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Z.Fiser > Fiser.08.Anesthesia > Flashcards

Fiser.08.Anesthesia Flashcards

1
Q

What is a concerning finding for BMI during the standard airway examination?

A

BMI > or = 31

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2
Q

What is a concerning finding for mouth opening during the standard airway examination?

A

inter-incisor or inter-gingival distance > 3cm

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3
Q

what is a concerning finding for Mallampati classification during the standard airway examination?

A

Class III and IV

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4
Q

What is a concerning finding for mandibular protrusion during the standard airway examination?

A

inability to protrude lower incisors to meet or extend past upper incisors

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5
Q

what are two concerning findings with neck anatomy during the standard airway examination?

A

radiation changes; thick/obese neck

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6
Q

name two concerning findings with C-spine mobility during the standard airway examination

A

limited extension; possibility unstable C-spine

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7
Q

What is a concerning finding with facial hair during the standard airway examination

A

presence of a full beard

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8
Q

Mallampati classification?

A

class I: full visibility of tonsils, uvula, and soft palate

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9
Q

Mallampati classification?

A

class II: visibility of hard and soft palate, upper portion of tonsils, and uvula

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10
Q

Mallampati classification?

A

class III: soft and hard palate and base of uvula are visible

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11
Q

Mallampati classification?

A

class IV: only hard palate visible

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12
Q

define MAC in anesthesia

A

minimum alveolar concentration: smallest concentration of inhalational agent at which 50% of patients will not move with incision

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13
Q

how do you interpret a small MAC (minimum alveolar concentration) in terms of lipid solubility?

A

small MAC is more lipid soluble

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14
Q

how do you interpret a small MAC (minimum alveolar concentration) in terms of potency?

A

small MAC is more potent

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15
Q

what is the relationship between speed of induction & solubility in terms of inhalational anesthetics

A

increased speed of induction with decreased solubility (inversely proportional)

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16
Q

what is the fastest acting inhaled induction agent?

A

nitrous oxide

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17
Q

what is the MAC & potency of nitrous oxide?

A

high MAC therefore low potency

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18
Q

name three anesthetic effects of inhalational agents

A

unconsciousness; amnesia; analgesia

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19
Q

name the respiratory effects of inhaled induction agents

A

blunts hypoxic drive

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20
Q

name three cardiovascular effects of inhalational induction agents

A

myocardial depression, increased cerebral blood flow, decreased renal blood flow

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21
Q

name 2 advantages and 1 adverse effect of nitrous oxide (NO2)

A

fast, minimal myocardial depression; tremors at induction

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22
Q

is the onset/offset of halothane fast or slow

A

slow onset / offset

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23
Q

name 2 cardiac effects of halothane

A

highest degree of cardiac depression and arrhythmias

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24
Q

why is halothane good for children?

A

least pungent

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25
Q

name 4 S/Sx of halothane hepatitis?

A

fever; eosinophilia; jaundice; increased LFTs

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26
Q

which inhalational induction agent is best for mask induction?

A

sevoflurane

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27
Q

name 3 benefits / advantages of sevoflurane

A

fast, less laryngospasm, less pungent

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28
Q

which inhalational induction agent is best for NSGY and why? (2 reasons)

A

isoflurane b/c lowers brain O2 consumption and no increase in ICP

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29
Q

name 1 AE of enflurane

A

seizures

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30
Q

what class of drugs is sodium thiopental?

A

barbiturate

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31
Q

is sodium thiopental fast-acting or slow-acting?

A

fast-acting

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32
Q

name 3 side effects of sodium thiopental

A

reduced cerebral blood flow; reduced metabolic rate; reduced BP

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33
Q

name 4 anesthetic advantages of propofol

A

very rapid distribution; rapid onset/offset; amnesia; sedative

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34
Q

is propofol an analgesic?

A

nope

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35
Q

name two side effects of propofol

A

hypotension; respiratory depression

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36
Q

for what type of allergy should you avoid propofol?

A

do not use propofol in patients with an egg allergy

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37
Q

name two ways propofol is metabolized

A

liver; plasma cholinesterases

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38
Q

define a cataleptic state

A

amnesia and analgesia

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39
Q

what is the MOA of ketamine?

A

dissociation of thalamic and limbic systems

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40
Q

name two anesthetic effects of ketamine

A

amnesia & analgesia

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41
Q

name the respiratory effects of ketamine

A

no respiratory depression

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42
Q

name six AEs of ketamine

A

hallucinations; increased airway secretions; increased cerebral blood flow; catecholamine release leading to hypercarbia and tachycardia

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43
Q

name one contraindication for ketamine

A

patients with head injury

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44
Q

is ketamine a good choice for children?

