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GENERAL OTOLARYNGOLOGY > CHAPTER 5: General Considerations of Anesthesia and Management of the Difficult Airway > Flashcards

CHAPTER 5: General Considerations of Anesthesia and Management of the Difficult Airway Flashcards

1
Q

Goal of airway management

A

Provide the most expeditious form of management that has the lowest potential for injury and the greatest potential for control of the airway

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2
Q

Fasting recommendation for clear liquids

A

2 hours

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3
Q

Fasting recommendation for breast milk

A

4 hours

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4
Q

Fasting recommendation for other food or beverages (infant formula and milk)

A

6 hours

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5
Q

Pharmacologic agents administered preoperatively may reduce the risk of aspiration

A
  1. Clear antacids (30 ml of Na citrate)
  2. Anticholinergic agents (atropine or glycopyrrolate)
  3. Metoclopramide (to stimulate gastric emptying and increase lower esophageal sphincter tone)
  4. H2- receptor antagonists (cimetidine or ranitidine) to decrease secretion of HCl
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6
Q

Most common used IV anesthetic agent

A

Propofol

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7
Q

TRUE or FALSE

Propofol will cause a 25% to 40% drop in BP with 15% to 20% drop in cardiac output

A

TRUE

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8
Q

TRUE or FALSE

Induction doses of propofol cause central apnea

A

TRUE

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9
Q

TRUE or FALSE

Propofol has inherent bronchodilating effects that favor its use is asthmatic patients

A

TRUE

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10
Q

TRUE OR FALSE

Propofol has antiemetic properties

A

TRUE

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11
Q

A dissociative anesthetic that produces unconsciousness without ablating spontaneous respiration, swallowing, eye movement, or airway protective reflexes

A

Ketamine

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12
Q

Most commonly used benzodiazepine in the preoperative setting because its onset of activity is within 2 to 4 minutes

A

Midazolam

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13
Q

Most commonly used benzodiazepine in the preoperative setting because its onset of activity is within 2-4 minutes

A

Midazolam

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14
Q

3 main task of anesthesiology team

A
  1. Keep the patient safe
  2. Keep the patient comfortable
  3. Provide for optimal conditions during the preoperative, intraoperative, and immediate postoperative periods
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15
Q

The component qualities of a general anesthetic are

A
  1. Loss of consciousness
  2. Amnesia
  3. Analgesia
  4. Muscle relaxation/paralysis
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16
Q

These standards include continual evaluation of the patient’s oxygenation, ventilation, circulation, and temperature during all administered anesthetic

A

Standards for Basic Anesthetic Monitoring

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17
Q

Basic anesthetic monitoring should include

A
  1. Continuous oxygen analysis of the anesthetic circuit
  2. Pulse oximetry
  3. Continuous waveform capnography
  4. Tidal volume measurement
  5. ECG
  6. Temperature measurement
  7. Intermittent measurement of arterial BP and HR
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18
Q

To assess the degree of muscle paralysis and the return of muscle strength after pharmacologic reversal of paralyzing agents

A

Twitch monitor

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19
Q

True or False
Ketamine can increase a patient’s BP, HR and cardiac output through sympathomimetic effects and release of stored catecholamines

A

True

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20
Q

Other unique properties of ketamine

A
  1. Can administered IM
  2. Analgesic properties
  3. Increase salivary production
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21
Q

True or False

Etomidate has neutral effects on BP and cardiac output

A
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22
Q

True or False

Etomidate will also suppress the patient’s adrenal glands

A

True

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23
Q

Given preoperatively for their sedative, anxiolytic and amnestic effects

A

Benzodiazepines

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24
Q

True or False

Benzodiazepines will produce anterograde amnesia

A

True

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25
Q

True or False

In sedative doses, benzodiazepines produce mild respiratory depression

A

True

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26
Q

True or False

Coadministration of benzodiazepines with opiods can synergistically produce profound respiratory depression

A

True

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27
Q

Used intraoperatively to provide analgesia and balanced anesthesia

A

Opiods

28
Q

The most commonly used opiods are

A
  1. Fentanyl
  2. Remifentanil
  3. Sufentanil
  4. Morphine
  5. Hydromorphone
29
Q

Antagonist of opiods

A

Naloxone (u-receptor)

30
Q

True or False

Doses of lidocaine kept to 1 to 1.5 mg/kg to avoid potential toxicity

A

True

31
Q

True or False
Lidocaine can also be administered prophylactically into the same IV line as propofol to reduce propofol-induced venous irritation and patient discomfort

A

True

32
Q

A newer anesthetic agent that works as an a-2 agonist to reduce sympathetic nervous system outflow and produce a sedative effect that more nearly mimics normal sleep

