FINAL EXAM REVIEW Flashcards
Non-cutting
Sprotte
Whitacre
Pencan
Definition – Chronic pain is a
physical and emotional response to tissue damage that
lasts longer than the expected duration of pain.
pain following a distribution of a nerve or group of nerves
Neuralgia –
perception of pain in an area that lacks sensation
Anesthesia dolorosa –
perception of a non‐painful stimulus as painful
Allodynia
Lack of all sensation, painful or otherwise
Anesthesia –
The presence of an unpleasant sensation whether or not a causitive stimulus is present
Dysesthesia –
– Diminished response to painful stimuli
Hypoalgesia
– Increased or aggravated response to painful stimuli
Hyperalgesia
– Exaggerated response to a mild stimus.
Hyperesthesia
Name layers of spinal
SIFEDASP
Reduced ability to sense cutaneous
stimuli such as light touch, pressure, or temperature
Hypoesthesia –
Abnormal sensation that occurs without
stimuli (numbness, tingling, pins &needles)
Paresthesia –
Functional abnormality associated with at least one nerve root
Radiculopathy
Complex interaction between peripheral and central pain mechanisms associated with lesions of peripheral nerves, nerve roots, ganglions, or spinal structures
Neuropathic pain
Sensation of pain in a limb that has been amputated
• Phantom pain
Lack of pain perception
Analgesia
Combined disorder consisting of hyperesthesthia, allodynia, and hyperalgesia
Hyperpathia
What former name for CRPS Type I?
Reflex sympathetic dystrophy
What former name for CRPS Type II?
Causalgia
CRPS – There are
two types. Type I and Type II.
Complex regional pain syndrome.
CRPS Characterized by
spontaneous pain, allodynia, hyperalgesia, sudomotor
and vasomotor dysfunction
Opioids receptors location in the SC
substantia Gelatinosa
Brain–: Periaqueductal gray, and the , Locus coeruleus
Liphophillic opioids
Fentanyl
sufentanyl
Methadone.
Depth of epidural Catheter
11-12 cm
Each black line
5 cm
Nerve stimulator lead placement
Orbicularis ocularis
Adductor policis
Posterial tibial
Action of SUCC
Binds to ACH
Metabolism of succ
Plasma pseudocholinesterase
TOF 1/4 Receptor blocked
90%
TOF 2/4 Receptor blocked
85%
TOF 3/4 Receptor blocked
80%
TOF 4/4 Receptor blocked
75%
Contraindications of SUCC
MD
Hx of MH
Old CVA
Increase ICP
Succinylcholine and M
2x dose MG
NDNMB and Asthma
Histamine release with Atracurium, hoffman and esters h
Treatment of Laryngospasm
Dosing of succ for laryngospasm________
then give ______
Call for help 0.1mg/kg 100% FiO2 Lidocaine 1.5mg/kg Sedate patient
Phase I block
FADE
Phase II Block
NO fade
Local anesthetics spread
B DGBA C
From OUTER TO INNER
B fibers, Adelta, Agamma , Abeta, Aalpha, C fibers
Block the conduction of impulses
Block Na channels
PA catheter cm RA
20-25cm
PA Catheter cm RV
30-35cm
PA catheter cm PA
40-45cm
Wedge site cm PA catheter
45-50cm
a waver
Atrial contractio
C wave
Tricuspid buldging in ventricle
v wave
systolic filling of the atrium
Most common used DLT
left
Tracheal cuff; how many ml of air
20 ml
Bronchial cuff how many mls of air
3 ml
Fire triad
Fuel
Oxygen
Heat
NORA
Oxygen supplies
Suction
Scavenger
Full tanks
Dexmetomidine (precedex)
Alpha 2 agonist
Produce both SEDATION and analgesia
1600:1 alpha 2 to alpha 1 ratio
Precedex class
Alpha 2 agonist
Sentinel
sentinel event as an unanticipated death or loss of function unrelated to the natural course of the patient’s illness or underlying condition or wrong-site, wrong-procedure, wrong-patient surgery. Such an event is called sentinel because it signals a need for an immediate investigation and response.
Monitored Anesthesia Care vs Sedate
MAC: Twillight sleep, potential for a deeper level of sedation than that provided by sedation/analgesia and is always administered by anesthesia professional
Sedation is performed by ICU nurses, non anesthesia personnel, with training sedation principles.
When performingthe laryngoscopy for the placement of a DLT, the stylet should be removed when?
