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Anesthesiologist Assistant > Comp Exam III > Flashcards

Comp Exam III Flashcards

1
Q

Drug and dose to treat post-op shivering

A

Meperidine (Demerol)
25mg IV

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2
Q

Primary cause of post-op shivering

A

Pre-operative Hypothermia

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3
Q

Post-op MI is the strongest predictor of what?

A

Preoperative cardiac morbidity

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4
Q

MH: 4 early signs

A

Unexplained increase in ETCO2
Muscle RIgidity
Tachycardia
Increased Temp

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5
Q

Respiratory: 4 effects/goals of PEEP

A

Increased FRC by preventing alveolar collapse
Decreased atelectasis and subsequent intrapulmonary shunt
Minimize atelectotrauma
Optimize pulmonary compliance

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6
Q

How does Preoxygenation affect oxygen reserve time

A

Provides a patient with roughly 5-8 mins of oxygen reserve
Up to 90% of FRC (2L) is filled with oxygen
Normal O2 demand is around 200-250 ml/min

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7
Q

Respiratory: effects of volatile agents

A

Dose-Dependent depression of ventilation
Decreased TV (Causes decreased MV)
Increased RR
Resp. drive response to hypoxemia is abolished at MAC >1

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8
Q

NS contents

A

Equal parts NS and Cl (154 mmol/L each)
Osmolarity 308 (Isotonic)
pH: 4.5-7

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9
Q

Intraop Monitoring: 1 twitch (TOF monitoring)

A

Single pulse delivered at 1-0.1 HZ (Every 1-10 seconds)
Each Stimuli lasts .2msec

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10
Q

Positioning for a nephrectomy

A

Lateral flexed position

Axillary roll is placed beneath the dependent upper chest to minimize risk of brachial plexus injury

This position is associated with adverse respiratory and circulatory effects

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11
Q

ASA Standard Monitoring

A

NIBP Cuff
Temp
EKG
SPO2

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12
Q

Most commonly injured nerve in Lithotomy position

A

Common Peroneal (Fibular)

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13
Q

Trendelenburg positioning effects on the lungs

A

Decreased FRC
Decreased Lung Compliance
Significant Atelectasis
Increased peak airway pressure (Can lead to barotrauma)

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14
Q

What NMB causes Histamine release?

A

Succinylcholine
Atracurium
Mivacurium
Gantacurium

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15
Q

Low-Dose Dopamine Dose

A

0.5-3 mcg/kg/min

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16
Q

Low-Dose Dopamine Effects

A

stimulates D1 receptors; causes vasodilation of renal vasculature/promotes diuresis

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17
Q

Moderate Dose Dopamine

A

moderate doses (3-10 mcg/kg/min)

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18
Q

Moderate Dopamine Effects

A

stimulates beta-1 receptors; causes inc. myocardial contractility, HR, SBP, and CO

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19
Q

High Dose Dopamine

A

high dose (10-20 mcg/kg/min)

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20
Q

High Dose Dopamine Effects

A

stimulates alpha-1 receptors; inc. PVR and dec. renal blood flow

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21
Q

most commonly injured nerves during patient positioning

A

ulnar nerve and brachial plexus
-due to arms out > 90º or falling off armboard (more of a concern in deep trendelenburg)

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22
Q

what patient position is directly associated with increased intraocular AND intracranial pressure

A

Steep Trendelenburg

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23
Q

lithotomy position: common procedures and physiological effect

A

-commonly used for GYN, urology, and rectal procedures
-dec. FRC/lung compliance
-inc. venous return and CO when raising legs

