Fiser.08.Anesthesia Flashcards
1
Q
What is a concerning finding for BMI during the standard airway examination?
A
BMI > or = 31
2
Q
What is a concerning finding for mouth opening during the standard airway examination?
A
inter-incisor or inter-gingival distance > 3cm
3
Q
what is a concerning finding for Mallampati classification during the standard airway examination?
A
Class III and IV
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
5
Q
what are two concerning findings with neck anatomy during the standard airway examination?
A
radiation changes; thick/obese neck
6
Q
name two concerning findings with C-spine mobility during the standard airway examination
A
limited extension; possibility unstable C-spine
7
Q
What is a concerning finding with facial hair during the standard airway examination
A
presence of a full beard
8
Q
Mallampati classification?
A
class I: full visibility of tonsils, uvula, and soft palate
9
Q
Mallampati classification?
A
class II: visibility of hard and soft palate, upper portion of tonsils, and uvula
10
Q
Mallampati classification?
A
class III: soft and hard palate and base of uvula are visible
11
Q
Mallampati classification?
A
class IV: only hard palate visible
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
13
Q
how do you interpret a small MAC (minimum alveolar concentration) in terms of lipid solubility?
A
small MAC is more lipid soluble
14
Q
how do you interpret a small MAC (minimum alveolar concentration) in terms of potency?
A
small MAC is more potent
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)
16
Q
what is the fastest acting inhaled induction agent?
A
nitrous oxide
17
Q
what is the MAC & potency of nitrous oxide?
A
high MAC therefore low potency
18
Q
name three anesthetic effects of inhalational agents
A
unconsciousness; amnesia; analgesia
19
Q
name the respiratory effects of inhaled induction agents
A
blunts hypoxic drive
20
Q
name three cardiovascular effects of inhalational induction agents
A
myocardial depression, increased cerebral blood flow, decreased renal blood flow
21
Q
name 2 advantages and 1 adverse effect of nitrous oxide (NO2)
A
fast, minimal myocardial depression; tremors at induction
22
Q
is the onset/offset of halothane fast or slow
A
slow onset / offset
23
Q
name 2 cardiac effects of halothane
A
highest degree of cardiac depression and arrhythmias
24
Q
why is halothane good for children?
A
least pungent
25
name 4 S/Sx of halothane hepatitis?
fever; eosinophilia; jaundice; increased LFTs
26
which inhalational induction agent is best for mask induction?
sevoflurane
27
name 3 benefits / advantages of sevoflurane
fast, less laryngospasm, less pungent
28
which inhalational induction agent is best for NSGY and why? (2 reasons)
isoflurane b/c lowers brain O2 consumption and no increase in ICP
29
name 1 AE of enflurane
seizures
30
what class of drugs is sodium thiopental?
barbiturate
31
is sodium thiopental fast-acting or slow-acting?
fast-acting
32
name 3 side effects of sodium thiopental
reduced cerebral blood flow; reduced metabolic rate; reduced BP
33
name 4 anesthetic advantages of propofol
very rapid distribution; rapid onset/offset; amnesia; sedative
34
is propofol an analgesic?
nope
35
name two side effects of propofol
hypotension; respiratory depression
36
for what type of allergy should you avoid propofol?
do not use propofol in patients with an egg allergy
37
name two ways propofol is metabolized
liver; plasma cholinesterases
38
define a cataleptic state
amnesia and analgesia
39
what is the MOA of ketamine?
dissociation of thalamic and limbic systems
40
name two anesthetic effects of ketamine
amnesia & analgesia
41
name the respiratory effects of ketamine
no respiratory depression
42
name six AEs of ketamine
hallucinations; increased airway secretions; increased cerebral blood flow; catecholamine release leading to hypercarbia and tachycardia
43
name one contraindication for ketamine
patients with head injury
44
is ketamine a good choice for children?
