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Exit Exam Notes Flashcards

1
Q

What are 10 anesthetic considerations for renal failure/dialysis patients?

A
  • Gastroparesis and risk of aspiration
  • Dysregulation of volume status
  • Dysregulation of acid-base (metabolic acidosis)
  • Dysregulation of electrolytes (increased K+, Decreased Na+/Ca+)
  • Coexisting diseases and end-organ complications
  • Autonomic dysfunction with hemodynamic instability
  • Pulmonary edema from low albumin/atelectasis
  • HTN, CAD, LV dysfunction, arrhythmias
  • Anemia/Thrombocytopenia
  • Altered pharmacokinetics due to decreased elimination, acidosis and hypalbuminemia

Avoiding renally excreting drugs (e.g., Morphine, Rocuronium)

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2
Q

What factors can cause an increase in temperature during anesthesia?

A
  • Malignant Hyperthermia
  • Sepsis/Fever
  • Pheochromocytoma (hypermetabolic state)
  • Medication
  • Warming patient too much
  • Blood Transfusion reaction
  • Thyroid Storm
  • Hypothalamic Lesion secondary to trauma, tumor, etc

These factors can lead to hyperthermia during surgical procedures.

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3
Q

Define hyperthermia and its associations.

A
  • Increased O2 consumption
  • Increased CO2 production
  • Increased HR, RR, and Sweating

In anesthetized patients, signs and symptoms include:
* Tachycardia
* Hypertension
* Increasing ETCO2
* Rhabdomyolysis

Hyperthermia is a hypermetabolic state characterized by elevated body temperature.

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4
Q

What is the goal of a massive transfusion protocol?

A

Volume replacement: +/- rapid infusion for adequate tissue perfusion.

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5
Q

List ways to assist during a massive transfusion protocol.

A
  • Communicate with surgeon to confirm severity of bleeding
  • Contact Blood Bank and start giving products (1:1:1 ratio of PRBC:FFP:Platelets with group specific blood or O negative)
  • Establish large/central IV access if possible (+ Arterial line)
  • Keep patient warm > 36 C
  • Checking labs Q30 min (ABG, CBC, Electrolytes, Lactate)
  • Checking Coags (PTT, INR, Platelets, Fibrinogen)
  • Permissive Hypotension (MAP 55-60) if allowable
  • Start Vasopressors
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6
Q

What specific medications can be started during a massive infusion protocol?

A
  • Vasopressors: Norepinephrine/Vasopressin
  • Sodium Bicarb (for acidosis)
  • CA2+ (Cardioprotective + part of Coag cascade)
  • TXA (to prevent breakdown of blood clots)
  • Plasma, platelets, fibrinogen if indicated
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7
Q

What are 10 anesthetic considerations for a massive infusion protocol?

A
  • Dilutional Coagulopathy
  • Hypothermia
  • Hyperkalemia
  • Acid/Base Abnormality
  • Transfusion Associated Lung Injury (TRALI)
  • Transfusion Acquired Circulatory Overload (TACO)
  • Citrate infusion inducing hypocalcemia
  • Citrate infusion resulting in metabolic acidosis/alkalosis
  • Anaphylaxis
  • Septic/Febrile reactions
  • Non-ABO compatible (non-checked blood)
  • DIC (hyper-coagulopathic state)
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8
Q

Define the mechanism of action (MOA) of Succinylcholine.

A

Depolarizing NMBA: competitive agonist at the NMJ and binds to the alpha-subunit of the NMJ. Once it binds, it cannot open the ion-channel to depolarize. It is broken down by plasma-cholinesterase in the blood.

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9
Q

What are the contraindications for administering Succinylcholine?

A
  • Known or suspicion of MH
  • Plasma Cholinesterase Deficiency
  • Known or suspected Hyperkalemic State (i.e. presence of burns within 72 hrs, ESRD)
  • Increased ICP or IOP
  • Muscular Dystrophy
  • Allergic Reaction
  • Not adequately sedated
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10
Q

What are the current CAS fasting guidelines for adults?

A
  • 6 hrs since solids, infant formula or non-human milk
  • 4 hrs after breast milk
  • 2 hrs clear fluids for adults
  • 1 hr for clear fluids for infants/kids
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11
Q

What are the anesthetic considerations for a patient with Down’s Syndrome?

