Charts Flashcards
What is the induction dose of propofol?
1.5-2.5mg/kg
What is the induction dose of etomidate?
0.3-0.6mg/kg
What is the induction dose of ketamine?
1-2mg/kg
What is the induction dose of methohexital?
1-2mg/kg
What is the induction dose of thiopental?
3-4mg/kg
What is the induction dose of succinylcholine?
1-1.5mg/kg
What is the induction dose of
Rocuronium?
0.6mg/kg = standard induction
What is the RSI induction dose of Rocuronium?
1.2mg/kg = RSI
What is the RSI induction dose of Vecuronium?
0.1mg/kg
What is the RSI induction dose of Cisatracurium?
0.1mg/kg
What is the defasculating dose of rocuronium?
0.04 mg/kg
What is the defasculating dose of vecuronium?
0.3 mg
What is the time to wait after giving Succinylcholine?
Good to excellent intubating conditions in 60-90 secs
What is the time to wait after giving induction dose Rocuronium?
Good to excellent intubating conditions in 1.5-2 min
What is the time to wait after giving RSI dose of Rocuronium?
Good to excellent intubating conditions within 45-90 secs
What is the time to wait after giving Vecuronium?
Good to excellent intubating conditions within 2-4 min
What is the time to wait after giving Cistracurium?
Time to maximum block is 5.2 min
What is the first component of negative pressure pulmonary edema development?
An upper airway obstruction occurs
What is the 2 component of negative pressure pulmonary edema development?
The patient continuous trying to inhale against the obstruction
What is the 3 component of negative pressure pulmonary edema development?
A high degree of negative intrathoracic pressure develops
What is the 4 component of negative pressure pulmonary edema development?
Venous return to the heart increases
What is the 5 component of negative pressure pulmonary edema development?
Cardiac output decreases
What is the 6 component of negative pressure pulmonary edema development?
Pressure in the pulmonary capillary bed increases
What is the 7 component of negative pressure pulmonary edema development
A disruption in the alveolar membrane junction occurs
What is the 8 component of negative pressure pulmonary edema development?
Fluid from the interstital space floods into the alveoli
What is the 9 component of negative pressure pulmonary edema development?
Airway obstruction is relieved
What is the 10 component of negative pressure pulmonary edema development?
Pulmonary edema remains
What are the signs of bronchospasms in an intubated patient?
- ) increased peak airway pressures
- ) wheezing on lung exam
- ) increased expiratory time
- ) Increased ETCO2 with upsloping waveform
- ) Decreased tidal volumes if pressure control
What is happening to a bronchospatic patient that suddenly develops hypo tension?
May be air trapping-disconnect patient from circuit to allow for complete exhalation
What is the treatment for bronchospasms?
- increase to 100% O2 high flow
- change I:E time to allow for adequate exhalation
- deepen volatile anesthetic (Sevo non irritating)
- rule out mainstem intubation or kinked ETT. Suction ETT
- administer inhaled agents (beta 2 agonists- albuterol), +/-anticholinergic (ipratropium)
- if severe consider epi (10 ug IV and escalate, monitor for tachycardia and hypertension)
- consider ketamine (0.2-1 mg/kg IV)
- Consider hydrocortisone 100 mg IV
- consider nebulized racemic epinephrine
- rule out analphylaxis (hypotension/tachycardia/rash)
- consider abg
If you believe someone is showing signs of bronchospasm what do you want to do
Call for help, inform the team or code cart
What is the I stage of anesthesia associated with?
Loss of pain sensation
What is the II stage of anesthesia associated with?
Combative behavior
What is the III stage of anesthesia depth associated with?
Surgical anesthesia
What is the iv stage of anesthesia depth associated with?
Medullary paralysis and death
Know the depth of anesthesia.
slide 30
What are presurgery components of ERAS? (4)
- Patient education and pre-surgery counseling
- meeting with a surgeon or nurse
- carb drink prior to surgery
- use of epidurals for pain control
What are during surgery components of ERAS? (4)
- goal directed fluid management
- judicious use of opioid pain medications
- shorter incisions and use of laparoscopic approach when possible
- careful considerations of blood transfusions
What are post-surgery components of ERAS? (4)
- early post procedure mobilization
- early removal of tubes and drains
- early transition to oral pain medications
- early allowance of food intake
What are better outcomes components of ERAS? (4)
- Increased patient satisfaction with care
- decreased perioperative complications
- decreased length of stay
- improved use of hospital resources
What is included in the prehospital phase of ERAS?
Patient/family education, pain management plan, patient optimization and prehabilitation of select patients
What is included in the preoperative phase of ERAS?
Opioid sparing (multimodal analgesia), normovolemia, n/v prophylaxis, normothermia, normaglycemia, avoid tubes and drains
What is included in the postoperative phase of ERAS?
Early nutrition, early mobilization, multimodal analgesia, N/V, no or judicious IV fluid management, patient/family education
What is included in the postdischarge phase of ERAS?
Monitor for symptoms or changes in health to seek assistance, follow up with surgeon, procedural, primary care and specialty, continue therapy and other interprofessional activities as planned
What is included in the continued quality improvement team activities phase of ERAS?
analyze and share quality measures, patient surveys and staff input to celebrate successes and id opportunities for improvement.
What are some indications for opioid free anesthesia?
- Narcotic abuse history
- opioid intolerance
- morbidity obese with OSA
- hyperalgesia
- Hx of chronic pain (immune deficiency, oncology surgery or inflam. disease)
- less preop. analgesic requirement
- ERAS after surgery
- Decreased PONV
- Decreased postoperative pumonary morbitity (COPD, asthma or respiratory insufficency)
- Decreased histamine release
- patient satisfication
What type of analegia action is produced with mu, kappa and delta receptor targets?
Supraspinal, spinal
Delta- modulates mu receptor activity
What type of cardiovascular action is produced with mu, kappa and delta receptor targets?
Only the mu has an effect of bradycardia
What type of respiratory action is produced with mu & delta receptor targets?
Depression
What type of respiratory is produced with kappa receptor targets?
Possible depression
What type of pupil is produced with mu, kappa and delta receptor targets?
Miosis from (Mu and kappa, no delta)
What type of GI is produced with mu, kappa and delta receptor targets?
Only in the Mu- inhibition of peristalsis, N/V
What type of GU is produced with mu and delta receptor targets?
Urinary retention
What type of GU is produced with kappa receptor targets?
Diuresis (inhibition of vasopressin release)
What type of pruitis is produced with mu, kappa and delta receptor targets?
Only with mu and delta, not occur from the kappa
What type of physical dependence is produced with mu, delta receptor targets?
Yes it is possible
What type of physical dependence is produced with kappa receptor targets?
Low abuse potential
What type of receptor stimulation produces antishivering?
Kappa receptor
What type of CNS is produced with mu receptor targets?
Euphoria, sedation, prolactin release, mild hypothermia, catalepsy, indifference to environment stimulus
What type of CNS is produced with kappa receptor targets?
Sedation, dysphoria, psychomimetic reactions (hallucinations and delirium)
