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Principles of Anesthesia I (Summer 2024: Cooper) > Exam I Clinical Monitoring (6/06/24 & 6/10/24) > Flashcards

Exam I Clinical Monitoring (6/06/24 & 6/10/24) Flashcards

1
Q

What physics law deals with pulse oximetry and the laws governing absorption of light?

A

Beer Lambert

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2
Q

A low concentration of hemoglobin results in a ____ light absorption rate.

A

lower

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3
Q

What should be utilized if oximetry is determined to be inaccurate?

A

Co-oximetry

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4
Q

What is co-oximetry?

A

Co-oximetry is the measurement of:
- O₂Hb
- DeO₂Hb
- MetHb
- CarboxyHb
all through differing wavelengths of light

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5
Q

Red wavelengths of light measure at ______ nanometers.

A

660

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6
Q

Infrared wavelengths of light measure at ______ nanometers.

A

940

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7
Q

Deoxyhemoglobin preferentially absorbs more ________ than oxyhemoglobin.

A

red

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8
Q

Oxyhemoglobin preferentially absorbs more ________ than deoxyhemoglobin.

A

Infrared

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9
Q

What makes up the AC portion of the graph below?

A

Light absorption from pulsatile arterial blood.

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10
Q

What makes up the DC portion of the graph below?

A

Light absorption from:

  • Non-pulsatile arterial blood
  • Venous and capillary blood
  • Tissue
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11
Q

What will falsely elevate SpO₂ ?

A

Elevated carboxyhemoglobin

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12
Q

Each __% of COHb (carboxyhemoglobin) will increase SpO₂ by __%.

A

1 : 1

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13
Q

_______ will absorb as much 660nm light at oxyHb does.

A

COHb

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14
Q

What percent carboxyhemoglobin will smokers have?

A

> 6% usually

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15
Q

What are possible reasons for SpO₂ signal artifact and thus incorrect readings?

A
  • Ambient light
  • Low perfusion
  • Venous blood pulsations
  • Dyes (ex. Methylene blue)
  • Nail polish
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16
Q

Where can a pulse ox be placed if the fingers won’t work?

A
  • Forehead
  • Tongue
  • Cheek

less affected by vasoconstriction, reflects desaturation quicker

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17
Q

Where might be a more reliable location to place the pulse ox if performing an epidural block?

A

Toes

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18
Q

What are Korotkoff sounds related to?

A

Blood pressure (Through partial occlusion with the BP cuff)

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19
Q

How is MAP calculated?

A

DP + ⅓(SP - DP)

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20
Q

What Korotkoff phase is the loudest?
Quietest?

A
  • Phase 1: loudest (SBP) due to turbulence
  • Phase 5: Sounds disappear
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21
Q

How should a cuff fit on a person’s arm?

A
  • 40% of arm circumference
  • 80% of length of upper arm
  • Centered over artery
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22
Q

A BP cuff that is too large will read a blood pressure that is _______.

A

too low

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23
Q

A BP cuff that is too small will read a blood pressure that is _______.

A

too high

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24
Q

Where can a blood pressure be obtained from an obese patient if the upper arm won’t work?

A

forearm

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25
Q

What is the best site for invasive blood pressure monitoring?

A

Radial artery

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26
Q

Describe Allen’s Test

A
  • Examiner compresses radial and ulnar arteries
  • Patient makes a tight fist
  • Patient opens hand
  • Examiner releases ulnar artery
  • Color of palm should return in seconds
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27
Q

How does the Transfixion technique for arterial catheter placement differ from the seldinger technique?

A

Transfixion involves puncturing through the back of the artery and withdrawing until the needle can be removed.

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28
Q

Label the various parts of the arterial waveform.

A
  1. Systolic upstroke
  2. Systolic peak pressure
  3. Systolic decline
  4. Dicrotic notch
  5. Diastolic runoff
  6. End-diastolic pressure
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29
Q

What occurs to an arterial waveform as it moves centrally (aorta) to the periphery (ex. femoral artery) ?

A
  • Arterial upstroke steepens
  • ↑ systolic peak
  • Dicrotic notch occurs later
  • Lower EDP
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30
Q

How are summation waves formed?

A

Through the combination of Fundamental and Harmonic waves.

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31
Q

How many oscillations should follow a square wave test?

A

No more than two

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32
Q

What would the systolic pressure read in an underdamped system?

A

↑ SBP

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33
Q

What would the characteristics of an overdampened arterial waveform be?

A
  • ↓SBP
  • Absent dicrotic notch
  • Loss of detail
  • Narrowed pulse pressure w/ accurate MAP
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34
Q

What occurs with RV and LV afterload during the inspiratory phase?

