ITE block 10 Flashcards
Normal FHR
110-160 bpm
Sinusoidal pattern on FHR
Sign of placental abruption, ominous
Early decelerations FHR
assoc w/ contractions
vagal activation from fetal head compression
Late decelerations
end of contraction
uteroplacental insuf or fetal hypoxia
What decreases hepatic blood flow?
Hypoxia
Hypercarbia
Catecholamine release
hypoTN
Which tests best determinate of synthetic fxn of liver?
PT or INR
b/c measures extrinsic pathway which has factor VII which is the shortest life span
Strong ion difference
(Na + Mg + K + Ca) - (Cl + lactate)
Inc in SID does what to pH
increase it -> alkalosis
Dec in SID does what to PH?
decrease it -> acidosis
How does inc in phosphate change pH?
Decrease -> metabolic acidosis
b/c inc in total acids
Dec in albumin change in pH
increases pH -> metabolic alkalosis
-b/c albumin mild acid -> dec = alk
CI to closed circuit anesthesia
Sevo (can’t run at high enough flows)
DKA (rebreath ketones)
Actively drunk/alcoholism (rebreath acetone)
Malnutrition
Cirrhosis
Heavy smokers (rebreath carbon monoxide)
Which meds will vasodilate and also decrease CBF?
Precedex
Propofol
gases at < 0.5 MAC
**labetalol doesn’t inc CBF!
Total O2 content equation
O2 content = )1.34 x Hg x O2 saturation in decimal) + .0003 * PaO2
Hypocalcemia EKG
Short PR interval
Prolonged QT
occasional inversion of T waves
Hypercalcemia EKG
Prolonged PR interval
Short QT
Peaked T waves
hyPeR Ca, PRolonged PR
alpha stat monitoring during CBG
pts temp is not corrected for in ABG
-does not add CO2 -> preserving cerebral autoregulation
pH stat monitoring during CBG
corrects pts temp for in ABG
-req adding CO2 -> inc CBF
-counteracts L shift of Hg curve
RF for severe bradycardia after spinal
young male
HR <60 prior to spinal
How to screen for cerebral vasospasm?
transcranial doppler
What is considered to be a positive transcranial doppler for cerebral vasospasm?
Compares fow velocity of middle cerebral artery to ICA
FVMCA > 120 cm/s
or if FVMCA: FVICA is > 3
When is rebleeding after SAH most likely to happen?
w/i 48 hours
When is vasospasm post SAH most likely to happen?
3-15 days
When to restart ppx heparin after epidural placement?
Immediately
UFH ppx <15k, when can put in catheter after last dose?
4-6 hours
UFH ppx <15k, when after injxn can you pull catheter?
4-6 hours
UFH ppx < 15k, when after catheter removal can you start heparin?
immediately
high dose UFH ppx >15k, when after last dose can you put catheter in?
12 hours
high dose UFH ppx >15k, when after catheter placement can you start again?
1 hour
high dose UFH ppx >15k, when after injxn can you remove catheter?
12 hours
high dose UFH ppx >15k, when after catheter removal can you restart?
1 hour
LMHW ppx, when can you do catheter after last dose?
12 hours
LMHW ppx, when can you restart after placing catheter?
12 hours
LMHW ppx dose given, when can you remove the catheter?
12 hours
LMHW ppx, catheter removed, when can you restart?
4 hours
LMHW therapeutic, when after last dose can you place catheter?
24 hours
LMHW therapeutic, when can you restart after catheter placement?
24 hours
LMHW therapeutic, when can you restart after catheter removal?
4 hours
Dx of carbon monoxide poisoning
Made on hx
Elevated carboxyHg levels
Amniotic fluid embolism dx progression
1st: pulm vasospasm and R heart failure
2nd: L heart failure pulm edema
DIC
-if pt still pregnant 911 c/s
When 2 NMB from same class are both given, whats the effect?
Additive ->no inc of duration of action
When small roc given before succ what’s the effect?
Antagonism
-req more succ to get paralysis -> shorter duration of action
What happens when you give 2 NMB from diff classes?
Synergistic
-inc duration of action
Which cardiac defects MC assoc w/ omphalocele?
ASD and VSD
older pt w/ no comorbidities change in DBP?
no change or decrease
Isovolumic hemodilution causes what hemodynamic changes?
Inc in cardiac output
Dec in SVR -> dec blood viscosity
Inc O2 extraction
How to tx vasogenic cerebral edema caused by brain tumor?
