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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
Q

cardiovascular: effects of volatile agents

A

-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!

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26
Q

positioning: posterior fossa

A

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)

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27
Q

intraop monitoring: 10 physiologic effects of hypothermia

A

-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

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28
Q

lithotomy position: considerations when positioning and common complications

A

-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

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29
Q

Advantages of Rocuronium

A

-suitable alternative to succ for RSI
-no metabolism and eliminated primarily by liver–> no active metabolite

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30
Q

intraop monitoring: 6 causes of ETCO2 increase

A

-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)

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31
Q

LR Contents

A

-Na (130) > Cl (109) > lactate (28) > K (4) > Ca (1.4)

-osmolarity: 273 (isotonic)

-pH: 6-7.5

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32
Q

at what platelet count is transfusion indicated

A

-normal patients < 10,000-20,000
-thrombocytopenic patients < 50,000

-1 unit inc. platelet count by approx. 5,000-10,000

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33
Q

positioning: axillary roll

A

placed BELOW the axilla/armpit to protect brachial plexus
-supports the thorax and prevents compression of lower arm

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34
Q

IV fluids with transfusion

A

crystalloids or colloids can be infused simultaneously through a second IV line for volume replacement

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35
Q

succinylcholine side effects with defasciculating dose of NDNMB

A

helps prevent fasciculations and dec. post-op myalgias

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36
Q

pulse ox law

A

pulse oximetry is based on Lambert-beer law

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37
Q

Lambert-Beer Law

A

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)

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38
Q

5 Patient risk factors for positioning

A

-thin or morbidly obese
-dec. blood flow: vascular diseases (smoking) , ischemia, and hypotension
-advanced age (dec. mobility)
-diabetes
-long procedures

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39
Q

central line positioning

A

optimal location of catheter tip is just superior to or at junction of the superior vena cava and right atrium

40
Q

most commonly injured nerve in lateral decubitis position

A

brachial plexus (protect w/ axillary roll!!)

-also radial and common peroneal

41
Q

cardiovascular: effects of desflurane

A

rapid inc. in desflurane conc. can cause transient (but sometimes worrisome) inc. in HR, BP, and catecholamine levels

42
Q

plasmalyte contents

A

-Na (140) > Cl (98) > acetate (27) > gluconate (23) > K (5) > Mg (1.5)

-osmolarity: 295 (isotonic)

-pH: 4-8 (7.4)

43
Q

succinylcholine hyperkalemia

A

-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
Q
A
45
Q

Remifentanil Half-Life

A

approx. 3 minutes regardless of infusion duration (lacks context sensitivity)

46
Q

How is remifentanil metabolized

A

Rapid degradation by plasma esterases

47
Q

When are bite blocks required

A

needed in prone position to secure ETT or any surgery in which MEPs are monitored

48
Q

Hypokalemia on an EKG

A

-inc. P wave height/peaked
-prolonged PR interval
-prolonged QT
-shorter and flattened or inverted T wave
-ST depression
-U waves

49
Q

Describe this ECG

A

Hypokalemia

50
Q

Describe this ECG

A

Normokalemia

51
Q

Prone position risks

A

Post-op blindness (ischemic optic neuropathy)

52
Q

prone position effects on ventilation

A

Improved ventilatory effect
increased FRC

53
Q

Prone position cardiac effects

A

Decrease in Cardiac Output, venous return, and LV Compliance

54
Q

4 Body heat loss routes

A

Radiation
Convection
Evaporation
Conduction

55
Q

Which body heat loss route is most common

A

Radiation

56
Q

Which body heat loss route is 2nd most common?

A

Conduction

57
Q

How does the epinephrine dose change which receptor will be effected?

A

Small doses are going to agonize Beta 2
Medium Doses will agonize Beta 1
Large doses will agonize Alpha and Beta

58
Q

Small Dose Epi

A

1-2 mcg/min

59
Q

Small dose epi receptor

A

Beta 2 Agonist

60
Q

Medium Dose EPi

A

4 mcg/min

61
Q

Medium Dose Epi Receptor

A

Beta 1 Agonist

62
Q

Large Dose EPi

A

10-20 mcg/min

63
Q

Large Dose Epi Receptor

A

Alpha and Beta agonist

64
Q

What can cause Pulse Oximetry interference?