A
  • Airway
  • Atlanto-occipital instability (C-spine precautions)
  • Small mouth opening + Large Tongue + excess Tissue = Difficult intubation
  • Duodenal Atresia = Increased risk of aspiration
  • Congenital Cardiac Conditions
  • VSD, ASD, AVSD, TOF, Pulm HTN
  • Obesity/OSA
  • Increased Risk of Nerve Damage = Joint Laxity
  • Increased Risk of Leukemia
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12
Q

Define Local Anesthetic MOA.

A

Local anesthetics (LAs) work by blocking the transmission of nerve impulses, primarily through inhibition of sodium (Na⁺) channels in the neuronal cell membrane.

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13
Q

What is Local Anesthetic Systemic Toxicity (LAST)?

A

Toxic amount of blood plasma levels by injection of LA into the bloodstream, caused by accidental intravascular injection or injection above the recommended maximum dose.

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14
Q

What are the hallmark symptoms of LAST?

A
  • CNS: Tinnitus, Metallic taste, Peri-oral numbness, progression to respiratory arrest and unconsciousness
  • CVS: Seizures, Hypotension, Compensated tachycardia progressing to Bradycardia, Ventricular arrhythmias, and Cardiac Arrest.
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15
Q

What is the treatment for LAST?

A
  • Airway management: Increase FiO2 to 100%
  • Seizure suppression with Benzodiazepine
  • Infuse 20% lipid emulsion (1.5ml/kg)
  • Resuscitation ACLS/BLS
  • Keep epinephrine bolus doses < 1mg/kg
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16
Q

Define Total/High Spinal and its presentation.

A
  • Local Anesthetic spread to the cervical roots and brainstem causing toxic effects
  • Hypotension/Bradycardia
  • Weakness hands/arms, SOB with weakness in accessory muscles
  • Shoulder Weakness, Hypoventilation and/or desaturation leading to respiratory arrest
  • Slurred Speech, Sedation, altered LOC
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17
Q

What is the treatment for Total/High Spinal?

A
  • Increase FiO2 to 100%
  • Supportive Management of Respiratory/Hemodynamics
  • Stop Epidural if present
  • Reverse Trendelenburg
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18
Q

What are the concentrations, duration of action, and toxic doses for Lidocaine?

A
  • Concentration Available: 0.5%, 1%, 1.5%, and 2% solutions.
  • Duration of Action: Without epinephrine: 30–60 minutes; With epinephrine: 2–6 hours.
  • Toxic Dose: Without epinephrine: 5 mg/kg (maximum of 300 mg); With epinephrine: 7 mg/kg (maximum of 500 mg).
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19
Q

What are the concentrations, duration of action, and toxic doses for Bupivacaine?

A
  • Concentration Available: 0.25%, 0.5%, and 0.75% solutions.
  • Duration of Action: Without epinephrine: 2–4 hours; With epinephrine: 3–7 hours.
  • Toxic Dose: Without epinephrine: 2.5 mg/kg (maximum of 175 mg); With epinephrine: 3 mg/kg (maximum of 225 mg).
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20
Q

What are the concentrations, duration of action, and toxic doses for Ropivacaine?

A
  • Concentration Available: 0.2%, 0.5%, and 0.75% solutions.
  • Duration of Action: Without epinephrine: 2–6 hours; With epinephrine: 4–8 hours.
  • Toxic Dose: Without epinephrine: 3 mg/kg (maximum of 200 mg); With epinephrine: 3.5 mg/kg (maximum of 250 mg).
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21
Q

How does the pediatric airway differ from the adult airway?

A
  • Peds are obligate nose breathers = easily obstructed via secretions
  • Larger occiput results in no need for sniffing position
  • Larger tongue creates more obstruction
  • Anteriorly slanted vocal cords = difficulty inserting ETT
  • Narrowest part of trachea is subglottic at cricoid
  • Larynx more anterior and superior in child
  • Floppier Epiglottis in children
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22
Q

Why do we ask about adverse history or family history related to anesthetics/surgery?

A
  • Confirm/Rule out MH
  • Plasma cholinesterase Deficiency
  • Prior potential difficult airway
  • Allergic reactions to any prior anesthetics
  • Prior adverse effects (PONV, Delayed emergence)
  • Individuals Response to Surgical Stress
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23
Q

What are the 5 T’s in the differential diagnosis for Post-Partum Hemorrhage (PPH)?