yes
45
name 1 AE of continuous etomidate infusion
adrenocortical suppression
46
name 2 advantages of etomidate
fewer hemodynamic changes compared to other anesthetics; fast-acting
47
name 5 inhalational induction agents
NO2; halothane; sevoflurane; isoflurane; enflurane
48
name 4 IV induction agents
sodium thiopental; propofol; ketamine; etomidate
49
name 5 indications for rapid sequence intubation
recent PO intake; GERD; delayed gastric emptying; pregnancy; bowel obstruction
50
name the three steps of rapid sequence intubation
pre-oxygenate, etomidate, succinate
51
which muscle is the last to go down and the first to recover from paralytics?
diaphragm
52
which muscles are the first to go down and the last to recover with paralytics?
neck and face muscles
53
what is the MOA of succinylcholine?
paralytic agents, depolarizing agent --\> depolarizes NMJ
54
name 6 AEs of succinylcholine
fasciculations; increased ICP; malignant hyperthermia; hyperkalemia; open angle glaucoma --\> closed angle glaucoma; atypical psuedocholinesterases in Asian patients --\> prolonged paralysis
55
name 2 advantages of succinylcholine
fast-acting; short-acting
56
what is the MOA of malignant hyperthermia
occurs with succinylcholine 2/2 defect in calcium metabolism. Calcium released from sarcoplasmic reticulum --\> muscle excitation-contraction syndrome
57
Name 6 S/Sx of malignant hyperthermia. Which presents first?
first sign: increased end-tidal CO2, then fever, tachycardia, rigidity, acidosis, hyperkalemia
58
name 5 treatments for malignant hyperthermia, include dose
dantrolene (10mg/kg); cooling blankets; bicarb; glucose; supportive care
59
what is the MOA of dantrolene
inhibits calcium release, decouples the excitation complex
60
why does succinylcholine cause hyperkalemia?
depolarizing agent, depolarization releases K+
61
name 6 contraindications to succinylcholine use and why
a/w hyperkalemia therefore contraindications include severe burns, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, renal failure
62
name 3 non-depolarizing paralytics
cistatracurium, rocuronium, pancuronium
63
what is the MOA of non-depolarizing paralytics
inhibits NMJ by competing with acetylcholine
64
what happens in patients with myasthenia gravis treated with non-depolarizing muscle relaxants?
prolonged action with myasthenia gravis
65
how is cisatracurium metabolized
Hoffman degradation: ester hydrolysis in plasma
66
can cisatracurium be used in liver or renal failure?
both can be used because they are metabolized by Hoffman degradation
67
what endogenous chemical is released with cisatracurium?
Histamine
68
how is rocuronium metabolized?
hepatic metabolism
69
what is the speed and duration of rocuronium?
fast-acting, intermediate duration
70
how is pancuronium metabolized?
renal metabolism
71
what is the speed and duration of pancuronium?
slow-acting, long-lasting
72
what is the MC side effect of pancuronium?
tachycardia
73
what is the MOA of neostigmine?
acetylcholinesterase inhibitor --\> increased Ach levels
74
what does neostigmine reverse?
reverses nondepolarizing paralytics
75
what is the MOA of edrophonium?
acetylcholinesterase inhibitor --\> increased Ach levels
76
what does edrophonium reverse?
reverses nondepolarizing paralytics
77
which meds should be administered with neostigmine or edrophonium and why?
atropine or glycopyrrolate to counteract effects of acetylcholine overdose
78
what is the MOA of local anesthetics?
increased action potential threshold therefore prevents sodium influx
79
what is the appropriate weight-based dose of 1% lidocaine?
0.5cc/kg
80
why are infected tissues hard to anesthetize?
2/2 acidosis
81
name three local anesthetics
lidocaine; procaine; bupivicaine
82
list three local anesthetics in order of length of action
bupivicaine \> lidocaine \> procaine
83
name 4 AEs of local anesthetics
tremors; seizures; tinnitus; arrhythmias
84
what symptoms occur first with local anesthetics? (CNS vs cardiac)
CNS symptoms before cardiac symptoms
85
why is epinephrine added to local anesthetics? (2 reasons)
allows higher doses of anesthetic to be used and stays locally
86
name 4 contraindications to adding epi to local anesthetic
arrhythmias, unstable angina, uncontrolled HTN, uteroplacental insufficiency
87
name two body locations you shouldn't use local anesthetic with epi and why
penis and ear because poor collaterals
88
name 3 AMIDE local anesthetics
lidocaine, bupivicaine, mepivacaine (all have "i" in the stem)
89
name an adverse effect of an AMIDE local anesthetic
rarely cause allergic reactions
90
name three ESTER local anesthetics
tetracaine, procaine, cocaine
91
why do ESTER-based local anesthetics have higher rates of allergic reactions?