A

yes

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45
Q

name 1 AE of continuous etomidate infusion

A

adrenocortical suppression

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46
Q

name 2 advantages of etomidate

A

fewer hemodynamic changes compared to other anesthetics; fast-acting

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47
Q

name 5 inhalational induction agents

A

NO2; halothane; sevoflurane; isoflurane; enflurane

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48
Q

name 4 IV induction agents

A

sodium thiopental; propofol; ketamine; etomidate

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49
Q

name 5 indications for rapid sequence intubation

A

recent PO intake; GERD; delayed gastric emptying; pregnancy; bowel obstruction

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50
Q

name the three steps of rapid sequence intubation

A

pre-oxygenate, etomidate, succinate

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51
Q

which muscle is the last to go down and the first to recover from paralytics?

A

diaphragm

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52
Q

which muscles are the first to go down and the last to recover with paralytics?

A

neck and face muscles

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53
Q

what is the MOA of succinylcholine?

A

paralytic agents, depolarizing agent –> depolarizes NMJ

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54
Q

name 6 AEs of succinylcholine

A

fasciculations; increased ICP; malignant hyperthermia; hyperkalemia; open angle glaucoma –> closed angle glaucoma; atypical psuedocholinesterases in Asian patients –> prolonged paralysis

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55
Q

name 2 advantages of succinylcholine

A

fast-acting; short-acting

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56
Q

what is the MOA of malignant hyperthermia

A

occurs with succinylcholine 2/2 defect in calcium metabolism. Calcium released from sarcoplasmic reticulum –> muscle excitation-contraction syndrome

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57
Q

Name 6 S/Sx of malignant hyperthermia. Which presents first?

A

first sign: increased end-tidal CO2, then fever, tachycardia, rigidity, acidosis, hyperkalemia

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58
Q

name 5 treatments for malignant hyperthermia, include dose

A

dantrolene (10mg/kg); cooling blankets; bicarb; glucose; supportive care

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59
Q

what is the MOA of dantrolene

A

inhibits calcium release, decouples the excitation complex

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60
Q

why does succinylcholine cause hyperkalemia?

A

depolarizing agent, depolarization releases K+

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61
Q

name 6 contraindications to succinylcholine use and why

A

a/w hyperkalemia therefore contraindications include severe burns, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, renal failure

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62
Q

name 3 non-depolarizing paralytics

A

cistatracurium, rocuronium, pancuronium

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63
Q

what is the MOA of non-depolarizing paralytics

A

inhibits NMJ by competing with acetylcholine

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64
Q

what happens in patients with myasthenia gravis treated with non-depolarizing muscle relaxants?

A

prolonged action with myasthenia gravis

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65
Q

how is cisatracurium metabolized

A

Hoffman degradation: ester hydrolysis in plasma

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66
Q

can cisatracurium be used in liver or renal failure?

A

both can be used because they are metabolized by Hoffman degradation

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67
Q

what endogenous chemical is released with cisatracurium?

A

Histamine

68
Q

how is rocuronium metabolized?

A

hepatic metabolism

69
Q

what is the speed and duration of rocuronium?

A

fast-acting, intermediate duration

70
Q

how is pancuronium metabolized?

A

renal metabolism

71
Q

what is the speed and duration of pancuronium?

A

slow-acting, long-lasting

72
Q

what is the MC side effect of pancuronium?

A

tachycardia

73
Q

what is the MOA of neostigmine?

A

acetylcholinesterase inhibitor –> increased Ach levels

74
Q

what does neostigmine reverse?

A

reverses nondepolarizing paralytics

75
Q

what is the MOA of edrophonium?

A

acetylcholinesterase inhibitor –> increased Ach levels

76
Q

what does edrophonium reverse?

A

reverses nondepolarizing paralytics

77
Q

which meds should be administered with neostigmine or edrophonium and why?

A

atropine or glycopyrrolate to counteract effects of acetylcholine overdose

78
Q

what is the MOA of local anesthetics?

A

increased action potential threshold therefore prevents sodium influx

79
Q

what is the appropriate weight-based dose of 1% lidocaine?

A

0.5cc/kg

80
Q

why are infected tissues hard to anesthetize?

A

2/2 acidosis

81
Q

name three local anesthetics

A

lidocaine; procaine; bupivicaine

82
Q

list three local anesthetics in order of length of action

A

bupivicaine > lidocaine > procaine

83
Q

name 4 AEs of local anesthetics

A

tremors; seizures; tinnitus; arrhythmias

84
Q

what symptoms occur first with local anesthetics? (CNS vs cardiac)

A

CNS symptoms before cardiac symptoms

85
Q

why is epinephrine added to local anesthetics? (2 reasons)

A

allows higher doses of anesthetic to be used and stays locally

86
Q

name 4 contraindications to adding epi to local anesthetic

A

arrhythmias, unstable angina, uncontrolled HTN, uteroplacental insufficiency

87
Q

name two body locations you shouldn’t use local anesthetic with epi and why

A

penis and ear because poor collaterals

88
Q

name 3 AMIDE local anesthetics

A

lidocaine, bupivicaine, mepivacaine (all have “i” in the stem)

89
Q

name an adverse effect of an AMIDE local anesthetic

A

rarely cause allergic reactions

90
Q

name three ESTER local anesthetics

A

tetracaine, procaine, cocaine

91
Q

why do ESTER-based local anesthetics have higher rates of allergic reactions?

