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SRNA4TopicsAnesthesia > Exam # 3 Prodigy Nagelhout > Flashcards

Exam # 3 Prodigy Nagelhout Flashcards

1
Q

Which A-type fibers are the most myelinated and largest in diameter?

A

A-Alpha

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2
Q

When a volatile anesthetic is administered to a patient undergoing EEG monitoring, there is an initial ______ in amplitude followed by a(n) _________ in both frequency and amplitude.

A

increase, decrease

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3
Q

All volatile anesthetics suppress the.

A

electroencephalogram (EEG) in a dose-dependent manner

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4
Q

At about 2.0 MAC, the EEG may temporarily exhibit what ? What is it refer to as?

A

electrical silence. This is referred to as burst suppression.

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5
Q

Which cholinesterase inhibitor has the shortest duration of action?

A

Edrophonium

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6
Q

Has the fastest onset and shortest duration of action for the cholinesterase inhibitor?

A

Edrophonium

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7
Q

Why is edrophonium not use as a reversal agent?

A

low doses of the drug should not be administered for primary reversal of muscle relaxants as the muscle relaxant could outlast the duration of the reversal.

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8
Q

Which of the following is a potential side effect from the use of eutectic mixture of local anesthetic (EMLA) cream?

A

Decreased oxygen saturation reading

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9
Q

Because EMLA cream contains prilocaine, it can result in

A

methemoglobinemia.

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10
Q

Methemoglobinemia has equal absorbent coefficient ratios for both

A

red and infrared wavelengths and results in a false pulse oximetry reading that tends to equal 85%.

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11
Q

Methemoglobinemia can result in falsely low pulse oximetry readings when the actual oxygen saturation is

A

higher than 85% and falsely high readings when the oxygen saturation is lower than 85%.

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12
Q

Which local anesthetic produces vasoconstriction, shrinks the mucosa, and helps facilitate nasal surgery?

A

Cocaine

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13
Q

The only naturally occurring local anesthetic? In fact, it is

A

Cocaine

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14
Q

Main action of cocaine on catecholamines ?

A

Blocks the reuptake of catecholamines in adrenergic neurons, resulting in vasoconstriction.

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15
Q

Main use of cocaine?

A

Its main use is for topical anesthesia for the nose and throat

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16
Q

Used in more than 50% of rhinolaryngologic procedures in the US.

A

Cocaine

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17
Q

What is the most common side effect of neuraxial opioids?

A

Pruritus

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18
Q

Pruritus caused by neuraxial opioids typically is concentrated on the

A

face, neck, and upper chest but can be distributed throughout the entire body.

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19
Q

Pruritus more common in these types of patients?

A

It is most common in obstetric patients, presumably from the combined pruritic effect of estrogen.

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20
Q

Which nondepolarizing muscle relaxant is metabolized predominantly by ester hydrolysis?

A

Atracurium

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21
Q

A small amount of Cisatracurium may be metabolized by_______

A

Plasma esterases

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22
Q

The primary route of metabolism is Hofmann elimination.

A

Atracurium

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23
Q

Most heavily on nonspecific esterases for its metabolism

A

Amount of Atracurium, on the other hand,

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24
Q

Primary metabolism of ATRACRURIUM

A

Nonspecific Plasma esterase

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25
Q

Only about 10-40% undergoes Hofmann elimination

A

Cisatracurium

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26
Q

Rocuronium is eliminated primarily in the

A

bile.

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27
Q

Vecuronium is metabolized to a small extent by the

A

liver and depends upon

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28
Q

Excretion of vecuronium

A

biliary and renal excretion.

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29
Q

Which of the following anesthetic formulations is most susceptible to bacterial growth?

A

Propofol

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30
Q

Propofol is prepared as a

A

lipid emulsion of soybean oil, glycerol, and egg lecithin with a pH between 7 and 8.5.

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31
Q

Why does propofol contains EDTA, metabisulfite, or benzyl alcohol?

A

to help prevent bacterial growth.

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32
Q

What substances, when added to a local anesthetic solution, will prolong the local anesthetic duration of action? 2

A

Epinephrine

Phenylephrine

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33
Q

The addition of dextran to a local anesthetic solution increases the

A

duration of action.

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34
Q

The addition of a vasoconstrictor such as epinephrine and phenylephrine will _______ of LA

A

prolong the effect of local anesthetics.

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35
Q

The addition of hyaluronidase facilitates the

A

spread of the local anesthetics into the tissue and speeds the onset of the block.

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36
Q

Which organs are primarily responsible for excreting opioids and their metabolites?

A

Kidneys

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37
Q

Oil:gas partition coefficient of Isoflurane is

A

99 (some sources cite 98)

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38
Q

Oil:gas partition coefficient of desflurane

A

Desflurane = 18.7

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39
Q

Oil:gas partition coefficient of Sevoflurane

A

Sevoflurane = 50 (some source cite 55),

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40
Q

Oil:gas partition coefficient of Nitrous oxide

A

Nitrous oxide = 1.4

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41
Q

Which of the following will exacerbate local anesthetic toxic reactions? (select two)

A

Hypoxia

Hypercapnia

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42
Q

Triad of LA toxicity is

A

Hypoxia, hypercapnia, and acidosis

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43
Q

Utmost importance in the management of inadvertent local anesthetic overdose.

