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SRNA4TopicsAnesthesia > EXAM 2 Reading 2 (B.Ch26) > Flashcards

EXAM 2 Reading 2 (B.Ch26) Flashcards

1
Q

What the optimal bispectral index range for general anesthesia?

A

40-60

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2
Q

A BIS score of 100 indicates that the patient is

A

awake and should respond to normal voice.

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3
Q

BIS score of 1-40

A

Deep anesthesia

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4
Q

BIS score of 41-60

A

Desired range of GA

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5
Q

BIS score of 61-90

A

Light anesthesia

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6
Q

BIS score of 91-100

A

Awake

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7
Q

Which of the following devices utilizes spectrophotometry to derive the values it produces?

A

Pulse oximetry

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8
Q

Pulse oximetry utilizes spectrophotometry, which is based on the what law?

A

Beer-Lambert law

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9
Q

If you pass a light with a constant intensity through tissue, the intensity of the light that passes through it is a

A

logarithmic function of the hemoglobin saturation.

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10
Q

Which arterial cannulation site provides the easiest access during low cardiac output states?

A

Femoral

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11
Q

Easy access for low-flow states for arterial cannulation and direct blood pressure monitoring

A

Femoral artery

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12
Q

Which of the following factors may lead to overestimation of the SaO2 by an SpO2 monitor?

A

Severe anemia

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13
Q

Severe anemia can result in overestimation of the SaO2, particularly at

A

low oxygen saturations. Non-hypoxic SaO2 values are typically normal in anemic patients, however.

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14
Q

Prominent venous pulsations and injection of certain dyes such as indigo carmine, lymphazurin, nitrobenzene, indocyamine green, methylene blue, and patent blue can result in

A

underestimation of the SaO2.

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15
Q

Methemoglobinemia tends to drive the pulse oximetry measurement towards _____ regardless of the actual oxygen saturation.

A

85%

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16
Q

Methemoglobinemia which can occur due to large doses of (3) what can they cause?

A

benzocaine, prilocaine or EMLA; skew the results of pulse oximetry.

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17
Q

Methemoglobin absorbs the two frequencies of light used in pulse oximetry in a

A

1:1 ratio, which corresponds to an oxygen saturation of 85%.

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18
Q

Because methemoglobin skews the result towards 85%, it will

A

underestimate the oxygen saturation if the true oxygen saturation is greater than 70% and will overestimate the oxygen saturation when the true hemoglobin saturation is less than 70%.

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19
Q

Calculate the mean arterial pressure (MAP) in mmHg for a patient with the following hemodynamics: SBP/DBP: 147/89; HR: 85. Round to the nearest whole number.

A

108 (Systolic + 2(DBP)]/ 3

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20
Q

A patient has suspected carbon monoxide poisoning. The best method for evaluating oxygen saturation in this case is

A

laboratory co-oximetry

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21
Q

In carbon monoxide poisoning,

A

the carbon monoxide molecule binds to hemoglobin, leaving less hemoglobin available to bind with oxygen. The patient can be hypoxic even though the oxygen saturation level is 100%.In this instance, oxygen saturation must be evaluated using a laboratory co-oximeter

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22
Q

The laboratory Co-oximetry uses

A

uses more wavelengths of light to distinguish between carboxyhemoglobin and oxyhemoglobin.

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23
Q

The bladder of a blood pressure cuff should have a LENGTH that is ___% of the circumference of the arm

A

80%

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24
Q

The bladder within the blood pressure cuff should have a WIDTH that is

A

about 40% of the circumference of the extremity

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25
Q

A cuff that is too small can lead to while

A

overestimation of the blood pressure

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26
Q

Cuffs that are too large can

A

underestimate the actual pressure.

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27
Q

Represents the initial stage of expiration. Gas sampled during this phase occupies

A

Phase A-B. anatomic dead space and is normally devoid of C02.

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28
Q

Types of oxygen analyzers commonly used in anesthesia

A

galvanic cell analyzers. paramagnetic analyzers

polarographic analyzers

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29
Q

The percent of hemoglobin that is saturated with oxygen is directly related to the

A

oxygen tension in the bloodstream

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30
Q

The percent of hemoglobin that is saturated with oxygen is directly related to the oxygen tension (or partial pressure of oxygen) within the bloodstream. Because of this relationship, it provides a

A

good way of estimating a patient’s oxygenation status.

