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06 - absite > Chapter 8: Anesthesia > Flashcards

Chapter 8: Anesthesia Flashcards

1
Q
  • Blunt hypoxic drive
  • Caused unconsciousness, amnesia, some analgesia
  • Most have myocardial depression, increase CBF, decrease RBF
A

Inhalational agent

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2
Q

Smallest concentration of inhalation agent at which 50% of patients will not move with incision

A

MAC (minimum alveolar concentration)

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3
Q

Fast, minimal myocardial depression; tremors at induction

A

Nitrous oxide (NO2)

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4
Q
  • Slow onset / offset, highest degree of cardiac depression and arrhythmias
  • Least pungent, which is good for children
A

Halothane

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5
Q

Manifestations of halothane hepatitis

A

Fever, eosinophilia, jaundice, increased LFTs

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6
Q

Fast, less laryngospasm and less pungent; good for mask induction

A

Sevoflurane

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7
Q

Good for neurosurgery (lowers brain oxygen consumption; no increase in ICP)

A

Isoflurane

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8
Q

Can cause seizures

A

Enflurane

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9
Q
  • (Barbiturate) fast acting

- Side effects: decrease CBF and metabolic rate, decrease blood pressure

A

Sodium thiopental

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10
Q
  • Very rapid distribution and on/off; amnesia; sedative
  • Not an analgesic
  • Metabolized in liver and by plasma cholinesterase’s
  • Side effects: hypotension, respiratory depression
A

Propofol

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11
Q

Dissociation of thalamic / limbic systems; places patient in a cataleptic state (amnesia, analgesia).

  • No respiratory depression
  • Contraindicated in patients with head injury
  • Good for children
A

Ketamine

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12
Q

Side effects: hallucinations, cathetcholamine release (increase CO2, tachycardia), increased airway secretions and increased cerebral blood flow

A

Ketamine

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13
Q
  • Fewer hemodynamic changes; fast acting

- Continuous infusions can lead to adrenocortical suppression

A

Etomidate

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14
Q

When is RSI indicated?

A
  • Recent oral intake
  • GERD
  • Delayed gastric emptying
  • Pregnancy
  • Bowel obstruction
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15
Q

Last muscle to go down and first muscle to recover from paralytics

A

Diaphragm

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16
Q

First to go down and last to recover from paralytics

A

Neck muscles and face

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17
Q

Only one is succinylcholine; depolarizes neuromuscular junction

A

Depolarizing agents

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18
Q
  • Caused by a defect in calcium metabolism

- Calcium released from sarcoplasmic reticulum causes muscle excitation: contraction syndrome

A

Malignant hyperthermia

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19
Q

First sign of malignant hyperthermia

A

Increased end-tidal CO2

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20
Q

Side effects: first sign is increased end-tidal CO2, then fever, tachycardia, rigidity, acidosis, hyperkalemia

A

Malignant hyperthermia

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21
Q

Tx: dantrolene (10mg/kg) inhibits calcium release and decouples excitation; cooling blankets, HCO3, glucose, supportive care

A

Malignant hyperthermia

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22
Q

When do you NOT use succinylcholine?

A 
Severe burns.
Neurologic injury.
Neuromuscular disorders.
Spinal cord injury. 
Massive trauma.
Acute renal failure.
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23
Q

Complications of succinylcholine

A
  • Malignant hyperthermia
  • Hyperkalemia
  • Open-angle glaucoma
  • Atypical pseudocholinesterases
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24
Q
  • Inhibits neuromuscular junction by competing with acetylcholine
  • Can get prolongation of these agents with myasthenia gravis
A

Nondepolarizing agents

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25
Q

Non-depolarizer

  • Undergoes Hoffman degradation
  • Can be used in liver and renal failure
  • Histamine release
A

Cis-atracurium

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26
Q

Non-depolarizer: Fast, intermediate duration; hepatic metabolism

A

Rocuronium

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27
Q

Non-depolarizer:

  • Slow acting, long-lasting; renal metabolism
  • Most common side effect: tachycardia
A

Pancuronium

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28
Q

Blocks acetylcholinesterase, increasing acetylcholine

A

Neostigmine

Edrophonium

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29
Q

Should be with neostigmine or edrophonium to counteract effects of generalized acetylcholine overdose

A

Atropine or glycopyrrolate

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30
Q

Work by increasing action potential threshold, preventing Na influx.
- Can use 0.5 cc/kg of 1% lidocaine.

A

Local anesthestics

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31
Q

Why are infected tissues difficult to anesthetize with local anesthetics?

A

Secondary to acidosis.

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32
Q

Length of action of local anesthetics: greatest to least

A

Bupivacaine > lidocaine > procaine

33
Q

Side effects of local anesthetics

A

Tremors
Seizures
Tinnitus
Arrhythmias (CNS symptoms occur before cardiac)

34
Q

What does addition of epinephrine to local anesthetics allow?