A

Airway control

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44
Q

Which of the following local anesthetics are hydrolyzed in plasma by cholinesterase systems?

A

Amino ester local anesthetics (chloroprocaine, procaine, benzocaine) are hydrolyzed in the plasma by pseudocholinesterase.

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45
Q

What are the amide LAs?

A

lidocaine, prilocaine, bupivacaine, ropivacaine

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46
Q

The amide local anesthetics are primarily metabolized in

A

the liver.

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47
Q

What is the approximate blood/gas partition coefficient of sevoflurane?

A

0.68

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48
Q

Following administration of morphine for pain, a patient complains of pruritus. Which agent would be the most appropriate to alleviate the itching?

A

nalbuphine

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49
Q

Can eliminate opioid-induced pruritus, they may also reverse the analgesia of the opioid.

A

Naloxone and naltrexone

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50
Q

Nalbuphine has been shown to be more effective than diphenhydramine, propofol, and naloxone in treating pruritus and does not

A

reverse analgesia.

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51
Q

The alveolar concentration of anesthetic that blunts adrenergic responses to noxious stimuli is termed as:

A

MAC BAR

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52
Q

MAC-BAR95 is the dose that prevents an

A

adrenergic response in 95% of patients.

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53
Q

Which opioid is most likely to cause histamine release?

A

Morphine

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54
Q

Morphine causes histamine to be released from mast cells. This results in

A

redness, generalized flushing, local itching, or hives near the site of injection.

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55
Q

Which local anesthetic only exists in a nonionized state?

A

benzocaine

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56
Q

It is able to pass into the cell membrane and block the sodium channel directly without entering the axoplasm.

A

Benzocaine

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57
Q

Which local anesthetic agent causes vasoconstriction?

A

With the exception of cocaine, ropivacaine, and lidocaine, all local anesthetics produce vascular smooth muscle relaxation.

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58
Q

Select the two local anesthetics that are found in Eutectic Mixture of Local Anesthetics (EMLA).

A

Lidocaine

Prilocaine

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59
Q

EMLA is a mixture of

A

2.5% prilocaine and 2.5% lidocaine. It is applied to the skin via patch or cream.

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60
Q

Which volatile anesthetic produces the least amount of coronary vasodilation?

A

Sevoflurane

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61
Q

All produce vasodilation of the coronary arteries, with sevoflurane producing the least coronary dilation.

A

Isoflurane, sevoflurane, and desflurane

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62
Q

Rank the intravenous agents in order with number one being the greatest degree of protein binding and number four the least.

A

From greatest to least, the degree of protein-binding is as follows: Propofol > Midazolam > Etomidate > Ketamine

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63
Q

Which of the following statements regarding fentanyl are true? (select two)

A

Termination of its effects are predominantly via hepatic metabolism

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64
Q

Peak effect of fentanyl

A

3-5 minutes

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65
Q

Fentanyl undergoes extensive first-pass metabolism, so the oral route is typically

A

insufficient for administration.

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66
Q

Solubility of Fentanyl

A

Because it has a high lipid solubility

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67
Q

Which of the following local anesthetics are amino ester agents? (select two)

A

Chloroprocaine

Cocaine

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68
Q

Are amino ester local anesthetics.

A

Chloroprocaine, tetracaine, and cocaine

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69
Q

Which of the following agents are capable of producing a phase I block?

A

Succinylcholine

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70
Q

A phase I block is characterized by Succinylcholine is the only drug available in the US that can produce a phase I block.

A

Muscle fasciculations prior to paralysis,
A lack of fade on tetanus
Train-of-four, or double-burst stimulation, and
A potentiation by acetylcholinesterase drugs.

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71
Q

A phase I block is characterized by Succinylcholine is the only drug available in the US that can produce a phase I block.

A

Muscle fasciculations prior to paralysis,
A lack of fade on tetanus
Train-of-four, or double-burst stimulation, and
A potentiation by acetylcholinesterase drugs

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72
Q

A phase I block is characterized by

A

Muscle fasciculations prior to paralysis,
A lack of fade on tetanus
Train-of-four, or double-burst stimulation, and
A potentiation by acetylcholinesterase drugs

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73
Q

Is the only drug available in the US that can produce a phase I block ?

A

Succinylcholine

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74
Q

3 conditions is associated with an increased risk of hyperkalemia following succinylcholine administration?

A

Closed head injury
Burn injury
Guillain-Barre Syndrome

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75
Q

Other conditions you should not give succ ? NEURO

A 
Massive trauma, 
spinal cord injury,
Stroke
ruptured cerebral aneurysm
Polyneuropathy
Near drowning
Myopathies
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76
Q

Which of the following statements concerning the metabolites of morphine is correct?

A

Morphine-6-glucuronide appears to exert a CNS effect that is far more potent than morphine. M6G is not lipid soluble. Despite its CNS potency, not much of it can usually cross the blood-brain barrier. After chronic administration, however, it can accumulate and begin to cross the blood-brain barrier by mass action.

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77
Q

Which of the following statements concerning the metabolites of morphine is correct?

A

Morphine-6-glucuronide appears to exert a CNS effect that is far more potent than morphine.

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78
Q

Inactive metabolite of morphine

A

Morphine-3-glucuronide is inactive.

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79
Q

Is M6G lipid soluble?