Steroids! Dexamethasone
-tumor disrupts BBB -> edema
What does a brain lesion w/ surrounding T2-weighted hyperintensity and a lack of diffusion restriction in white matter mean?
Vasogenic cerebral edema like 2/2 tumor
-more common in WHITE matter
Cytotoxic edema
Usually occurs 2/2 cell injury or death 2/2 ischemia, hypoxia, trauma, toxins
-occurs in GRAY matter
-steroids don’t help
Advantages of pH stat
Improved O2 delivery to tissues (counteracts L shift of Hg curve)
Inc speed of cerebral cooling due to cerebral vasodilation (from CO2 that is added)
-used in congenital heart surgery
Disadvantage of pH stat
Inc embolic load to brain
cerebral vasodilation -> loss of cerebral autoregulation
Dexmedetomidine and Cardiac output
Decreases it
What should be used in a Bair block?
Lidocaine .5% or 1% NO EPI
Lid lag hyper or hypothyroid?
Hyperthyroidism
-adrenergic hyperactivity -> spasming of muscle
How to estimate an anatomical shunt fraction
pulm phys shunt/Cardiac output= (1-Art O2 sat)/ (1-ven O2 sat)
-normal: 0.05
Normal shunt fraction
0.05
Calculation of stroke volume variation
SVV= (SVmax -SVmin) / [(SVmax +SVmin) / 2 ]
ex: 80 and 60
80-60/ [ (80+60) /2 ]
Endometritis
POSTPartum uterine infxn
Above what Reynolds number is considered turbulent flow?
4000
What factors determine flow rate Poiseuille’s law?
Assume laminar flow
pressure exerted on fluid
length of tubing
viscosity of liquid
radius of tubing *** biggest impact
When determining flow rate of fluid by Poiseuille’s law, what impact will doubling the radius have?
increase flow 16x
r ^ 4
Diabetic autonomic neuropathy symptoms
GI: GERD (dec LES tone), gastroparesis, chronic diarrhea
CV: loss of heart rate variability, resting tachy, orthostatic hypoTN *MI can have NO PAIN
peripheral: no sweating in hands and feet, periperhal edema
hypoglycemia unawareness (no symp)
erectile dysfxn
bladder dysfxn
Dose of PO midaz
0.5 mg/kg
Cardiac anomaly with carcinoid tumor
Tricuspid regurge
What has a large uptake in lungs?
Serotonin
NE
PG
bradykinin
When NMB administered which muscles respond first?
diaphragm and laryngeal muscles
b/c greater BF
Which muscle recovers from NMB first?
Diaphragm
Corrugator supercilii correlates w/ recovery of?
Diaphgram and laryngeal muscles
(no o’s)
Orbicularis oculi correlates w/ recovery of?
adductor pollicis
2 o’s: Orbicularis Oculi
When NMB blockers given, muscle group recovery order
- Diaphragm
- laryngeal m
- corrugator supercilii
- abd muscles
- orbicularis oculi
- geniohyoid
- adductor pollicis
Begins at epiglottis and ends at cricoid
hypophyarnx
Innvervation of nasopharynx
V2 (maxillary trigeminal n)
begins at the epiglottis and ends at cricoid cartilage
larynx
begins at nasal cavity ends at soft palate
nasopharynx
begins at soft palate and ends at hyoid bone
oropharynx
Larynx vertical location in infants v adults?
C3-5 in infants
C4-6 in adults
Larynx of invants v adults
epiglottis longer and omega-shaped
aryepiglottic folds closer to midline
pliable laryngeal cartilage
larynx proportionally smaller
vertical location C3-5 (C4-6 in adults)
Where in lung is atelectasis most likely to occur
lower segments of lung near diaphragm
Atelectasis inhal v TIVA
it the same
tramadol MOA
mu opiod agonism and inh of serotonin and NE reuptake
Buprenorphine MOA
mixed agonist/antagonist at mu-opioid receptor
Type of blood rxn: IgM antigen-Ab complex activating complement
acute hemolytic transfusion rxn
For screening tests: highly specific or sensitive?
highly sensitive
For confirmatory tests: highly specific or sensitive?
highly specific
Bronchiectasis tx
prevention w/ aggressive antimicrobials
chest PT
classic triad of congenital diaphragmatic hernia
cyanosis
dyspnea
dextrocardia
w/ congenital diaphragm repair, where should IVs go?
