Chapter 8 - Anesthesia

Question 2

Small MAC means what?

Answer 2

More lipid soluble = more potent = slow speed of induction

Question 3

Effects of inhalational agents?

Answer 3

Unconsciousness, amnesia, some degree of analgesia

Question 4

Side effects of inhalational agents?

Answer 4

Blunted hypoxic drive, myocardial depression, increased cerebral blood flow, decreased renal blood flow

Question 5

Characteristics of NO2?

Answer 5

Fast, minimal myocardial depression

Question 6

Characteristics of halothane?

Answer 6

Slow, highest degree of cardiac depression and arrhythmias, least pungent (good for kiddies)

Question 7

What is halothane hepatitis?

Answer 7

Fever, eosinophilia, jaundice, increased LFTs

Question 8

Side effect of enflurane?

Answer 8

Seizures

Question 9

Characteristics of sevoflurane?

Answer 9

Less myocardial depression, fast on/off, less laryngospasm, higher cost

Question 10

Side effects of sodium thiopental (barbiturate)?

Answer 10

Decreased cerebral blood flow and metabolic rate, decreased blood pressure

Question 11

Characteristics of propofol?

Answer 11

Very rapid distribution and on/off, amnesia, sedative; NOT an analgesic

Question 12

Side effects of propafol?

Answer 12

Hypotension, respiratory depression; do not sure in pts with egg allergy

Question 13

Characteristics of ketamine?

Answer 13

Dissociation of thalamic/limbic systems, places pts in cataleptic state (amnesia, analgesia); no respiratory depression

Question 14

Side effects of ketamine?

Answer 14

Hallucinations, catecholamine release (inc. CO and tachycardia), inc. airway secretions, inc. cerebral blood flow (contraindicated in head injuries)

Question 15

Characteristics of etomidate?

Answer 15

Fewer hemodynamic changes, fast acting

Question 16

Side effect of etomidate?

Answer 16

Continuous infusions can lead to adrenocortical suppression

Question 17

What is the last muscle to go down and 1st to recover from paralytics?

Answer 17

Diaphragm

Question 18

What is the 1st muscles to go down and last to recover from paralytics?

Answer 18

Neck and face muscles

Question 19

What is the only depolarizing agent?

Answer 19

Succinylcholine

Question 20

Characteristics of succinylcholine?

Answer 20

Fast, short acting; causes fasciculations

Question 21

Side effects of succinylcholine?

Answer 21

Malignant hyperthermia, inc. ICP, incraed end-tidal CO2 then fever, tachycardia, rigidity, acidosis, hyperkalemia

Question 22

Treatment of malignant hyperthermia?

Answer 22

Dantrolene: inhibits Ca release and decouples excitation complex; cooling blankets, HCO3, glucose, supportive care

Question 23

What patients do you NOT use succinycholine in?

Answer 23

Burn patients, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure

Question 24

Nondepolarizing agents MOA?

Answer 24

Inhibit neuromuscular junction by competing with ACh

Question 25

What can cause prolongation of nondepolarizing agents?

Answer 25

Hypothermia, hypercarbia, certain abx, electrolyte abnormalities, myasthenia gravis

Question 26

Which nondepolarizing agent can be used in liver and renal failure?

Answer 26

Cis-atracurium (because it undergoes Hoffman degradation)

Question 27

Where is rocuronium metabolised?

Answer 27

Liver

Question 28

How does neostigmine reverse nondepolarizing agents?

Answer 28

Blocks AChE, increasing ACh

Question 29

How does edrophonium reverse nondepolarizing agents?

Answer 29

Blocks AChe, increasing ACh

Question 30

What should be given with nondepolarizing reveral agents to counteract effects of generalized ACh overdose?

Answer 30

Atropine or glycopyrrolate

Question 31

How do local anesthetics work?

Answer 31

By increasing action potential threshold, preventing Na influx

Question 32

What is the max dose of 1% lidocaine?

Answer 32

0.5cc/kg

Question 33

Why are infected tissues hard to anesthetize?

Answer 33

Acidosis

Question 34

When should you not use epinephrine with local anesthetics?

Answer 34

Patients with arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals, uteroplacental insufficiency

Question 35

What type of local anesthetic has a higher rate of allergic reaction?

Answer 35

Esters (secondary to PABA analogue)

Question 36

Narcotic receptor?

Answer 36

Mu

Question 37

What happens when you mix narcotics in patients on MAOIs?

Answer 37

Can cause hyperpyrexic coma

Question 38

Effects of narcotics?

Answer 38

Profound analgesia, respiratory depression (dec. CO2 drive), no cardiac effects, blunted sympathetic response

Question 39

Unique side effects of morphine?

Answer 39

Decreased cough, constipation, histamine release

Question 40

Unique side effects of demerol?

Answer 40

Tremors, fasciculations, convulsions, NO histamine release

Question 41

In which patients should you avoid the use of demerol?

Answer 41

Renal failure - can get buildup of normeperidine analogue and result in seizures

Question 42

Morphine in epidural can cause what?

Answer 42

Respiratory depression

Question 43

Lidocaine in epidural can cause what?

Answer 43

Decreased heart rate and blood pressure

Question 44

Treatment for acute hypotension and bradycardia in patient with epidural?

Answer 44

Turn epidural down, fluids, phenylephrine, atropine

Question 45

Treatment for spinal headaches?

Answer 45

Rest, increased fluids, caffeine, analgesics; blood patch if persists >24h

Question 46

Contraindications for spinal anesthesia?

Answer 46

Hypertrophic cardiomyopathy, cyanotic heart disease

Question 47

What two conditions are associated with the most postoperative hospital mortality?

Answer 47

CHF and renal failure

Question 48

Presentation of post-op MI?

Answer 48

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

Question 49

Which patients need a cardiology workup?

Answer 49

Angina, previous MI, SOB, CHF, FEV1 5/min, age >70, patients undergoing major vascular surgery

Question 50

Biggest risk factors for postop MI?

Answer 50

Age >70, DM, previous MI, CHF, unstable angina

Question 51

What is the best determinant of esophageal vs. tracheal intubation?

Answer 51

End tidal CO2

Question 52

What causes an intubated patient to have sudden transient rise in ETCO2?

Answer 52

Alveolar hypoventilation; increase TV or RR

Question 53

What causes an intubated patient to have a sudden drop in ETCO2?

Answer 53

Disconnected from the vent; PE or significant hypotension