A

NO

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80
Q

Which of the following conditions would most likely prolong or potentiate the effects of neuromuscular blockade?

A 
Acidosis
Hypercarbia
Hypothermia
Hypokalemia
Hypermagnesemia.
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81
Q

Prilocaine is metabolized to _______________, which can result in methemoglobinemia.

A

O-toluidine

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82
Q

O-toluidine, a metabolite of prilocaine MOA

A

oxidizes hemoglobin to methemoglobin, resulting in methemoglobinemia.

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83
Q

Acidosis effects on neuromuscular blockade?

A

Potentiates

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84
Q

Hypercabia effects on neuromuscular blockade?

A

Potentiates

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85
Q

Hypothermia effects on neuromuscular blockade?

A

Potentiates

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86
Q

Hypermagnesemia effects on neuromuscular blockade?

A

Potentiates

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87
Q

Which value for an inhaled anesthetic would you expect to be the highest? MAC wise

A

MAC-BAR

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88
Q

The term MAC-Awake is the concentration that produces unconsciousness in

A

50% of patients.

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89
Q

Typically, the MAC-Awake is about

A

half of MAC.

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90
Q

What is MAC-memory?

A

MAC-Memory is the concentration that produces amnesia in 50% of patients.

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91
Q

The MAC-BAR50 of both isoflurane and desflurane is

A

1.85 times MAC, and that’s with the addition of 60% nitrous oxide.

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92
Q

Which agent is a pure opioid antagonist that reverses opioid induced respiratory depression and analgesia?

A

Naloxone

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93
Q

Naloxone reverses analgesia through those receptors?

A

Through antagonism at mu, delta, and kappa receptors.

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94
Q

How does diazepam affect the CO2 response curve?

A

decreases the slope of the curve

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95
Q

Unlike most other CNS depressants, however, diazepam does not

A

shift the curve to the right.

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96
Q

Unlike most other CNS depressants, however, diazepam does not

A

shift the curve to the right.

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97
Q

The action of which of the following nondepolarizing muscle relaxants would be prolonged in the presence of liver failure? (select two)

A

Rocuronium

Pancuronium

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98
Q

A NDNMB agent that depends significantly (about 20%) on hepatic metabolism for clearance and its action is prolonged in patients with liver failure/cirrhosis.

A

Pancuronium

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99
Q

Depends upon metabolism by nonspecific esterases and is not prolonged by liver disease

A

Atracurium

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100
Q

It should also be noted that in patients with cirrhosis, the initial dose to achieve adequate muscle relaxation with pancuronium is

A

high and simultaneously there is slow disappearance of pancuronium from plasma.

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101
Q

Which of the following statements regarding respiratory gas tension and cerebral blood flow (CBF) is true?

A

Hypocapnia (decrease CO2 in blood) decreases cerebral blood flow. This effect usually lasts for about 4-6 hours.

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102
Q

PaO2 has little effect on CBF until it reaches a tension of 50 mmHg at which point it

A

dramatically increases CBF.

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103
Q

Which term describes the diversion of blood from a myocardial bed with limited or inadequate perfusion to a bed with more adequate perfusion?

A

Coronary steal

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104
Q

Explain coronary steal syndrome?

A

As the normal vessels dilate, blood is shunted towards the normal areas of the heart and away from the areas supplied by the already diseased vessels. This can result in worsening of ischemia.

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105
Q

The drugs most commonly involved in anesthesia-related allergic reactions are (select two)

A

Neuromuscular blocking agents

Antibiotics

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106
Q

Which A type fibers transmit temperature sensation and pain?

A

A-delta fibers transmit temperature sensation and pain.

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107
Q

Which of the following would explain a duration of action for succinylcholine of 6-8 hours?

A

Homozygous atypical pseudocholinesterase

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108
Q

A dibucaine number of 50 and heterozygous atypical pseudocholinesterase are also associated with a prolongation of action by

A

about 20-30 minutes.

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109
Q

Organophosphates will prolong the duration of succinylcholine

A

usually only by about 20-30 minutes

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110
Q

Homozygous atypical pseudocholinesterase occurs in 1:3200 persons and results in the production of a

A

pseudocholinesterase that has 1% of the normal affinity for succinylcholine. This results in greatly reduced metabolism of succinylcholine and a duration of action of 6 to 8 hours. .

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111
Q

How many sodium ions exit a cell for each two potassium ions that enter during repolarization?

A

3

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112
Q

What is the dibucaine number in a normal, healthy adult?

A

70 or higher

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113
Q

The dibucaine number is used to

A

assess the degree of pseudocholinesterase deficiency.

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114
Q

A normal dibucaine number is

A

greater than 70.

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115
Q

Heterozygous deficiency is defined as a dibucaine number between

A

30-70.

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116
Q

Atypical homozygous deficiency is characterized by a dibucaine number

A

below 30.

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117
Q

What is the elimination half-life of flumazenil?

A

60 minutes (1 hour)

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118
Q

Sevoflurane may need to be used with caution or possibly avoided in patients with

A

epilepsy; Sevoflurane can enhance seizure activity and needs to be used with caution in patients with a history of epilepsy.

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119
Q

Double-burst stimulation (DBS) is characterized by I.

A

Two short sequences of 50 Hz electrical impulses separated by 750 milliseconds.

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120
Q

The primary use for Double-burst stimulation (DBS) is to

A

detect residual blockade by a nondepolarizing neuromuscular relaxant.

