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Anesthesia based on Nebuchanedzzer II > ITE QBANK Misc 1 > Flashcards

ITE QBANK Misc 1 Flashcards

1
Q

How does hypocalcemia result from hyperventilation?

A

Hyperventilation -> respiratory alkalosis ->
H+ bound to negatively charged plasma proteins (albumin) is released ->
Ca2+ (positively charged) can bind to albumin

*paresthesias/perioral numbness can occur with hyperventilation

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2
Q

During Respiratory alkalosis (ie hyperventilation) What is the metabolic compensation of serum bicarb : PaCO2?

A

decrease in serum bicarb by 2 mmol/L per 10 mmHg PaCO2 decrease

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3
Q

What do the kidneys do if respiratory alkalosis becomes subacute or chronic?

A

The kidneys
decrease their bicarb reabsorption or
increase bicarb secreation

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4
Q

How does hyperventilation cause HYPOkalemia?

A

H+-K+ transporter pump H+ out of cells to restore physiologic pH

K+ is simultaneously pumped intracellularly to ensure electroneutrality
- hypokalemia

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5
Q

there is an (increase/decrease) in serum albumin over the course of pregnancy

A

Decrease: not in total volume of albumin, but d/t increase in plasma volume

1st trimester - 4.5g/dL -> 3.9g/dL
Term: 3.3g/dL

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6
Q

There is an increase in these two clotting factors during pregnancy

A

fibrinogen and factor VII

- creates hypercoagulable state in pregnant women

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7
Q

What happens to transferrin and TIBC during pregnancy?

A

Increase transferin and TIBC

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8
Q

The Bohr effect refers to ?

A

Shift in the oxygen dissociation curve caused by changes in the [ ] of carbon dioxide or the pH of the environment

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9
Q

How does PTH increase Ca2+ lvls?

A
  1. PTH stimulates osteoclasts, increasing bone resorption and raising serum calcium.
  2. Ca2+ reabsorption in distal renal tubule
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10
Q

High flow jet ventilation is applied how?

A

applied with set driving pressure, followed by passive exhalation for very short period of time b4 next jet is delivered
- essentially creating “auto-peep”

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11
Q

Furosemide can cause HYPOkalemic-HYPOchloremic metabolic alkalosis 2/2 to _____.
How do you treat this?

A

potassium excretion and contraction alkalosis

*if pt gets diuresis -> alkalemia gets worse

Treat with acetazolamide (carbonic anhydrase inhibitor) to correct alkalemia

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12
Q

Loop diuretics work at the _____ part of the loop of henle where they block the ______.

A

ascending loop of henle

Na-K chloride transporter

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13
Q

Acetazolamide may impair carbon dioxide elimination in pts w/ _____

A

COPD

- use caution

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14
Q

Which diuretic causes hypokalemic-hypochloremic metabolic alkalosis and which ones causes hyperchloremic metabolic acidosis?

A

hypokalemic-hypochloremic metabolic alkalosis

  • Loop diuretics
  • Thiazide diuretics

hyperchloremic metabolic acidosis?
- acetazolamide

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15
Q

Which evoked potentials are most and least affected by volatile anesthetics?

A

Most: Visual evoked potentials (VEP)

Least: auditory evoked potentials (AEP)

*all of the volatile anesthetics produce dose dependent effects on the VEP, EEG, SSEPs, and MEPs

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16
Q

Pupillary light reflex

  • Afferent limb
  • Efferent limb
A
  • Afferent limb: optic nerve

- Efferent limb: occulomotor nerve

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17
Q

Corneal reflex

  • Afferent limb
  • Efferent limb
A
  • Afferent limb: Ophthalmic br of Trigeminal nerve

- Efferent limb: Temporal and Zygomatic br of Facial nerve

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18
Q

How is the rate of inhaled anesthetic induction (FA/FI) affected by minute ventilation?

The effect is greatest in which anesthetic agents?

A

Rate is increased with increased minute ventilation

Greatest in agents w/ high solubility (Halothane 2.54, Isofluourane 1.46)

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19
Q

Blood:Gas solubility (K B:G) values

A 
Halothane 2.54
Isoflourane 1.46
Sevoflurane 0.65
Nitrous Oxide 0.47
Desflurane 0.42
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20
Q

Blood gas solubility

Halothane

A

2.54

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21
Q

Blood gas solubility

Isoflurane

A

1.46

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22
Q

Blood gas solubility

Sevoflurane

A

0.65

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23
Q

Blood gas solubility

Nitrous oxide

A

0.47

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24
Q

Blood gas solubility

Desflurane

A

0.42

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25
Q

Clevidipine is an IV, ultra-short acting (5-15min), _______ CC antagonist with selectivity for ________ vasodilation.
It is metabolized by ______

A

dihydropyridine

Arteriolar

plasma and RBC esterases

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26
Q

Hofmann elimination is used in metabolism of ______

A

cistatracurium

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27
Q

______________ is responsible for the metabolism of morphine, hydromorphone, and heroin

A

Phase II conjugation

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28
Q

Plasma and RBC esterases metabolize? (name at least 3)

A

clevidipine
esmolol
remifentanil

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29
Q

Pseudocholinesterase metabolize? (name at least 3)

A

succinylcholine
ester local anesthetics
Mevacurium

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30
Q

Pediatric airway characterized by: (5)

A
  1. greater collapsibility of nasopharyngeal tissue and epiglottis
  2. more cephalad position of the larynx (C3-C4)
  3. omegal shaped epiglottis
  4. slanted vocal cords
  5. functionally narrow subglottic region
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31
Q

Position of larynx in infant vs adults?