PABA analogue (same as sulfa drugs)
92
name 4 narcotics (opioids)
fentanyl, morphine, demerol, codeine
93
what is the MOA of opioids / narcotics?
act on mu-opioid receptors
94
name 3 systemic effects of narcotics / opioids
profound analgesia, respiratory depression, blunt sympathetic response
95
what is the MOA of respiratory depression 2/2 opioids / narcotics
reduced CO2 drive
96
do narcotics / opioids have any cardiac effects?
nope
97
where are narcotics / opioids metabolized and excreted?
metabolized in liver, excreted by kidney
98
why should you avoid narcotics in patients on MAOIs
can cause hyperpyrexic coma
99
does narcan work for all opioids
yerp
100
name 3 AEs of morphine
constipation; histamine release can --\> hypotension; reduced cough reflex
101
name 4 AEs of demerol
tremors, fasciculations, convulsions, seizures
102
does demerol cause histamine release?
nope
103
what chemical builds up to cause seizures with demerol?
buildup of normeperidine analogues (causes CNS toxicity)
104
what comorbidity is a CI to using demerol?
avoid demerol in renal failure patients
105
what are the effects of methadone?
simulates morphine with less euphoria
106
what is the strength of fentanyl compared to morphine?
fentanyl = 80x strength of morphine
107
does fentanyl cause histamine release?
no
108
does morphine cause histamine release?
yes and it leads to hypotension
109
can you use fentanyl in patients with a morphine allergy?
yes, fentanyl does not cross-react in patients with morphine allergy
110
what is the most potent narcotic?
sufentanil
111
how fast-acting is and what is the half life a/w sufentanil? (general not specific)
very fast acting narcotic with short half life
112
how fast-acting is and what is the half life a/w remifentanil? (general not specific)
very fast acting narcotic with short half life
113
how are benzodiazapenes metabolized?
liver metabolism
114
name 4 effects of benzodiazapenes
anticonvulsant, amnesic, anxiolytic, respiratory depression
115
can versed be used in pregnancy?
no, contraindicated because it crosses the placenta
116
is versed (midazolam) short-, intermediate-, or long-acting?
short-acting
117
is valium (diazepam) short-, intermediate-, or long-acting?
intermediate-acting
118
is ativan (lorazepam) short-, intermediate-, or long-acting?
long-acting
119
what med is given for benzodiazepene overdose
flumazenil
120
what is the MOA of flumazenil?
Flumazenil competitively inhibits the activity at the benzodiazepine recognition site on the GABA/benzodiazepine receptor complex.
121
what are two adverse effects of flumazenil?
seizures, arrhythmias
122
name 2 contraindications for flumazenil
elevated ICP, status epilepticus
123
what is the MOA of epidural anesthesia
analgesia by sympathetic denervation
124
what are the vasoactive effects of epidural anesthesia
vasodilation
125
name 1 AE of morphine with epidural anesthesia
respiratory depression
126
name two AEs of lidocaine in epidural anesthesia
reduced HR, reduced BP
127
how can you spare motor function when administering epidural anesthesia?
dilute concentration of anesthetic
128
how do you treat acute hypotension and bradycardia with epidural anesthesia (4)
turn epidural down, IVF, phenylephrine, atropine
129
what level of epidural can affect cardiac accelerator nerves?