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121
Q

Double-burst stimulation : Fade on the second burst of DBS is easier to detect than

A

fade on a train of four.

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122
Q

Tetanus consists of

A

repeated electrical impulses at a rapid frequency of 50, 100, or even 200 Hertz.

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123
Q

With Tetanus, in the case of a depolarizing block, the amplitude of the contraction is

A

decreased and fade is exhibited over the course of the five-second recommended duration of stimulus

124
Q

A train-of-four stimulus consists of

A

four single pulses of equal intensity at intervals of 0.5 seconds.

125
Q

With a TOF, when a partial depolarizing block is present, all four contractions will be

A

diminished

126
Q

With a TOF, when a partial NON-depolarizing block there will be

A

Fade in intensity of the contraction over the course of the stimulations, with the potential absence of some or all of the contractions depending on the intensity of the block.

127
Q

The use of meperidine requires caution in patients with renal failure because of the potential for

A

prolonged respiratory depression

128
Q

Most of the commonly used opioids are inactivated by the ______and some or all of the metabolites are excreted in

A

liver, the urine.

129
Q

With the exception of ____and _____most opioids do not result in significant prolongation.

A

morphine and meperidine,

130
Q

The metabolites morphine-6-glucuronide and normeperidine however, are capable of exerting

A

clinical effects and may result in respiratory depression in patients with renal failure.

131
Q

Which opioid agonist agent is the least potent?

A

Alfentanil

132
Q

The following is a ranking of potency for the above opioid agonists: SFRA

A

Sufentanil>Fentanyl=Remifentanil>Alfentanil

133
Q

Which drug produces a functional dissociation between the thalamocortical and limbic systems?

A

Ketamine

134
Q

Which nerve fiber is associated with motor function?

A

A-alpha

135
Q

Large fibers that are heavily myelinated.

A

A-Alpha

136
Q

When administered for induction, etomidate may cause a slight decrease in blood pressure. If it occurs, this is most likely due to a decrease in

A

systemic vascular resistance

137
Q

Etomidate administration causes minimal It is well as any other patients in whom maintenance of a normal BP is imperative.

A

changes in hemodynamic status.

138
Q

Considered the induction drug of choice in patients with cardiovascular disease

A

Etomidate

139
Q

Slight decreases in BP following administration of etomidate are due to a

A

minor decrease in SVR.

140
Q

The oil:gas partition coefficient for sevoflurane is about

A

50

141
Q

Used in patients addicted to opioids to prevent the euphoric effects of opioids

A

Naltrexone

142
Q

are heavily myelinated, have a diameter of 12-20 microns, and are responsible for .

A

A-alpha fibers

143
Q

Responsible for somatic motor impulses and proprioception.

A

A-Alpha

144
Q

Moderately myelinated, have a diameter of 5-12 microns, and transmit touch and pressure impulses

A

A-beta fibers

145
Q

Moderately myelinated, have a diameter of 3-12 microns, and transmit proprioception impulses.

A

A-gamma fibers

146
Q

LIightly myelinated, have a diameter of <3 microns, and transmit autonomic impulses.

A

B fibers

147
Q

Transmit pain and temperature impulses.

A

C fibers have a diameter of 0.3-1.3 microns

148
Q

Diameter of 0.3-1.3 microns

A

C fibers

149
Q

Which of the following conditions would most likely prolong or potentiate the effects of neuromuscular blockade?

A

Hypothermia

150
Q

Which nerve fiber is responsible for transmitting pain, cold temperature, and touch?

A

. A-delta

151
Q

Following injection of lidocaine during an epidural anesthetic, the patient begins to complain of numbness of her lips, dizziness, and ringing in the ears. Which of the following would be an appropriate intervention?

A

Encourage the patient to hyperventilate. This patient exhibits early signs of central nervous system toxicity from local anesthetics, possibly due to intravascular injection during the epidural

152
Q

LAST, As the toxic symptoms progress, treatment for bradycardia and termination of seizures.

A

atropine may be indicated for bradycardia or sodium thiopental 50-100 mg to terminate seizures.

153
Q

In the early stages of Local anesthetic toxicity , what is the treatment of choice? why?

A

Hyperventilation (preferably with 100% oxygen) is the treatment of choice.a

154
Q

Why is hyperventilation with 100% O2 is the treatment of choice for LAST in early stages?

A

Hyperventilation with 100% oxygen increases the plasma pH to counteract these effects and denitrogenates the lungs in the event emergency intubation becomes necess

155
Q

Acidosis worsens the toxic effects of local anesthetics by causing

A

cerebral vasodilation and delivering more drug to the brain, reducing plasma protein binding which leaves more free drug available in the circulatory system, and by causing ion trapping within the neuron due to increased intracellular acidosis.

156
Q

Why is a Phase II block rarely seen with succinylcholine?

A

The doses required to produce a Phase II block are rarely administered (4-8 mg/kg)

157
Q

Which of the following agents would be able to precipitate malignant hyperthermia in a susceptible patient?

A

All VA

158
Q

The most serious effect volatile anesthetics can have on the neuromuscular system is their ability to trigger

A

malignant hyperthermia, an acute, uncontrolled syndrome that results in increased skeletal muscle metabolism.

