ITE Flashcards
Function of carotid body chemoreceptors
Increase minute ventilation in response to PaO2 less than 60
Lungs are extensively involved in metabolism but play no role in metabolizing what key substances?
Dopamine Epinephrine Vasopressin Oxytocin PgI2 and PgA2 Angiotensin I Histamine
Factors that up regulate ACh receptors
Stroke Burns >24h Immobility MS ALS Guillain barre Muscular dystrophy
Disease that causes down regulation of ACh receptors
Myasthenia gravis
Describe the hepatic arterial buffer response
Decreased flow to the portal vein leads to accumulation of adenosine which causes dilation and increased flow to the hepatic artery
What are the nerves involved in the laryngospasm reflex?
Afferent: internal branch of the superior laryngeal nerve
Efferent: recurrent laryngeal nerve
Haldane effect
The process of O2 binding to hgb and displacing CO2 from the blood. This causes a downward shift of the CO2 dissociation curve
Bohr effect
Hypercarbia causes a right shift of the oxyhemoglobin saturation curve, increases oxygen unloading to the tissues
Dibucaine number: normal, heterozygous, homozygous
Normal: 80
Heterozygous: 40-70
Homozygous: 20
Three complications of TURP and their presentations
Glycine toxicity: hyperammonemia causes CNS symptoms including N/V, transient blindness
Hyponatremia causes CNS symptoms
Bladder perforation causes N/V, abdominal or shoulder pain
Dead space: what is it? What increases it?
Ventilation without perfusion
Increased by upright positioning, bronchodilation, neck extension, low cardiac output
Stroke ACLS:
Fibrinolysis should be initiated within xx hours of arrival to hospital? Xx hours of symptom onset?
Evaluation by neurology should occur within what timeframe?
Goal BP? What drugs should be used for hypertension?
Goal sats?
Goal BG?
Goal T?
Fibrinolysis within 1hr of arrival to hospital, 4.5 hrs of symptom onset
Eval by neuro within 10m of arrival
Goal BP <185/110 using labetalol, nicardipine
Sat>94%
BG 140-180
T<38
What effect does lipid solubility of opioids have on epidural spread?
As opioids cross the dura and enter the CSF, highly lipophilic drugs like fentanyl will remain at the level of injection
Opioids with low lipid solubility like morphine will diffuse and have a wide spread in CSF
What factor of local anesthetics affects their spread within the intrathecal space? The epidural space?
Baricity affects intrathecal spread
Lipophilicity affects epidural spread
CO2 is transported in the blood in what three forms?
Bicarbonate (73%)
Hgb-bound (20%)
Dissolved (7%)
Dalton’s law
Total pressure is sum of partial pressures
Boyle’s Law
Pressure is inversely related to volume at a constant temperature
Contraindications to closed circuit or low flow anesthetic
Sevo
Alcoholism
Cirrhosis
DKA
Factors involved in Aldrete Score
Respiration SpO2 BP Consciousness Extremity movement
Drugs metabolized by Cyp2C9
Warfarin
Ibuprofen
Phenytoin
Drugs metabolized by Cyp2D6
Beta blockers
Codeine
Diltiazem
Tramadol
Drugs metabolized by cyp2C19
Omeprazole
Drugs metabolized by MC1R
Morphine
Effect of phenytoin use on neuromuscular blockade: Acute v chronic
Acute phenytoin use potentiates blockade
Chronic phenytoin use reduces sensitivity to NMBDs
4 most accurate sites of the body for temperature monitoring
Tympanic membranes
Nasopharynx
Distal esophagus
Pulmonary artery
Metabolic derangements associated with alcoholism
Hypokalemia Hypomagnesemia Hyponatremia Metabolic acidosis Respiratory alkalosis
Triad of cyanide toxicity
Metabolic acidosis
Increased mixed venous O2
Tachyphylaxis
Fenoldapam:
MOA
Second messenger
Effects
Dopamine 1 agonist
cAMP stimulation
Causes peripheral vasodilation, decreased preload and afterload, diuresis, and natriuresis
Nesiritide: MOA, effects
Recombinant brain natriuretic peptide that acts as a counter hormone to angiotensin II, norepinephrine, and endothelin. Causes arterial and venous dilation, diuresis, and natriuresis.
With nitrous administration, how quickly will a PTX double? Triple?
Double in 10m, triple in 30m
Definition of anuria? Oliguria?