A

PABA analogue (same as sulfa drugs)

92
Q

name 4 narcotics (opioids)

A

fentanyl, morphine, demerol, codeine

93
Q

what is the MOA of opioids / narcotics?

A

act on mu-opioid receptors

94
Q

name 3 systemic effects of narcotics / opioids

A

profound analgesia, respiratory depression, blunt sympathetic response

95
Q

what is the MOA of respiratory depression 2/2 opioids / narcotics

A

reduced CO2 drive

96
Q

do narcotics / opioids have any cardiac effects?

A

nope

97
Q

where are narcotics / opioids metabolized and excreted?

A

metabolized in liver, excreted by kidney

98
Q

why should you avoid narcotics in patients on MAOIs

A

can cause hyperpyrexic coma

99
Q

does narcan work for all opioids

A

yerp

100
Q

name 3 AEs of morphine

A

constipation; histamine release can –> hypotension; reduced cough reflex

101
Q

name 4 AEs of demerol

A

tremors, fasciculations, convulsions, seizures

102
Q

does demerol cause histamine release?

A

nope

103
Q

what chemical builds up to cause seizures with demerol?

A

buildup of normeperidine analogues (causes CNS toxicity)

104
Q

what comorbidity is a CI to using demerol?

A

avoid demerol in renal failure patients

105
Q

what are the effects of methadone?

A

simulates morphine with less euphoria

106
Q

what is the strength of fentanyl compared to morphine?

A

fentanyl = 80x strength of morphine

107
Q

does fentanyl cause histamine release?

A

no

108
Q

does morphine cause histamine release?

A

yes and it leads to hypotension

109
Q

can you use fentanyl in patients with a morphine allergy?

A

yes, fentanyl does not cross-react in patients with morphine allergy

110
Q

what is the most potent narcotic?

A

sufentanil

111
Q

how fast-acting is and what is the half life a/w sufentanil? (general not specific)

A

very fast acting narcotic with short half life

112
Q

how fast-acting is and what is the half life a/w remifentanil? (general not specific)

A

very fast acting narcotic with short half life

113
Q

how are benzodiazapenes metabolized?

A

liver metabolism

114
Q

name 4 effects of benzodiazapenes

A

anticonvulsant, amnesic, anxiolytic, respiratory depression

115
Q

can versed be used in pregnancy?

A

no, contraindicated because it crosses the placenta

116
Q

is versed (midazolam) short-, intermediate-, or long-acting?

A

short-acting

117
Q

is valium (diazepam) short-, intermediate-, or long-acting?

A

intermediate-acting

118
Q

is ativan (lorazepam) short-, intermediate-, or long-acting?

A

long-acting

119
Q

what med is given for benzodiazepene overdose

A

flumazenil

120
Q

what is the MOA of flumazenil?

A

Flumazenil competitively inhibits the activity at the benzodiazepine recognition site on the GABA/benzodiazepine receptor complex.

121
Q

what are two adverse effects of flumazenil?

A

seizures, arrhythmias

122
Q

name 2 contraindications for flumazenil

A

elevated ICP, status epilepticus

123
Q

what is the MOA of epidural anesthesia

A

analgesia by sympathetic denervation

124
Q

what are the vasoactive effects of epidural anesthesia

A

vasodilation

125
Q

name 1 AE of morphine with epidural anesthesia

A

respiratory depression

126
Q

name two AEs of lidocaine in epidural anesthesia

A

reduced HR, reduced BP

127
Q

how can you spare motor function when administering epidural anesthesia?

A

dilute concentration of anesthetic

128
Q

how do you treat acute hypotension and bradycardia with epidural anesthesia (4)

A

turn epidural down, IVF, phenylephrine, atropine

129
Q

what level of epidural can affect cardiac accelerator nerves?

A

T5 epidural

130
Q

name 2 CIs of epidural anesthesia and why?

A

hypertrophic cardiomyopathy and cyanotic heart disease because epidural anesthesia causes sympathetic denervation leading to decreased afterload which worsens these cardiac conditions

131
Q

where is spinal anesthetic injected?

