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Comprehensive Prep > Chapter 8: Anesthesia > Flashcards

Chapter 8: Anesthesia Flashcards

1
Q

Inhalational agents: effects

A
  • Blunt hypoxic drive
  • Caused unconsciousness, amnesia, some analgesia
  • Most have myocardial depression, increase CBF, decrease RBF
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2
Q

MAC (minimum alveolar concentration)

A

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

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3
Q

Nitrous oxide (NO2)

A

Fast, minimal myocardial depression; tremors at induction

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4
Q

Halothane

A
  • Slow onset / offset, highest degree of cardiac depression and arrhythmias
  • Least pungent, which is good for children
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5
Q

Manifestations of halothane hepatitis

A

Fever, eosinophilia, jaundice, increased LFTs

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6
Q

Sevoflurane

A

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

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7
Q

Isoflurane

A

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

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8
Q

Enflurane

A

Can cause seizures

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9
Q

Sodium thiopental

A
  • (Barbiturate) fast acting

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

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10
Q

Propofol

A
  • Very rapid distribution and on/off; amnesia; sedative
  • Not an analgesic
  • Metabolized in liver and by plasma cholinesterase’s
  • Side effects: hypotension, respiratory depression
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11
Q

Ketamine

A

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

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12
Q

Etomidate

A

Fewer hemodynamic changes; fast acting

- Continuous infusions can lead to adrenocortical suppression

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13
Q

When is RSI indicated?

A
  • Recent oral intake
  • GERD
  • Delayed gastric emptying
  • Pregnancy
  • Bowel obstruction
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14
Q

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

A

Diaphragm

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15
Q

First to go down and last to recover from paralytics

A

Neck muscles and face

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16
Q

Malignant hyperthermia: pathophysiology

A
  • Caused by a defect in calcium metabolism

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

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17
Q

Malignant hyperthermia: signs

A

Increased end-tidal CO2…

then fever, tachycardia, rigidity, acidosis, hyperkalemia

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18
Q

Malignant hyperthermia: treatment

A

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

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19
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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20
Q

Complications of succinylcholine

A
  • Malignant hyperthermia
  • Hyperkalemia
  • Open-angle glaucoma
  • Atypical pseudocholinesterases
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21
Q

Nondepolarizing agents: mechanism

A
  • Inhibits neuromuscular junction by competing with acetylcholine
  • Can get prolongation of these agents with myasthenia gravis
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22
Q

Cis-atracurium

A

Non-depolarizer

  • Undergoes Hoffman degradation
  • Can be used in liver and renal failure
  • Histamine release
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23
Q

Rocuronium

A

Non-depolarizer: Fast, intermediate duration; hepatic metabolism

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24
Q

Pancuronium

A

Non-depolarizer:

  • Slow acting, long-lasting; renal metabolism
  • Most common side effect: tachycardia
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25
Q

Neostigmine, Edrophonium: mechanism

A

Blocks acetylcholinesterase, increasing acetylcholine

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26
Q

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

A

Atropine or glycopyrrolate

27
Q

Local anesthestics: mechanism

A

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

28
Q

Why are infected tissues difficult to anesthetize with local anesthetics?

A

Secondary to acidosis.

29
Q

Length of action of local anesthetics: greatest to least

A

Bupivacaine > lidocaine > procaine

30
Q

Side effects of local anesthetics

A

Tremors
Seizures
Tinnitus
Arrhythmias (CNS symptoms occur before cardiac)

31
Q

What does addition of epinephrine to local anesthetics allow?

A

Allows higher doses to be used, stays locally

32
Q

When do you not use epinephrine with local anesthetics?

A

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

33
Q

Two different genres of local anesthetics

A

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

Esters

34
Q

Allergic reactions: amides vs esters

A

Esters: increased allergic reactions due to PABA analogue

35
Q

Metabolism: opioids

A

Metabolized by the liver and excreted via kidney

36
Q

What can narcotics cause precipitate in patients on MAOIs?

A

Hyperpyrexic coma

37
Q

Morphine: effects

A

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

38
Q

Demerol: effects

A

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

39
Q

Does demerol cause histamine release?

A

NO.

40
Q

Why avoid demerol in patients with renal failure?

A

Can cause seizures (buildup of normeperidine analogues)

41
Q

Fentanyl

A

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

42
Q

Benzodiazepines: effects

A

Anticonvulsant.
Amnesic.
Anxiolytic.
Respiratory depression.

43
Q

Benzodiazepines: metabolized in

A

Liver

44
Q

Versed (midazolam)

A

Benzo:

  • Short acting
  • Contraindicated in pregnancy
  • Crosses placenta
45
Q

Valium (Diazepam)

A

Benzo:

- Intermediate acting

46
Q

Ativan (lorazepam)

A

Benzo:

- Long acting

47
Q

Flumazenil

A
  • Competitive inhibitor
  • May cause seizures and arrhythmias
  • Contraindicated in patients with elevated ICP or status epilepticus
48
Q

Epidural anesthesia

A

Allows analgesia by sympathetic denervation.

Vasodilation.

49
Q

Epidural with morphine can cause…

A

Can cause respiratory depression

50
Q

Epidural with lidocaine can cause…

A

Decreased heart rate and blood pressure

51
Q

How can motor function be spared with epidural?

A

Dilute concentrations

52
Q

Tx: acute hypotension / bradycardia with epidural

A

Turn epidural flow down.
Fluids.
Phenylephrine.
Atropine

53
Q

Epidural level: affect cardiac accelerator nerves

A

T1-5

54
Q

Contraindications: epidural

A

Hypertrophic cardiomyopathy.

Cyanotic heart disease.

55
Q

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

A

Sympathetic denervation causes decreased after load, which worsens these conditions

56
Q

Spinal anesthesia

A

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

57
Q

Contraindications: spinal

A

Hypertrophic cardiomyopathy.

Cyanotic heart disease.

58
Q

Tx: Spinal headache

A

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

Headache is worse sitting up.

59
Q

Associated with most postop hospital mortality

A
  1. Pre-op renal failure

2. CHF

60
Q

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

A

Postop MI

61
Q

Considered high risk surgery

A

Most aortic, major vascular, peripheral vascular surgery

62
Q

Risk: carotid endarterectomy (CEA)

A

Considered moderate risk surgery

63
Q

Biggest risk factors for post MI

A 
Age > 70.
DM.
Previous MI.
CHF.
Unstable angina.
64
Q

MC PACU complication

A

nausea and vomiting.

Comprehensive Prep (45 decks)

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