Final exam Review Flashcards
Indications for cervical plexus block include
carotid endartectomy, clavicle fracture, superficial neck surgery
The major nerves of the cervical plexus include
greater auricle, lessor occipital, supraclavicular, transverse cervical nerve, phrenic nerve
If the patient is not able to “pull” this describes appropriate blocking of the
musculocutaneous nerve
The nerves of the brachial plexus are in the tightest bundle at the
supraclavicular level
Injury to the _____- & ____ can occur with interscalene block
dorsal scapular & long thoracic nerve
Lipid emulsion dosing is
1.5 mL/kg
The quadratus lumborum targets the
ilioninguinal & iliohypogastric nerves
The lumbar plexus supplies sensory & motor innervation to
the thigh, anterolateral knee, & sensory innervation to the medial aspect of the lower extremity below the knee
The femoral triangle includes:
medial aspect of sartorius, medial aspect of adductor longus, & inguinal ligament
Landmark technique for the sciatic (subgluteal block)
greater trochanter & ischial tuberosity
Landmark for the iPack block includes
the posterior capsule & the popliteal fossa
Labs for myomectomy include
T&C & H&H
A total hysterectomy involves removal of
uterus & cervix
Hemabate is contraindicated for
asthmatics
methergine should not be given for those with hypertension
Cervidil will
ripen the cervix
Normal GFR is
125 mL/min.
ADH works in the
distal tubule to reabsorb water
General anesthesia is associated with a decrease in
renal blood flow, GFR, urinary flow, electrolyte secretion, & impairs autoregulation
S/s of fluoride toxicity include
hypernatremia & increased creatinine
CKD exists when
GFR is less than 60 mL/min.
Risk factors for AKI include
age >50 years, cardiac comorbidities & AAA
Symptoms of CKD do not appear until
less than 40% of normal functioning nephrons remain `
The most common cause of death for patients with CKD is
ischemic heart disease
Treatment for hyperkalemia includes
25-50 grams of dextrose, 10-20 units of regular insulin, 50-100 mEq for sodium bicarbonate
The most reliable test for renal function is
creatine clearance
Glycine toxicity can cause
transient blindness
Complications of TURP are related to
water intoxication, fluid overload, & hyponatremia
Most important prevention for TURP is
to avoid Tendelenburg position
The spinal cord ends at
L1-L2 in adults & L3 in children
When added to a spinal, clonidine
is not a vasoconstrictor & has synergistic effects, can help with tourniquet pain
Fiber types include
type b- preganglionic autonomic type C- pain, warm, could, & touch Type A- alpha- proprioception, motor Type A beta- touch, pressure Type A gamma- muscle tone Type A delta- pain, cold, temperature & touch
33 bones of the spinal column include
7 cervical 12 thoracic 5 lumbar 5 sacral 5 coccyx
Total CSF volume in an adults is
150 mL, produce 21 mL/hour, SAH holds 20-35 mL
The phrenic nerve is _____ the anterior scalene
anterior
If both recurrent laryngeal nerve paralyzed then cords will be
paramedian
if vagus is paralyzed then cadaveric position
Disadvantages to regional block include
hypotension & unpredictable success rate
Uvulopalatopharyngoplasty enlarges airway through removal of
soft palate, palatine tonsils, & uvula
____ is more soluble than air, helium, oxygen, or nitrous
CO2
IAP
15 mmHg
Physiologic changes of pneumoperitneum include
increased PaCO2, EtCO2, & decreased VR
Sphincter of Oddi spasm can be treated with
glucagon
Pickwickian syndrome is a
severe chronic OSA leading to cor pulmonale
Describe how biventricular failure develops in obese patients.
