Final Review - 1st 1/2 of semester Flashcards by Kristen Nelson

Compression of fibular head on leg brace causes damage to which nerve?

Common perineal

How well did you know this?

Not at all

Perfectly

Compression of medial tibial condyle causes damage to which nerve?

Saphenous

How well did you know this?

Not at all

Perfectly

Excessive external rotation of legs and excessive extension of the knees causes damage to which nerve?

Sciatic

How well did you know this?

Not at all

Perfectly

Excessive flexion of the going from the surgeon leaning on the inside of the leg causes damage to which nerve?

Obturator and femoral

How well did you know this?

Not at all

Perfectly

Levels of regional anesthesia for cystoscopy

T9-10 sensory level or T8 for ureters

How well did you know this?

Not at all

Perfectly

Risks of bladder perf specific to general and regional anesthesia for a TURBT

General - coughing or straining –> bladder perf

Regional - bladder atonic –> thinner when distended –> increased risk of perf

How well did you know this?

Not at all

Perfectly

S/S bladder perf in awake pt

shoulder discomfort
N/V
suprapubic fullness
abd spasm
pain

How well did you know this?

Not at all

Perfectly

S/S bladder perf in anesthetized pt

HTN and tachycardia followed by severe HoTN

also DIC

How well did you know this?

Not at all

Perfectly

Early signs of venous absorption of irrigation fluid during TURP

HTN and tachycardia, dyspnea, SOB

How well did you know this?

Not at all

Perfectly

Late signs of TURP syndrome

apprehension, disorientation, convulsions, coma

How well did you know this?

Not at all

Perfectly

Disadvantages to the following irrigation solutions:
Glycine
Sorbitol
Mannitol

Glycine - blindness
Sorbitol - hyperglycemia and lactic acidosis
Mannitol - hypervolemia, osmotic diuresis

How well did you know this?

Not at all

Perfectly

TURP syndrome tx

Fluid restriction and diuretics (give hypertonic solutions cautiously)

How well did you know this?

Not at all

Perfectly

Anesthesia considerations with Methylene blue 1% dye and indigo carmine dye

Methylene blue - can cause Hotn

Indigo - HTN Alpha sympathomimetic

Both - O2 sat appears to be low when it is actually ok (methylene greater effect than indigo)

How well did you know this?

Not at all

Perfectly

Problem w kidney bar during nephrectomy

can cause vena cava compression and HoTN

How well did you know this?

Not at all

Perfectly

What should be given for angioedema during anaphylactoid reaction?

FFP, then give it 20-30 min to work. you may not need to intubate. Decadron won’t work.

How well did you know this?

Not at all

Perfectly

S/S hemolytic transfusion reaction in anesthetized pt

CV instability
HoTN
Fever
hemoglobinuria
bleeding diathesis

How well did you know this?

Not at all

Perfectly

A pt with HIV is on NNRTIs. What is the anesthesia team concerned about?

NNRTIs induce the CYP450 system

How well did you know this?

Not at all

Perfectly

Most common opportunistic pathogen in HIV

Pneumocystic carinii

PNA responsible for most deaths

How well did you know this?

Not at all

Perfectly

Risk for percutaneous exposure to HIV

0.3%

How well did you know this?

Not at all

Perfectly

Most common cause of death in SLE pt

Renal failure

How well did you know this?

Not at all

Perfectly

3 anesthesia considerations in SLE pts

cricoarytenoid arthritis (difficult intubation)
RLN pasty
Cyclophosphamide (immunosuppressant) inhibits plasma cholinesterase –> ester LA and Succs last longer (RA pts also take this drug)

Absolute contraindications to central line placement

Refusal
Infection at site
Anatomic obstruction
Superior vena cava syndrome

Relative contraindications to central line placement

Coagulopathy
Systemic infection
Pacing wires or indwelling catheters present at insertion site
RVAD

How long to prep with CHG before central line insertion

30 sec, let it dry for 2 min

Where is the IJ located

B/t the sternal and clavicular heads of the sternocleidomastoid muscle - insert the needle at the apex of the triangle Lateral to carotid artery

major risk factors in the development of PVD

Smoking and DM

Single most significant risk factor influencing long-term survivability after abd aortic reconstruction.