A

injected into subarachnoid space

132
Q

name 2 factors that affect spread of spinal anesthesia

A

Pt position and Baricity (Baricity refers to the density of a substance compared to the density of human cerebrospinal fluid. Baricity is used in anesthesia to determine the manner in which a particular drug will spread in the intrathecal space. Hyperbaric solutions will flow in the direction of gravity and settle in the most dependent areas of the intrathecal space. Conversely, hypobaric mixtures will rise in relation to gravitational pull. These properties allow the anesthesia provider to preferentially control the spread of the block by choice of mixture and patient positioning.)

133
Q

which is higher up the levels with spinal anesthesia: neurologic or motor?

A

neurologic blockade is above motor blockade

134
Q

name 2 CIs for spinal anesthesia

A

hypertrophic cardiomyopathy and cyanotic heart disease

135
Q

name two surgical indications for cervical block

A

pediatric hernias and perianal surgery

136
Q

where do you place a caudal block

A

through the sacrum

137
Q

name 6 complications with epidural / spinal anesthesia

A

respiratory depression with high spinal; hypotension; headache; urinary retention; abscess; hematoma

138
Q

what is the underlying cause of spinal headache a/w spinal/epidural anesthesia

A

CSF leak

139
Q

which position exacerbates spinal headaches?

A

sitting upright

140
Q

name 5 tx for spinal HA s/p spinal/epidural anesthesia

A

rest; fluids; caffeine; analgesia; blood patch if symptoms persist for > 24 hours

141
Q

what is the MC preop complication

A

renal failure

142
Q

which postop complication is a/w highest postop mortality rates?

A

CHF

143
Q

name three respiratory sx indicating need for preop cards workup

A

SOB; SOB with < 2 blocks walking; FEV < 70%

144
Q

which two classes of operations require preop cards workup/

A

major vascular surgery (peripheral and aortic)

145
Q

name 7 cardiac comorbidities / sx indicating need for preop cards workup

A

angina, h/o MI, CHF, walks < 2 blocks 2/2 angina, severe valvular dz, PVCs > 5/min, high grade heart block

146
Q

name age and two non-cards/pulm comorbidities that indicate need for preop cards workup

A

DM; renal insufficiency; age > 70y/o

147
Q

name 7 Sx a/w postop MI

A

+/- chest pain ; +/- EKG changes; hypotension; arrhythmias; increased filling pressures; oliguria; bradycardia

148
Q

define ASA class 1

A

healthy

149
Q

define ASA class 2 + comorbidity examples

A

mild disease without limitation (ex: controlled HTN, obesity, DM, h/o tobacco use, older age)

150
Q

define ASA class 3 + comorbidity examples

A

severe disease. ex: angina, previous MI, poorly controlled HTN, DM with complications, moderate COPD

151
Q

define ASA class 4 + comorbidity examples

A

severe constant threat to life. ex: unstable angina, CHF, renal failure, liver failure, severe COPD

152
Q

define ASA class 5

A

moribund ex: ruptured AAA, saddle pulmonary embolus

153
Q

define ASA class 6

A

organ donor

154
Q

name 5 biggest risk factors for postop MI

A

age > 70; DM, h/o MI; CHF, unstable nagina

155
Q

what does the cardiac risk stratification for noncardiac surgical procedures estimate?

A

risk of cardiac death and nonfatal MI

156
Q

name 5 surgeries / types considered high cardiac risk

A

emergent procedures, aortic surgery, peripheral vascular surgery, major vascular surgery (not CEA), long procedures with large fluid shifts

157
Q

what is the combined incidence of cardiac death and nonfatal MI with high risk noncardiac surgery

A

>5%

158
Q

what is the combined incidence of cardiac death and nonfatal MI with intermediate risk noncardiac surgery?

A

<5%

159
Q

what is the combined incidence of cardiac death and nonfatal MI with low risk noncardiac surgery?

A

<1%

160
Q

name 6 classes of intermediate cardiac risk noncardiac surgeries

A

CEA; head/neck surgery; intraperitoneal surgery; intrathoracic surgery; orthopedic surgery; prostate surgery

161
Q

name 4 classes of low cardiac risk noncardiac surgeries

A

endoscopy; superficial/skin surgeries; cataract surgery; breast surgery

162
Q

what is the best way to differentiate esophageal vs tracheal intubation

A

end-tidal CO2

163
Q

what is the MCC of sudden, transient increase in ETCO2 in the intubated surgical patient? What is the tx?

A

MCC = hypoventilation. Tx = increase tidal volume or increase respiratory rate

164
Q

name 2 likely underlying causes of sudden drop in ETCO2 in the intubated surgical patient

A

disconnected from ventilator or PE (a/w hypotension)

165
Q

where should the ET tube be placed relative to the carina

A

2cm above the carina

166
Q

what are the 2 MC PACU complications?

A

nausea / vomiting

167
Q

name 2 operations a/w reduced mortality a/w high volume hospitals

A

AAA repair, pancreatic resection

Z.Fiser (22 decks)

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