159
Q

MH causes accelerated ______which leads to

A

Increases metabolism produces increased oxygen consumption and heat production, the formation of lactate, and rhabdomyolysis.

160
Q

MH Overall clinical manifestations include

A

tachycardia, an unexplained increase in end-tidal CO2, tachypnea, and masseter or total body rigidity.

161
Q

Propofol, nitrous oxide, and ketamine and MH

A

are not triggers of malignant hyperthermia.

162
Q

During intravenous induction, you administer 10 percent of your calculated rocuronium dose followed by your induction agent, then the rest of the rocuronium dose. This technique is known as

A

priming

163
Q

When used for rapid sequence induction, the onset of rocuronium can be accelerated by a technique called

A

priming. This is achieved by giving 10% of the calculated intubating dose before the induction of anesthesia.The patient is then induced following a period of 1 to 3 minutes, and the rest of the rocuronium dose is administered.

164
Q

Rocuronium when using priming dose speeds the

A

onset, however it can result in respiratory distress in 10% of patients.

165
Q

You suspect that a patient has local anesthetic systemic toxicity from an inadvertent vascular injection. Which of the the following agents is the treatment of this condition?

A

. lipid emulsion therapy

166
Q

As soon as signs of local anesthetic toxicity appear, you should consider

A

lipid emulsion therapy as it is now considered a standard part of the resuscitation of patients with LAST.

167
Q

How do you dose lipid emulsion ?

A

The initial bolus is 1.5 mL per kilogram of a 20% lipid emulsion over 1 minute followed by a continuous infusion of 0.25 mL/kg/minute.

168
Q

Medications to avoid when the patient presents with LAST?

A

Vasopressin, beta blockers, calcium channel blockers are to be avoided.

169
Q

Which intravenous opioid has the fastest onset?

A

Alfentanil has an almost immediate onset when administered.

170
Q

Alfentanil FASTEST speed of onset is due to

A

small volume of distribution, and 90 percent of the drug is in the nonionized form at physiologic pH, leading to an increased amount of drug being available for binding.

171
Q

Acidosis and MAC

A

decreases MAC

172
Q

Pregnancy and MAC

A

decreases MAC.

173
Q

It has been demonstrated that natural redheads have

A

a significantly higher anesthetic requirement for desflurane than do non-redhead patients.

174
Q

Vecuronium is chemically derived from what other neuromuscular blocking agent?

A

Pancuronium

175
Q

Vecuronium was created by manipulating the

A

pancuronium molecule, changing it from a bisquaternary compound to a monoquaternary compound. This alteration produced a drug that has an onset time and potency that is 1.5 times greater than that of the parent drug pancuronium.

176
Q

What is the usual concentration of epinephrine added to local anesthetics to prolong epidural blockade?

A

The usual concentration of epinephrine added to local anesthetics is 1:200,000 or 5 mcg/mL

177
Q

Using a peripheral nerve stimulator with electrodes overlying the patient’s ulnar nerve, you have delivered a series of four twitches every half-second for a total of 2 seconds. Which test have you performed?

A

Train-of-four

178
Q

The train-of-four test is comprised of a

A

series of four twitches applied every half-second (2 Hz stimulation) for a total of 2 seconds.

179
Q

Which of the following would be added to a local anesthetic prior to injection to facilitate the spread of the drug through the tissues?

A

Hyaluronidase

180
Q

Hyaluronidase is added to local anesthetic to facilitate the spread of the drug through the tissues. The primary use for this technique is when injecting local anesthetic into

A

the orbit prior to opthalmologic surgery.

181
Q

Sodium bicarbonate is added to LA to

A

speed the onset of the drug.

182
Q

Epinephrine is added to a local anesthetic to

A

prolong the duration of the drug.

183
Q

The speed at which Hofmann elimination acts to degrade atracurium depends primarily on (select two)

A

pH

Temperature

184
Q

Hofmann elimination is both pH and temperature dependent. When LA injected, what happens ?

A

the pH of the solution rises to normal body pH, the temperature rises from room temperature to body temperature, and Hofmann elimination begins.

185
Q

Select two agents that may produce myoclonic-like activity.

A

Propofol and etomidate both produce myoclonic-like activity

186
Q

Least to true epileptogenic activity?

A

Methohexital

187
Q

You administer succinylcholine in a high dose to a patient that has a pseudocholinesterase deficiency. What results would you expect to see?

A

A prolonged phase 2 block

188
Q

Small doses of succinylcholine in a normal patient produce a phase 1 block. High doses of succinylcholine or succinylcholine administered to patients with a pseudocholinesterase deficiency will produce a

A

phase 2 block.

189
Q

Of the toxic central nervous system effects attributed to intravascular injection of a large volume of local anesthetic, which would likely appear first?

A

Tingling of the lips

190
Q

The typical sequence of CNS symptoms seen from local anesthetic toxicity in order of appearance are
CiLiTiVi, SMIUGCA

A

Circumoral numbness
Lightheadedness
Tinnitus
Visual disturbances,

slurring of speech
muscle twitching, 
irrational conversation, 
unconsciousness, 
grand mal seizures, 
coma, and apnea.
191
Q

Select two opioids that cause the release of histamine from mast cells when administered in high doses.

A

Morphine
Meperidine
Codeine

192
Q

Select two disorders where succinylcholine is avoided.