A
  • Tone: Uterine Atony (most common)
  • Tissue: Retained Product
  • Trauma: Vascular Injury
  • Thrombin: Coagulopathy
  • Turn Out: Uterine Inversion
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24
Q

What are the overall goals in managing PPH?

A
  • Determine severity of hemorrhagic shock and resuscitate
  • Consider early intubation/Massive Transfusion Protocol
  • Avoid lethal triad: Hypotension, Acidosis, Coagulopathy
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25
Q

What is the treatment and management of PPH?

A
  • Transfuse and volume resuscitation
  • Treat Triad (hypotension, acidosis, coagulopathy)
  • Gather resources (Rapid infuser, Blood products, Cell Saver)
  • Send blood work (CBC, ABG, Electrolytes, Coags)
  • Assist with intubation (RSI/Glide)
  • Assist with large-bore IV access/Arterial Line insertion
  • Prepare induction medications
  • Prepare uterotonics with PPH kit
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26
Q

Describe the uterotonics used for PPH.

A
  • Carbetocin: analogue of oxytocin with longer duration causing uterine contraction.
  • Ergometrine: Direct uterine and smooth muscle constriction; not given if patient had a prior stroke or HTN.
  • Hemabate: form of prostaglandin causing uterine stimulation; not to be given to asthmatics.
  • Misoprostol: Form of prostaglandin causing uterine stimulation.
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27
Q

What types of patients are known to have difficult airways?

A
  • History of difficult airway
  • Small mouth opening
  • Mallampati 3 or 4
  • Micrognathia, retrognathia, or macroglossia
  • Limited Neck Mobility
  • Obesity
  • Pregnant
  • Beard
  • OSA
  • Short thyromental distance
  • Trauma/Past surgeries to upper airway
  • High arched or narrow palate
  • Tumors or masses in airway or neck
  • Infections causing swelling
  • Burns or scarring
  • Congenital syndromes
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28
Q

What are 6 history factors that can classify a patient as having a difficult airway?

A
  • Documented Hx of difficult airway
  • Obese/High BMI
  • Pregnant
  • Hx of rheumatoid Arthritis
  • Hx of C-Spine Surgery/injury
  • Hx of radiation to head/neck
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29
Q

What is the drug calculation for 1:100000 epinephrine?

A

1g epi in 100000 solution, which is equivalent to 10 mcg/ml.

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30
Q

What is the equivalent dose to 10 mg Morphine for IV hydromorphone?

A

2 mg Hydromorphone (5X stronger than morphine).

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31
Q

What is the equivalent dose to 10 mg Morphine for IV Fentanyl/Remifentanil?

A

100 mcg Fentanyl & Remifentanil (100X stronger than morphine).

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32
Q

What is the equivalent dose to 10 mg Morphine for Oral Morphine?

A

30 mg Oral Morphine = 10 mg IV Morphine.

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33
Q

What is the equivalent dose to 10 mg Morphine for a Fentanyl Patch?

A

10 mcg/hr (24 hrs) Fentanyl patch = approx. 10 mg IV Morphine.

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34
Q

What is the strength comparison of 2mg Hydromorphone to morphine?

A

5X stronger than morphine

Hydromorphone is significantly more potent than morphine, requiring careful dosing.

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35
Q

What is the strength of 100 mcg Fentanyl compared to morphine?

A

100X stronger than morphine

Fentanyl is a highly potent opioid used in various medical settings.

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36
Q

How does 30 mg Oral Morphine compare to IV Morphine?

A

30 mg Oral Morphine = 10 mg IV Morphine

This conversion is crucial for pain management strategies.

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37
Q

What is the approximate equivalence of a 10 mcg/hr Fentanyl patch in IV Morphine?

A

Approx. 10 mg IV Morphine

This conversion aids in transitioning patients from IV to transdermal opioid therapy.

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38
Q

What is the conversion factor for IV morphine to oral morphine?

A

3:1

This means 10 mg of IV morphine is roughly equivalent to 30 mg of oral morphine.

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39
Q

What does a 25 mcg/hr fentanyl patch correspond to in terms of oral morphine?

A

Approximately 60 mg of oral morphine daily

This is essential for determining appropriate pain management regimens.

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40
Q

What is the acronym for Differential Diagnosis in Anesthesia?

A

D.I.M.S.

This helps anesthesiologists consider potential issues during patient emergence.

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41
Q

What are some anesthetic considerations for obese patients?

