ITE OpenAnesthesia

Question 1

Signs of malignant hyperthermia (x5)

Answer 1

1. Rigidity
2. Increased EtCO2
3. Hyperthermia
4. Increased MV
5. Increased CO, HR, SBP +/- arrhythmias
6. Increased O2 consumption
7. Following volatile anesthetics or suxx

Question 2

Lab results of malignant hyperthermia (x8)

Answer 2

1. Mixed metabolic and respiratory acidosis
2. Increased serum potassium, sodium, calcium, phosphate
3. Increased myoglobin and creatine kinase
4. Lactic Acidosis

Question 3

Malignant hyperthermia vs thyroid storm

Answer 3

MH: intra-op, rigid, hyperkalemia, elevated CK and lactic acid (LA)

TS: post-op, hypokalemia, not rigit, normal CK and LA

Question 4

Type and Screen determines and test for…

Answer 4

ABO-Rh of the patient and screens for the presence of the most commonly found unexpected antibodies

Question 5

ABO-RH testing (“Type”) is done by…

Answer 5

The patient’s blood cells are mixed with serum known to have antibodies against A or against B to determine blood type.

The patient’s blood cells are also treated with anti-D antibodies to determine Rh.

Question 6

Antibody Screen (“Screen”) is done by…

Answer 6

The patient’s serum is mixed with red cells of known antigenic composition

Test = Indirect Coombs test

Question 7

Crossmatching (“Cross”) is done by…

Answer 7

The donor cells are mixed with the recipient’s serum so check for lysis

Question 8

Differentiating decreased cardiac function vs decreased afterload as the cause of hypotension with TEE

Answer 8

decreased afterload: manifests as a hypercontractile ventricle

decreased cardiac function: manifests as a hypocontractile ventricle with/without wall motion abnormalities +/- increased LVEDA

Question 9

Etiologies of Hypotension Easily Identifiable by TEE (x5)

Answer 9

Poor LV function
Decreased LV afterload
Decreased LV preload
Pericardial tamponade
Acute valvular dysfunction

Question 10

Ketamine’s effect on EEG

Answer 10

Characterized by the abolition of alpha rhythm and the dominance of theta activity

Question 11

Ketamine’s effect on the CNS

Answer 11

Generally considered to increase cerebral blood flow (CBF), cerebral metabolism (CMRO2), and intracranial pressure (ICP)

Recent data: does not increase ICP and has little impact on cerebral hemodynamics

Question 12

Ketamine’s effect on the cardiovascular system (x5)

Answer 12

Dose dependent direct stimulation of the CNS that leads to increased sympathetic nervous system outflow although direct negative inotropic effects.

1. Increased systemic and pulmonary blood pressures, 2. Increased heart rate
2. Increased cardiac output
3. Increased cardiac work
4. Increased myocardial oxygen requirements

Question 13

Ketamine’s effect on the cardiovascular system in critically ill patients

Answer 13

critically ill patients may occasionally respond to ketamine with unexpected decreases in blood pressure and cardiac output

depletion of endogenous catecholamines and exhaustion of sympathetic compensatory mechanisms, unmasking ketamine’s direct negative inotropic effects.

Question 14

Ketamine’s effect on the pulmonary system

Answer 14

Bronchodilatory activity but has been shown to increases salivary and tracheobronchial mucous gland secretions

unchanged ventilation

Question 15

Ketamine’s effect on the renal and hepatic systems

Answer 15

No change

Question 16

Turbulent gas flow increases with… (x2)

Answer 16

1. increasing gas density

2. gas flow rate

Question 17

Decrease gas density with ____ to relieve airway obstruction e.g. in tracheal stenosis.

Answer 17

heliox (molecular weight 9.6)

Question 18

Decreasing gas flow rates through _____ helps to ventilate patients with airway obstruction in larger airways e.g. tracheal stenosis

Answer 18

slow, deep breaths

(remember that disease of peripheral airways such as emphysema or cystic fibrosis contribute little total airway resistance since the total cross-sectional area of small airways is very large and flow there is laminar).

Question 19

Poiseuille’s law equation

Answer 19

Resistance = (8 * length * viscosity) / (pi * r^4)