A

RADIAL NERVE

can be comprrss around the humerus b/w middle and lower portions spiral groove

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22
Q

dystonic reaction about 1%

A

DROPERIDOL

TX
DIPHENHYDRAMUNE
BENZATROPINE ( can cross bbb)

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23
Q

most freq injured nerve in the antecubital fossa

A

MEDIAN NERVE

palmar surface of the lat 3 and 1 half fingers

motor:
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis ms

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24
Q

diaphoresis
tachycardia
heache
htn

A

pheochromocytoma

average sized contains 100-800mg NE

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25
pheochromocytoma + medullary ca thyroid + and neuroma of the oral mucosa
MEN Type IIb
26
dec hepatic gluconeogenesis | not hypoglycemia
METFORMIN
27
improve insulin sensitivity | no hypoglycemia effect
piolitazone | rosiglitazone
28
delay carbo absorption | no hypo gly
Acarbose | miglitol
29
stimulate insulin secretion | RISK of hypogly
``` glimeperide glipizide glyburide tolbutanidr tolazamide chlor ```
30
alcohol withdrawal early symptoms? life threatening ?
alcohol withdrawal early symptoms? 6-8hrs life threatening ?2-4days
31
HYPERCALCEMIA SIGNS AND SYMPTOMS
``` HTN dysrhythmia short qt kidney stoney seizure nause and vomiting weakness a depression psychosis ``` <12 no intervention notmal 2.25-2.75mmol/l
32
red eyedrop? green eyedrop? white?
reD-myDriasis green -MIOSis white no pupillary size changes
33
wt in children how to compute?
``` newborn-3.5kg 5mons bw x 2 1year bw x 3 1-6 2kg/year 6-10 3kg/year ```
34
HYPERCALCEMIA SIGNS AND SYMPTOMS
``` HTN dysehythmia short qt kidney stoney seizure nause and vomiting weakness a depression psychosis ``` <12 no intervention notmal 2.25-2.75mmol/l
35
red eyedrop? green eyedrop? white?
reD-myDriasis green -MIOSis white no pupillary size changes
36
wt in children how to compute?
``` newborn-3.5kg 5mons bw x 2 1year bw x 3 1-6 2kg/year 6-10 3kg/year ```
37
WHAT CBF ? first sign of cerebral ischemia no eeg sign
22ml/100g/min
38
What CBF? eeg become isoelectric
15ml/100g/min
39
what CBF? irreversible membrane damage an cellular death
6ml/100g/min
40
what CBF? zone of ischemic penumbra
6-15ml/100g/min
41
PEEP increase?
arterial oxygenation pulmonary compliance FRC by expanding prev collapsed but perfused alveoli >> dec shunt >> imp ventilatio
42
PEEP effect ok arterial blood pressure?
dec arterial blood pressure caused by dec in venous return , left ventricular filling and stroke volume and cardiac output other adverse effect: pneumothorax pneumomediastinum subq emphysema
43
clopidogrel MOA?
irrevesible inhibitor of plt p2Y12 block ADP Inhibit platelet activation, aggregation and degranulation
44
Glycoprotein 2b/3a inhibitor?
abcixima eptifabatidr tirofiban
45
inhibit cox1 ? | inhibit release of ADP by platelet and plt aggregation
aspirin naproxen ibuprofen
46
Direct thrombin inhibitor?
``` hirudin agratroban lepirudin desidurin bivalirudin DABIGATRAN ``` supress plt function
47
how to compute for oil/gas | coefficient
150/MAC high - lipid soluble ( lower MAC)
48
HYPERNATREMIA serum hyperosmolarity polyuria urine hypoosmolality
DIABETES INSIPIDUS develop 4-12 hrs post op txt desmopressin acetate DDAVP
49
in alzheimer disease, which anticholinergic drug should not be given scopolamine atropine glycopyrolate
scopolamine and atropine can pass the bbb can cause confusion
50
administration of sux to any pt who has already received an anticholinesterase will result ina PROLONGED block ? true or false