CAD

Most reliable definition of coronary anatomy and extent of CAD

Coronary angiography

Thought to be the primary cause of AAA in 90% of pts

atherosclerosis

Surgical intervention is recommended for aneurysms greater than ____ cm in diameter

5.5 (another place says 4-5 cm)

Most common type of endoleak

Type II - collateral retrograde perfusion; spontaneously closes w/i the first mo of implantation

What poses the greatest risk of mortality after an open AAA reconstruction?

Myocardial ischemia intraop: monitor lead II for detection of dysrhythmias and V5 for analysis of ischemic ST-segment changes

Standard approach for elective AAA repair

Transperitoneal incision | retroperitoneal incision appears to maybe have fewer complications though

best and most common site for AoX in open AAA repair

infrarenal (most aneurysms develop below the level of the renal arteries)

T/F: AoX causes HTN above the cross clamp and HoTN below the cross clamp.

True (increase in MAP and SVR above clamp, but CO decreases or remains unchanged. Nitro is the drug of choice for tx of HTN during AoX)

T/F: The incidence of neurologic complications increases as the clamp is positioned higher on the aorta

True | Artery of Adamkiewicz is somewhere b/t T9-T12

How to prepare for AoX release

FLUID LOAD THE PT - increase CVP 3-5 mmHg or PAOP 3-4 mmHg Increase minute ventilation and maybe NaHCO3 to tx acidosis Vasopressors ready to go

What should UOP be during AAA repair?

1 mL/kg/hr

What contributes more frequently to poor surgical outcomes of CEA, MI or stroke?

MI Dipyridamole-thallium imaging is very suggestive of increased risk of adverse cardiac events

Vasoconstrictors released by the endothelial cells

Thromboxane A2 and Adenosine diphosphate (ADP)

Vasodilators released by endothelial cells

NO and Prostacyclin

What causes the plt to undergo a conformational change and become "activated"?

Tissue Factor

What is the role of GP Ib? | How about GP IIb and IIIa?

GP Ib - attaches pots to vWF and attracts additional plts to the endothelial lining GP IIb-IIIa complex links plts together to form a primary plt plug

With the exception of Factor V and Factor VIII, all cofactors are ________

enzymes Thye circulate in their inactive state until they are activated to assist in coagulation

Which coag factors aren't synthesized in the liver? Where are they synthesized?

Factor III - Tissue Factor - Vasc wall/extravasc cell membrane Factor IV - Calcium - Diet vWF - Endothelial cells

Which factors are vitamin K dependent?

II - Prothrombin VII - Stable factor IX - Christmas factor X - Stuart Prower Factor

Antithrombin III interferes w coagulation by binding to and removing which clotting factors from the clotting cascade?

XII, XI, X, and IX which influences II

Proteins C and S inhibit clot formation by inhibiting which factors?

III, V, and VIII

Which clotting component works both on the procoagulant and fibrinolytic systems?

Thrombin Procoagulant: Activates Factors V, VIII, I, and XIII, recruits plts to injured area, and must be present in adq amts to activate sufficient fibrin to form a stable (secondary) clot Fibrinolytic: Releases tPA from endothelial cells, stimulates proteins C and S, ?Antithrombin III

Plasminogen is activated into plasmin in the presence of ______ and ______

tPA, urokinase, and streptokinase

What halts fibrinolysis when the clot is digested?

A-Antiplasmin and Tissue plasminogen activator inhibitor (tPA inhibitor)

2 main functions of vWF

1. facilitate plt adhesion (to the vessel wall) | 2. behave as a plasma carrier for factor VIII