A
  • Difficult BVM
  • Decreased FRC
  • OSA sensitivity
  • Difficult IV access
  • Increased aspiration risk
  • Altered pharmacology
  • Increased postoperative morbidity
  • Co-morbid diseases

These factors significantly impact anesthesia management in obese individuals.

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42
Q

What are absolute contraindications for neuraxial anesthesia?

A
  • Patient refusal
  • Coagulopathy
  • Infection at injection site
  • Allergy to medication
  • Increased ICP

Recognizing these contraindications is critical for patient safety.

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43
Q

What is the Post-Anesthesia Discharge Scoring System (PADSS)?

A

5 categories with max 2 points each

Categories include vitals, activity level, pain, nausea/vomiting, and surgical site bleeding.

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44
Q

What are complications of a Femoral Nerve Block?

A
  • Prolonged motor block
  • LAST
  • Infection
  • Nerve damage
  • Hematoma
  • Allergic reaction

Awareness of these complications is necessary for risk management.

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45
Q

Define Rheumatoid Arthritis.

A

Chronic inflammatory disease affecting joints and major organ systems

This condition has significant implications for anesthesia management.

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46
Q

What is the equation for Coronary Perfusion Pressure (CPP)?

A

CPP = Aortic DBP - LVEDP

Understanding this equation is vital for cardiac anesthetic management.

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47
Q

What is the difference between concentric and eccentric hypertrophy?

A
  • Concentric: Pressure overload, thickened muscle, smaller chamber
  • Eccentric: Volume overload, stretched chamber, decreased compliance

These conditions affect cardiac function and anesthetic management.

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48
Q

What are early complications of significant blood transfusions?

A
  • Hyperkalemia
  • Hypocalcemia
  • Hypothermia

Monitoring for these complications is essential during and after transfusions.

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49
Q

What are the indications for lung isolation?

A
  • Surgery of lungs, bronchus, pleura
  • Heart/great vessels surgery
  • Esophageal surgery
  • Non-thoracic surgery
  • Nonsurgical procedures

Lung isolation techniques are critical in specific surgical contexts.

50
Q

What should be the normal ACT time before going onto CPB Pump?

A

Normal ACT = 80-120 seconds, prior to pump suction = 400 seconds

This is crucial for ensuring adequate anticoagulation during cardiac procedures.

51
Q

What is the dose of Heparin given for cardiac surgery?

A

400 units/kg

Proper dosing is vital for preventing thromboembolic events.

52
Q

What are the considerations for administering Ketorolac?

A
  • Allergic reactions
  • Renal impairment
  • Recent GI bleeding
  • Impact on fetal circulation
  • Hepatic function considerations

These factors must be assessed before administration.

53
Q

What drugs are used to shift K+ for treating Hyperkalemia?

A
  • Insulin
  • Bicarb
  • Calcium chloride
  • Salbutamol
  • Lasix
  • Hyperventilation
  • Consider dialysis

Prompt treatment is necessary to prevent life-threatening complications.

54
Q

What are indications for using LMA?

A
  • Spontaneously breathing patients
  • Difficult airway algorithm
  • Post tonsillectomy bleed

LMA can be a less invasive alternative for airway management.

55
Q

What medication should be continued on the morning of surgery?

A
  • Cardiac and hypertensives (except ACE inhibitors and ARBs)
  • Chronic disease medications
  • Steroids

Continuation of these medications is crucial for patient stability.

56
Q

What should be discontinued prior to surgery?

A
  • ACE inhibitors
  • Anticoagulants
  • Antidepressants
  • Oral hypoglycemic medications
  • NSAIDs

Stopping these medications can reduce surgical risks.

57
Q

What is the normal ACT range prior to going onto CPB Pump?

A

80-120 seconds

Normal ACT is critical for ensuring adequate anticoagulation during CPB.

58
Q

What is the required ACT before going onto the CPB Pump?

A

480 seconds

This is necessary to ensure sufficient anticoagulation.

59
Q

What is the dose of Heparin given for Cardiac/CPB Surgery?

A

400 units/kg

This dose is standard for achieving therapeutic anticoagulation.

60
Q

What is the reversal agent for Heparin in Cardiac Surgery?

A

Protamine 0.7 – 1 mg/100 units of Heparin given

Protamine neutralizes the effects of Heparin.

61
Q

What are the treatment steps for suspicion of Air/Gas Embolism?

