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AP Summer > Exam 2: Key Terms > Flashcards

Exam 2: Key Terms Flashcards

0
Q

What is the potential benefit of inducing deliberate hypothermia during cardiopulmonary bypass?

A

Improves tissue tolerance of ischemia and protects against cerebral and cardiac ischemia

CNS injury may be higher with normothermic CPB

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1
Q

Why do patients lose heat under anesthesia?

A

Anesthesia lowers thermoregulatory threshold for shivering and causes vasodilation.

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2
Q

What is the physiologic response to heat loss in adults?

A

Shivering followed by vasoconstriction, moving the temperature gradient toward the core.

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3
Q

What effect does temperature have on MAC requirements?

A

Decreases MAC 5% for every 1*C lost

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4
Q

What are some physiologic consequences of hypothermia?

A
  • Impaired immune function
  • Decreased oxygen flow to tissue
  • Increased incidence of arrhythmias
  • Decreased drug metabolism
  • Reduced platelet function and activation of clotting cascade (more blood loss)
  • Marked increase in O2 consumption (shivering)
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5
Q

What is a potential benefit of monitoring temperature via the auditory meatus?

A

Theoretically reflects brain temperature because the auditory canal’s blood supply is the external carotid artery

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6
Q

What effect does hypothermia have on metabolic requirements?

A

For every 1°C below 37°C there is a 5 to 7% decrease in metabolic requirements (BMR & CMRO2)

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7
Q

To what temperature would you have to cool the patient in order for it to be neuroprotective?

A

< 35°C may be neuroprotective

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8
Q

How do we confirm placement of a double lumen tube?

A

With a flexible fiber-optic bronchoscope

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9
Q

When using a FFOB to look out of the Murphy Eye in a right-sided double lumen tube what should be seen?

A

“Mercedes sign”

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10
Q

What are some of the predictors of increased morbidity during thoracic procedures?

A

PPO < 40% **
Max VO2 <10 mL/kg/min **

Type of surgery (pneumonectomy = highest)
Post-op hemorrhage (20% mortality)

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11
Q

Regardless of the procedure the major anesthetic consideration for patients with esophageal disease is what?

A

Risk of pulmonary aspiration

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12
Q

How does the lateral decubitus position effect ventilation and perfusion?

A

Perfusion favors the dependent lung whereas ventilation favors the less perfused upper lung

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13
Q

What are some examples of thoracic procedures?

A 
Lung resection
Lung transplantation
Pneumonectomy
Tracheal resection
LVRS
Bronchoalveolar lavage
Esophageal procedures
Mediastinoscopy
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14
Q

According to our lecture notes, what are some absolute indications for one lung ventilation?

A

Contamination
Bronchoalveolar lavage
Necessary controlled distribution of ventilation

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15
Q

How can we achieve one lung ventilation?

A

Double lumen tube
Single lumen tube with bronchial blocker
Endobronchial intubation

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16
Q

What is the difference between resectability and operability?

A

Resectability is determined by the anatomic stage of the tumor

Operability is dependent upon the extent of the procedure and the physiological status of the patient

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17
Q

What factors can inhibit HPV?

A 
Vasodilators
Inhalational anesthetics
PEEP
Calcium channel blockers
Hypocapnia
High PVR
Hypothermia
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18
Q

What are some of the ventilation goals for one lung ventilation?

A

Optimize oxygenation & ventilation!

6-8 mL/kg to ventilated lung
Peak pressure <25 cmH2O
Typically use PC
\+/- PEEP to ventilated lung (auto peep=bad)
\+/- CPAP to non-ventilated lung
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19
Q

What are the two special monitor placement requirements for a mediastinoscopy?

A

Right sided pulse ox

Left sided BP cuff

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20
Q

What is the most common site for cerebral aneurysms?

A

At the bifurcation of the large arteries at the base of the brain (Anterior circle of Willis)

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21
Q 
What are the normal values for:
CBF
CMRO2
CSF volume
CPP
ICP
A 
CBF = 50mL/100g/min (750mL/min)
CMRO2 = 3.5mL/100g/min (50mL/min)

CSF volume = 150mL

CPP = 80-100 mmHg
ICP = 5-10mmHg
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22
Q

How is intracranial hypertension defined and how does the body naturally compensate?

A

Sustained ICP > 15mmHg

Compensates by:

  1. Displacing CSF
  2. Increasing CSF absorption
  3. Decreasing CSF production
  4. Decreasing CBF
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23
Q

What are some risks associated with intracranial hypertension?