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24
Q

recovery from NMBs: head lift time

A

At least 5 seconds

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25
cardiovascular: effects of volatile agents
-dec. BP -dec. SVR (except halothane) -dec. CO (except isoflurane and minimally by desflurane) -cardiac protective effects via ischemic preconditioning -N2O has no cardiovascular effects!
26
positioning: posterior fossa
craniotomy of the posterior skull -can be done in prone or beach-chair position -mayfield pins are used (causes acute inc. in BP when pins are positioned)
27
intraop monitoring: 10 physiologic effects of hypothermia
-cardiac arrhythmias and ischemia -inc. PVR -LEFT shift of Hgb-O2 saturation curve -reversible coagulopathy (platelet dysfunction) -inc. post-op protein catabolism and stress response -altered mental status -impaired renal function -delayed drug metabolism -impaired wound healing -inc. risk of infection
28
lithotomy position: considerations when positioning and common complications
-flex legs 90º and abduct 30º at hip joint -raise/lower legs at same time to avoid lumbar torsion -common complications: common peroneal nerve injury and venous thrombosis due to obstructed venous drainage
29
Advantages of Rocuronium
-suitable alternative to succ for RSI -no metabolism and eliminated primarily by liver--> no active metabolite
30
intraop monitoring: 6 causes of ETCO2 increase
-hypoventilation -rebreathing of CO2 -iatrogenic administration of CO2 (ex. from lap insuflation) -bicarbonate administration -tourniquet release -sepsis or other hyper metabolic conditions (fever, MH, thyroid storm)
31
LR Contents
-Na (130) > Cl (109) > lactate (28) > K (4) > Ca (1.4) -osmolarity: 273 (isotonic) -pH: 6-7.5
32
at what platelet count is transfusion indicated
-normal patients < 10,000-20,000 -thrombocytopenic patients < 50,000 -1 unit inc. platelet count by approx. 5,000-10,000
33
positioning: axillary roll
placed BELOW the axilla/armpit to protect brachial plexus -supports the thorax and prevents compression of lower arm
34
IV fluids with transfusion
crystalloids or colloids can be infused simultaneously through a second IV line for volume replacement
35
succinylcholine side effects with defasciculating dose of NDNMB
helps prevent fasciculations and dec. post-op myalgias
36
pulse ox law
pulse oximetry is based on Lambert-beer law
37
Lambert-Beer Law
oxygenated and deoxygenated hemoglobin differ in their absorption of red and infrared light: oxyhemoglobin absorbs more infrared light (940nm) and deoxyhemoglobin absorbs more red light (660 nm)
38
5 Patient risk factors for positioning
-thin or morbidly obese -dec. blood flow: vascular diseases (smoking) , ischemia, and hypotension -advanced age (dec. mobility) -diabetes -long procedures
39
central line positioning
optimal location of catheter tip is just superior to or at junction of the superior vena cava and right atrium
40
most commonly injured nerve in lateral decubitis position
brachial plexus (protect w/ axillary roll!!) -also radial and common peroneal
41
cardiovascular: effects of desflurane
rapid inc. in desflurane conc. can cause transient (but sometimes worrisome) inc. in HR, BP, and catecholamine levels
42
plasmalyte contents
-Na (140) > Cl (98) > acetate (27) > gluconate (23) > K (5) > Mg (1.5) -osmolarity: 295 (isotonic) -pH: 4-8 (7.4)
43
succinylcholine hyperkalemia
-serum potassium inc. by 0.5 mEq/L -this can be catastrophic in pt's with preexisting hyperkalemia: burn injury, massive trauma, severe chronic infection, and neurological disorder (stroke, Parkinson's, etc., muscular denervation, muscular dystrophy)
44
45
Remifentanil Half-Life
approx. 3 minutes regardless of infusion duration (lacks context sensitivity)
46
How is remifentanil metabolized
Rapid degradation by plasma esterases
47
When are bite blocks required
needed in prone position to secure ETT or any surgery in which MEPs are monitored
48
Hypokalemia on an EKG
-inc. P wave height/peaked -prolonged PR interval -prolonged QT -shorter and flattened or inverted T wave -ST depression -U waves
49
Describe this ECG
Hypokalemia
50
Describe this ECG
Normokalemia
51
Prone position risks
Post-op blindness (ischemic optic neuropathy)
52
prone position effects on ventilation
Improved ventilatory effect increased FRC
53
Prone position cardiac effects
Decrease in Cardiac Output, venous return, and LV Compliance
54
4 Body heat loss routes
Radiation Convection Evaporation Conduction
55
Which body heat loss route is most common
Radiation
56
Which body heat loss route is 2nd most common?
Conduction
57
How does the epinephrine dose change which receptor will be effected?