A
  • Head down/left lateral position
  • Stop source of air/gas entry
  • Stop Nitrous/pneumoperitoneum (if in use)
  • Aspirate Central Line (if in use)
  • Chest compressions (break up volumes of air)

These steps help manage the embolism effectively.

62
Q

What are the Hs and Ts in ACLS reversible causes of cardiac arrest?

A
  • Hypoxia
  • Hypovolemia
  • Hydrogen Ions (Acidosis)
  • Hypothermia

Identifying these causes is crucial for effective ACLS intervention.

63
Q

What is the rate of chest compressions recommended during ACLS?

A

100-120/min

This rate is essential for optimal perfusion during CPR.

64
Q

What is the depth of chest compressions recommended during ACLS?

A

5 cm = 2 inches

Adequate depth ensures effective blood circulation.

65
Q

What is the compression to ventilation ratio in ACLS for an un-intubated patient?

A

30:2

This ratio is used to maximize the effectiveness of CPR.

66
Q

What are the first steps in managing V-fib/V-tach in ACLS?

A
  • Start Compressions
  • Shock immediately 200J
  • Epinephrine 1 mg after 2nd shock (then Q3-5 min)
  • Amiodarone 300 mg after 3rd shock (150 mg 2nd dose)
  • Consider Reversible causes

These steps are vital for restoring normal rhythm.

67
Q

What is the immediate action for PEA/Asystole in ACLS?

A
  • Start compressions
  • Epinephrine 1 mg immediately
  • IV/Airway Access
  • Consider Reversible causes

Prompt action improves chances of survival.

68
Q

What should be done for tachycardia in ACLS?

A
  • Airway/IV Access/monitors (12 leads)
  • Is tachycardia causing signs of decreased LOC/Hypotension/Chest Pain?
  • Synchronized Cardioversion OR Adenosine (6mg then 12 mg)

Evaluating the patient’s condition is critical before treatment.

69
Q

What is the recommended action for NRP HR < 100?

A

PPV via BVM with room air and increase as needed

Proper ventilation is crucial for newborns with low heart rates.

70
Q

What is the Gold Standard for confirming Malignant Hyperthermia diagnosis?

A

Muscle Biopsy (then Genetic Testing)

This is the most definitive method for diagnosis.

71
Q

What is the average blood volume for a term infant?

A

80 ml/kg

Understanding blood volume is essential in pediatric care.

72
Q

What is the formula for allowable blood loss (ABL) once allowable Hb is determined?

A

[(Initial Hb – Allowable HB) x EBV] / Initial HB

This formula helps in managing blood loss during surgery.

73
Q

What is the suggested anesthetic management before cord clamping during an emergency C-section?

A
  • High gas flow and 2 MAC
  • Avoid Benzo and Narcotics

Proper management ensures maternal and fetal safety.

74
Q

Termination of effect of IV anesthetics occurs through ________.

A

[redistribution]

This process is crucial for the recovery from anesthesia.

75
Q

List factors that increase MAC.

A
  • Childhood (highest at 6 months)
  • Hyperthyroidism
  • Hyperthermia
  • Hypernatremia
  • Chronic Alcohol Use
  • Drugs: Amphetamines, Cocaine (Acute)

These factors influence the potency of anesthetics.

76
Q

List factors that decrease MAC.

A
  • Elderly/Pregnancy
  • Hypercarbia/Hypoxia/Hypothermia
  • Hyponatremia
  • Anesthetics/Opioids
  • Chronic Amphetamines
  • Acute Alcohol use

Understanding these factors is important for anesthetic management.

77
Q

What are the diagnostic criteria for Pre-Eclampsia?

A
  • BP > 140/90 x 2
  • > 20 weeks gestation
  • Proteinuria
  • +/- Organ Dysfunction

Early recognition is key for maternal and fetal health.

78
Q

What is the definitive treatment for Preeclampsia?

A

Immediate delivery

This is essential to prevent complications.

79
Q

Which drug class is most commonly responsible for intraoperative anaphylactic reactions?

A

Muscle Relaxants (most common)

Awareness of this risk is important for surgical teams.

80
Q

Name the receptors targeted for PONV.

A
  • Histamine
  • Serotonin
  • Dopamine

Targeting these receptors helps in managing postoperative nausea and vomiting.

81
Q

What are the negative effects of hypothermia?

