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ERAS (AB) Flashcards

1
Q

What are the three main phases of Enhanced Recovery After Surgery (ERAS)?

A

Preoperative. intraoperative. postoperative

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2
Q

What are two key areas of focus in anesthesia for ERAS?

A

Fluid therapy and analgesia

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3
Q

What is Goal-Directed Fluid Therapy (GDFT)?

A

Individualized fluid management to optimize cardiac output and avoid hypovolemia or fluid overload

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4
Q

Why is multimodal, opioid-sparing analgesia preferred in ERAS?

A

To reduce opioid side effects like nausea, vomiting, and urinary retention

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5
Q

What was the first surgical procedure to employ ERAS protocols?

A

Colonic surgery

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6
Q

What lifestyle changes are emphasized preoperatively in ERAS?

A

Smoking cessation and cessation of alcohol intake

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7
Q

What is an important preoperative element to prevent postoperative nausea and vomiting (PONV)?

A

Prevention strategies and multimodal antiemetics

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8
Q

What is recommended to ensure full recovery of neuromuscular blockade in ERAS?

A

Careful titration of anesthesia

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9
Q

What surgical technique is preferred in ERAS to minimize stress response?

A

Minimally invasive surgery (laparoscopic)

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10
Q

What type of anesthesia is recommended for major open abdominal and thoracic procedures in ERAS?

A

Thoracic epidural anesthesia

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11
Q

What are the benefits of thoracic epidural anesthesia in ERAS?

A

Excellent analgesia. facilitates mobilization. decreases ileus

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12
Q

How long should prophylactic antibiotics be continued after surgery (non-cardiothoracic)?

A

Within 24 hours

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13
Q

How long can prophylactic antibiotics be continued for cardiothoracic surgery?

A

48 hours

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14
Q

What is a key strategy to minimize surgical stress response?

A

Maintenance of normothermia

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15
Q

What types of anesthesia techniques help minimize surgical stress response?

A

Neural blockade. multimodal opioid-sparing analgesia

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16
Q

What regional anesthesia technique blocks nociceptive pathways and reduces opioid use?

A

Peripheral nerve blocks (PNBs)

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17
Q

What nerve block is an alternative to femoral nerve block with better-preserved quadriceps strength?

A

Hunter Canal Block

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18
Q

How does regional anesthesia contribute to faster recovery in ERAS?

A

Provides targeted pain relief. reduces opioid use. enhances early mobilization

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19
Q

What type of intravenous infusion is used in colorectal and radical rectal surgeries for analgesia?

A

Intravenous lidocaine infusion

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20
Q

What is the typical dose for IV lidocaine infusion in colorectal surgery?

A

100 mg bolus followed by 1.5-3 mg/kg/h continuous infusion

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21
Q

What drug class helps blunt the sympathetic response during laryngoscopy in ERAS?

A

Beta-blockers (e.g.esmolol)

22
Q

What are benefits of esmolol in ERAS?

A

Reduces MAC. post-op pain. opioid consumption and PONV

23
Q

What alpha-2 agonists are used for analgesia in ERAS?

A

Clonidine and dexmedetomidine

24
Q

What is the intravenous anesthetic drug of choice in ERAS?

25
What two inhalational anesthetics are preferred in ERAS?
Desflurane and sevoflurane
26
What is the importance of maintaining normothermia in ERAS?
Prevents surgical wound infections
27
How does early mobilization affect postoperative oxygenation and DVT risk?
Improves oxygenation and reduces DVT risk
28
What is the preferred type of fluid for extracellular losses in ERAS?
Isotonic balanced crystalloid
29
What type of fluid is used to replace physiologically important blood losses in ERAS?
Iso-oncotic colloids
30
What is a key mechanism that contributes to postoperative ileus?
Sympathetic inhibitory reflexes
31
What postoperative intervention can help reduce postoperative shivering?
Maintaining normothermia
32
What are key components of multimodal analgesia in ERAS?
NSAIDs. acetaminophen. gabapentinoids. NMDA antagonists. lidocaine. regional blocks
33
What analgesic technique can provide up to 72 hours of pain relief post-surgery?
Single-shot perineural liposomal bupivacaine
34
What factors contribute to postoperative ileus?
Sympathetic reflexes. local inflammation. systemic opioids. bowel edema
35
What is the recommended use of nasogastric tubes in ERAS?
Discouraged or used for very short periods
36
What genetic condition predisposes patients to malignant hyperthermia (MH)?
Mutation in RYR1 gene on chromosome 19
37
What triggers malignant hyperthermia in susceptible patients?
Inhaled anesthetics and succinylcholine
38
What is the earliest and most sensitive intraoperative indicator of malignant hyperthermia?
Sudden rise in end-tidal CO2
39
What is the definitive treatment for malignant hyperthermia?
IV dantrolene
40
What is the mechanism of action of dantrolene?
Inhibits calcium release from the sarcoplasmic reticulum
41
What is the initial dose of dantrolene for malignant hyperthermia?
2.5 mg/kg IV every 5 minutes (up to 10 mg/kg)
42
Why should calcium channel blockers not be given with dantrolene?
Risk of severe hyperkalemia
43
What diagnostic test confirms malignant hyperthermia susceptibility?
Halothane-caffeine contracture test
44
What is the genetic testing approach for malignant hyperthermia in family members?
RYR1 genetic testing
45
What are key signs of malignant hyperthermia?
Hyperthermia. tachycardia. muscle rigidity. hypercapnia. metabolic acidosis
46
What muscular condition increases susceptibility to malignant hyperthermia?
Central core disease
47
What is the gold standard diagnostic test for malignant hyperthermia?
Halothane-caffeine contracture test
48
Can malignant hyperthermia occur after uneventful anesthesia?
Yes
49
What type of anesthesia is recommended if surgery must proceed in a patient with malignant hyperthermia susceptibility?
Total intravenous anesthesia (TIVA)
50
What environmental factor can trigger malignant hyperthermia in susceptible individuals outside the OR?
Excessive exertion or extreme heat

AAA-ANESTHESIOLOGY (14 decks)

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