A

Dexmedetomidine

33
Q

Been used for sleep endoscopy to pinpoint the area of pharyngeal obstruction prior to uvulopalatopharyngoplasty

A

Dexmedetomidine

34
Q

The most commonly seen hemodynamic effect of Dexmedetomidine

A

Bradycardia

35
Q

The most potent but slowest and longest acting of the currently available volatile anesthetics

A

Isoflurane

36
Q

Contraindicated during middle ear surgery because it can expand in a closed air space

A

Nitrous oxide

37
Q

It impairs methionine synthase, which may cause an increased rate of surgical wound infections

A

Nitrous oxide

38
Q

True or False
The volatile anesthetic agents are not often used for induction of general anesthesia in adults, but they are the most commonly used agents for maintenance of GA

A

True

39
Q

Characterized by uncontrolled skeletal muscle metabolism that leads to hyperthermia, acidosis, rhabdomyolysis, and sometimes death

A

Malignant hyperthermia

40
Q

The most commonly agent for TIV

A

Propofol

-mixes of ketamine and propofol may also be used to balance the hemodynamic effects

41
Q

Commonly used during suspension laryngoscopy

A

Remifentanil

42
Q

Two classes of paralytic agents:

A
  1. Depolarizing agents

2. Nondepolarizing neuromuscular blockers

43
Q

Only depolarizing paralytic agent

A

Succinylcholine

44
Q

Acts on acetylcholine receptors in the neuromuscular junction, activating the receptors but then occupying them, thereby prolonging the refractory period before the muscle can contract again

A

Succinylcholine

45
Q

Major advantage of succinylcholine

A

Very fast onset of action

46
Q

Succinylcholine:

Paralysis sufficient for endotracheal intubation can be reliably produced within

A

45-60 seconds

47
Q

Succinylcholine is metabolized and deactivated by

A

Pseudocholinesterase

48
Q

Clinical paralysis of succinylcholine usually dissipates within

A

5-8 minutes

49
Q

Most common muscle relaxant trigger for MH

A

Succinylcholine

50
Q

Primary contraindications to the use of succinylcholine:

A
  1. Known or suspected MH
  2. Increased ICP
  3. Increased IOP
  4. Elevated serum K
51
Q

Nondepolarizing agent of choice for RSI in whom succinylcholine use is contraindicated

A

Rocuronium

* onset action between 60 and 75 seconds

52
Q

Marked disadvantage of Rocuronium

A

Given in doses sufficient for intubation, persists for 40-40 minutes

53
Q

A newly available reversal agent that binds Rocuronium and Vecuronium, thus removing neuromuscular bloackade

A

Sugammadex

54
Q

In CNS, it prevents reuptake of neurotranmitters, including dopamine and NE

A

Cocaine

55
Q

Most commonly used anesthetics for local infiltration or nerve blocks

A

Lidocaine and Bupivacaine

56
Q

True or False
Local anesthetic toxicity manifests initially as CNS depression and seizures followed by cardiovascular dysrhythmias with the potential for ventricular fibrillation

A

True

57
Q

True or False
The maximum dose of lidocaine (5mg/kg) may be increased (to 7mg/kg) if epinephrine is used in the solution to slow uptake from the subcutaneous tissues into the general circulation

A

True

58
Q

The maximum dose of Bupivacaine + Epinephrien solution

A

2-3 mg/kg

59
Q

True or False

Local anesthetics can produce toxic effects at much lower doses if they are administered directly into the circulation

A

True

60
Q

Most commonly used drugs for intraoperative control of hypertension and tachycardia related to airway management

A
  1. Beta blockers esmolol and metoprolol

2. Mixed alpha and beta-blocker labetalol

61
Q

“ A clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both”—ASA

A

Difficult airway

62
Q

System of 3 classes to predict a difficult airway based on the position and visibility of certain anatomic structures (Mallampati)

A
  1. Uvula
  2. Fauces
  3. Soft palate
63
Q

System of four grades to predict a difficult airway based on the position and visibility of certain anatomic structures (Modified Mallampati/Cormack an d Lehane)

A
  1. Glottic aperture
  2. Posterior arytenoids
  3. Epiglottis
64
Q

Other physical predictors of anticipated difficulty with conventional direct laryngoscopy include

A
  1. Prominent overbite
  2. Receding chin
  3. Large tongue
  4. Narrow mouth opening (interincisor distance or gap)
  5. Short neck
  6. Limited neck flexibility
  7. Obesity
65
Q

Other ways to predict a difficult airway use a measurement of the

A

Thyromental distance or the sternomental distance

66
Q

LMA

A

Laryngeal mask airway

GENERAL OTOLARYNGOLOGY (12 decks)

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