A

Allows higher doses to be used, stays locally

35
Q

When do you not use epinephrine with local anesthetics?

A

No epi with:

Arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals (penis and ear), uteroplacental insufficiency

36
Q

Two different genres of local anesthetics

A

Amides (all have “i” in first part of their name)

Esters

37
Q

Allergic reactions: amides vs esters

A

Esters: increased allergic reactions due to PABA analogue

38
Q

Metabolism: opioids

A

Metabolized by the liver and excreted via kidney

39
Q

What can narcotics cause precipitate in patients on MAOIS?

A

Hyperpyrexic coma

40
Q

Analgesia, euphoria, respiratory depression, miosis, constipation, histamine release (causes hypotension), decreased cough

A

Morphine

41
Q

Analgesia, euphoria, respiratory depression, miosis, tremors, fasciculations, convulsions

A

Demerol

42
Q

Does demerol cause histamine release?

A

NO.

43
Q

Why avoid demerol in patients with renal failure?

A

Can cause seizures (buildup of normeperidine analogues)

44
Q

simulates morphine, less euphoria

A

Methadone

45
Q

Fast acting; 80x strength of morphine (does not cross-react in patients with morphine allergy); no histamine release

A

Fentanyl

46
Q

Very fast acting narcotics with short half lives

A

Sufentanil and remifentanil

47
Q

Most potent narcotic

A

Sufentanil

48
Q

Anticonvulsant.
Amnesic.
Anxiolytic.
Respiratory depression.

A

Benzodiazepines

49
Q

Do benzodiazepines have pain relief?

A

No.

50
Q

Metabolism: benzos

A

Liver

51
Q

Benzo:

  • Short acting
  • Contraindicated in pregnancy
  • Crosses placenta
A

Versed (midazolam)

52
Q

Benzo:

- Intermediate acting

A

Valium (Diazepam)

53
Q

Benzo:

- Long acting

A

Ativan (lorazepam)

54
Q
  • Benzo OD
  • Competitive inhibitor
  • May cause seizures and arrhythmias
  • Contraindicated in patients with elevated ICP or status epilepticus
A

Flumazenil

55
Q

MC side effect flumazenil

A

Nausea

56
Q

Allows analgesia by sympathetic denervation.

Vasodilation.

A

Epidural anesthesia

57
Q

Epidural with morphine

A

Can cause respiratory depression

58
Q

Lidocaine in epidural

A

Decreased heart rate and blood pressure

59
Q

How can motor function be spared with epidural?

A

Dilute concentrations

60
Q

Tx: acute hypotension / bradycardia with epidural

A

Turn epidural flows down.
Fluids.
Phenylephrine.
Atropine

61
Q

Epidural level: affect cardiac accelerator nerves

A

T1-5

62
Q

Contraindications: epidural

A

Hypertrophic cardiomyopathy.

Cyanotic heart disease.

63
Q

Why h-cmp and cyanotic heart disease contraindications to epidural anesthesia?

A

Sympathetic denervation causes decreased after load, which worsens these conditions

64
Q

Injection into subarachnoid space, spread determined by baricity and patient position

A

Spinal anesthesia

65
Q

Contraindications: spinal

A

Hypertrophic cardiomyopathy.

Cyanotic heart disease.

66
Q

Caused by CSF leak after spinal / epidural.

Headache gets worse sitting up.

A

Spinal headache

67
Q

Tx: Spinal headache

A

Rest. Fluids. Caffeine. Analgesics. Blood patch to site if it persists > 24 hours.

68
Q

Associated with most postop hospital mortality

A
  1. Pre-op renal failure

2. CHF

69
Q

May have no pain or EKG changes. Can have hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia.

A

Postop MI

70
Q

Patients who need cardiology workup pre-op (x13)

A

Angina. Previous MI. SOB. CHF. METs 5min. High grade heart block. Age >70. DM. Renal insufficiency. Patients undergoing major vascular surgery.

71
Q

Considered high risk surgery

A

Most aortic, major vascular, peripheral vascular surgery

72
Q

Risk: carotid endarterectomy (CEA)

A

Considered moderate risk surgery

73
Q

Biggest risk factors for post MI

A 
Age > 70.
DM.
Previous MI.
CHF.
Unstable angina.
74
Q

Best determinate of esophageal vs tracheal intubation

A

End-tidal CO2

75
Q

Intubated patient undergoing surgery with sudden transient rise in ETCO2
Dx? Tx?

A

Dx: most likely hypoventilation.
Tx: increased tidal volume or increased respiratory rate.

76
Q

Goal endotracheal tube placement

A

2cm above the carina

77
Q

Associated with lower mortality for abdominal aortic aneurysm repair and for pancreatic resection

A

Higher volume hospitals

78
Q

MC PACU complication

A

nausea and vomiting.

06 - absite (44 decks)

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