A

Herniation
Ischemia
Hypoxia
Cell death

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24
Q

What are the risk factors for subarachnoid hemorrhage?

A

Same as for freaking everything else

Smoking
HTN
Alcohol/Drug abuse
Familial (1st gen.)
Oral contraceptives
Hypercholesterolemia
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25
Q

What are the critical values for CBF and CPP?

A

CBF = 18mL/100g

Irreversible damage @ CPP <25 mmHg

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26
Q

What are some of the determinants CBF?

A
  • CPP [= MAP-ICP (or CVP)]
  • Autoregulation (MAP)
  • Respiratory gas tension (PaCO2 more than PaO2)
  • Temperature (decrease temp, decrease CBF)
  • Viscosity
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27
Q

What effect do IV induction drugs have on CBF? What is the exception?

A

Induction drugs = decrease CBF

Ketamine = increase CBF

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28
Q

What can we do to lower ICP?

A

Treat underlying cause
Fluid restriction
Decrease CSF volume (drainage, diuretics)
Decrease CBF
Decrease brain volume (steroids, mannitol 1g/kg)

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29
Q

What are some anesthetic considerations for a patient with a seizure disorder?

A 
NMB Resistance (due to chronic therapy)
Avoid: ketamine, etomidate, and N2O
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30
Q

What are some potential complications of subarachnoid hemorrhage?

A

-Rerupture (kiss of death)
-Reactive vasospasm w/ infarction
(acute=5-30min after, long-term=3-12days)
-Intracranial HTN
-Hydrocephalus -> 2* hyponatremia
-Seizures

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31
Q

What are some of the signs & symptoms of intracranial mass lesions?

A

Headache
Seizure
Decline in cognitive function
Focal neurological deficits

32
Q

In general, how is the prognosis for intracranial tumors related to growth?

A

Slow changes are better tolerated.

Acute changes and fast growth leads to a poor prognosis.

33
Q

What is the most aggressive primary brain tumor?

A

Glioblastoma multiforme

34
Q

Which neurological disease is treated with a deep brain stimulator(DBS)? How does it work?

A

Parkinson’s Disease

DBS promotes dopamine release

35
Q

What 2 adverse events are the 2 leading causes of morbidity and mortality in patients with intracranial aneurysms?

A
  1. Rebleed

2. Vasospasm

36
Q

According to Dr. Ghani, What is the difference between slightly, moderately and severely increased ICP?

A

Slightly increased = 15-20 mmHg
Moderately increased = 21-40 mmHg
Severely increased = >40 mmHg

37
Q

Which brain herniation site is associated with the highest mortality?

(Bonus: what congenital malformation can cause this?)

A

Cerebellar tonsils through the Foramen Magnum (#3 on diagram)

(Bonus: Arnold-Chiari malformation)

38
Q

What is the triple H therapy of cerebral vasospasm treatment?

A

Hypervolemia
Hypertension
Hemodilution

39
Q

What is the time course of re-bleeding following subarachnoid hemorrhage?

A

1-3 days

40
Q

AVM vs. Aneurysm: Matching

Compare: Blood Loss, Vasospasm, hyperperfusion, BP mgmt, BV mgmt

A 
Blood Loss: 
(AVM=massive, An.=min. unless rupture)
Vasospasm:
(AVM= no, Aneurysm= yes, problem)
Hyperperfusion:
(AVM = yes, Aneurysm = no)
BP Post-Op management:
(AVM = Low, Aneurysm = High)
Blood vol. Post-Op management:
(AVM = Normal, Aneurysm = High)
41
Q

What are the effects of changes in cerebral perfusion pressure (CPP)?

A

Too high = edema

Too low = ischemia

42
Q

What can cause shifts in the CBF curve?

A 
Right = HTN
Left = hypercarbia, vasodilators, anesthetics
43
Q

What is an important positioning consideration for neuroanesthesia?

A

Encourage venous drainage

obstruct IJs -> increase ICP

44
Q

What are the four emergence goals for neuroanesthesia?

A
  1. No coughing
  2. No hypertension
  3. Prompt - neurological fxn
  4. Minimal hypercarbia
45
Q

What is the most important consideration during induction for an intracranial aneurysm?

A

AVOID HYPERTENSION

46
Q

What do you do if the aneurysm ruptures?

A
  • Keep up with blood loss
  • Controlled hypotension (if surgeon needs it)
  • Adenosine
  • Barbiturates: propofol (not etomidate)
47
Q

How do we protect the brain during repair of a cerebral aneurysm?