Anuria: less than 50cc/d
Oliguria: less than 0.5cc/kg/hr or <400cc/d
What two factors increase the rate of Hoffman elimination?
Increased pH, increased temperature
Perioperative Hypothermia can lead to what adverse outcomes?
Infection
impaired Healing
Cardiac events
Blood loss
It’s Hella Cold B!
Metabolism/renal elimination/hepatic elimination of: Rocuronium Vecuronium Cisatracurium Pancuronium
Roc: no metabolism/20% renal/>70% hepatic
Vec: 30% hepatic metabolism/45% renal/55% hepatic
Cis: 77% Hoffman elimination/ 15% renal/no hepatic
Pan: 15% hepatic metabolism/85% renal/ 15% hepatic
Which neuromuscular blocking drugs have active metabolites that accumulate in renal failure and prolong NMB?
Pancuronium and vecuronium
Borders of: nasopharynx, oropharynx, larynx
Nasopharynx: base of skull to soft palate
Oropharynx: soft palate to epiglottis
Larynx: epiglottis to cricoid cartilage
Most common valve abnormalities associated with rheumatoid arthritis
Mitral and aortic regurgitation
Acute changes with bicarbonate administration
Increase PaCO2, etCO2
Transient decrease Ca, K
Elevated ICP (controversial)
Roller pump v. Centrifugal pump for bypass: what determines flow for each type? What patient characteristic determines type used? What are benefits of centrifugal?
Roller pumps are used in pediatrics and flow is dependent on roller speed
Centrifugal pumps are used with adults and flow is dependent on preload and afterload.
Centrifugal pumps result in less blood destruction, decreased wear on the tubing which leads to less spalation (plastic emboli) and less inflow and out outflow obstruction.
FEV1, FVC, FEF 25-75, and FEV1:FVC ratio for obstructive and restrictive pulmonary disease
Obstructive: FEV1 ⬇️, FVC nml, FEF 25-75 ⬇️, FEV1:FVC ⬇️
Restrictive: FEV1 ⬇️, FVC ⬇️, FEF 25-75 nml, FeV1:FVC nml
Main steps in formation of arteriosclerotic thrombus
Lipid laden macrophage invasion (foam cells), formation of smooth mm and collagen cap, calcium accumulation, plaque rupture allows for interaction with platelet to form a thrombus which can remain local or embolize.
Autonomic derangements seen with aging
Increased sympathetic activity Decreased parasympathetic activity Decreased baroreceptor responsiveness Decreased beta receptor responsiveness No change in alpha receptor responsiveness
Potential adverse effects of celiac plexus block? Most common? Indications for celiac plexus block?
Adverse effects: orthostatic hypotension (most common) with reflex tachycardia, diarrhea, hiccups, pleurisy, retroperitoneal bleeding, abdominal aortic dissection, paraplegia, transient paralysis.
CRPS: what is the difference between type I and type II? What treatments are available?
Type 1- no nerve damage
Type 2- nerve damage
Tx: Physical therapy—> TCA —> sympathetic block (confirm by checking that temperature increases in the affected limb). Last resort SCS.
What do the following EEG waveforms indicate? Alpha Beta Gamma Delta Theta
Alpha-awake, resting
Beta-sedation vs awake and concentrating
Gamma-cortical processing
Delta and theta-sleep and sedation
Enzyme inhibited by etomidate? Effects?
Inhibits 11 beta hydroxylase, causes adrenal suppression with decreased secretion of aldosterone and cortisol
Risk factors PONV pediatric patients
> 30m surgery
3 years
H/o PONV in patient, parent, or sibling
Strabismus surgery
Indications for intracranial ICP monitoring in pts with severe TBI
GCS<8 with abnormal head CT or normal head CT but two of the following:
Age>40, SBP <90, posturing
Desired spinal level with TURP
T10, umbilicus
Commonly used anesthetic drugs that do not cross the placenta? General rule of thumb re: what crosses placenta?
Sux NDNMBDs Glycopyrrolate Heparin Insulin
Things that cross BBB generally cross placenta
Hypersensitivity reactions to aminoamides are usually due to? Name the aminoamides.
Hypersensitivity reactions to aminoesters are usually d/t? Name the aminoesters.
What type of reactions are seen and how do they present?