A

RV afterload increases
LV afterload decreases

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35
Q

What occurs with RV and LV preload during the inspiratory phase?

A

RV preload decreases
LV preload increases

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36
Q

RV stroke volume ____ during early phase of inspiration.

A

drops

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37
Q

How much systolic pressure variation is typical in mechanically ventilated patients?

A

7 - 10 mmHg

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38
Q

What would increase systolic pressure variation be indicative of?

A

Volume responsiveness (i.e. patient needs fluids)

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39
Q

What is the normal change in pulse pressure variation over an entire respiratory cycle?

A

13 - 17%

If greater than 13 - 17% you need to give volume.

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40
Q

What is normal Stroke Volume Variation (SVV) ?

A

10 - 13%

If greater, patient will likely respond to fluids.

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41
Q

What are the two types of gas sampling systems?

A
  • Side-stream (Diverting) monitoring
  • Mainstream monitoring
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42
Q

time lag for the gas sample to reach the analyzer

A

Transit Time

43
Q

time taken by the analyzer to react to the change in gas concentration

A

Rise Time

44
Q

dependent on sampling tubing inner diameter, length, and gas sampling rate

A

Side-Stream Responses

45
Q

What are challenges associated with mainstream CO₂ gas sampling?

A
  • H₂O vapor
  • Secretions
  • Blood
  • Disconnections
46
Q

What are challenges associated with sidestream CO₂ gas sampling?

A
  • Tubing kinking
  • H₂O vapor
  • Failure of sampling pump
  • leaks in line
  • slower response time
47
Q

What is the partial pressure of O₂ at sea level?

A

160 mmHg

48
Q

What is the Patm ?

A

760 mmHg

49
Q

What is the percentage O₂ at sea level?

exclude water vapor

A

160 mmHg ÷ 760 mmHg = 21%

50
Q

Concentration determined according to mass/charge ratio

A

Mass Spectrometry

51
Q

Mass Spectometry can calculate up to ___ different gases.

A

Eight

52
Q

High powered argon laser produces photons that collide with gas molecules in a gas sample, no longer in use

A

Raman Spectroscopy

53
Q

What does infrared analysis measure?

A

Concentrations of gases

54
Q

How are quantities of CO₂, N₂O, H₂O, and VAA’s measured?

A

Infrared Analysis

55
Q

Which gas cannot be measured via infrared analysis?

A

Carboxyhemoglobin cannot be measured via IR analysis.

56
Q

The less IR light that reaches the sensor means that the gas has a ___ concentration.

A

higher

Amount of IR light that reaches the detector is inversely related to the

57
Q

What is the partial pressure of water vapor?

A

47 mmHg

58
Q

O₂ is at 30%, what is the partial pressure?

Be sure to take water vapor into account.

A

(760 - 47) x 0.30 = 214 mmHg

59
Q

Which type of oxygen analyzer has a more rapid response time and is utilized with side-stream sampling analyzers?

A

Paramagnetic

Side-Stream is seen more often

60
Q

Which type of oxygen analyzer has a slower response time and is best to monitor O₂ concentration in the inspiratory limb?

A

Fuel or Galvanic cell

61
Q

While sampling inside the expiratory limb, we want to ensure ___.
How can we measure this?

A

Complete denitrogenation

ETO2 above 90% is adequate

62
Q

If there is an oxygen tank that is incorrectly filled or there was a pipeline crossover, we may see ___.

A

A low O2 alarm

63
Q

What two conditions would set off a high O₂ alarm?

A
  • Premature infants
  • Bleomycin (chemotherapy)
64
Q

Describe important components of mechanical pressure gauges

A
  • No recording of data
  • No alarm system
    * Must be continually scanned!!
65
Q

What should the Low-pressure limit be set at?

A

Just below the normal peak airway pressure

66
Q

What is normal peak airway pressure?

A

18 - 20 mmhg

67
Q

Causes of a “Sub-Atmospheric” pressure alarm?

A
  • Active (suction) scavenging system malfunctions
  • Pt inspiratory effort against a blocked circuit
  • Inadequate fresh gas flow
  • Suction to misplaced NGT/OGT
  • Moisture in CO2 absorbent
68
Q

Which type of alarm, per lecture, is valuable in pediatrics?

A

High-Pressure Alarms

69
Q

When is the continuing pressure alarm triggered?

A

Triggered when circuit pressure exceeds 10 cm H2O for >15 seconds

70
Q

True or False:
Magnetic peripheral nerve stimulation is the most common type used, but is the more painful option.