A

Myotonia

Muscular dystrophy

193
Q

Which sedative-hypnotic agent may cause an increase in blood pressure and heart rate?

A

Ketamine

194
Q

The duration of action of which local anesthetic would be prolonged the least by the addition of epinephrine prior to injection?

A

The addition of epinephrine does not significantly affect the duration of action of bupivacaine, etidocaine, or prilocaine, whereas mepivacaine and lidocaine are significantly prolonged.

195
Q

Which sequence accurately describes the progression of paralysis following the administration of neuromuscular blocking agents?

A

Eye muscles, extremity muscles, abdominal muscles, diaphragm

196
Q

Which sequence accurately describes the RETURN of paralysis following the administration of neuromuscular blocking agents?

A

diaphragm, abdominal muscles, extremity muscles, Eye muscles

197
Q

Stimulation of GABA receptors results in an

A

Influx of Chloride into the cell

198
Q

Gamma-aminobutyric acid (GABA) receptors are

A

ligand-gated ion channel receptors in the cell membrane of neurons in the central nervous system.

199
Q

Which of the following agents would be most likely to produce adrenocortical suppression?

A

Etomidate

200
Q

Side effects of etomidate.

A

Adrenocortical suppression

myoclonia, pain on injection, thrombophlebitis, and postoperative nausea and vomiting

201
Q

Which agent is most likely to produce nausea and vomiting in adult patients?

A

Etomidate

202
Q

Ketamine is associated with an increased incidence of ____In what patients?

A

nausea and vomiting in pediatric patients but not adult patients.

203
Q

Which of the following IV anesthetics agents would most readily cross the placenta?

A

Ketamine

204
Q

Ketamine and placental ?

A

is very lipid soluble and quickly crosses from the placenta to the fetus. Uterine blood flow is maintained as well as uterine tone.

205
Q

Ketamine Induction doses of not compromise neonatal status at delivery?

A

0.5-1 mg/kg, however, do not compromise neonatal status at delivery.

206
Q

Ketamine Induction doses that result in a depressed neonate upon delivery.

A

2-2.5 mg/kg

207
Q

Which value for an inhaled anesthetic would you expect to be the lowest?

A

MAC-memory

208
Q

Which of the following statements is true concerning the effect of opioids on the CO2 response curve

A

They shift the curve to the right, which represents a decrease in responsiveness to CO2

209
Q

Which opioid agent is used mainly for the treatment of opioid abstinence syndromes, heroin addiction, and chronic pain relief?

A

Methadone

210
Q

What are the characteristics of a phase II block from succinylcholine administration? (select two)

A

Posttetanic potentiation

Fade on train-of-four

211
Q

Which intravenous anesthetic has the fastest elimination half-life?

A

Propofol has the fastest elimination with a half-life as short as 30 minutes to 1.5 hours.

212
Q

Etomidate and midazolam both have an elimination half-life of

A

2-4 hours.

213
Q

The elimination half-life of ketamine is about

A

2-3 hours.

214
Q

Which effect on the respiratory system are you most likely to see with the administration of an inhalation anesthetic?

A

Respiratory depression due primarily to a decrease in tidal volume

215
Q

Inhalation agents depress the

A

respiratory system in a dose-dependent fashion.

216
Q

Inhalation agents, The tidal volume is primarily affected, followed by the respiratory rate. The tidal volume is decreased as the

A

concentration of the agent increases. The respiratory rate increases, but this is typically insufficient to prevent increases in arterial CO2 due to hypoventilation.

217
Q

Which nerve would be most appropriate to monitor using a peripheral nerve stimulator to determine adequacy of muscle relaxation prior to intubation?

A

Facial nerve

218
Q

Which neuromuscular blocker is contraindicated in patients with muscle denervation from CVA, spinal cord injury, or myelopathy?

A

Succinylcholine

219
Q

Which local anesthetics will produce vasodilation (select two)

A

prilocaine, bupivacaine

220
Q

Isoflurane has 5 fluorides, desflurane has 6, and sevoflurane is the most fluorinated with 7 fluoride atoms.

A

IDS (567)

221
Q

Approximately 77% of cisatracurium is eliminated by

A

Hofmann elimination, and 23% is by nonspecific esterases.

222
Q

Max dose of Neogstigmine is

A

0.07 mg/kg

223
Q

Anticholinesterase that is a tertiary amine

A

Physostigmine

224
Q

Which inhalational agent has a vapor pressure of about 160 mmHg?

A

Sevoflurane

225
Q

Which agent is a pure opioid antagonist that reverses opioid induced respiratory depression and analgesia?

A

Naloxone

226
Q

hat is the most common cause of local anesthetic systemic toxicity?

A

Inadvertent vascular injection

227
Q

What is the drug of choice for preventing seizures in a patient with local anesthetic systemic toxicity?

A

Benzodiazepines

228
Q

The addition of sodium bicarbonate to local anesthetics would be responsible for all of the following except:

A

Increase ionization

229
Q

Mivacurium owes its short duration to its elimination process: it is rapidly hydrolyzed by Diseases affecting the production of this enzyme will result in a longer duration of action. I

A

plasma cholinesterases into two molecules of a quaternary alchohol and a dicarboxylic acid, which are then eliminated in bile and urine.

230
Q

Mivacurium owes its short duration to its elimination process: it is rapidly hydrolyzed by

A

plasma cholinesterases into two molecules of a quaternary alchohol and a dicarboxylic acid, which are then eliminated in bile and urine.