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31
Q

2 Non-metabolic causes of increased end-tidal CO2?

A

Hypoventilation

Rebreathing

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32
Q

Hyperthermia, sepsis, malignant hyperthermia, shivering, and hyperthyroidism are all factors that:

A

increase the metabolic rate and subsequently, the amount of carbon dioxide produced.

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33
Q

Your anesthesia machine has a removeable oxygen sensor. You know that this device is most likely a _____ sensor

A

Galvanic

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34
Q

Galvanic analyzers measure the current produced at the

A

anode of an electrical circuit as oxygen diffuses across a membrane.

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35
Q

Have a sensor capsule that must be replaced regularly.

A

Galvanic analyzers

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36
Q

The removable oxygen sensors seen on anesthesia machines are most commonl

A

galvanic sensors.

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37
Q

Which is the most common site for central venous cannulation by anesthesia providers

A

Right INTERNAL JUGULAR VEIN

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38
Q

Central venous cannulation with the most success rate

A

right IJ vein

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39
Q

A decrease in the end-tidal carbon dioxide level could be caused by any of the following conditions except

A

Sepsis

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40
Q

Pulse oximetry uses ___ light and ___ light to evaluate the oxygen saturation.

A

Read; Near-infrared light

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41
Q

A pulse oximeter uses light of two different wavelengths to distinguish between

A

deoxygenated hemoglobin and oxygenated hemoglobin.

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42
Q

Pulse ox emits red light with a wavelength of _____and near infrared light with a wavelength of ____

A

660 nm;940 nm.

43
Q

What is the preferred site for invasive monitoring of arterial blood pressure

A

Radial artery

44
Q

Statement about the BIS monitoring : level of sedation and BIS relationshi

A

The level of sedation and the BIS score are inversely related

45
Q

Which factor decreases ETCO2 during anesthesia

A

Hypothermia

46
Q

What is the preferred position for a noninvasive blood pressure cuff in an infant with a patent ductus arteriosus

A

RIGHT ARM

47
Q

The preferred placement of a noninvasive blood pressure cuff in pediatric patients and why ?

A

upper extremity because it most closely mirrors cerebral perfusion.

48
Q

If a patent ductus arteriosus is present, the pressure should be taken in the right arm to provide the most accurate representation of

A

cerebral perfusion.

49
Q

The ETCO2 waveform suddenly drops to near zero and the waveform disappears. What are the potential causes you must immediately consider? (select four

A

a. Malposition of the endotracheal tube
b. Cardiac arrest
c. Obstruction of the sample line
d. Circuit disconnection.

50
Q

Where is the oxygen analyzer located

A

INSPIRED LIMB of circuit

51
Q

Is there a delay in the pulse ox reading?

A

Yeah about 15-30 seconds

52
Q

Pulse ox and HR and BP

A

Plethysmotraphic waveform measurement of HR and crude estimation of BP, DAMPENED WITH HYPOTENSION

53
Q

The best monitor for determining the adequacy of ventilation

A

Measurement of Exhaled CO2.

54
Q

Shape of capnograph provides important information including presence of

A

Bronchospasm

55
Q

Sudden loss or decrease ETCO2

A

Misplaced ETT

Reduction in lung perfusion from PE, anaphylaxis and cardiac arrest.

56
Q

Cardiac ischemia is best detected by monitoring

A

Leads II and V5

57
Q

BP at the very least should be measured

A

Every 5 minutes.

58
Q

BP use what method to measure BP

A

Oscillometric method

59
Q

Temperature probes preferred during anesthesia

A

Nasopharyngeal or ESOPHAGEAL TEMPERATURE.

60
Q

Surrogate marker for adequate perfusion to the rest of the body?

A

Urine output

61
Q

Target UO

A

0.5 ml/kg/hr

62
Q

NMB most commonly used pattern is the

A

TOF

63
Q

EACTH Train consists of

A

four stimuli applied at 2 Hz.

64
Q

What happens to TOF height as NMB increases?

A

With increasing NDNMB height of twitch response decrease, each twitch in the TOF sequence has a smaller height than the one before it.