A

False

Electrical is most common, Magnetic is less painful

71
Q

What nerve is the gold standard for peripheral nerve stimulation monitoring?

A

ulnar nerve

72
Q

What is the most resistant place to neuromuscular blocking drugs?

A

Diaphragm

73
Q

What muscle is a better indicator (vs the adductor pollicis) of neuromuscular blockade at the laryngeal muscles and abdominal muscles?

A

- Corrugator supercilli

74
Q

Single twitch stimulations occurs every…

A

1hz every second

75
Q

TOF fade is noted with what drug class?

A

non-depolarizing NMBD’s

76
Q

What is the case if fade has occurred with succinylcholine administration?

A

Phase II Blockade

77
Q

What are the reversal drugs (and doses) use for intense/extreme blockade?

A
  • Neostigmine N/A
  • Sugammadex 16 mg/kg
78
Q

What are the reversal drugs (and doses) use for deep blockade?

A
  • Neostigmine usually doesn’t work
  • Sugammadex 4 mg/kg
79
Q

What are the reversal drugs (and doses) used for moderate blockade?

A
  • Neostigmine after TOF 4/4
  • Sugammadex 2 mg/kg
80
Q

What EEG signals are noted for an awake patient?

A
  • Βeta (>13Hz) waves
81
Q

What EEG signals are noted for patients who are mildly anesthetized?

A

Αlpha (8 - 13Hz) waves

82
Q

What EEG signals are noted for patients who are fully anesthetized?

A

Theta (4-7 hz) and Delta (< 4 hz) waves

83
Q

Ideal BIS range for General Anesthesia

A

40-60

84
Q

Most common type of evoked potentials monitored intra-op:

A

Sensory-Evoked Potentials

85
Q

BAEPs or VEPs?

Monitors the responses to click stimuli

A

BAEPs

86
Q

BAEPs or VEPs?

Monitors the responses to flash stimulation of the retina:

A

VEPs

87
Q

These type of evoked potentials monitor the responses to stimulation of peripheral mixed nerves (contain motor and sensory nerves) to the sensorimotor cortex

A

Somatosensory-Evoked Potentials

88
Q

Most common MEP

A

Transcranial motor-evoked potentials

89
Q

Where is the primary thermoregulatory control center?

A

Hypothalamus

90
Q

What causes the initial decrease of 0.5 - 1.5°C in anesthesia?

A

Anesthesia induced vasodilation

91
Q

How much will body temp decrease for every hour of surgery?

A

0.3°C

92
Q

What is the cause of heat loss during anesthesia?

A
  • Anesthesia-induced vasodilation
  • GA-induced decrease in metabolic rate by 20-30%
93
Q

True or False:
Central thermoregulatory control is inhibited in neuraxial anesthesia?

A

TRUE

94
Q

Methods of Heat transfer:

heat loss to the environment, approx. 40% of heat loss in pt

A

Radiation

95
Q

Methods of Heat transfer:

loss of heat to air immediately surrounding the body, approx. 30%

A

Convection

96
Q

Methods of Heat transfer:

heat loss due to direct contact of body tissues or fluids with a colder material, negligible

A

Conduction

97
Q

Methods of Heat transfer:

latent heat of vaporization of water from open body cavities and respiratory tract, approx. 8-10%

A

Evaporation

98
Q

Hypothermia Complications:

A
  • Coagulopathy
  • Transfusion needs increased (22%)
  • Blood loss increased (16%)
  • Decreased oxygen delivery to tissues
  • Increased BP, HR, Catecholamine levels
  • Shivering
  • Decreased drug metabolism (Longer DOA of NMBD)
99
Q

Hypothermia Benefits:

A
  • Protective against cerebral ischemia
  • Reduces metabolism… 8% per degree Celsius
  • Improved outcome during recovery from cardiac arrest
  • Neurosurgery when brain tissue ischemia is expected
  • More difficult to trigger MH
100
Q

Which types of patients may need an increased room temperature?

A
  • Liver Transplants
  • Major Trauma
  • Pediatrics
101
Q

Most commonly used peri-op temperature management method?

A. Cutaneous Warming
B. Forced Air Warming
C. Warm IV Fluids
D. Airway Heating
E. Hot Water Mattresses

A

B. Forced Air Warming

Most common, prevent heat loss from radiation
Uses convection to transfer heat to pt

102
Q

Gold standard temperature monitoring site:

A

Pulmonary Artery

103
Q

21°C = ____°F

A

70

104
Q

18°C = ____°F

A

65

Principles of Anesthesia I (Summer 2024: Cooper) (18 decks)

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