TRUE because it can no longer be easily hydrolyzed
51
measurement of DIFFUSING capacity of the lung
DLCO 20-30ml/min/mmHg
52
DLCO influenced by ?
vol of blood hgb dec DLCO: dec oxygen toxicity pulmonary edema ``` increased DLCO: supine position exercise obesity left to right cardiac shunt ```
53
Thyroidectomy postoperative complication results in upper airway obstruction?
hemorrhage - compression hypocalcemia- stridor -- laryngospasm recurrent laryngeal nerve unilateral- hoarseness bilateral - airway obstruction sup laryngeal nerve sensory only hoarseness only
54
MH | most early signs ?
TACHYCARDIA
55
nonspecific pulmonary function test that measures the ENDURANCE of ventilatory muscles and indirectly reflects compliance of the lung and thorax as airway resistance
MMB MAXIMUM VOLUNTARY VENTILATION dec- impairment to inspiration or rxpiration FLOW VOLUME LOOP- confirmatory test
56
PADSS | what are the five criteria
``` stable vs walk w/o dizziness controlled pain absence of nausea and vomiting min sx bleeding ```
57
TOOL TO OBJECTIVELY assesing a patients readiness for discharge from the surgical center and includes 5 criteria
PADSS post anethetics discharge scoring system
58
MH | LATE finding
fever
59
test for MH
caffeine halothane contracture test muscle biopsy
60
leukotriene pathway inhibitor
zileuton
61
leukotriene receptor antagonist
montelukast
62
Treatment of mild hyponatremia 120-135
water restriction furosemide no neuro symptoms
63
what level of na has neurologic symptoms | ecg changes
less than 120
64
hyponatremia ecg changes?
widening qrs st elevation ventricular tach vfib
65
how to compute for na correction
TBW x ( desirrd- actual na )
66
rapid correction of na will lead to
demyelinating cns
67
MH TRISMUS after sux in how many % inpatient will develop MH
50 percent
68
KETAMINE demonstrate myocardial depressant when??
cathecholamines are depleted | under deep anesthesia
69
MH is due to ____ control of intracelluar _____
MH is due to DEC control of intracelluar CALCIUM STORE tx dantrolene blocks the release of calcium from sarcoplasmic reticulum
70
inc intracellular ca leads to muscle contraction ? true or false
true
71
bleomycin
PULMONARY TOXICITY
72
increase risk of pulmonary toxicity ( in pt taking bleomycin)
radiotherapy | inc conc of 02 ( > 30percent)
73
head flexion or extension, how many cm?
1.9 cm towards the carina
74
turn head laterally will move the et tube ___cm?
0.7cm away from the carina
75
sulfur hexafluoride ppv to prevent changes in size of the bubbles? can nitrous be given?
prevention: 02. 15mins before injevtion NO NITROUS FOR 10days
76
post thyroidectomy , hypocalcemia can occur ___hrs?
first 24 -96 hrs manifest as laryngospasm and stridor tx: cal gluconate and ca chloride
77
which confirms euthyroid state?
TSH
78
TURP: | fluid absorption rate ?
10-30ml/min
79
TURP: | inc rate of absorption can cause?
htn bradycardia pulmonary congestion treatment: diuretics 3% nacl
80
BURN: after 24 hrs sensitivity to depo? or non depo?
depo sensitive non depo resistant upregulation of extrajunctional recptor
81
nerve injured during parotidectomy
FACIAL NERVE orbicularis oris frontalis close ehwlids purse the kips raise the eyebrows
82
how manu ml of 02 is ther per gram of hgb?
1gram hgb=1.34ml O2
83
allergic reaction is most likely secondary to
MUSCLE RELAXANT latex allergy after 15-mins
84
HUNTINGTON CHOREA | effects on succinylcholine
PROLONGED INC SENSITIVITY TO NON DEPO because they have dec pseudocholinesterase