ONLY UPPER extremity
-no lower b/c risk of compression of IVC w/ reduction of hernia
Anesthesia considerations for congenital diaphragm hernia
- permissive hypercapnia: lower TV to prevent PTX, keep peak p below 25
- no lower extremity IV (IVC comp w/ reductino of hernia)
- avoid hypothermia (inc PVR), and nitrous oxide
Changes in resp volumes in pregnancy
DEC: FRC, ERV, RV
INCREASE: MV, TV, RR
Interscalene block: what is posterolateral to the roots?
Middle scalene muscle
PPV inspiration on RV preload and LV afterload
both DECREASE (+ pressure compressed LV reducing force req to eject blood)
PPV inspiration on RV afterload and LV preload
both INCREASE
-b/c compression causes inc in PVR and compression forces blood into LA
Acute altitude change hypoxia CV changes
Inc HR
Inc Cardiac output
Dec SVR -> however compensation w/ sympathetic activation could lead to an in in MAP
(in in symp tone)
inc PVR (hypoxic pulm vasoconstriction)
Compensation for prolonged hypoxia
- EPO -> Inc Hg
- hyperventilation
- Renal bicarb elimination (counteract resp alk)
- inc 23DPG prod -> shift Hg curve to R
- Inc mitochondria (inc aerobic efficiency)
What effect of dexmedetomidine occurs b/c of alpha 2 rec w/i spinal cord
Analgesia
-alpha 2 receptors in dorsal horn suppress pain transmission
Dexmedetomidine suppresses shivering by agonism of alpha 2 where?
hypothalamus
Dexmedetomidine produces sedation and anxiolysis by binding to alpha 2 receptors where?
locus coeruleus of brainstem
Dexmedetomidine produces bradycardia by binding to alpha 2 receptors where?
brainstem vasomotor center -> centrally mediated inhibition of sympathetic NS
What muscles does the SLN external branch innervate?
cricothyroid
anechoic space b/w parietal and visceral pleura is?
pleural effusion
Cutaneous landmark for LFCN block
ASIS
landmark for blocking sural n
lateral malleolus
landmark for blocking posterior tibial n
medial malleolus
Chassaignac tubercle is landmark for what n block?
C6
deep cervical plexus
Dabigatran MOA
direct oral thrombin inhibitor
Dabigatran coag lab change
Increase in thrombin time (TT) -> not used for monitoring b/c levels predictable
-possible inc in PTT
If no posttetanic twitches present, sugammadex dose?
16 mg/kg
if posttenic twitches are present for TOF twitches <1, sugammadex dose?
4 mg/kg
If TOF ct of 1 sugammadex dose?
4 mg/kg
If TOF ct of 2, sugammadex dose?
2 mg/kg
alpha-methyl-para-tyrosinee MOA
inhibits tyrosine hydroxylase, rate limiting step in catecholamine synthesis
when to use alpha-methyl-para-tyrosine
adjust in malignant or inoperable tumors (pheo)
-to limit catecholamine synthesis
What causes early mortality (1-2 days) in pts after inhalational burn injury
carbon monoxide poisoning
What medications inc likelihood of LAST w/tumescent anesthesia?
SSRI/SNRI b/c they CYP450 inh -> lidocaine metabolized by CYP1A2 and 3A4
CYP450 inhibitors
SICKFACES.COM
Sodium Valproate/SSRI/SNRI
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Acute alcohol cute
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
CYP Inducers
CRAP GPS
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
How frequently should tubing for blood products and TPN be changed?
24 hours
In emergencies where aseptic technique not guaranteed for central line, when should catheter be replaced?
w/i 48 hours
How frequently should dressing be changed on CVC?
every 7 days or sooner if damp, loose or soiled
Why hypoTN w/ hypoplastic L heart during induction w/ sevo 100% FiO2
tachypnea + high O2 -> dec pulm vascular resistant
-pt dependent on BF from pulm vasc to PDA to body -> if dec PVR blunt shunts to lungs instead of body
Why does phenylephrine worsen situation w/ hypoTN in hypoplastic L heart?
