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SRNAClinical Practicuum Prep > DUKE'S Anesthesia 100 secrets Summary > Flashcards

DUKE'S Anesthesia 100 secrets Summary Flashcards

1
Q

What is the Purpose of the preop visit ?

Choice of premedication depends on

A 
Provides psychological preparation and calm the patient's fears and anxiety. 
Choice of preMedication depends on :
PHYSICAL and MENTAL STATUS
Inpatient or outpatient
Elective or emergent, 
Hx of PONV
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2
Q

Wheezes: All wheezes

A

All wheezes is not asthma
CHF, PE, mechanical airway obstruction, allergic reaction,
aspiration, ENDOBRONCHIAL intubation.

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3
Q

Periinduction hypotension responds best to _________. Estimating volume status requires gathering________
Replace intra-operaitve fluid losses with

A

Responds best to IV fluids
As much clinical information as possible, single variable may be misleading.
Replace intraoperative fluids losses with isontonic fluids.

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4
Q

What is of paramount importance? what does is prevent?

A

Thorough airway examination
Identification of patient with potential difficult airway
Prevent difficult to ventilate, difficult to intubate situation

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5
Q 
For the elective case, fasting guidelines
Clear liquids
Nonclear liquids
Light meal or snack
Full meal
A

2 hours
4 hours
6 hours
8 hours

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6
Q

4 factors to speed onset of Volatile anesthetics (DAFU)

A 
Increase
– Delivered concentration of anesthetics
– Alveolar ventilation
– Fresh gas flow
– Use non-lipid soluble anesthetics
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7
Q

Obese patients consideration

A

May be difficult to ventilate and intubate, have back up strategies readily available

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8
Q

Infants airway, comment on larynx, tongues and epiglottis.

What is the narrowest part of the airway for an infant?

A

larynx is anterior
large tongues
Floppy epiglottis

The narrowest part of the airway is BELOW THE VOCAL CORDS at the cricoid Cartilage

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9
Q

Most common circuit use in anesthesia ?

What are the components of it(6)?

A

Semi CLOSED circuit of a circle system

Components: Insp and exp limbs, unidirectional valves, CO2 absorber, a reservoir bag, POP off Valve on EXPIRATORY limb

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10
Q

Advantages of a circle system (3)

Disadvantage (2)

A

Conservation of heat and moisture
Low flow of fresh gas
Ability to scavenge the system

Dis : Multiple sites for disconnection, high compliance

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11
Q

2 types of Local anesthetics

how do they differ ?

A

AminoAmides
AminoEsters’
Differ in allergic potential and method of biotransformation

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12
Q

Termination of effect of IV anesthetics is by

A

Redistribution not biotransformation or breakdown

Benzo and IV inducation agents have synergistic effects., requiring adjustments in dosing

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13
Q

Neuropathic pain and response to opioids

A

Neuropathic pain less responsive to opioids compared to pain originating from Nociceptors

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14
Q

What are the most common complications of epidural analgesia?
What are the less common but potentially detrimental complications?

A

Hypotension, Inadequate analgesia requiring replacement and manipulation.; Pruritus, N/V
Post Dural Puncture Headace (PDPH); High total spinal, Intrathecal or IV catheter placement, Systemic toxicity and nerve injury

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15
Q

What is the definitive treatment of pre-eclampsia? Mainstay of management is ?

A

Immediate delivery

Blood pressure control with Beta Blocker and seizure prophylaxis with magnesium sulfate

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16
Q

High risk for postpartum hemorrhage or uterine atony

A

Prepare accordingly

Type and cross and have blood to transfuse readily available.

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17
Q

Elective thoracic surgical procedures in adults in one lung ventilation (OLV) using _______
Harder to place are the ____and ______
What is the main action of initiation of OLV?

A

Left double lumen ET tube
– Right double lumen tubes and BRONCHIAL BLOCKERS are more difficult to place and more likely to move during surgery and needs to be placed with a Fiberoptic Bronchoscope (FOB).
– It stops all ventilation to one lung, which would create a 50% right to left shunt and relative hypoxemia if perfusion were unchanged

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18
Q

Consideration for somatosensory-evoked potentials (SSEPs) are monitored

A

During spine surgery, avoid exceeding 1 MAC of volatile anesthetics, to maximize the effectiveness of signal acquisition.

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19
Q

Prolonged spine surgery in the prone position consideration? avoid what?

A

Use a combination of COLLOID and CRYSTALLOID for fluid replacement to help avoid ISCHEMIC OPTIC NEUROPATHY

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20
Q

If the patients on Beta Blockers when should they take the dose? Why? Beta blockers are _____initiated day of surgery. Medication such as______ should be continued

A

–Day of surgery and continue periop
Because the receptors are UPREGULATED, withdrawal may be precipitate, HTN, tachycardia and Myocardial ischemia
– Clonidine

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21
Q

Hypothermia effect on patient outcome

What increases 3 folds?

A

Increase rate of wound infection
Delay wound healing
Increase blood loss
Increase cardiac morbidity three folds

22
Q

What is the UNIVERSAL DONOR for PRBCs? What about for PLASMA?

A

O negative blood

AB positive

23
Q

T/F Not all elderly patients need an extensive preop workup.
Some patient that gets more confused with preop meds

A

True: just tailor to their underlying illness and invasiveness of the surgery
Alzheimer’s patients

24
Q

Basal function of most organ systems is relatively _______by the aging process per se, but the functional reserve and ability to compensate for physiological stress are ______Anesthetics requirement in the elderly are _______; Increase potential for a variety of _______. what is the most common complication ?