231
Q

ndividuals with atypical plasma cholinesterase should not be given mivacurium because

A

it could result in a significantly prolonged blockade.

232
Q

Individuals with atypical plasma cholinesterase should not be given mivacurium because

A

it could result in a significantly prolonged blockade.

233
Q

LA vasodilation except

A

cocaine, lidocaine, and ropivacaine.

234
Q

Imagine four anesthesia gases identified as gas A, B, C, and D. Given the oil:gas partition coefficients for each gas as follows: Gas A = 78, Gas B = 5.5, Gas C = 102, and Gas D = 2.1, which anesthetic gas would you expect to be the most potent?

A

Gas C

235
Q

The oil:gas solubility coefficient provides an indication to

A

the potency of an inhalation anesthetic.

236
Q

The higher the oil:gas solubility, the

A

greater the potency.

237
Q

The estimated MAC of an agent can be calculated by

A

dividing 150 by the oil:gas coefficient.

238
Q

Place the muscle groups in the correct order in which they would become paralyzed by a non-depolarizing muscle relaxant.

A

Ocular , extremities, then diaphragm

239
Q

Place the muscle groups in the correct order in which they would recover from paralysis by a non-depolarizing muscle relaxant.

A

Diaphragm, extremities, ocular

240
Q

The duration of action of which local anesthetic would be prolonged the least by the addition of epinephrine prior to injection?

A

Bupivacaine, etidocaine and prilocaine

241
Q

Which opioid receptor produces diuresis when stimulated? How?

A

Kappa; When stimulated, kappa receptors inhibit the release of vasopressin, resulting in diuresis.

242
Q

You have just performed a train-of-four assessment on your patient using a peripheral nerve stimulator. What is the minimum amount of time you should wait before repeating the test?

A

12 seconds

243
Q

You are preparing to induce general anesthesia with a volatile anesthetic in a patient with a left-to-right shunt. You know that this condition would

A

In a left-to-right shunt, the blood delivered to the lungs has a higher partial pressure of anesthetic than the blood that has passed through the tissues. As a result, a left-to-right shunt will offset the dilutional effect of a right-to-left shunt. In fact, the effect of a left-to-right shunt on the speed of induction is only detectable if a right-to-left shunt is already present. Ventricular septal defect (as may occur with tetralogy of Fallot) produces a right-to-left shunt.

244
Q

Atracurium should be refrigerated because

A

it loses potency if not refrigerated

245
Q

Atracurium refrigerated, When stored refrigerated at

A

5 degrees Celsius, atracurium loses potency at a rate of 6% per year, whereas when it is stored at room temperature, it loses potency at a rate of roughly 5% per month.

246
Q

Atracurium recommended unrefrigerated shelf life is

A

14 days.

247
Q

What are the major factors that determine the rate of elimination of amide local anesthetics? (select two)

A

Hepatic enzyme activity

Hepatic blood flow

248
Q

Cisatracurium is primarily metabolized by

A

Hoffman

249
Q

Rhabdomyolysis in a pediatric patient who has received succinylcholine is associated with undiagnosed

A

Duchenne’s muscular dystrophy

250
Q

What are the major factors that contribute to the negative inotropic and chronotropic effects of local anesthetic toxicity? (select three)

A

Hypoxia
Hypercarbia
Acidosis

251
Q

Which local anesthetic has the highest potency and longest duration?

A

Tetracaine

252
Q

Both intermediate in potency and duration, while

A

Lidocaine and mepivacaine

253
Q

Procaine has low

A

potency and a short duration of action.

254
Q

Which local anesthetic produces vasoconstriction, shrinks the mucosa, and helps facilitate nasal surgery?

A

Cocaine

255
Q

NDNMB and Ketamine: Ketamine will

A

potentiate the effects of nondepolarizing muscle relaxants, but does not prolong depolarizing blockade.

256
Q

Pregnancy is associated with low levels of

A

pseudocholinesterase and may result in a prolonged depolarizing block.

257
Q

Which neuromuscular blocking agent is best suited for a rapid sequence induction?

A

Rocuronium

258
Q

Rocuronium intubating dose and onset

A

A dose between 0.6 and 1.2 mg/kg generally produces conditions suitable for intubation within 45 to 90 seconds.

259
Q

Which ion channels are the most important to the initiation and propagation of an action potential?

A

sodium

260
Q

The primary means of elimination of rocuronium is

A

Elimination of rocuronium is via both hepatic and renal mechanisms. Biliary elimination of unchanged drug is its primary route of elimination, however it also undergoes de-acetylation in the liver. Excretion via the kidneys represents roughly 33% of rocuronium’s elimination.

261
Q

Which local anesthetic has low potency and short duration?

A

procaine

262
Q

Which IV sedative-hypnotic agent has the highest degree of protein binding?

A

Propofol

263
Q

Compared to nalbuphine, butorphanol exhibits (select two)

A

greater analgesic qualities

greater sedative effects

264
Q

Regarding local anesthetics, which of the following are associated with acidosis? (select two)

A

Increased uptake of the local anesthetic into the brain

Increased proportion of free drug in the bloodstream

265
Q

Acidosis and/or hypercarbia and seizures.

A

decrease the convulsive threshold of local anesthetics.

