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Anesthesia Practice > Exam 1 Part 3 > Flashcards

Exam 1 Part 3 Flashcards

1
Q

Emergence characterized by

A
  • Airway obstruction
  • Agitation
  • Delirium
  • Hypothermia
  • Shivering
  • Autonomic lability
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2
Q

Emergence planning

A
  • Should start as soon as you put the patient to sleep
  • vapors decreased or off
  • Excess muscle relaxation is reversed
  • pt is breathing spontaneously
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3
Q

Emergence is synonymous with removal of ETT or other airway device. Coughing is an indication that the patient is awake. T or F?

A

False

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4
Q

Factors influencing emergence

A
  • agent solubility
  • agent concentration
  • duration of anesthesia
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5
Q

Emergence of inhalational anesthesia depends chiefly on ______________

A

pulmonary elimination

Combination of building CO2 and breathing gas off

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6
Q

_____ and/or _____ ______ blunt the ventilatory responses to both hypercarbia and hypoxemia.

A
  • IV
  • inhalational anesthetics
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7
Q

What drives a pt to take a breath?

A
  • central/chemical chemoreceptors
  • hypercapnic ventilatory drive–the more narcotic we give, the higher the capnic threshold
  • hypoxic ventilatory drive
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8
Q

PaCO2 where spontaneous ventilation is initiated is ______ ______.

A

apneic threshold

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9
Q

To increase PaCO2, need to:

A
  • Adjust minute ventilation (RR x TV)
  • Maintain FiO2 > 0.85 during hypoventilation
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10
Q

Maintain FiO2 > 0.85 during hypoventilation except in _________ ______ patients.

A

severe COPD because their drive to breath will go away

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11
Q

The following are effects of __________:

Stimulation of sympathoadrenal system

Vasodilator (except pulmonary arteries CONSTRICT)

hypercarbic narcosis

dysrhythmias

A

hypercarbia

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12
Q

Intermediate NMB is between ____ and ____ minutes

A

15-45 minutes

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13
Q

NMB depolarizes the end-plate _______ receptor.

A

nicotinic

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14
Q

Succx has short duration due to _______________ metabolism . It quickly diffuses away and is metabolized.

A

pseudocholinesterase

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15
Q

Side effects of succx:

A
  • myocyte rupture
  • hyperkalemia
  • myalgia
  • sinus bradycardia – muscarinic receptor
  • malignant hyperthermia
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16
Q

Non depolarizing NMB __________ inhibit end plate nicotinic cholinergic receptor.

A

competitively

17
Q

Non depolarizing NMBs (do/do not) bind to the Ach receptors.

A

do not bind

17
Q

What NMBs block the Ach receptor sites, thn as the Ach continues to be released it pushes the drug off the site so it can bind once again?

A

non-depolarizing

18
Q

Monitoring locations

A
  • ulnar nerve
  • facial nerve
  • posterior tibial nerve (medial malleolus, flexes big toe)
  • external peroneal nerve (dorsiflexion)
19
Q

__________________ is a better monitoring location during intubation. ______ is better for emergence.

A

orbicularis oculi

adductor pollicis

20
Q

4 out of 4 twitches, I can still have ____ % block.

3 out of 4, ____ % block.

2 out of 4, ____ % block

1 out of 4, _____ % block

0 out of 4, ______ % block

A

75 %

85%

90

95

99

21
Q

Conditions prior to NMB reversal:

A
  • 1 twitch or
  • post-tetanic count > 10
22
Q

If profound NMB with no response to single twitch, then (5):

A
  • apply 50 Hx tetany for 5 seconds
  • wait 3-5 seconds
  • single twitch response (1/sec)
  • count total twitches
  • >10 twitches indicates sufficient receptors for reversal
23
Q

NDMB reversal by ___________.

A

anticholinesterases … which inhibits acetylcholinesterase. Neostigmine

24
Q

Neostigmine side effects causes stimulation of ______ nervous system.

A

parasympathetic

25
Q

Neostigmine peak onset:

Dose?

A

5-10 minutes

Max 0.07 mg/kg NOT 5mg!!

26
Q

How much glycopyrollate with Neo?

A

0.2 mg per 1 mg of neo

27
Q

Assessing adequacy of ventilation

A

Arterial blood gas:

  • PaO2 > 65 on FiO2 < 0.4
  • PaCO2 < 50 torr
  • EtCO2
  • SpO2 > 90%
  • Tidal volume
28
Q

In obstructive sleep apnea, what is the major factor in arousal?

A

SaO2 = 85%

Hypercapnia = increased PAP

Increased afterload = right ventricular hypertrophy

29
Q

Factors that incr ease incidence of PONV:

A
  • Type of surgery: eye, ENT, abdominal, GI/GU
  • use of volatile anesthetics
  • nitrous oxide
  • large does of neostigmine
  • opioids
30
Q

Surgical sites that have increased risk of PONV:

A
  • intra-abdominal
  • laparoscopic
  • orthopedic
  • gynecological
  • ENT
  • Breast
  • Plastic
  • Neuro
31
Q

If 80 kg patient, how much reversal do you need to give?

A

8 cc: 4cc of Neo, 4cc of glycopyrrolate

32
Q

Anti emetics work on the chemotaxic trigger zone:

A
  • seratonin antagonist (Zofran)
  • dopamine antagonist (Droperidol)
  • antihistimine
  • others (Decadron)
33
Q

Post op pain magement: (3)

A
  • epidural
  • narcotics
  • NSAIDS–Toradol 30mg)
34
Q

NSAID Toradol 30 mg equivalent to ___ mg morphine.

Contraindications?

A

10

Contra: GI ulcers/bleeding, coagulopathy, renal impairment, bone grafts

35
Q

Narcotics titrate to ____ to ____ breaths per minute.

A

10-16

36
Q

No droperidol to what patients?

A

Parkinsons

37
Q

Epidural placement is for post-op pain management.

A
  • Bolus 6-8 cc of numbing agent in divided doses prior to extubation
  • VERIFY NORMOVOLEMIA PRIOR TO BOLUS!
  • be prepared for hypotension

Anesthesia Practice (6 decks)

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