Aminoamides: rxn to preservatives (methylparaben). Lido, prilo, bupi, mepiv, ropiv
Aminoesters: rxn to metabolic byproduct parabenzoic acid. Procaine, tetracaine, chloroprocaine, cocaine. (Mnemonic PABA can cause trouble)
Type 1, IgE mediated anaphylaxis (rare)
Type 4, 12-48h dermatitis
Medication to avoid with stereotactic deep brain stimulator placement? Why?
Midazolam because it interferes with microelectrode recordings
List the transplantable organs in order of shortest allowable ischemic time to longest alllowable
Heart, lungs, liver, intestines, pancreas, kidneys
Temperature at which burst suppression occurs? Complete suppression of EEG activity occurs?
Burst suppression below 25C, complete suppression below 18C
Barbiturate metabolism and excretion
Hepatic metabolism, biliary conjugation, renal excretion
Hemodynamic goals during cardiopulmonary bypass
Pump flow 1.5-3L/m/m^2
MAP 50-90mmHg
Venous O2 sat>65%
Warfarin: MOA? Coag factors affected? Is it safe in pregnancy? Breastfeeding? ESRD? Monitoring? Metabolism?
MOA: inhibits vitamin K reductase, traps vitamin k in inactive form
Factors affected: 2, 7, 9, 10, C, S
Contraindicated in pregnancy. Safe with breastfeeding and ESRD.
Monitoring with PT/INR
Metabolized by Cyp2C9
Metabolic derangements associated with increased risk of digoxin toxicity
Hypokalemia
Hypercalcemia
Hypomagnesemia
What percent of blood flow to the liver is delivered via the portal vein? Hepatic artery? What percent of O2 supply is delivered by each?
Portal vein: 75% blood flow, 50% oxygen supply
Hepatic artery: 25% blood flow, 50% oxygen supply
Most common causes of atlantoaxial instability
Achondroplasia
Downs
RA
Pulmonary parameters that increase with aging? Decrease? No change?
Functional residual capacity Closing capacity Total lung capacity Vital capacity Inspiration capacity Residual volume Inspiratory reserve volume Expiratory reserve volume Tidal volume
⬆️ FRC, RV, CC
⬇️ TLC, VC, IC, IRV
no change: ERV, VT
By what mechanism does nitrous inhibit DNA synthesis?
Irreversibly inactivates B12 via oxidation of cobalt atom, which inhibits methionine synthetase
Frequent cosmetic use is associated with allergy to what substance?
Amino steroid neuromuscular blocking drugs: pancuronium, vecuronium, rocuronium, pipercurium
Symptoms of propofol infusion syndrome (aka propofol toxicity)
Bradycardia Acidosis (metabolic) Rhabdo Fatty liver Hyperkalemia Lipemia
Considerations for peds spinals
Higher CSF volume per kg
Spinal cord ends at L3
Dural sac ends at S3
No bradycardia side effects with spinals
Myxedema coma symptoms
Non-pitting edema, hypotension, hypothermia, hypoventilation, AMS
List routes of midazolam in order of bioavailability from greatest to least
IV, subQ, IM, sublingual, intranasal, rectal, oral
Relationship between wavelength and frequency on US penetration and resolution
Increased wavelength (decreased frequency) achieves greater depth of penetration.
Increased frequency (decreased wavelength) achieves greater resolution.
What medication class is contraindicated for treatment of malignant hyperthermia? Why?
Calcium channel blockers interact with dantrolene to cause cardiac instability and hyperkalemia
Serotonin syndrome presentation
Tachycardia, clonus, hyperreflexia, ataxia, AMS
Aminocaproic acid and TXA MOA
Antifibrinolytic lysine analogs that bind plasminogen/TPA complexes to prevent plasmin formation. This prevents plasmin from binding to fibrin clots and initiating their breakdown.
Formula for standard error of the mean
Std deviation/ sqrt(n)
Milrinone MOA, 2nd messenger, and effects on: Lusitropy Inotropy PVR SV
MOA: phosphodiesterase 3 inhibitors Second messenger: cAMP Lusitropy ⬆️ Inotropy ⬆️ PVR ⬇️ SV ⬆️
Nerve that is spared in brachial plexus blocks and can cause tourniquet pain. What is the nerve’s sensory distribution?
