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2-General Anesthesia Exam 1 > Charts > Flashcards

Charts Flashcards

1
Q

What is the induction dose of propofol?

A

1.5-2.5mg/kg

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2
Q

What is the induction dose of etomidate?

A

0.3-0.6mg/kg

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3
Q

What is the induction dose of ketamine?

A

1-2mg/kg

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4
Q

What is the induction dose of methohexital?

A

1-2mg/kg

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5
Q

What is the induction dose of thiopental?

A

3-4mg/kg

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6
Q

What is the induction dose of succinylcholine?

A

1-1.5mg/kg

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7
Q

What is the induction dose of

Rocuronium?

A

0.6mg/kg = standard induction

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8
Q

What is the RSI induction dose of Rocuronium?

A

1.2mg/kg = RSI

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9
Q

What is the RSI induction dose of Vecuronium?

A

0.1mg/kg

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10
Q

What is the RSI induction dose of Cisatracurium?

A

0.1mg/kg

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11
Q

What is the defasculating dose of rocuronium?

A

0.04 mg/kg

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12
Q

What is the defasculating dose of vecuronium?

A

0.3 mg

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13
Q

What is the time to wait after giving Succinylcholine?

A

Good to excellent intubating conditions in 60-90 secs

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14
Q

What is the time to wait after giving induction dose Rocuronium?

A

Good to excellent intubating conditions in 1.5-2 min

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15
Q

What is the time to wait after giving RSI dose of Rocuronium?

A

Good to excellent intubating conditions within 45-90 secs

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16
Q

What is the time to wait after giving Vecuronium?

A

Good to excellent intubating conditions within 2-4 min

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17
Q

What is the time to wait after giving Cistracurium?

A

Time to maximum block is 5.2 min

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18
Q

What is the first component of negative pressure pulmonary edema development?

A

An upper airway obstruction occurs

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19
Q

What is the 2 component of negative pressure pulmonary edema development?

A

The patient continuous trying to inhale against the obstruction

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20
Q

What is the 3 component of negative pressure pulmonary edema development?

A

A high degree of negative intrathoracic pressure develops

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21
Q

What is the 4 component of negative pressure pulmonary edema development?

A

Venous return to the heart increases

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22
Q

What is the 5 component of negative pressure pulmonary edema development?

A

Cardiac output decreases

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23
Q

What is the 6 component of negative pressure pulmonary edema development?

A

Pressure in the pulmonary capillary bed increases

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24
Q

What is the 7 component of negative pressure pulmonary edema development

A

A disruption in the alveolar membrane junction occurs

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25
Q

What is the 8 component of negative pressure pulmonary edema development?

A

Fluid from the interstital space floods into the alveoli

26
Q

What is the 9 component of negative pressure pulmonary edema development?

A

Airway obstruction is relieved

27
Q

What is the 10 component of negative pressure pulmonary edema development?

A

Pulmonary edema remains

28
Q

What are the signs of bronchospasms in an intubated patient?

A
  1. ) increased peak airway pressures
  2. ) wheezing on lung exam
  3. ) increased expiratory time
  4. ) Increased ETCO2 with upsloping waveform
  5. ) Decreased tidal volumes if pressure control
29
Q

What is happening to a bronchospatic patient that suddenly develops hypo tension?

A

May be air trapping-disconnect patient from circuit to allow for complete exhalation

30
Q

What is the treatment for bronchospasms?

A
  • 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
31
Q

If you believe someone is showing signs of bronchospasm what do you want to do

A

Call for help, inform the team or code cart

32
Q

What is the I stage of anesthesia associated with?

A

Loss of pain sensation

33
Q

What is the II stage of anesthesia associated with?

A

Combative behavior

34
Q

What is the III stage of anesthesia depth associated with?

A

Surgical anesthesia

35
Q

What is the iv stage of anesthesia depth associated with?

A

Medullary paralysis and death

36
Q

Know the depth of anesthesia.

A

slide 30

37
Q

What are presurgery components of ERAS? (4)

A
  • Patient education and pre-surgery counseling
  • meeting with a surgeon or nurse
  • carb drink prior to surgery
  • use of epidurals for pain control
38
Q

What are during surgery components of ERAS? (4)

A
  • goal directed fluid management
  • judicious use of opioid pain medications
  • shorter incisions and use of laparoscopic approach when possible
  • careful considerations of blood transfusions
39
Q

What are post-surgery components of ERAS? (4)

A
  • early post procedure mobilization
  • early removal of tubes and drains
  • early transition to oral pain medications
  • early allowance of food intake
40
Q

What are better outcomes components of ERAS? (4)

A
  • Increased patient satisfaction with care
  • decreased perioperative complications
  • decreased length of stay
  • improved use of hospital resources
41
Q

What is included in the prehospital phase of ERAS?

A

Patient/family education, pain management plan, patient optimization and prehabilitation of select patients

42
Q

What is included in the preoperative phase of ERAS?

A

Opioid sparing (multimodal analgesia), normovolemia, n/v prophylaxis, normothermia, normaglycemia, avoid tubes and drains

43
Q

What is included in the postoperative phase of ERAS?

A

Early nutrition, early mobilization, multimodal analgesia, N/V, no or judicious IV fluid management, patient/family education

44
Q

What is included in the postdischarge phase of ERAS?

A

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

45
Q

What is included in the continued quality improvement team activities phase of ERAS?

A

analyze and share quality measures, patient surveys and staff input to celebrate successes and id opportunities for improvement.

46
Q

What are some indications for opioid free anesthesia?

A
  • 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
47
Q

What type of analegia action is produced with mu, kappa and delta receptor targets?

A

Supraspinal, spinal

Delta- modulates mu receptor activity

48
Q

What type of cardiovascular action is produced with mu, kappa and delta receptor targets?

A

Only the mu has an effect of bradycardia

49
Q

What type of respiratory action is produced with mu & delta receptor targets?

A

Depression

50
Q

What type of respiratory is produced with kappa receptor targets?

A

Possible depression

51
Q

What type of pupil is produced with mu, kappa and delta receptor targets?

A

Miosis from (Mu and kappa, no delta)

52
Q

What type of GI is produced with mu, kappa and delta receptor targets?

A

Only in the Mu- inhibition of peristalsis, N/V

53
Q

What type of GU is produced with mu and delta receptor targets?

A

Urinary retention

54
Q

What type of GU is produced with kappa receptor targets?

A

Diuresis (inhibition of vasopressin release)

55
Q

What type of pruitis is produced with mu, kappa and delta receptor targets?

A

Only with mu and delta, not occur from the kappa

56
Q

What type of physical dependence is produced with mu, delta receptor targets?

A

Yes it is possible

57
Q

What type of physical dependence is produced with kappa receptor targets?

A

Low abuse potential

58
Q

What type of receptor stimulation produces antishivering?

A

Kappa receptor

59
Q

What type of CNS is produced with mu receptor targets?

A

Euphoria, sedation, prolactin release, mild hypothermia, catalepsy, indifference to environment stimulus

60
Q

What type of CNS is produced with kappa receptor targets?

A

Sedation, dysphoria, psychomimetic reactions (hallucinations and delirium)

2-General Anesthesia Exam 1 (7 decks)

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