AS soon as the tracheal cuff passes the vocal cords
you inflate the cuff
When performing the laryngoscope
AS soon as the tracheal cuff passes the vocal cords
you inflate the cuff
Spinal Anesthesia ASA contraindications
None
Spinal Anesthesia contraindications Antiplatelets: Clopidogrel
Stop for 7 days prior to neuraxial block ; if considered between 5-7 days, check platelet function
Spinal Anesthesia contraindications Antiplatelets: Prasugrel
Stop for 7-10 days prior to neuraxial block , wait 9 hours
Spinal Anesthesia contraindications Antiplatelets: Ticagrelor
Stop for 5-7 days prior to neuraxial block , wait 10 hours
Spinal Anesthesia contraindications Antiplatelets: Ticlopidine
Stop 14 days prior
Spinal Anesthesia contraindications: WARFARIN
stop 4-5 days ,
When catheter removed for warfarin, INR
INR <1.5
Warfarin held when INR is
INR> 3
For heparin prophylaxis dose wait
10-12 hours
For heparin treatment dose wait
24 hours
To restart heparin therapy , catheter should have been out for at least______prior to initiation of therapy. Single dose therapy , wait how long
2 hours; 10-12 hours
Thrombin and Xa inhibitors restart
DAR (dabigatran, Apixaban, Rivaroxaban)
56 Wait 5 days, then 6 hour after
37 wait 3 days, then 6 hour after
38 wait 3 days then 8 hour
Tetany with Fade
Non-depolarizing
Tetany no FADE
Depolarizing
The entry of this ion facilitates the release of the neurotransmitter at the NMJ end plate
CALCIUM
The last to be paralyzed but the first to recover among the different muscles of the body from nondepolarizers are the muscles of the
DIAPHRAGM
TOF use to determine
NM blockade.
No problem to give SUCC TO those patients
Parkinson’s Disease
Epilepsy
Acute CVA
Do not give SUCC
Spinal cord injry > 1 wk
Dose of succinylcholine with fasciculation
1-2 mg /kg
AANA standard regarding infection
One needle, one patient, one syringe
PPE
OR masks
eye protection
OR hats
2 principles that violate infection control recommendations
Monitoring cable should be wiped down once a day
Anesthesia machine should be wiped down once a day
Review fibers blocked first and last
B fibers A Delta A Gamma A Beta A Alpha C fibers
Fast impulses for sharp pain is mediated by what specific nerve fiber
A delta fibers
Recurarization in the PACU definite signs
AID
Appears uncoordinated
Increase resp effort
Declining O2 saturation
Maximal duration of tourniquet time is not well defined, although
2 hours is generally considered safe to avoid distal tissue ischemia.
Max tourniquet pressure.
The inflation pressure should not exceed 100 mm Hg above the systolic pressure for the upper extremity or above 150 mm Hg for the lower extremity. However, higher pressure may be needed in morbidly obese patients to prevent arterial inflow.
Signs and symptoms recurarization in the PACU
O2 sats drop, unresponsive pt, floppy,
ineffective abdominal and intercostal activity.
Feeling of suffocation
Treatment recurarization in the PACU
Resedate the patients
Give reversal
Entry of PA
35-45 cm
Proper sizing of the DLT is baed off of
HEIGHT
Proper depth of ETT For MALE
20-22
Proper depth of ETT for FEMALE
22-24
Hockey stick correlates
Height
A line transducer higher then bed
Underestimate BP
A line transducer lower then bed
Overestimate BP
A line transducer at PHLEBOTAXIS AXIS
Accurate BP
MAC involves the administration of drugs with
Anxiolytic
Amnestic
Hypnotic
Analgesia.
What 2 drugs can be used to help sedate the patient for the block as well as for positioning on the OR table prior to THA
Propofol/Ketamine
Anatomy of the spine for SPINAL Anesthesia
IP SADEL SIST Intervertebral disc Pia mater Spinal nerve Arachnoid Matter Dura matter Epidural Fat Ligamentum Flavum Spinous process Interspinous Ligament Supraspinous Ligament Transverse process.
The meaning of underdampened
Systolic overestimated
Diastolic underestimated
The meaning of Overdampened
Systolic underestimated
Diastolic overestimated.
CVP measures and should be measured at
Filling pressure of the Right side of the heart
END EXPIRATION
Ease of cannulation
IJ better than subclavian
Complications IJ vs Subclavian
IJ better than subclavian
PAC indications
evaluation of response to fluid administration Valvular heart disease ARDS Recent MI Massive trauma
Zone lungs
Zone 1 PA> Pa> Pv
Zone 2 Pa> PA> Pv
Zone 3 Pa>Pv> PA
The Tip of PAC must lie in
ZOne 3 for accurate measurements of PAWP
Supine position favors
Zone 3