A

Methemoglobinemia
Methylene Blue dye use
Other artifacts

65
Q

Methemoglobinemia effects on SpO2

A

Carbon Monoxide poisoning can result in methemoglobinemia, causing a false 85% reading on the SPO2 monitor

66
Q

How does methylene blue affect SpO2 readings

A

Blue dye causes falsely low readings

67
Q

What artifacts can affect SpO2

A

Excessive ambient light
Motion
Low perfusion

68
Q

What 4 ECG Artifacts can simulate arrhythmias?

A

Patient or lead wire movement
Electrocautery use
60-hz interference from nearby alternating current devices
Faulty electrodes

69
Q

What is a common cause of mainstem intubation?

A

Happens during patient positioning because increased head flexion causes increased tube depth

70
Q

What does mainstem intubation present as?

A

Increased PIP
Decreased Saturation
No change in ETCO2

71
Q

When must an arterial line be zeroed?

A

Any time the patient is moved if the patient is not moved in tandem

72
Q

Where should an arterial line be zeroed?

A

At the body level that is being monitored:
ex. at ear level to measure cerebral/circle of willis Pressure

73
Q

True or false: Transducer measurements in arterial lines are static

A

False
They drift over time.
Zeroing should be done regularly

74
Q

Parkinson’s Comorbidities

A

HTN, ischemic heart disease, musculoskeletal disorders, HLD, and diabetes
(plus psychiatric comorbidities: depression, sleep disorders, cognitive impairment anxiety)

75
Q

Medications contraindicated in Parkinson’s patients

A

Avoid metoclopramide/reglan, anti-dopaminergic drugs, and succinylcholine (more susceptible to hyperkalemia)

76
Q

How do we check recovery from NMBs?

A

Sustained Tetany for 5 sec
Sustained head life for 5 sec
Inspiratory force (At least -25cm H2O)
Vital Capacity
Tidal Volume

77
Q

What 11 things will LOWER MAC?

A

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
Q

Core Temp Monitoring Goals

A

Maintain temp >=36 C

79
Q

What is the gold standard for Core temperature monitoring

A

Pulmonary Artery

80
Q

Core Temp Locations

A

Pulmonary Artery Catheter
Distal Esophagus
Nasopharyngeal
Tympanic Membrane

81
Q

What properties about desflurane would make it a good mask induction agent?

A

low solubility in blood and body tissue cause very rapid induction and emergence

82
Q

What properties of Desflurane make it a bad induction agent?

A

pungency, airway irritation, and inc. airway resistance in children w/ reactive airway susceptibility (associated w/ more coughing, breath-holding, and laryngospasms)

83
Q

Anticholinesterase (Like Neostigmine) side effects

A

SLUDGE BB
Salivation
Lacrimation
Urination
Defecation
GI Upset
Emesis
Bronchoconstriction
Bradycardia

84
Q

4 Consequences of intra-op Hypothermia

A

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
Q

Considerations that must be taken into account for patients in NORA for MRI Procedures

A

-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
Q

use and disadvantage of ECG monitoring filters

A

used to reduce “motion” artifact
-lead to distortion of the ST segment and may impede diagnosis of ischemia

87
Q

train of four Hz

A

2 Hz (4 stimuli in 2 secs, each for a 200 microseconds/.2 msec duration)

88
Q

increased resistance to succinylcholine occurs in what instances?

A

-myasthenia gravis (or any condition associated w/ fewer ACh receptors)
-dibucaine-resistant variant allele (or any pt w/ abnormal pseudocholinesterase genes)

89
Q

succinylcholine termination of action

A

metabolized by pseudocholinesterase into succinylmonocholine in plasma and liver

90
Q

MAC anesthetic requirements by age

A

dec. by 6% per decade of age

91
Q

Which 2 leads are used for ECG ischemia detection

A

-mainly V5 (anterior and lateral wall ischemia)
-lead II (arrhythmias mainly, but also inferior wall ischemia)

92
Q

4 consequences of shivering

A

Increased O2 consumption by 200%
Increased sympathetic activation
increased intracranial and intraocular pressure
Aggravate wounds from stretching

93
Q
A
94
Q
A
95
Q
A
95
Q
A
96
Q
A

Anesthesiologist Assistant (12 decks)

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