Small doses are going to agonize Beta 2 Medium Doses will agonize Beta 1 Large doses will agonize Alpha and Beta
58
Small Dose Epi
1-2 mcg/min
59
Small dose epi receptor
Beta 2 Agonist
60
Medium Dose EPi
4 mcg/min
61
Medium Dose Epi Receptor
Beta 1 Agonist
62
Large Dose EPi
10-20 mcg/min
63
Large Dose Epi Receptor
Alpha and Beta agonist
64
What can cause Pulse Oximetry interference?
Methemoglobinemia Methylene Blue dye use Other artifacts
65
Methemoglobinemia effects on SpO2
Carbon Monoxide poisoning can result in methemoglobinemia, causing a false 85% reading on the SPO2 monitor
66
How does methylene blue affect SpO2 readings
Blue dye causes falsely low readings
67
What artifacts can affect SpO2
Excessive ambient light Motion Low perfusion
68
What 4 ECG Artifacts can simulate arrhythmias?
Patient or lead wire movement Electrocautery use 60-hz interference from nearby alternating current devices Faulty electrodes
69
What is a common cause of mainstem intubation?
Happens during patient positioning because increased head flexion causes increased tube depth
70
What does mainstem intubation present as?
Increased PIP Decreased Saturation No change in ETCO2
71
When must an arterial line be zeroed?
Any time the patient is moved if the patient is not moved in tandem
72
Where should an arterial line be zeroed?
At the body level that is being monitored: ex. at ear level to measure cerebral/circle of willis Pressure
73
True or false: Transducer measurements in arterial lines are static
False They drift over time. Zeroing should be done regularly
74
Parkinson's Comorbidities
HTN, ischemic heart disease, musculoskeletal disorders, HLD, and diabetes (plus psychiatric comorbidities: depression, sleep disorders, cognitive impairment anxiety)
75
Medications contraindicated in Parkinson's patients
Avoid metoclopramide/reglan, anti-dopaminergic drugs, and succinylcholine (more susceptible to hyperkalemia)
76
How do we check recovery from NMBs?
Sustained Tetany for 5 sec Sustained head life for 5 sec Inspiratory force (At least -25cm H2O) Vital Capacity Tidal Volume
77
What 11 things will LOWER MAC?
hypothermia Hyperthermia Elderly Acute alcohol use Anemia Hct<10 Hypoxia (PaO2<40) Hypercarbia (PaCo2>95) MAP <40 Hypercalcemia Hyponatremia All anesthetic drugs except ephedrine Chronic Amphetamine use
78
Core Temp Monitoring Goals
Maintain temp >=36 C
79
What is the gold standard for Core temperature monitoring
Pulmonary Artery
80
Core Temp Locations
Pulmonary Artery Catheter Distal Esophagus Nasopharyngeal Tympanic Membrane
81
What properties about desflurane would make it a good mask induction agent?
low solubility in blood and body tissue cause very rapid induction and emergence
82
What properties of Desflurane make it a bad induction agent?
pungency, airway irritation, and inc. airway resistance in children w/ reactive airway susceptibility (associated w/ more coughing, breath-holding, and laryngospasms)
83
Anticholinesterase (Like Neostigmine) side effects
SLUDGE BB Salivation Lacrimation Urination Defecation GI Upset Emesis Bronchoconstriction Bradycardia
84
4 Consequences of intra-op Hypothermia
Increased Cardiovascular morbidity Increased risk of wound infection (Dec. temp 1.9C triples incidence of wound infection increased risk of bleeding Prolonged anesthesia recovery time
85
Considerations that must be taken into account for patients in NORA for MRI Procedures
-must exclude all ferromagnetic materials from magnet area -all anesthesia equipment must be compatible with the scanner -patients must be free of implants that could interact with the magnet (ex. pacemaker)
86
use and disadvantage of ECG monitoring filters
used to reduce "motion" artifact -lead to distortion of the ST segment and may impede diagnosis of ischemia
87
train of four Hz
2 Hz (4 stimuli in 2 secs, each for a 200 microseconds/.2 msec duration)
88
increased resistance to succinylcholine occurs in what instances?
-myasthenia gravis (or any condition associated w/ fewer ACh receptors) -dibucaine-resistant variant allele (or any pt w/ abnormal pseudocholinesterase genes)
89
succinylcholine termination of action
metabolized by pseudocholinesterase into succinylmonocholine in plasma and liver
90
MAC anesthetic requirements by age
dec. by 6% per decade of age
91
Which 2 leads are used for ECG ischemia detection
-mainly V5 (anterior and lateral wall ischemia) -lead II (arrhythmias mainly, but also inferior wall ischemia)
92
4 consequences of shivering
Increased O2 consumption by 200% Increased sympathetic activation increased intracranial and intraocular pressure Aggravate wounds from stretching
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Anesthesiologist Assistant (12 decks)

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