Shape of epiglottis?

A

Infant: C3-C4, omega shape
Adult: C4-C5, U shape

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32
Q

Dexmedetomidine is a ______ that is metabolized in the _____

A

a2- agonist (inhibits presynaptic NE release)

liver

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33
Q

Pupillary light response

- is it intact under GA?

A

Yes, but the pt’s eyes are fixed in midline (dolls eyes - occulocephalic reflex)

*many other reflexes are lost under GA (gag, oculocephalic/vestibulo-ocular, corneal)

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34
Q

Sympathetic drug metabolic effect (through alpha and beta receptor activiation)

A

Hyperglycemia - a-2 receptor activation inhibits insulin release from pancreatic islet cells

Increased FFA - b-1 receptor activation increases glycogenolysis in muscle and fat and gluconeogenesis in liver

Hypokalemia - b-2 receptor mediated shift of K into cells

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35
Q

Carcinoid syndrome mostly arises in the gut

- Pts are generally asymptomatic unless they have _____

A

liver metastases
- tumor secretory products broken down via 1st pass metabolism

*lung metabolism of serotonin prevents involvement of L heart

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36
Q

______ Law relates Pressure and Temperature

P1/T1 = P2/T2

A

Gay-Lussac Law

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37
Q

______ Law relates
Pressure and Volume

P1 * V1 = P2 * V2

A

Boyles law

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38
Q

______ Law relates Volume and Temp

V1/T1 = V2/T2

A

Charles Law

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39
Q

things to shift hgb dissociation curve to RIGHT (6)

A
  1. Hyperthermia
  2. Acidosis
  3. Pregnancy
  4. Increased 2-3 DPG (chronic anemia, CHF)
  5. Hypercarbia
  6. Sickle hgb
  7. Sulfhemoglobinemia
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40
Q

things to shift hgb dissociation curve to LEFT

A
  1. Cold
  2. Alkalosis
  3. Carboxyhemaglobin
  4. decreased 2-3 DPG (transfusions, septic shock, hypophosphatemia)
  5. Hypocarbia
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41
Q

How does Invasive BP monitoring with an a-line work?

A

Pressure transducer senses mechanical energy and converts it into electrical energy
- Summation of several pressure waves = arterial waveform

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42
Q

Ideal humidity in OR?

A

50-55% - decreases static discharge

*water vapor acts as a conductor

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43
Q

Combustion in OR requires what 3 components?

A

fuel
ignition source
oxidizer

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44
Q

TAP block covers which nerves?

Which two layers does the local bissect?

A
  1. Intercostal
  2. Subcostal
  3. Ilioinguinal
  4. Iliohypogastric

Internal oblique and Transversus abdominis muscle

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45
Q

Provide examples

Mineralocorticoid

Glucocorticoid

Catecholamine

A

Mineralocorticoid (aldosterone)

Glucocorticoid (Cortisol)

Catecholamine (adrenaline/noradrenaline)

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46
Q

Aldosterone (mineralocorticoid)

  • function?
  • Where is it secreted from?
  • Where does it act?
A

Retains Na and H2O in response to RAS. Excretes K+ in exchange for Na. H2O follows Na.

Zona glomerulosa (outer layer)

Distal convoluted tubules and collecting ducts of kidney

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47
Q

Cortisol (glucocorticoid)

  • function?
  • Where is it secreted from?
A

Maintains Blood Glucose by promoting gluconeogenesis and fat metabolism

Zona Fasciculata in response to ACTH secretion

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48
Q

For pts on chronic steroids (>5mg prednisone/d), how long does it take for steroid function to resume?

Which steroid can be used to stress dose pts?

A

2 - 6 mo

Hydrocortisone (equal glucocorticoid and mineralocorticoid activity)
- ~ 100mg q12h or 200mg daily (equivelent to 8mg dexamethasone)

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49
Q

Which steroid . . .

  • has equal Glucocorticoid:Mineralocorticoid
  • Gluc > Mineral
  • Gluc < Mineral
A

Equal Glucocorticoid:Mineralocorticoid
- Hydrocortisone 1:1

Gluc > Mineral

  • Prednisone 4:0.8
  • Prednisolone 4:0.8
  • Methylprednisolone 5:0.5
  • Dexamethasone 30:0

Gluc < Mineral
- Fludrocortisone 10:120

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50
Q

Beginning in the ____ week of gestation, the gravid uterus can exert mass effect on the _____.