A
  • Increasing rates of wound infection
  • Decreased Drug Metabolism
  • Cardiac Arrhythmias and Ischemia
  • Delayed wound healing
  • Increasing blood loss

Maintaining normothermia is crucial during surgery.

82
Q

What are common opioid side effects other than analgesia?

A
  • Respiratory Depression
  • Nausea and Vomiting
  • Bradycardia
  • Urinary Depression
  • Pruritus (itching)

Awareness of side effects is important for patient safety.

83
Q

Name active cardiac conditions that may lead to surgical cancellation.

A
  • Unstable Coronary Syndrome
  • Decompensated Heart Failure
  • Severe Valvular Disease
  • Significant Cardiac arrhythmias

Assessing cardiac risk is essential before surgery.

84
Q

What are the effects of Vasopressin on HR/SVR/PVR?

A
  • HR decreases
  • SVR Increases
  • PVR decreases

Understanding these effects can guide treatment in specific clinical scenarios.

85
Q

What are the effects of Dobutamine on HR/SVR/PVR?

A
  • HR increases
  • SVR decreases
  • PVR decreases

Dobutamine is often used in cases of cardiogenic shock.

86
Q

What is the ABG profile for a Malignant Hyperthermia crisis?

A
  • pH: Acidotic
  • PaCO2: Increased
  • PaO2: Decreased
  • Mixed Respiratory and Metabolic Acidosis

Recognizing this profile is critical for timely intervention.

87
Q

What should NOT be administered during a Malignant Hyperthermia crisis if giving Dantrolene?

A
  • Ca Channel Blockers
  • Beta blockers

Certain medications can exacerbate the condition.

88
Q

What determines the rate of onset and offset for volatile anesthetics?

A

Solubility

Understanding solubility helps predict anesthetic effects.

89
Q

What are the contraindications for using N2O?

A
  • Pneumothorax/Bowel Obstruction
  • High ICP
  • CAD
  • Emphysema

Awareness of contraindications is vital for patient safety.

90
Q

List physiological alterations during pregnancy.

A
  • Increased CO/HR/MV/O2 consumption
  • Decreased SVR/FRC
  • Anemia
  • Hypercoagulable

These changes impact anesthetic management.

91
Q

What does the first letter in the pacemaker coding system represent?

A

Chamber Paced (A,V,O)

Understanding the coding system is essential for interpreting pacemaker function.

92
Q

What happens when a magnet is placed over a Pacemaker/ICD?

A

Prevents device sensing; in Pacemakers it leads to asynchronous pacing at a preprogrammed rate

This can affect device function and patient safety.

93
Q

What methods can improve oxygenation for OLV?

A
  • Increasing FiO2
  • Checking Bronchial Blocker/DLT Placement
  • PEEP to ventilated lung
  • CPAP to nonventilated lung
  • Restrict pulmonary blood flow to non-ventilated lung

These methods enhance oxygenation during one-lung ventilation.

94
Q

What primarily influences the PaCO2-EtCO2 gradient?

A

Physiological Deadspace (phase 3 of capnograph)

This gradient provides insights into ventilation efficiency.

95
Q

What are the anesthetic considerations with laparoscopic surgery?

A
  • Increased MAP, SVR, and CVP
  • Decrease Cardiac Output and Stroke Volume
  • Cephalad displacement of Diaphragm = decreased FRC, decreased compliance, atelectasis, and V/Q mismatch
  • Endobronchial migration of ETT
  • Hypercarbia

These considerations guide anesthetic management during laparoscopic procedures.

96
Q

What is the correct order for performing a Bier Block (Upper Extremity)?

A
  • Insert catheter as distal as possible and secure
  • Place double-pneumatic tourniquet
  • Elevate arm and wrap with Esmarch bandage to allow for exsanguination (from fingertips to distal cuff)
  • Inflate DISTAL first, then proximal
  • Inject LA then withdraw IV cannula with pressure

Following the correct order ensures effective anesthesia.

97
Q

What is the mechanism of action for Propofol?

A

GABA-a receptor agonist

Propofol is commonly used for induction due to its rapid onset.

98
Q

What is the mechanism of action for Etomidate?

A

Selective GABA-a receptor modulation

Etomidate is known for its stable hemodynamic profile.

99
Q

What is the mechanism of action for Ketamine?

A

NMDA receptor inhibitor

Ketamine provides dissociative anesthesia and analgesia.

100
Q

What is the mechanism of action for Dexmedetomidine?

