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My 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
Non-depolarizer - Undergoes Hoffman degradation - Can be used in liver and renal failure - Histamine release
Cis-atracurium
26
Non-depolarizer: Fast, intermediate duration; hepatic metabolism
Rocuronium
27
Non-depolarizer: - Slow acting, long-lasting; renal metabolism - Most common side effect: tachycardia
Pancuronium
28
Blocks acetylcholinesterase, increasing acetylcholine
Neostigmine | Edrophonium
29
Should be with neostigmine or edrophonium to counteract effects of generalized acetylcholine overdose
Atropine or glycopyrrolate
30
Work by increasing action potential threshold, preventing Na influx. - Can use 0.5 cc/kg of 1% lidocaine.
Local anesthestics
31
Why are infected tissues difficult to anesthetize with local anesthetics?
Secondary to acidosis.
32
Length of action of local anesthetics: greatest to least
Bupivacaine > lidocaine > procaine
33
Side effects of local anesthetics
Tremors Seizures Tinnitus Arrhythmias (CNS symptoms occur before cardiac)
34
What does addition of epinephrine to local anesthetics allow?
Allows higher doses to be used, stays locally
35
When do you not use epinephrine with local anesthetics?
No epi with: | Arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals (penis and ear), uteroplacental insufficiency
36
Two different genres of local anesthetics
Amides (all have "i" in first part of their name) | Esters
37
Allergic reactions: amides vs esters
Esters: increased allergic reactions due to PABA analogue
38
Metabolism: opioids
Metabolized by the liver and excreted via kidney
39
What can narcotics cause precipitate in patients on MAOIS?
Hyperpyrexic coma
40
Analgesia, euphoria, respiratory depression, miosis, constipation, histamine release (causes hypotension), decreased cough
Morphine
41
Analgesia, euphoria, respiratory depression, miosis, tremors, fasciculations, convulsions
Demerol
42
Does demerol cause histamine release?
NO.
43
Why avoid demerol in patients with renal failure?
Can cause seizures (buildup of normeperidine analogues)
44
simulates morphine, less euphoria
Methadone
45
Fast acting; 80x strength of morphine (does not cross-react in patients with morphine allergy); no histamine release
Fentanyl
46
Very fast acting narcotics with short half lives
Sufentanil and remifentanil
47
Most potent narcotic
Sufentanil
48
Anticonvulsant. Amnesic. Anxiolytic. Respiratory depression.
Benzodiazepines
49
Do benzodiazepines have pain relief?
No.
50
Metabolism: benzos
Liver
51
Benzo: - Short acting - Contraindicated in pregnancy - Crosses placenta
Versed (midazolam)
52
Benzo: | - Intermediate acting
Valium (Diazepam)
53
Benzo: | - Long acting
Ativan (lorazepam)
54
- Benzo OD - Competitive inhibitor - May cause seizures and arrhythmias - Contraindicated in patients with elevated ICP or status epilepticus
Flumazenil
55
MC side effect flumazenil
Nausea
56
Allows analgesia by sympathetic denervation. | Vasodilation.
Epidural anesthesia
57
Epidural with morphine
Can cause respiratory depression
58
Lidocaine in epidural
Decreased heart rate and blood pressure
59
How can motor function be spared with epidural?
Dilute concentrations
60
Tx: acute hypotension / bradycardia with epidural
Turn epidural flows down. Fluids. Phenylephrine. Atropine
61
Epidural level: affect cardiac accelerator nerves
T1-5
62
Contraindications: epidural
Hypertrophic cardiomyopathy. | Cyanotic heart disease.
63
Why h-cmp and cyanotic heart disease contraindications to epidural anesthesia?
Sympathetic denervation causes decreased after load, which worsens these conditions
64
Injection into subarachnoid space, spread determined by baricity and patient position
Spinal anesthesia
65
Contraindications: spinal
Hypertrophic cardiomyopathy. | Cyanotic heart disease.
66
Caused by CSF leak after spinal / epidural. | Headache gets worse sitting up.
Spinal headache
67
Tx: Spinal headache
Rest. Fluids. Caffeine. Analgesics. Blood patch to site if it persists > 24 hours.
68
Associated with most postop hospital mortality
1. Pre-op renal failure | 2. CHF
69
May have no pain or EKG changes. Can have hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia.
Postop MI
70
Patients who need cardiology workup pre-op (x13)
Angina. Previous MI. SOB. CHF. METs 5min. High grade heart block. Age >70. DM. Renal insufficiency. Patients undergoing major vascular surgery.
71
Considered high risk surgery
Most aortic, major vascular, peripheral vascular surgery
72
Risk: carotid endarterectomy (CEA)
Considered moderate risk surgery
73
Biggest risk factors for post MI
``` Age > 70. DM. Previous MI. CHF. Unstable angina. ```
74
Best determinate of esophageal vs tracheal intubation
End-tidal CO2
75
Intubated patient undergoing surgery with sudden transient rise in ETCO2 Dx? Tx?
Dx: most likely hypoventilation. Tx: increased tidal volume or increased respiratory rate.
76
Goal endotracheal tube placement
2cm above the carina
77
Associated with lower mortality for abdominal aortic aneurysm repair and for pancreatic resection
Higher volume hospitals
78
MC PACU complication
nausea and vomiting.

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