Intercostobrachial; medial upper arm
Cardiac anomaly assoc w omphalocele
VSD
Cardiac anomalies assoc w Turner syndrome
Bicuspid aortic valve and aortic coarctation
Syndrome associated with conotruncal abnormalities including tetralogy of fallot
DiGeorge 22q11 deletion
Anesthetic that increase hepatic blood flow
Propofol
MAC decreases by what percent per decade of life?
6%
Block of choice for treatment of chronic pelvic pain as with gynecologic malignancies? Where is the target located?
Superior hypogastric block at lower third of L5 anterior to the aortic bifurcation
Block of choice for chronic, sympathetically mediated upper extremity pain
Stellate ganglion block
Glucagon:
What stimulates secretion?
Where is it secreted from?
Effect on gluconeogenesis? Glycogenolysis? Lipolysis? Glycolysis? Glycogen synthesis?
Secreted by alpha cells of pancreas IRT hypoglycemia, catecholamines.
Increases gluconeogenesis, glycogenolysis, and lipolysis (to increase free fatty acids and glycerol for gluconeogenesis)
Decreases glycolysis and glycogen synthesis.
Potential complication of occluded oxygenator outflow during cardiopulmonary bypass
Pressure in gas chamber can exceed pressure in blood chamber and cause arterial air embolus
Ultrasound has a frequency above what threshold?
2000 cycles/second
Effect of thyroid hormone on potassium levels?
Promotes cellular uptake of potassium, leading to decreased serum K
Best commonly administered drug for suppressing cough reflex? Laryngospasm reflex?
Cough: opioids
Laryngospasm: propofol
Ideal angle of incidence of probe when measuring cardiac output by esophageal Doppler?
Zero degrees
Dominant pressure driving movement of water across the BBB in normal healthy state? In cases of BBB disruption?
Healthy: oncotic pressure
Disrupted: hydrostatic pressure
Which crosses the BBB: atropine or glycopyrrolate?
Atropine
Mechanism of acute hemolytic transfusion reaction? Presentation?
ABO incompatibility
P/w chills, fever, N/V, hemoglobinuria, bleeding distress, hypotension
Mechanism of delayed hemolytic transfusion reaction? Time course? Pt characteristics?
Incompatibility with minor erythrocyte antigens (Rh, Kidd)
Presents 2-21 days post transfusion
More common in females of childbearing age (prior pregnancy, prior silent miscarriage) and pts who have been transfused in the past.
Mechanism of non-hemolytic febrile transfusion reaction? Presentation? Treatment? Prevention?
Recipient antibodies against antigens on donor leukocytes or platelets.
P/w chills, fever, N/V, cough
Tx: APAP, Benadryl
Prevent by leukoreducing blood products
TRALI MOA. Incidence is declining significantly d/t what intervention?
Donor antibodies attack recipient leukocytes. Incidence decreasing d/t restriction of women of childbearing age from donating plasma.
What happens when an IgA deficient patient is transfused blood product with IgA? What is the mechanism?
Acute anaphylaxis as donor IgA activates recipient mast cells
Describe why gas will preferentially be delivered via supply line instead of cylinder even if cylinder valve is left open.
Pipeline pressure is greater than cylinder pressure (as long as cylinder pressure regulator is functional), so gas will only flow from the lower pressure cylinders if pipeline pressure drops.
Color codes of cylinders: O2 Air N2O CO2 N He
O2: green Air: yellow N2O: blue CO2: gray N: black He: brown
Pressure (PSI) and volume (L) of O2, air, and N2O cylinders?
O2: 2000 PSI, 625 L
Air: 1800 PSI, 625 L
N2O: 750 PSI, 1600 L
Volatile anesthetics in order of ascending blood gas partition coefficient
Des, Nitrous, Sevo, Iso, En, Halo
Volatile anesthetics in order of ascending vapor pressure
Sevo, en, iso, halo, des, nitrous
Major risk of enflurane?
Seizure (enflurane = epileptic)
Major risks of halothane?
Hepatotoxicity and arrhythmia
Poiseuille’s Law
Flow through a tube= (pipressure differencer^4)/8viscositylength of tube
As viscosity and length increase, flow decreases
As pressure change and radius increase, flow increases
Effects of pregnancy on: FRC ERV RV IC IRV VT VC TLC
FRC ⬇️ ERV ⬇️ RV ⬇️ IC ⬆️ IRV ⬆️ VT ⬆️ VC↔️ TLC ↔️
Pre-op treatment of Von Willebrand type 1? Type 2? Type 2b? Type 3? Acquired antibody mediated?