Inc afterload -> will shunt blood trying to go through PDA to pulm circulation instead -> worsening BF to pulm vasculature instead of going systemically
Determinants of pulm vascular resistance
PAO2 (hypoxic pulm vasoconstriction_
PaCO2
temp
intrathoracic pressure
FRC
vasodilators( Nitric, NG, nitroprusside)
How to inc PVR
Dec FiO2
Dec MV
Inc intrathoracic pressure
Inc PaCO2 (acid -> inc extraceullar Ca -> contriction)
Acidemia
Acromegaly and VC changes
VC paresis 2/2 stretching of RCLN by cartilaginous expansion i neck
Treacher Collins airway cahnges
mandibular hypoplasia
microstomia (small sized mouth)
Neurofibromatosis anesthesia concerns
-Neurofibromas in airway
-Neurofibrama in SC or assoc w/ scoliosis issues -> problem w/ spine and DL
-neurofibromas bleed profusely when dirupted
-screen for HTN: renal artery stenosis, catecholamine-secreting neurofibroma, pheo
-intracranial tumors
-endocine anomalies
Post ECT
parasympathetic initial resp -> symp
inc in CBF
Inc ICP
Inc CMRO2
Inc Intraocular pressure
Inc Intragastric pressure
Gold standard for ECT meds
Methohexital
How fast should sugar be fixed in DKA?
No faster than 100 mg/dL an hour -> brain needs time to compensate
-> if too fast -> cerebral edema
Risk of transmission after contaminated needle stick in HIV is
0.3%
Risk of transmission after contaminated needle stick in Hep C
2%
Risk of transmission after contaminated needle stick in of Hep B
23-62% -> why HCW get vaccinated against Hep B
When should postexposure ppx against HIV be given?
as soon as possible when necessary and continued for 4 weeks
-ideally w/i hours of exposure, but can extend up to 2-4 weeks postexposure
In OLV, what volumes allow max pulm BF?
Maintaining the lung at FRC and PEEP
In One lung ventilation, once settled and time passes, how much is shunt fraction?
20-30% in healthy pt
Hypoxic pulm vasoconstriction response timing
biphasic temporal resp
-initial rapid phase plateau after 20-30 minutes
-delayed phase max 2-3 hours
Effect on cardiac output changes w/ one lung ventilation
if you inc cardiac output -> worsens hypoxia b/c inc BF to nonventilated lung
-if cardiac output dec -> tissue extraction inc before HPV and shutning can occur -> drop in PaO2 and dec in mixed venous O2
Predictors of hypoxemia during one lung ventilation
Normal preop spirometry
Normal FEV1/FVC
R side thoracotomy
Supine position
low partial P of O2 during 2 lung
high % of V/Q on operative lung on V/Q scan
Dest w/ One lung ventilation what to do?
- Inc FiO2
- Confirm tube placement w/ fiberoptic
- Dec volatile and optimize cardiac output
- Recruitment to ventilated lung
- apneic oxygenation insufflation of nonvent lung
- recruitement maneuver w/ CPAP to nonvent lung
- pharm, VV ECMO
At the NMJ, ACh release during action potential binds where
postjunctional nAChR -> m contraction
prejunctional nAChR to mobilize ACh to the n termal to be available for release during next action potential
What receptors do NDNMB lock?
BOTH postjunctional and prejunctional nAChRs
-inhibits m contraction
-prevents replenishment of ACh at n termianl for repeat or sustained contractions
Why does TOF fade occur?
Decreased release of ACh molecules w/ repetitive or sustained stimulation
-due to continued inhibition of prejunctional nicotinic ACh receptors
Why do we have no fade w/ phase I succ
b/c it doesn’t bind to the prejunctional nicotinic ACh receptors
Klippel-Feil syndrome
fusion and dec neck mobility
-scoliosis assoc
What peds syndrome has hypoglycemia assoc?
Beckwith-Wiedemann
hypoglycemia, macroglossia, and organomegaly (why get hypoglycemia)
RF that inc the potential of n injury
male sex
extremes of body habitus
prolonged hospitalization
malnutrition
With spinal stenosis, which are affected first sensory n or motor n?
Sensory
Post-Anesthetic D/c Scoring System
vital signs
activity level
N/V
Pain
Surgical site bleeding
Aging and sensitivity to muscle relaxants at NMJ
DOES NOT CHANGE
When do hearing and vision begin to decline for physicians
as early as 40
Labs for hyperosmolar hyperglycemic syndrome
pH > 7.3
bicarb > 18
serum osmolality > 320
**no acidosis b/c no ketone formation
Intial symptoms of pt w/ hyperglycemic hyperosmolar syndrome
Neurologic!
AMS, possibly seizures
Transcutaneous electrical nerve stimulator, how to reverse analgesic effects?
Naloxone
Type I v Type II CRPS
type II has n injury assoc w/ it
type I has no n injury
SE of paracervical n block during labor
fetal bradycardia -> dec fetal O2 and acidosis
What part of the circuit is dead space?