A

Alpha 2 agonist

Dexmedetomidine is used for sedation with minimal respiratory depression.

101
Q

What is the mechanism of action for Opioids?

A

Mu-opioid receptor agonists

Opioids are widely used for pain management.

102
Q

What is the mechanism of action for Benzodiazepines?

A

GABA-a receptor agonist

Benzodiazepines provide anxiolysis and sedation.

103
Q

What is the best induction agent for hypovolemic trauma patients?

A

Ketamine

Ketamine is preferred due to its hemodynamic stability.

104
Q

What causes Negative Pressure Pulmonary Edema (NPPE)?

A
  • Obstruction of Airway during NEGATIVE pressure breath
  • Biting of Tube
  • Laryngospasm

Recognizing these causes is important for prevention and management.

105
Q

What are potential complications with magnets and Pacemakers/ICDs?

A
  • Programming is patient-specific; fixed rate pacing is “generic” and may be too high or low.
  • Competition with native rate causing asynchronous pacing on “R on T”
  • Pacemakers may be programmed not to respond to magnets (rare)

Understanding these complications is crucial for safe management of patients with devices.

106
Q

What determines the speed of onset of local anesthetics?

A

pKa

A lower pKa leads to faster onset due to greater proportion of unionized drug.

107
Q

What determines the duration of action for local anesthetics?

A
  • Protein Binding
  • Lipid Solubility
  • Vascularity of Injection Site
  • Addition of vasoconstrictor (epinephrine)

These factors influence how long an anesthetic remains effective.

108
Q

What determines the onset/speed of volatile anesthetics?

A
  • Blood-Gas Coefficient
  • Alveolar Ventilation
  • Cardiac Output
  • Concentration of Inhaled Anesthetic
  • Oil-Gas Partition Coefficient
  • MAC
  • Tissue Uptake and Distribution
  • Elimination and Recovery

These parameters are important for predicting anesthetic effects.

109
Q

What determines the potency of volatile anesthetics?

A

Higher Lipid Solubility = More Potent = Lower MAC

Understanding potency is essential for effective anesthetic management.

110
Q

Describe the physiological response to ECT therapy (BP/HR).

A

Short-lasting parasympathetic discharge resulting in bradyarrhythmias followed by a sympathetic stimulus resulting in hypertension and tachycardia.

This response is important for monitoring during ECT.

111
Q

What medications are given for post-operative shivering?

A
  • Meperidine (Opioid)
  • Clonidine (Alpha-2 agonist)

These medications help manage shivering effectively.

112
Q

Tramadol, Buprenorphine, and Nalbuphine are all classes of what?

A

Opioid Agonist-Antagonists

These drugs provide analgesia while minimizing side effects.

113
Q

What is Buprenorphine used for?

A

Pain management and opioid addiction treatment

Buprenorphine is found in formulations such as Suboxone and Subutex, often combined with naloxone.

114
Q

What is the mechanism of action of Buprenorphine?

A

Partial agonist at opioid receptors

It relieves withdrawal symptoms without causing intense euphoria.

115
Q

What is a key advantage of Buprenorphine?

A

Lower risk of overdose due to ceiling effect on respiratory depression

This makes it safer compared to full opioid agonists.

116
Q

What is a consideration when using Buprenorphine?

A

Long half-life complicates acute pain management

Additional opioids may be needed during acute pain.

117
Q

What is the mechanism of action of Nalbuphine?

A

Agonist at kappa-opioid receptor and partial antagonist at mu-opioid receptor

This dual action provides pain relief while limiting side effects.

118
Q

What are the uses of Nalbuphine?

A

Treatment of moderate to severe pain, labor pain, postoperative pain

It can also reverse respiratory depression caused by full opioid agonists.

119
Q

What is an advantage of Nalbuphine?

A

Effective analgesia with less risk of respiratory depression

This is in comparison to full mu-opioid agonists.

120
Q

What is a consideration when using Nalbuphine?

A

Can cause dysphoria or unpleasant mood changes

It should be avoided in patients dependent on opioids.

121
Q

True or False: Buprenorphine can cause intense euphoria.

A

False

Its partial agonist nature prevents the intense euphoria associated with full agonists.

122
Q

Fill in the blank: Nalbuphine is used to treat _______.

A

[moderate to severe pain]

It is also used during labor and after surgery.

AAframework (6 decks)

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