266
Q

Acidosis decreases the

A

plasma protein binding, which increases the free form of the drug in the bloodstream which results in an increased amount available for diffusion into the brain.

267
Q

Which local anesthetic only exists in a nonionized state?

A

benzocaine

268
Q

You have just performed a train-of-four assessment on your patient using a peripheral nerve stimulator. What is the minimum amount of time you should wait before repeating the test?

A

12 sec

269
Q

What is the most common serious complication associated with opioid intrathecal and epidural administration?

A

Respiratory depression

270
Q

Succinylcholine recovery?

A

It takes 12-15 minutes on average before full neuromuscular recovery occurs.

271
Q

What is the negative membrane potential of a resting peripheral nerve?

A

. -60 to -90 mV

272
Q

Nystagmus is a common side effect of which IV anesthetics?

A

Ketamine

273
Q

Which agent is least likely to reduce bispectral index levels?

A

Ketamine

274
Q

Which agent can be added to increase absorption and speed the onset of a local anesthetic?

A

Sodium bicarbonateThe addition of sodium bicarbonate to a local anesthetic solution increases the pH of the solution, resulting in more drug in the unionized form. This increases absorption, speeds onset, and decreases the pain of infiltration

275
Q

The duration of which local anesthetic is prolonged the most by the addition of the epinephrine?

A

Lidocaine

276
Q

The potency of local anesthetics increases with:

A

Increased lipid solubility

277
Q

Other factors that increase potency are an increased

A

number of carbon atoms which increases the lipid solubility, adding a halide to the aromatic ring, an ester linkage, or the presence of large alkyl groups on the tertiary amide nitrogen.

278
Q

What is the main determinant of the rate at which an amide local anesthetic is metabolized?

A

Hepatic clearance

279
Q

Which of the following is true regarding the use of ketamine in obstetric patients?

A

Maternal doses of 2 mg/kg produce neonatal depression

280
Q

Which of the following is associated with decreased concentrations of plasma cholinesterase and a prolonged duration of action of succinylcholine?

A

Muscular dystrophy

281
Q

Which of the following agents is an alpha-2 agonist?

A

Dexmedetomidine

282
Q

You are preparing to perform nasal intubation for a patient undergoing dental surgery and are administering 4% cocaine intranasally to constrict the nasal passages. What is the maximum volume of the cocaine solution that can be administered?

A

4 ml

283
Q

A patient has a known history of homozygous atypical plasma cholinesterase. Which of the following drugs should be avoided in this patient?

A

Mivacurium

284
Q

Where in the axon do local anesthetics primarily exert their effects?

A

Nodes of Ranvier

285
Q

The functional unit of a peripheral nerve cell is the

A

axon.

286
Q

The myelin acts as

A

insulation that greatly increases the speed of electrical conduction.

287
Q

The intracellular contents of the axon, known as the axoplasm, are surround by a cell membrane called the

A

axolemma.

288
Q

Which agent should not be used in a neuraxial block?

A

Remifentanil

289
Q

Select two opioids that cause the release of histamine from mast cells when administered in high doses.

A

It has a molecular weight of 200.1

It contains more fluorine atoms than desflurane

290
Q

Which nerve fibers are responsible for muscle tone?

A

Gamma

291
Q

What is the IV induction agent of choice for patients with active bronchospasm?

A

Ketamine

292
Q

Which nerve fibers would you expect to be more resistant to the effects of local anesthetics?

A

Unmyelinated nerve fibers responsible for pain and temperature transmission

293
Q

Respectively, what are the approximate vapor pressures (mm Hg) of desflurane and isoflurane?

A

660 ; 240

294
Q

During intravenous induction with etomidate, the patient complains of burning in the arm with the IV. You know that this is due to

A

the propylene glycol preservative

295
Q

Which statement is a correct summary of the Meyer-Overton rule?

A

Potency of an anesthetic is proportional to its lipid solubility

296
Q

The metabolism of which benzodiazepine is least affected by liver disease?

A

Lorazepam

297
Q

Ketamine exerts its CNS effects primarily by antagonizing the phencyclidine site on the ________receptor.

A

NDMA

298
Q

Which nerve supplies the adductor pollicis muscle?

A

Ulnar

299
Q

What is the treatment for methemoglobinemia caused by prilocaine?

A

Methylene blue 1-2 mg/kg

300
Q

At what MAC level would you expect to first see burst suppression on the EEG with desflurane?

A

1.5-2.0 MAC

301
Q

Lipophilic opioids penetrate faster and achieve higher concentrations in the spinal cord than hydrophilic opioids. Select the two most lipophilic opioids.

A

Fentanyl

Sufentanil

302
Q

Which anesthetic agent is most associated with a transient increase in liver enzyme levels?

A

Desflurane

303
Q

Which of the following benzodiazepines has the longest elimination half-life?

A

Diazepam has a slow hepatic extraction ratio and a large volume of distribution which is responsible for its long elimination half-life of 30-40 hours.

304
Q

Which of the following is a metabolite of succinylcholine?

A

Succinylmonocholine

305
Q

hat is the resting membrane potential of a nerve cell?

A

The negative membrane potential of a resting peripheral nerve is -70 to -90 mV

306
Q

hat is the recommended intravenous dose of ketamine used for preemptive analgesia?

A

10-20mg

SRNA4TopicsAnesthesia (47 decks)

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