Which is most common?
Type 1: Desmopressin (most common) Type 2: desmospressin Type 2b: vwf concentrate Type 3: vwf concentrate Acquired ab-mediated: IVIG
Level of spinal cord injury in quadriplegia? Paraplegia?
Quadriplegia: C1-8 spinal cord level
Paraplegia: T1-L5
Why is work of breathing increased in infants compared to adults?
Increased chest wall compliance causing functional airway closure with each breath
Fewer type 1 slow twitch fibers increases fatiguability
Smaller diameter airways
Higher MV to keep up with increased relative oxygen demand
Triad of hepatopulmonary syndrome? Other characteristic symptoms?
Triad: Increased Aa gradient >20, liver failure, intrapulmonary vascular dilation (d/t excess NO)
Other: platypnea and orthodeoxia (worsened SOB with standing; standing causes blood to pool in lower lungs where ventilation is poorest which increased VQ mismatch)
VQ values approached with dead space and shunt
Dead space: high VQ mismatch, approaches infinity
Shunt: low VQ mismatch; approaches zero
What product is indicated with each of the following TEG findings? Decreased MA K value prolongation R value prolongation Teardrop configuration
Decreased MA: platelets
K value prolongation: cryo
R value prolongation: FFP
Teardrop configuration: antifibrinolytics
Formula for coronary perfusion pressure
Coronary Perfusion pressure = Aortic diastolic pressure - LVEDP
Cushing Triad of elevated ICP
HTN
Bradycardia
Respiratory changes
Indications for intraaortic balloon pump counter pulsation? Contraindications?
Indications: RV dysfunction, carcinogenic shock, as a bridge to definitive therapy (transplant v VAD), severe MR, failure to wean from CPB, during PCI
Contraindications: Aortic disease, AI, severe peripheral vascular disease
Which anesthetic is associated with high complication rates when used for pediatric radiation therapy?
Ketamine
Carcinoid syndrome:
What is it?
Sx?
Dx?
GI malignancy wherein enterochromaffin cells release serotonin
Dx by increased urine 5 HIAA (serotonin metabolite)
Dx: episodic flushing, diarrhea, right heart disease with pulmonary stenosis, wheezing d/t bronchospasm, hyperglycemia
Bio stats: Formula for calculating sensitivity?
Sn= TP/(TP + FN)
Bio stats: formula for calculating PPV?
PPV= TP/(TP + FP)
Supplements that interfere with platelet function
Ginger
Ginkgo
Garlic
Vitamin E
Major risk factors for post op AKI
Surgery specific: intrathoracic, intraperitoneal, vascular, significant blood loss
COPD Obesity Peripheral vascular occlusive dz Age 59+ Liver dz
Expected FENa, BUN:Cr with prerenal AKI
FENa <1
BUN:Cr >20:1
Factors that affect level of spinal anesthesia
Dose (volume * concentration) Injection site Baricity Pt posture CSF volume and density
What constitutes a clinically significant change in Evoked Potentials?
50% decrease in amplitude
10% increase in latency
Neuro vascular structures of the antecubital fossa in order from medial to lateral
Median n, brachial a, radial n
Estimated blood volume in cc/kg: Premature neonate Term neonate Infant Child Adult male Adult female
Premature neonate: 100cc/kg Term neonate: 90cc/kg Infant: 80cc/kg Child: 75cc/kg Adult male: 70cc/kg Adult female: 65cc/kg
Best way to diagnose cerebral vasospasm after SAH? Tx?
Dx: cerebral angiography
To: triple H—hypertension, hypervolemia, hemodilution + nimodipine, balloon angioplasty
Meds that can be used to identify seizure foci intraoperatively?
Etomidate, sufentanil, alfentanil
Chemo drugs associated with cardiomyopathy? What should be avoided intraop if pt is taking one of these drugs?
Chemo drug associated with interstitial pnuemonitis? What should be avoided intraop if pt is taking this drug?
Cardiomyopathy: doxorubicin, rituximab, 5FU, cyclophosphamide, paclitaxel. Avoid excessive IVFs
Interstitial pneumonitis: bleomycin. Avoid 100% O2, lidocaine.
Components of biophysical profile?
Non stress test, fetal breathing, movement and muscle tone, amniotic fluid volume
Pulmonary parameters unchanged in obese pts? Decreased?