Anything on the pt side of the Y piece
Dec in V dead space/ V TV and CO2
higher end tital CO2 due to less dilutional effect from dead space ventilation
pt w/ new heachaches and CN symp -> first test?
MRI
Gold standard for ICP measurement
ventriculostomy catheter
Hemifacial microsomia, what syndrome?
Goldenhar syndrome
oculo-auriculo-vertebral synderome OAVS
-hemifacial microsomia, mandibular hypoplasia, epibulbar dermoid, vertebral anomalies
How does BIS work?
microprocessor w/ proprietary algorithm to process EEG signal into a numerical representation
Which dec protein S or C?
S!
C the same
PPx for hypoxic pulm vasoconstriction causing high altitude pulm edem
Nifedipine
PDE 5 inh (sildenafil)
Peds sedation guidelines, minimum freq of vital signs and monitoring data?
10 minutes
MOA of hashimoto thyroiditis
Autoantibodies targeting thyroid peroxidase
Quadriplegia injury where?
Above 1st thoracic vertebrae w/i C1-8
Paraplegis injury where?
T1-L5
1st line for postherpetic neuralgia
TCAs: Nortriptyline
opioids
gabapentin
Graves antibodys
Target thyrotropic receptor
Airway fire 1st 2 things to do
Turn off gas flows
extubate
Propofol and RR
increases RR when used as an infusion w/ spontaneous ventilation intact but dec TV
Propfol and baroreceptor HR response
Blunts! why we don’t get tachycardia despite hypoTN
Propofol and bronchioles
potent bronchodilator -> inc diameter in bronchi
What pt population should you be careful w/ LR?
liver failure
-lactate converted to bicarb -> can build up in liver failure
Which hormones cross cellularl membranes and exert effect in nuclei of target cells?
Steroid hormones!
Aldosterone
-but b/c lipophilic need carrier protein in serum
How do benzos act as a muscle relaxant?
Centrally acting GABA potentiation
Aprepitant MOA
neurokinin-1 antagonist -> more effective at preventing late PONV (24-48 hrs postop)
Who would benefit most from early invasive strategies?
Ischemia at rest
Elevated biomarkers
New ST seg depression
worsening FG or MR
EF < 40%
V tach
Hemodynamic instability
recent PCI
Prior CABG
TIMI risk score: risk of death and ischemic events RF:
Age > 65
> 3 CAD RF (HTN, HLD, DM, fam hx)
known CAD ( > 50%)
ASA use in 7 days
severe angina (> 2 episodes in 24 hrs)
ECG ST changes > 0.5 mm
Positive cardiac marker
Def of proteinuria for preeclamspia
> 300 mg/ 24 hrs
protein-cr ratio > 0.3
1+ or higher on urine dipstick
Lithium and anesthesia interference
Reduces the release of ACh -> prolonoging blockade
-Dec anesthetic requirements (b/c reduces release of neurotransmitters)
SE of lithium
-T wave changes
-Leukocytosis
-hypothyroid
-DI
-Heart block
-hypoTN
-Sz
Lithium and taking during surgery
-D/c 24 hours prior to surgery b/c hypoNa (from diuretics) or NSAID use inc levels and potential for toxicity
Glucagon MOA
activates adenylyl cyclase -> inc cAMP -> positive inotropic and chronotropic cardiac response
After donor hepatectomy, when will INR returnt o normal
5-7 days
After donor hepatectomy, when will INR be it’s highest?
2-3 days
no greater than 2
After donor hepatectomy, when can an epidural catheter be removed?
3-5 days after normalization of INR
After donor hepatectomy, what does TEG look like?
hypercoagulable state
Hemodynamic changes during a forced expiration against a closed glottis
Valsalva
-initial: Inc in LV output b/c compression of thoracic aorta -> baroreceptor dec in HR
-2nd: straining: dec in venous return, RV and LV output, SV, MAP -> baroreceptor inc in HR
-3rd: release: arterial pressure dec b/c rlease of thoracic aorta compression -> brief reflex tachycardia by baroreceptor
-last: rapid inc in cardiac filling -> inc in stroke volume and pressure -> baroreceptor of HR dec
Anrep effect
Frank-Starling Curve
-inc in ventricular contractility following acute inc in afterload
Periop concern of Methotrexate
Pulmonary toxicity: review all chest imaging beforehand -> if signs will need lung protective ventilation (restrictive lung dx)
symp: fever, chills, dyspnea, nonprod cough
Treacher Collins syndrome
cheekbone and mandibular hypoplasia
microstomia (small mouth)
Acromegaly Cardiovascular changes
LVH
Diastolic dysfxn
HTN
cardiomyopathy
arrhythmias
-more likely to get HF and valve issues
Why would a pt have AMS after GI bleed w/ hx of cirrhosis?