85
normal intraocular pressure
10-22mmHg
86
causes inc in iop
ketamine elevation of PaCO2 sux coughing and vomiting ( 35-50mmHg)
87
AHI | apnea-hypopnea index ?
used to QUANTIFY number of apnea or hypoapnea per hr greater than 30 >>> OSA
88
no ventilation for period of 10sec or more
APNEA
89
50% dec in airflow or a dec sufficient to cause dec oxygen saturation of 4%
HYPOPNEA
90
INCREASED operative risk for pneumonectomy? what are the test?
``` RV/TLC >50 FEV1 < 0.8L mPAP >40mmHg PaCO2 60mmhg PaO2 <45 mmHg ```
91
for every degree Celsius decreased how many percent dec with PaO2
1 degre = 6 %
92
nonspecific pulmonary function test that measures the ENDURANCE of ventilatory muscles and indirectly reflects compliance of the lung and thorax as airway resistance
MMB MAXIMUM VOLUNTARY VENTILATION dec- impairment to inspiration or rxpiration FLOW VOLUME LOOP- confirmatory test
93
PADSS | what are the five criteria
``` stable vs walk w/o dizziness controlled pain absence of nausea and vomiting min sx bleeding ```
94
TOOL TO OBJECTIVELY assesing a patients readiness for discharge from the surgical center and includes 5 criteria
PADSS post anethetics discharge scoring system
95
MH | LATE finding
fever
96
test for MH
caffeine halothane contracture test muscle biopsy
97
leukotriene pathway inhibitor
zileuton
98
leukotriene receptor antagonist
montelukast
99
Treatment of mild hyponatremia 120-135
water restriction furosemide no neuro symptoms
100
what level of na has neurologic symptoms | ecg changes
less than 120
101
hyponatremia ecg changes?
widening qrs st elevation ventricular tach vfib
102
how to compute for na correction
TBW x ( desirrd- actual na )
103
rapid correction of na will lead to
demyelinating cns
104
MH TRISMUS after sux in how many % inpatient will develop MH
50 percent
105
KETAMINE demonstrate myocardial depressant when??
cathecholamines are depleted | under deep anesthesia
106
MH is due to ____ control of intracelluar _____
MH is due to DEC control of intracelluar CALCIUM STORE tx dantrolene blocks the release of calcium from sarcoplasmic reticulum
107
inc intracellular ca leads to muscle contraction ? true or false
true
108
bleomycin
PULMONARY TOXICITY
109
increase risk of pulmonary toxicity ( in pt taking bleomycin)
radiotherapy | inc conc of 02 ( > 30percent)
110
head flexion or extension, how many cm?
1.9 cm towards the carina
111
turn head laterally will move the et tube ___cm?
0.7cm away from the carina
112
sulfur hexafluoride ppv to prevent changes in size of the bubbles? can nitrous be given?
prevention: 02. 15mins before injevtion NO NITROUS FOR 10days
113
post thyroidectomy , hypocalcemia can occur ___hrs?
first 24 -96 hrs manifest as laryngospasm and stridor tx: cal gluconate and ca chloride
114
which confirms euthyroid state?
TSH
115
TURP: | fluid absorption rate ?
10-30ml/min
116
TURP: | inc rate of absorption can cause?
htn bradycardia pulmonary congestion treatment: diuretics 3% nacl
117
BURN: after 24 hrs sensitivity to depo? or non depo?
depo sensitive non depo resistant upregulation of extrajunctional recptor
118
nerve injured during parotidectomy
FACIAL NERVE orbicularis oris frontalis close ehwlids purse the kips raise the eyebrows
119
how manu ml of 02 is ther per gram of hgb?
1gram hgb=1.34ml O2
120
allergic reaction is most likely secondary to
MUSCLE RELAXANT latex allergy after 15-mins
121
HUNTINGTON CHOREA | effects on succinylcholine
PROLONGED INC SENSITIVITY TO NON DEPO because they have dec pseudocholinesterase