Unchanged: closing capacity, residual volume
Decreased: TLC, VC, FRC, and ERV. ERV affected most.
Side effects of fospropofol?
Paresthesias (often genital, perianal) and genital pruritis
SSEP pathway?
MEP pathway?
SSEP: peripheral nerve➡️ dorsal root ganglion➡️ posterolateral spinal cord➡️ medial lemniscus (in brain stem)➡️ thalamus➡️ cortex
MEP: cortex➡️ internal capsule➡️ brain stem➡️ corticospinal tract➡️ peripheral nerve
Magnesium effect on neuromuscular blockade
Prolongs blockade of polarizing and non-depolarizing NMBDs
Lithium effect on neuromuscular blockade
Potentiates non depolarizing NMBDs
Where do the cardiac accelerating sympathetic fibers originate?
T1-T4
When do infants develop physiologic anemia of the newborn? How low do hgb levels drop?
8-12 weeks
Hgb~11
Treatment of botulism in infants v adults?
Infants: human-derived immune globulin
Adults: equine-derived antitoxin
Risk factors for adverse events during pediatric sedation
ASA 3+ Ages less than 3mos Airway procedures Obesity Multiple drug combinations
When do accelerations and decelerations on fetal heart tracing lead to change in baseline fetal heart rate?
When they last >10m
Cause of early decelerations on fetal heart tracing?
Late decelerations?
Variable?
Early: fetal head compression, vagal stimulation.
Late: uteroplacental insufficiency or myocardial depression d/t hypoxia
Variable: cord compression
Potential complications of brachial artery cannulation?
Median n damage
Distal ischemia d/t lack of collaterals
Catheter related blood stream infections
Which local anesthetic has the lead amount of placental transfer via epidural route? Why?
2-chloroprocaine bc it is rapidly metabolized by plasma cholinesterase
The onset of local anesthetic is affected by what 4 factors?
Concentration (higher is faster) Lipid solubility (higher is faster) Environmental pH (higher is faster) pKA (lower is faster = more unionized at physiologic pH)
Myasthenia gravis: affect on neuromuscular blockade
Resistant to sux
More susceptible to nondepolarizing NMBDs
Pyridostigmine use can decrease the efficacy of NDNMBDs
EKG changes with hypermagnesemia?
Hypercalcemia?
Hypermagnesemia: long PR, wide QRS
Hypercalcemia: short QT
Tx organophosphate poisoning
Pralidoxime chloride
Atropine
Decontamination
Supportive care
Volatile agent that most significantly augments neuromuscular blockade?
Desflurane
Hemodynamic goals for brain dead donors for organ procurement
Hematocrit >30%
UOP 1cc/kg/hr or more
MAP 60+
EF 45% or more
Management of Acute mountain sickness
Acetazolamide Hyperbaric chamber Descent O2 Water (hydration) Non-bento sleep aids
AH go DOWN
Medication that should be avoided in pediatric patients post-tonsillectomy? Why?
Codeine
Prodrug activated by Cyp2D6 to morphine. Because of variable metabolism, rates of conversion to morphine are unpredictable and fast metabolizers can accumulate morphine, leading to respiratory depression. Has been linked to post-op deaths.
Which of the following drugs should be dosed to TBW? IBW? LBW?
Propofol—induction v maintenance
Opioids
NDNMBDs
Sux
TBW: sux, maintenance propofol
IBW: NDNMBDs
LBW: propofol (indxn), opioids
Fresh gas flow required for spontaneous ventilation with Mapleson A circuit? Spontaneous ventilation with Mapleson DEF? Controlled ventilation with DEF?
Spontaneous A: equal to MV
Spontaneous D, E, F: 2-3xMV
Controlled D, E, F: 1-2x MV
Propofol mechanism of action (be specific). Which other medication class shares this MOA?
Decreases the dissociation of GABA from its receptor by causing increased chloride ion influx and thus hyperpolarization; hyperpolarization makes the cell membrane resistant to excitatory neurotransmitter impulses.
Barbiturates have the same MOA.
Predictors of postoperative ventilation in pts with myasthenia gravis
Duration of disease 6 yrs or more
Concomitant respiratory disease
Pyridostigmine dose >750mg/d
VC <2.9L
Parkinson’s disease pathophysiology
Loss of dopamine secreting neurons in the substantia nigra of the basal ganglia
What are the risk factors for intraoperative awareness?