b/c breakdown of Hg -> breakdown and absorption of amino acids -> inc nitrogen -> inc ammonia
-liver responsible for metabolism of N/ammonia
-if compromised it builds up -> hepatic encephalopathy
Tx of hepatic encephalopathy
Lactulose
Rifaximin (kills ammonia prod GI organisms
Critical temp of nitrous oxide
36.5 C
-under pressurized conditions at room temp => nitrous oxide will be a mixed liquid and gas form
-at temps greater than 36.5 -> nitrous oxide will only be a gas
When Peak pressure elevated alone why?
Change in airway resistance
When peak and plateau pressure elevated why?
Decrease in lung compliance
UOF for infants in mild, mod sevre dehydration
mild: < 2 cc/kg/hr
mod: < 1
severe < 0.5
urine specific gravity of mild, mod, severe dehydration
mild: < 1.02
mod: 1.02-1.03
severe: > 1.03
Repletion for mod to sevre dehyration in infants
Bolus: 20-30 cc/kg
phase 1: 25-50 cc/kg over 6-8 hrs
2: remainder of deficit over 24 hours
Elderly body mass changes
-Dec in lean body mass
-inc in body fat
-decrease in total body water
-> smaller central compartment w/ inc concentration of medications
-> inc fat inc volume of distribution and can prolong medication effects
If doctor has a license restrictions what next
MUST notify ABA themselves w/i 60 days
If a pt has thalassemia besides Hg what else workup should you have?
possibly an echo?
Iron overload related cardiomyopathy
Contraindications to shock waave lithotripsy
Pregnancy
Active UTI
Untreated bleeding d/o
What is persistent L SVC?
L brachiocephalic v doesn’t form properly -> L arm, head, neck drain into coronary sinus and RA
**retrograde cardioplegia is useless
Equation for pressure across the aortic valve?
4 * (Peak volocity) ^2
Early post HD labs
hypoK (most intracellular and hasn’t equilibrated yet)
Inc PTT (from heparin in HD machine)
Anemia
Clear safety goggles used for which laser?
CO2
green safety goggles used for which laser?
neodymium: yttrium aluminum garnet laser
orange safety goggles used for which laser?
Argon
orange-red safety goggles used for which laser?
potassium-titanyl-phosphate Nd:YAG lser
How does NG reduce mycoardial O2 demand
NG dilates veins > arteries –> dec preload -> dec stretching of LV -> dec demand
Physiologic changes after brain death
Catecholamine storm:
-pulm edema (OL from heart)
-polyuria (death of posterior pit -> DI)
-myocardial dysfunction
-hyperglycemia
-hyperNa (fluid loss)
-hypovolemia
Meds commonly given during organ procurement
Thyroid hormone
Steroids
Vasopressin
Peds adjsutment of dosing for succ compared to adults
infants 3 mg/kg
peds 2 mg/kg
adults 1 mg/kg
**because infants have inc ECF and high cardiac output -> redistributed quickly
NMB to avoid in hyperthyroid or pheo
Pancuronium
**causes sympathetic stimultion!
Which gases in a cylinder, is the weight of the clyinder the best way to see how much is left in the cylinder? (as opposed to pressure)
Nitrous oxide
CO2
-exist as liquid and gas -> why WEIGHT needs to be used not psi
Which cylinders contain ONLY gases, no liquid
O2
air
helium
nitrogen
**why can use pressure to see what’s left!
What color is a helium cylinder?
brown
Which IV anesthetic assoc w/ inc in hepatic BF?
Propofol -> the rest decrease
Most abudant CYP enzyme in liver
CYP3A4
Foe 5 year MOCA -> minmum number of quality impromvent points required
25
-25 in years 1-5, and ADDITIONAl 25 in 6-10
CME req for MOCA
125 category 1 in each 5 years -> 250 total
Optimal pump flow during CPB
1.6 -3 L/min/m^2
Optimal MAP during CPB
50-90
ptimal venous O2 sat during CPB
> 65%
Strong Ion Difference
(Na + K + Mg + Ca) - (Cl + lactate)
Anion Gap
(Na + K ) - ( Cl + bicarb)
Normal strong ion difference
40!
Normal serum osmolality
275-290
DES elective surgery time
6 months
DES time sensitive surgery
3 months