T5 epidural
130
name 2 CIs of epidural anesthesia and why?
hypertrophic cardiomyopathy and cyanotic heart disease because epidural anesthesia causes sympathetic denervation leading to decreased afterload which worsens these cardiac conditions
131
where is spinal anesthetic injected?
injected into subarachnoid space
132
name 2 factors that affect spread of spinal anesthesia
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
which is higher up the levels with spinal anesthesia: neurologic or motor?
neurologic blockade is above motor blockade
134
name 2 CIs for spinal anesthesia
hypertrophic cardiomyopathy and cyanotic heart disease
135
name two surgical indications for cervical block
pediatric hernias and perianal surgery
136
where do you place a caudal block
through the sacrum
137
name 6 complications with epidural / spinal anesthesia
respiratory depression with high spinal; hypotension; headache; urinary retention; abscess; hematoma
138
what is the underlying cause of spinal headache a/w spinal/epidural anesthesia
CSF leak
139
which position exacerbates spinal headaches?
sitting upright
140
name 5 tx for spinal HA s/p spinal/epidural anesthesia
rest; fluids; caffeine; analgesia; blood patch if symptoms persist for \> 24 hours
141
what is the MC preop complication
renal failure
142
which postop complication is a/w highest postop mortality rates?
CHF
143
name three respiratory sx indicating need for preop cards workup
SOB; SOB with \< 2 blocks walking; FEV \< 70%
144
which two classes of operations require preop cards workup/
major vascular surgery (peripheral and aortic)
145
name 7 cardiac comorbidities / sx indicating need for preop cards workup
angina, h/o MI, CHF, walks \< 2 blocks 2/2 angina, severe valvular dz, PVCs \> 5/min, high grade heart block
146
name age and two non-cards/pulm comorbidities that indicate need for preop cards workup
DM; renal insufficiency; age \> 70y/o
147
name 7 Sx a/w postop MI
+/- chest pain ; +/- EKG changes; hypotension; arrhythmias; increased filling pressures; oliguria; bradycardia
148
define ASA class 1
healthy
149
define ASA class 2 + comorbidity examples
mild disease without limitation (ex: controlled HTN, obesity, DM, h/o tobacco use, older age)
150
define ASA class 3 + comorbidity examples
severe disease. ex: angina, previous MI, poorly controlled HTN, DM with complications, moderate COPD
151
define ASA class 4 + comorbidity examples
severe constant threat to life. ex: unstable angina, CHF, renal failure, liver failure, severe COPD
152
define ASA class 5
moribund ex: ruptured AAA, saddle pulmonary embolus
153
define ASA class 6
organ donor
154
name 5 biggest risk factors for postop MI
age \> 70; DM, h/o MI; CHF, unstable nagina
155
what does the cardiac risk stratification for noncardiac surgical procedures estimate?
risk of cardiac death and nonfatal MI
156
name 5 surgeries / types considered high cardiac risk
emergent procedures, aortic surgery, peripheral vascular surgery, major vascular surgery (not CEA), long procedures with large fluid shifts
157
what is the combined incidence of cardiac death and nonfatal MI with high risk noncardiac surgery
\>5%
158
what is the combined incidence of cardiac death and nonfatal MI with intermediate risk noncardiac surgery?
\<5%
159
what is the combined incidence of cardiac death and nonfatal MI with low risk noncardiac surgery?
\<1%
160
name 6 classes of intermediate cardiac risk noncardiac surgeries
CEA; head/neck surgery; intraperitoneal surgery; intrathoracic surgery; orthopedic surgery; prostate surgery
161
name 4 classes of low cardiac risk noncardiac surgeries
endoscopy; superficial/skin surgeries; cataract surgery; breast surgery
162
what is the best way to differentiate esophageal vs tracheal intubation
end-tidal CO2
163
what is the MCC of sudden, transient increase in ETCO2 in the intubated surgical patient? What is the tx?
MCC = hypoventilation. Tx = increase tidal volume or increase respiratory rate
164
name 2 likely underlying causes of sudden drop in ETCO2 in the intubated surgical patient
disconnected from ventilator or PE (a/w hypotension)
165
where should the ET tube be placed relative to the carina
2cm above the carina
166
what are the 2 MC PACU complications?
nausea / vomiting
167
name 2 operations a/w reduced mortality a/w high volume hospitals
AAA repair, pancreatic resection