A

Unchanged; reduced; decreased; postop complications;

Post op cognitive dysfunction

25
Q

Pregnant women and airway

A

Pregnant women can pose airway management problems because of airway edema, large breasts that make laryngoscopy difficult, FULL stomach rendering them prone to ASPIRATION and RAPID O2 desaturation due to DECREASED of functional residual capacity

26
Q

Normal saline in large quantity

A

Lead to Hyperchloremic Metabolic acidosis; associated base deficit may lead the provider to conclude incorrectly that the patient continue to be hypovolemic

27
Q

Is there a set hemoglobin/hematocrit for transfusion

A

There is no set hemoglobin/hematocrit level at which transfusion is required. The decision should be individualized to the clinical situation, taking into consideration the patient’s health status. If blood is needed, type O- PRBCs or type specific unit may be used.

28
Q

What is the most COMMON INTRAOPERATIVE BLEEDING diathesis (meaning unusual susceptibility to bleeding)

A

Dilutional thrombocytopenia. Not seen until significant blood loss has occurred and has been replaced with IV crystalloid and blood products that do not contain platelets.

29
Q

What is thromboelastography?

A

Dynamic POC testing that can help distinguish between surgical and non-surgical bleeding. It can identify specific deficiencies of coagulation factors, fibrinogen and platelet and can detect plasmin dysregulation and abnormal clot breakdown

30
Q

What is the primary treatment of DIC

A

Treat the underlying medical condition

31
Q

What are the most clinical helpful indices obtained from spirometry?

A

Forced Vital Capacity (FVC)
Forced Expiratory Volume in 1 sec (FEV1)
FEV1/ FVC ratio
Flow between 25-75% of the FVC (mean maximal flow)

32
Q

Common opioid side effect include

A 
Nausea
Pruritus
Bradycardia 
Urinary retention
Resp depression
33
Q

Appropriate IV dosing of IV anesthetics requires considering

A

Intravascular volume status
comorbidities
age
Chronic medications

34
Q

What is the best induction agetn for patients with hypovolemic trauma as long as there is no risk for increased ICP; Also used for patients with Bronchoplastic disease?

A

Ketamine

Ketamine

35
Q

What is the least likely agent of all induction agents to result in Nausea and vomiting and the terminating effects of IV anesthetics is by________ and not by _____or ______

A

Propofol; redistribution , not biotransformation and breakdown

36
Q

– Metabolism of relaxants is _____Important that pharmacological reversal for termination of relaxant effect. –Train of four assessment __________ and has been demonstrated to underestimate residual NMB. It may be a best practice to administer reversal agent to all patients receiving non-depolarizing agents.
–What do you do to a clinically weak patient?

A

–More
–HIGHLY selective
–Leave clinical weak patients intubated and support respirations until the patient can demonstrate return of strength

37
Q

What determines potency of local anesthetics?
What determines onset of local anesthetics?
What determines duration of action of local anesthetics

A

–lipid solubility
–pKa
–protein binding

38
Q

What does vasopressin has a role in ?

A

Vasopressin has a role in BP maintenance in septic shock

Cardiogenic shock and other shock states

39
Q

Is low dose dopamine effective for prevention and treatment of ARF and for protection of the gut?
Is DOPAMINE effective at treating septic shock?
What is the best way to maintain renal function during surgery ?

A

–NO
–NO
–ensure an adequate intravascular volume, maintain cardiac output, avoid drugs known to decrease renal perfusion

40
Q

Rate the risk of clinically significant aspiration pneumonitis in healthy patients? is routine use of pharmacologic agents to alter the volume of pH or gastric contents necessary?

A

Very low; many patients require low or no premedication.

- NO

41
Q

What is the gold standard for preop cardiac assessment? However, the most important component of the pre-anesthetic evaluation is a _______

A

– American College of Cardiology / AHA

– thorough, accurate, and focused history and physical examination.

42
Q

What are the four cardiac conditions that will likely result in cancellation to assess cardiac evaluation and treatment?

A

– Unstable coronary syndrome
– Decompensated Heart failure
– Significant cardiac arrhythmias
– Severe Valvular disease

43
Q

What is increasing in frequency as far as the eyes, what can be done to prevent it?

A

Postop blindness is increasing in frequency . During lengthy spine procedures in the prone position, maintain intravascular volume, hematocrit, and perfusion pressure.

44
Q

What is the most common post op nerve injury? Who is it most common is ? presentation ?

A

ULNAR NEUROPATHY

Older than 50 years, is not invariably prevented by padding, and is multifactorial in origin

45
Q

2 separate respiratory processes? what does not assess adequacy of ventilation?

A

Oxygenation and ventilation
Pulse ox does not assess adequacy of ventilation
treat the patient not the symptom

46
Q

Isolated value vs trends

A

Trends better than isolated values

Should always be evaluated in the context of the patient

47
Q

Systolic BP in radial artery

A

It may be as much as 20-50 mmHg higher than the pressure in the central aorta.

48
Q

Awareness is most likely in what cases?

A

Cases where minimal anesthetic is administered such as with CPB , hemodynamic instability, trauma and fetal delivery

49
Q

Symptoms of awareness can be

A

nonspecific , and the use of NMB increases the risk of unrecognized awareness

50
Q

Even mild hypothermia has a negative influence on patient outcome, increasing ________ rates, increasing________ delaying _______ increasing Blood _______ , and increasing __________ as well as ______morbidity. What is the best method to treat hypothermia

A 
wound infection
nitrogen loss
Blood loss
Hospitalization 
Cardiac morbidity.

– forced-air warming blankets
Warm all fluids and and blood products

SRNAClinical Practicuum Prep (21 decks)

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