ITE Flashcards
Most reliable method of confirming and moitoring correct placement of ETT?
Continuous waveform capnography
Renin-angiotensin system?
renin secreted by juxtaglomerular cells of the kidney. Cleaves angiotensinogen to angiotensin 1 and 2. II is a potent vasopressor.
Anesthesia for cardiac tamponade?
Fast (HR), Full (max preload), and forward (no cardiac depressants). Peripheral vasoconstriction to preserve venous return and MAP, increase HR to preserve cardiac output.
Anesthesia for cardiac tamponade 2?
Intravscular volume, maintenance of spontaneous ventilation(avoid decreased preload positive pressure breaths) avoid drugs that decrease blood pressure, slow heart rate, or have myocardial depressant effects.
What happens if cardiopulmonary bypass machine oxygenator microscopic pores are clogged?
They are gas outlet ports, gas space pressure would increase and precipiatte gas bubbles wihtin circulation.
POst-op MI types?
Type 1 is thrombus formation and inadequate blood flow. Type 2 is relates to an oxygen supply-demand imbalance.
What increases clot formation in in the postop period?
Increased prcoaulants(fibrinogen, facto VIII, vWF), increased platelet reactivity, and decreased endogenous anticoagulants(protein C, antithrombin iii, alpha-2-macroglobulin)
Patients at highest risk for PM1?
exertional chest pain, previous MI, uncontrolled HTN, carotid disease, DM, chronic renal insufficiency, and Hf.
Metoprolol around surgery?
Started in perioperative period decreased the risk of perioperative MI(DECREASE and POISE trial). initiation of metoprolo within 1-2 days before surgery increased incidence of stroke and death.
VEssel stenosis that causes ischemia?
95% at rest. 60 percent when stressed by activity or emotion. Myocardium extracts approximately 50-75 percent of oxygen delivered. Leaves little extraction reserve when myocardium is tressed.
Systolic anterior motion of mitral valve?
Occurs during periods of hypotension, leading to wrosening of hypotension and hypovolemia when attempting to separate from bypass. (TEE mid-esophogeal long axis around 120 degrees) Phenylephrine helps stent open the left ventircular outflow tract in order to prevent dynamic obstruction that occurs with SAM. Contractility will worsen
How to prevent coughin?
Block recurrent laryngeal and superior laryngeal branches of the vagus nerve.(glossopharyngeal, recurrent larngeal, and superior laryngeal
How to differentiate CSF from normal saline?
POC glucose test
Amount of reflection during ultrasound imaging?
little reflection(hypoechoic)Water is most, followed by air. Curved array ultrasound probe maximize returning. Linear will have higher resolution at the expense of less penetration.
Cardiac side effects of spinal anesthesia?
hypotension and bradycardia. Due to decreased ventricular filling, intracardiac stretch receptors can lead to a significant parasympathetic response leading to bradycardia. Increases with increasing block height. Also may be due to block of cardio-accelerator fibers t1 -t4.