122
normal intraocular pressure
10-22mmHg
123
causes inc in iop
ketamine elevation of PaCO2 sux coughing and vomiting ( 35-50mmHg)
124
AHI | apnea-hypopnea index ?
used to QUANTIFY nuper of apnea or hypoapnea per hr greater than 30 >>> OSA
125
no ventilation for period of 10sec or more
APNEA
126
50% dec in airflow or a dec sufficient to cause dec oxygen saturation of 4%
HYPOPNEA
127
INCREASED operative risk for pneumonectomy? what are the test?
``` RV/TLC >50 FEV1 < 0.8L mPAP >40mmHg PaCO2 60mmhg PaO2 <45 mmHg ```
128
for every degree Celsius decreased how many percent dec with PaO2
1 degre = 6 %
129
causes of central cyanosis
dec arterial o2 saturation hgb abnormality
130
``` what kind of heparin? immediate t1/2 .5 to 2hrs reversed by protamine aptt act ```
UNFRACTIONATED HEPARIN
131
``` what kind of heparin? 20-60 mins onset t1/2 4.5hr partially reverse by protamine LOWER INCIDENCE OF HIT ```
LMWH
132
relationship of gfr and crea ?
inversely proportional
133
``` MC chromosomal syndrome in congetinal hypothyroidism smaller tracheas occipito atlantaoaxial isntability subluxation congetinal heart disease ```
TRISOMY 21 | Downs syndrome
134
anticholinergic like scopolamine can cause
mydriasis | cyclopedia
135
neuroleptic malignant syndrome vs MH DIFFERENTIATE?
Non depo NMB will cause FLACCID paralysis in NMS but not in MH
136
classic signs of fat embolism
``` tachycardia dyspnea confusion fever PETecHial rash on the upper part was ``` most common after LONG BONE sx occurs 12-72 hrs after
137
REMIFENTANIL IS metabolized by
nonspecific pseudocholinesterasr
138
acceptable preductal oxygen saturation
``` 1 min - 60-65 2 min 65 3min 70 4min 75 5 mins 80 10 min 85 a% ```
139
MOST common readin for unexpected admission post GA
nausea and vomiting
140
min alveolar concentration of anesthetic that will prevent movement of 50% of pt whwn skin incision is made
MAC 1
141
min alveolar concentration of anesthetic that will prevent movement of 95% of pt whwn skin incision is made
MAC 1.3
142
OBESE: | cardiac output increased or decreased?
increased by 100ml/min/kg additional blood vessel> inc ventricular dilation inc sv and resting hr not increased
143
alternative for Na nitroprusside for tx for severe htn?
FENOLDOPAM Dopamine 1 agonist no thiocyanate toxicity no rebound effect no coronary stral contraindicated: sulfite sensitivity
144
Hemophilia | how many percent of F8 is needed for major or
ideally 100 percent F8 elimination t1/2 12 hrs tx F8 conc cryoprecipitate
145
THE REASON 4 twitches are used in TOF instead of 5?
succesive twitches deplete ach syore after 4th twitch ni affitional decrement in height
146
INFERIOR ISCHEMIA complete heart block what coronary artery
right RCA AV NODE supplied by the RCA
147
INCREASE MAC
``` hyperthermia CHRONIC ETHANOL USE hypernatremia red hair natural infancy ```
148
DECREASE MAC
``` narcotics iv LA ACUTE ETHANOL USE hypothermia Hypoxia anemia inc age pregnancy hypoxia ```
149
NO EFFECT IN MAC
``` duration sc typr sx thyroid function gender hyperkalemia ```
150
long term lithium therapy can cause
hypothyroidism ( inhibit thyroid hormones) sedative properties associated nephrogenic DI prolong osncu and sux but does not cause hyperkalemia
151
Carcinoid syndrome | tx
octreotide synthetic somatostatin analog surpress serotonin
152
minimum dermatomal level for orchiectomy
T10
153
GCS ? mild head injury moderate and severe?
severe 3-8 mod 9-12 mild 13-15 e4 v5 m6
154
associated with FALSELY elevated SaO2 ?
CARBOCYHEMOGLOBIN
155