increased total blood volume, increased CO, increased RAAS, increased left-side heart pressures & LVH
Anesthetic considerations for spinal surgeries include
visual loss, bleeding, VAE
BCIS symptoms include
hypotension & hypoxemia & heart block
Pneumatic tourniquet should not be used for more than
2 hours
Fat embolism s/s include
petechia, hypoxemia, & pulmonary edema
The two branches of the vertebral artery include
the anterior spinal artery & posterior spinal arteries
6 extraocular muscles of the eye include:
superior rectus- supraduction- CN III
inferior rectus- infraduction- CN III
medial rectus- adduction- CN III
lateral rectus- abduction- CN VI
superior oblique- intorsion, depression-CN IV
inferior oblique- extorsion, elevation- CN III
Describe the oculocardiac reflex.
the nerve that carries signal to the brain for the reflex is the trigeminal nerve
the vagus sends back out to cause bradycardia–> stop pulling on the muscle, give atropine or glycopyrrolate
What’s unique about the optic nerve?
part of the CNS- outgrowth of the brain
it is not a cranial nerve & so the meninges surround it
Intraocular pressure measures
measures the pressure of the eye & is formed by aqueous humor
normal pressure is 12-20 mmHg
someone with glaucoma will have higher intraocular pressure
The following medications can be administered to bring intraocular pressure down:
diamox- contraindications include sulfa allergy & liver/kidney dysfunction
mannitol
The branches of the trigeminal nerve include
ophthalmic, maxillary, & mandibular
The facial nerve includes
the zebra bit my cousin paul
anterior: temporal, zygomatic, buccal & mandibular
inferior: cervical
posterior: posterior auricular
Fire triad includes
oxidizer
fuel source
ignition source
TTJV is
rapid, small volume ventilation
be mindful of expiratory time
pressure you’re ventilating at is 60 psi
Most common complication of plastics is
DVT & PE
______ presents the highest risk for morbidity & mortality in plastic surgery
liposuction
The FDA max dose of lidocaine is
35 mg/kg
Considerations for burns include:
concern for airway edema- check cuff leak
may have to suture ETT
keep the room warm
aseptic
paralytic dosages- don’t use succinylcholine, requires higher doses of NMDRs
very painful so give opioids
Endpoints for burn surgeries include
> 3 hours, >10 units of blood, <35 degrees
Nerves most often monitored in ENT surgery include
facial, vagus, recurrent & superior laryngeal nerve, & spinal accessory nerve
Tonsil surgery considerations include:
rebleeding into the stomach, RSI, bad PONV, want an H&H if they rebleed
Endoscopic sinus surgery considerations include
controlled hypotension
dural puncture
positioning-rotated away with arm tucked
With sentinel lymph node biopsy,
axillary nerve monitoring is being performed so you can’t paralyze
When dye is injected for masectomy
pulse ox can drop
allergic reaction to dyes
If a patient is having a DIEP flap
avoid vasopressors specifically pheylephrine b/c microvasculature
For ambulatory surgery
6 months for labs if no change
no routine preop testing
cheaper to do surgery here
Disadvantages of ambulatory surgery include
less time monitoring for complications
have to transfer for higher level care
have to coordinate PT/OT
don’t have set preop-decreased privacy
Perioperative complications most commonly occur in
20-49 year olds
Appropriate patients for ambulatory surgery include
ASA 1 or 2, no known difficult airway, should be at baseline health status
Need ____ bottles of dantrolene
36 vials
dose 2.5 mg/kg
Damage to dorsal scapular produces
atrophy & weakness of the rhomboid
Spinal cord specific gravity is
1.003-1.009
Hyperbaric will
settle in the thoracic if you lay them flat
For epidural anesthesia, ____ determines block density
concentration determines density and volume determines spread
Bupivacaine is cardiotoxic because
it is highly protein bound & it sticks around
Benefits for laparoscopic surgery include
early mobilization
less pain
less blood loss
Disadvantages for laparoscopic surgery include
decreased visualization PONV retained gas with shoulder pain- Toradol crepitus subcutaneous emphysema
Obesity types include gynecoid & android
android is worse because it is around the heart
In obese patients, lung volumes are
decreased & all capacities are decreased as well
Fat emboli will present as
SOB
petechiae
fat globules in urine