A 
Hypothermia
Hypertension (with focal ischemia)
Moderate hypocarbia
Drugs (barbiturates, propofol, Iso)
Normoglycemia
48
Q

What is hyperperfusion phenomenon?

A

When areas surrounding an AVM are ischemic, sudden reperfusion is not tolerated. (Avoid HTN)

49
Q

Oculocardiac reflex effects which cranial nerves?

A

Afferent- Trigeminal (V)

Efferent- Vagus (X)

50
Q

What are some of the risks associated with a retrobulbar block?

A 
Hematoma
Brainstem anesthesia
Oculocardiac reflex
Central retinal artery occlusion
Perforation of globe
Retinal detachment
Optic atrophy
Vitreous hemorrhage
51
Q

What are the contraindications for a retrobulbar block?

A

Bleeding disorders
Extreme myopia
Open eye injury

52
Q

What are the advantages of a peribulbar block?

A

Avoids injection into muscle cone
Avoids need for facial nerve block
Lowers risk of globe perforation

53
Q

What is the purpose of hyaluronidase with local anesthesia for ophthalmologic procedures?

A

It’s an enzyme to breakdown orbital fat which allows for faster onset time of block

54
Q

What happens if local is accidentally injected into the spatium intervaginale? Why?

A

After 5 to 7 minutes the patient will lose consciousness and stop breathing (lasts 10-15 mins)

Why? Spatium intervaginale is a subarachnoid space

55
Q

What is the leading cause of cataracts?

A

Diabetes

56
Q

What drug can you not give to strabismus patients and why?

A

Succinylcholine

  • Interferes with forced duction testing
  • Increased MH incidence with strabismus patients
57
Q

What part of the eye allows you to see details?

A

Macula

58
Q

Why is it important that a patient not move or cough during ophthalmological procedures?

A
  • Surgeon is working in a tiny area

- Can cause increased IOP & expulsive hemorrhage

59
Q

What are the two most important determinants of intraocular pressure?

A

Rate of formation and drainage

60
Q

What is the treatment for oculocardiac reflex?

A

Tell surgeon & wait it out (will eventually stop)

Supportive therapy if necessary

61
Q

For purposes of convention what is the definition of geriatric?

A

Persons over the age of 65

62
Q

What are some examples of continuously replicating cells, cells Replicating in response to a challenge and non-replicating cells?

A

Continuously replicating:
-GI, epidermal, hematopoietic

Replicating in response to challenge:
-hepatic

Non-replicating:
-neurons, skeletal and cardiac muscle

63
Q

Why does the geriatric population in general require lower drug doses?

A

They have increased or exaggerated pharmacologic effects due to less efficient protein binding

64
Q

How does the blood volume of an elderly patient compare to that of an average adult?

A

Elderly have 20 to 30% reduction in blood volume

65
Q

How does the thermoregulatory setpoint in an elderly patient compare to the average adult? How does that affect their ability to thermoregulate?

A

Set point = 0.5°C lower in elderly

They cool faster, warm slower

66
Q

What are the physiologic changes in the CNS associated with aging?
How do they present?

A

Decreased: neuronal mass, CBF, CMRO2

Presentation:

  • Decreased complex learning, sleep requirement, REM sleep.
  • Slower psychomotor performance
  • Increased motor response time
67
Q

Which lab values remain unaffected in the aging population?

A 
H&H
WBC
Platelets
Electrolytes
BUN
LFTs
TSH
Ca2+
Phosphorus
68
Q

What is the most important part of the preoperative assessment for the geriatric patient?

A

Functional status

69
Q

What is the best choice of anesthesia for a geriatric patient?

A

Depends….

In general, less is more.
-local without sedation is better than regional or general

70
Q

What is the main difference between anaphylactic and anaphylactoid reactions?

A

Anaphylactoid reactions resemble anaphylaxis but are NOT mediated by immune system

71
Q

Anaphylaxis, angioedema, urticaria, and atopy are examples of what type of reaction?

A

Type I: immediate

72
Q

What must have first happened in order for an anaphylactic reaction to occur?

A

Previous exposure to antigen

73
Q

What is the most common drug induced allergic reaction seen in the OR?

A

Muscle relaxants

74
Q

Redman’s syndrome is an example of what?

A

Anaphylactoid reaction

75
Q

What is the only anaphylactic reaction that has a delayed onset as seen in the OR?

A

Latex

76
Q

What is the first sign of an anaphylactic reaction?

A

Hypotension, but depending on cuff cycling times reflex tachycardia may be seen first

77
Q

Define anaphylaxis

A

Exaggerated response to a foreign substance that is mediated by an antigen-antibody reaction

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