anticonvulsant | centrally acting active GABA
GABAPENTIN
156
most common cause of blindness post surgery?
ISCHIEMIA OPTIC NEUROPATHY ``` associated factors: prolonged hypotension anemia large blood loss prolonhed surgery favial edema ```
157
POVL may result form
``` corneal traume retinal artery occlusion retinal vein occlusion optic nerve ischemia cortical disease ```
158
postoperative shivering. can ..
inc metabolic rate and o2 consumption | inc co and mv
159
postoperative shivering treatment
``` suppl o2 rewarming meperidine clonidine mg sulfate ca chloride chlorpromazine droperidol ``` ``` drugs: meperidine clonidine mg cacl chlorpromazine butorphanol ```
160
hyperkalemia ecg changes?
narrowed and peaked t wave ( earliest manifestation) dec p wavr prolonged pr interval widened qrs potentianed by hypocalcemia
161
s/p tss is Cpap contraindicated?
YES !
162
neutral protease stored in mast cell ?
TRYPTASE should be measure 1-2 hrs histamine level returns to normal after 30-60 mins
163
what enzyme is responsible to metablosim of fentanyl sulfentanil alfentanul
CYP3A4
164
LIVER TRANSPLANTATION | phase where the greatest degree of hemodynamics
REPERFUSION Hypotension dec cardiac contractilitcardiac arrythmia hyperkalemia
165
PONV: | Strongest independent predictor
FEMALE
166
PONV: | risk factor
``` female non smoker hx of ponv migraine narcotics length of sx use of nitrous voltile anes ```
167
MH MUTAtion with what receptor
RYANODINE RECEPTOR
168
glycopyrrolate can pass the placenta? true or false?
FALSE only ATROPINE AND SCOPOLAMINE
169
greatest predictor of OSA
neck circumference | >44cm
170
conversion of morphine iv to oral?
1:3 methadone 1:2 me2done
171
equilibrium with alveolar partial pressure is rapid , how many mins?
8-10mins
172
which compartment reach equilibrium last?
VPG vessel poor group
173
hazards of oxygen administration
ROP bronchopulmonary dysasia adsorption atelectasis
174
what nerve arises from branches of c2-c3 spinal nerves and innervates the skin of the outer ear, the mastoid process and the parotid gland
GREAT AURICULAR NERVE
175
vasopasm
associated with SAH | OCCURS 4-12 days after bleed
176
treatment for hodgkin lumphoma and testicular tumor . causing pulmonary toxicity
BLEOMYCIN use low oxygen concentration
177
most common cardiac event in pediatrics
bradycardia
178
difficult mask ventilation
``` bmi >26 without teeth pt who snore beard age older than 55 facial tumor facial trauma ```
179
symptoms of compartment syndrome
pain parethesias paralysis pulseless treatment? fasciotomy
180
CSF IN NEONATES? LA dose? duration
4ml/kg adult: 2ml/kg increase dose shorter duration
181
ET TUBE SIZE are measured according to
INTERNAL DIAMETER
182
colorless, odorless gas that bonds to hgb with affinity more than 200 times stronger than oxygen.
carbon monoxide
183
what nerve ? weakness of all muscles below the knee
SCIATIC NERVE INJURY
184
what nerve ? foot drop, loss of dorsal extension of the toes
common peroneal nerve
185
what nerve ? | weakness of the ms that exten the knee
obturator nerve injury
186
what nerve ? | inability to addduct the leg; diminished sensation over the medial side of the thigh
OBTURATOR NERVE INJURY
187
what nerve ? mc caused by placement of pt into lithotomy position
common peroneal
188
what nerve ? numbness over the lateral aspect of the thigh
lateral femoral cutaneous nerve injury
189
amount of air expired in 1 second
FEV1
190
normal FEV/FVC
75%- 80%

ANESTHESIA : Hall (6 decks)

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