Cardiac surgery, ob surgery, and trauma surgery
What is Conn syndrome? How is it treated?
Primary hyperaldosteronism caused by aldosterone-producing adrenal adenoma. Tx with spironolactone and potassium depletion prior to adenoma resection.
Medication that should be given before surgery on pts with catecholamine-producing tumors?
Phenoxybenzamine, a non-specific alpha blocker
Type I vs type II hepatorenal syndrome
Type I: Acute renal failure caused by an inciting event in a cirrhotic patient. Type I improves with treatment.
Type II: progressive, insidious onset renal failure in a cirrhotic pt with no precipitating event. Does not respond to treatment except transplant.
Transplant is definitive tx for both types.
Half life of albumin?
3 weeks
Absolute contraindications to ECT
Brain tumor Brain surgery in last 3mos Unstable C spine MI in last 6 weeks Pheochromocytoma Stroke in last 3 mos
Similarities and differences of cerebral salt wasting and SIADH?
Both present with hyponatremia and high urine sodium and osms.
SIADH p/w euvolemia or hypervolemia and is treated with water restriction
Cerebral salt wasting p/w hypovolemia and is treated with salt and water replacement.
Mechanism of pre-eclampsia development?
Thromboxane A2 is a potent vasoconstrictor. With pre-e, thromboxane A2 levels are increased, leading to global vascular reactivity and vasoconstriction with elevated SVR, as well as uterine vasoconstriction with decreased placental/uterine blood flow.
Timeframe after SAH when rebleeding occurs vs vasospasm
Rebleeding: peaks at 24hrs
Vasospasm: 3-10d
Butorphanol MOA? Buprenorphine MOA? Methadone MOA?
Butorphanol: mu agonist/antagonist, kappa agonist
Buprenorphine: mu agonist, kappa antagonist
Methadone: mu agonist, NMDA antagonist
Cole formula pediatric ETTs
Age/4 +4
Subtract half a size for cuffed
What property of bupivicaine accounts for its low placental transfer?
Highly protein bound
Muscle involved in relieving obstruction with jaw thrust
Genioglossus muscle. It anchors the tongue to the mandible.
What two substances are mixed for each of the following:
ABO type?
Antibody screen?
Crossmatch?
ABO type: recipient RBCs with commercial serum
Antibody screen: recipient serum with commercial RBCs
Crossmatch: recipient serum and donor RBCs
MOA of neuraxial opioids?
Act at mu receptors in the substantia gelatinosa in the dorsal horn of the spinal cord to inhibit afferent excitatory inputs and prevent release of substance P and glutamate
Alveolar gas equation
PAO2= FiO2 * (Patm - PH2O) - (PaCO2/R)
PH2O is 47
Patm is 760 at sea level
R is respiratory quotient and is usually 0.8
Apnea hypopnea index:
Mild OSA
Moderate OSA
Severe OSA
How is it calculated?
Mild: 5-14
Mod: 15-29
Severe: more than 30
AHI is number of apneic episodes divided by number hours slept
Diseases linked with malignant hyperthermia
Central core disease
King Denborough disease
Multi-mini core disease
When does separation anxiety begin to manifest in infants?
6-8 mos
Barbiturate used for ECT. Why?
Methohexitol—it doesn’t increase the seizure threshold or decrease seizure duration
Cardiac resynchronization therapy is indicated if what criteria are met?
All of the following should be present: Sinus rhythm EF 35 or less NYHA class 2-4 QRS 150 or greater LBBB
Coag factors that decrease during pregnancy?
XI and XIII, C and S
Mivacurium metabolism
Pseudocholinesterase
Clotting factors that are increased in liver disease?
8 and vWF. Everything else is decreased.
Name the anti-dopaminergics
Droperidol
Metoclopramide
Prochlorperazine
Treatment methemoglobinemia
Methylene blue
Unless pt has g6pd deficiency, then ascorbic acid
Max recommended dose of neostigmine
0.07 mg/kg
List the GP IIb IIIa inhibitors. What do they do?
Tirofiban
Eptifibatide
Abciximab
They prevent platelet aggregation and thus thrombus formation
List ADP inhibitors.
What do they do?
Clopidogrel, prasugrel, ticagrelor
They impair ADP-dependent activation of the GP IIb IIIa complex
Definition ED95
Effective dose required to achieve 95% effect in 50% of the population