65
Q

For NMB to be considered fully reversed, T4/T1 should be

A

> 0.9

66
Q

What are potential site for monitoring neuromuscular blockade?

A

Ulder
Tibilis posterior
Facial nerve

67
Q

Ulnar nerve NMB monitor which muscle:

A

Adductor pollicis

68
Q

Tibialis Posterior nerve NMB monitor which muscle:

A

Flexor hallucis brevis

69
Q

Facial nerve NMB monitor which muscle:

A

Orbicularis occuli

Corrugator supercilii

70
Q

Where should esophateal probe be placed?

A

Lower third of esophagus

71
Q

Where should pressure transducers be placed?

A

Level with upper border of the heart, 5 cm below the sternal border in a supine patient.

72
Q

Measurement components of A-line

A

Systolic BP at the peak of the upstroke, diastolic blood pressure at the nadir, and mean arterial pressure.

73
Q

Where do you see the dicrotic notch?

A

After systolic peak, during the down stroke, REPRESENTS the pressure reflection form closure of the aortic valve.

74
Q

Overdamping of the waveform is caused by

A

Air bubbles

Blood clots in the catheter’or tubing.

75
Q

Overdamping and BP estimation

A

UNDERESTIMATION

76
Q

Underdamping of the waveform and BP

A

Overestimation of true systolic pressure.

77
Q

The ______is the most reliable measurement for most monitoring purposes

A

MAP.

78
Q

What are component of the CVP?

A

Consists 3 peaks (a, c, v)

and 2 descents (x, y)

79
Q

Atrial contraction waveform component

A

a-wave

80
Q

c wave

A

Isovolumetric ventricular contraction, closure of tricuspid valve

81
Q

V wave is the

A

venous filling of the right atrium, tricuspid valve.

82
Q

y-descent is

A

Blood flow from the right atrium to right ventricle after tricuspid valve opens.

83
Q

A wave happens at phase of the cardiac phase

A

End diastole.

84
Q

c wave happens at phase of the cardiac phase

A

Early systole

85
Q

v wave happens at phase of the cardiac phase

A

Late systole

86
Q

y descent happens at phase of the cardiac phase

A

Early diastole

87
Q

x-descent is

A

Atrial relaxation and descent of the base of the heart.

88
Q

Afib changes with CVP

A

A wave disappears

C wave becomes more prominent

89
Q

Tall cannon a wave is associated with

A

Junctional rhythm

90
Q

Cannon a wave caused by

A

Atrium contracting against a closed tricuspid valve as during AV dissociation,

91
Q

Large v waves caused by

A

Regurgitant flow during ventricular contraction, as with TR

92
Q

Wave seen with tricuspid bulging

A

C wave

93
Q

Analysis of CVP; decrease in CVP with increase BP without changes in SVR

A

The CVP has fallen because of increased cardiac performance.

94
Q

Analysis of CVP; decrease in CVP with decrease BP without changes in SVR

A

Decrease CVP is due to increase intravascular volume or venous return.

95
Q

Analysis of CVP; increase in CVP with increase BP without changes in SVR

A

The cause of the increased CVP is an increase in volume or venous return

96
Q

Analysis of CVP; increase in CVP with decrease BP without changes in SVR

A

the increased CVP is due to decreased cardiac performance.

97
Q

PPV and CVP

A

PPV affect both CO and VR.

98
Q

The transmural pressure is the

A

Difference between atrial pressure and the extracardiac pressure.

99
Q

AT low levels of PEEP , the CVP

A

increases with increased PEEP.

100
Q

AT high levels of PEEP , the CVP

A

High PEEP is >15 cm H2O ; CVP increases as the CO is depressed because of impaired RV output.

101
Q

Advancing the balloon-tip PAC into the pulmonary artery will allow the catheter to wedge and record the

A

PAWP or PAOP

102
Q

The pulmonary artery wedge pressure provides an indirect measurement of

A

Left atrial pressure.

103
Q

Noninvasive CO and volume assessment use which fundamental technologies:

A

Ultrasound
Indicator dilution
Pulse contour analysis

104
Q

Echocardiography used to evaluate

A

ventricular function
Assess valvular pathology
such as new valve murmur.

SRNA4TopicsAnesthesia (47 decks)

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