A

20-24th weeks

aorta and IVC (aortocaval compression)
- supine hypotension syndrome

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51
Q

Which inhaled anesthetic can inhibit DNA synthesis?

A

Nitrous oxide

- irreversibly inactivates Vit B12, preventing prod of tetrahydrofolate and DNA synthesis

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52
Q

When is the best time for a pt to have dialysis relative to surgery?

A

the day before - lots of fluid and electrolyte shifts

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53
Q

Why are pts w/ Gilbert syndrome at inc risk for jaundice following blood transfusion?
- What enzyme are they missing?

A

They have 1/3 amt of hepatic enz, Bilirubin Glucuronyltransferase
- Enz is needed for hepatocyte uptake of unconjugated bilirubin

*blood transfusions increase serum bili ~ 250mg/u and overwhelms limited enzyme ability

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54
Q

Pts present with jaundice when serum bilirubin levels above __ mg/dL

A

2-2.5 mg/dL

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55
Q

How does Propofol and Fentanyl decrease the amplitude of somatosensory evoked potentials (SSEPs)?

A

it increases SSEP latency in a dose dependent manner

*SSEPs are used to check the integrity of peripheral nerves, posterior/lateral spinal cord, thalamus, and sensory cortex

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56
Q

Changes in somatosensory evoked potentials (SSEPs) amplitude and latency can be d/t what?

A

Ischemia or traction on spinal cord

Anesthestic drugs

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57
Q

How does Etomidate and Ketamine affect somatosensory evoked potentials (SSEPs)?

A

Both Increases amplitude of SSEP

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58
Q

Gabapentin (anticonvulsant) MOA

A

binds a2-delta subunit of VG-CC to reduce the release of glutamate -> decreases production of substance P and neuronal transmission of pain

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59
Q

What causes the ductus arteriosus to close in the first 12-24hrs of life?

A
  1. Decrease in fetal pulmonary vascular resistance
  2. Increase in SVR
  3. Increase in PaO2 >50 mmHg (causes arterial sm of the ductus to contract)
  4. Normocarbia
  5. Euvolemia
60
Q

How to you medically close a patent ductus arteriosus?

A
  1. Indomethacin (nonselectively inibits PG synthesis, which helps sm relaxation in ductus arteriosis)
  2. fluid restriction

If that doesn’t work, suture ligation

61
Q

The diagnosis of a persistent fetal circulation or persistent pulmonary HTN of the newborn can be made by noting a __ mmHg difference in PaO2 between ___ and ____ arterial lines

A

> 20 mmHg

Preductal and postductal arterial lines

62
Q

*Pearl: In congenital heart disease, impaired growth of nl cardiac structures is d/t _____

A

inadequate or absent blood flow

- what does not see flow will not grow

63
Q

Hunter Toxicity Criteria Decision Rules

A

Criteria for serotonin syndrome (need 1)

  • Spontaneous clonus
  • Inducible clonus + agitation/diaphoresis
  • Ocular clonus + agitation/diaphoresis
  • Tremor + hyperreflexia
  • Hypertonia + Temp >38 + ocular clonus or inducible clonus
64
Q

Critical temp of NO? Why is that important?

A

36.4 C (which is above RT 23C)

At RT, the gas can be converted to a liquid with sufficient pressure.

*NO and CO2 are “wet” gases

65
Q

Wet gases vs Dry gases

A

Wet: NO and CO2

  • Crit Temp is > RT
  • exist in both gaseous and liquid phase in compressed cylinder

Dry: air, helium, nitrogen, oxygen

  • Critical Temp is below RT.
  • Gas will never liquify at RT
66
Q

Critical Temp

A

Temp above which gas cannot be liquified no matter what pressure

67
Q

Critcal Pressure

A

Minimum pressure that causes liquefaction of gas at critical temperature

68
Q

Which part of the nephron segment accounts for the majority of Na+ reabsorption?

A

Proximal tubule (~70%) reabsortion of ultrafiltrate from bowman capsule

69
Q

_____ is responsible for the synthesis and release of angiotensinogen

A

Liver

*it is cleaved by renin to form angiotensin I

70
Q

Which clotting factors do the liver synthesizes?

A

Fibrinogen (I)

Thrombinogen (II)

Factor 5, 7, 8, 9, 10
_____________
Protein S and C

Antithrombin III

Plasminogen

71
Q

Where is VWF synthesized?

A

From Weibel-Palade Bodies and Subendothelium

72
Q

____________ is used to eval anticoagulant fx of high dose heparin admin
- What is nl?

A

Activated clotting time (ACT)

  • assesses intrinsic and final common pathway
  • Nl: 107 sec

*ACT has a linear response curve with increasing heparin doses. PTT loses linear relationship with heparin at doses needed for cardiac surgery

73
Q

A value of __ sec for ACT is used as a marker of adequate anticoagulation prior to going on bypass.

A

400-480 sec

*nl is 107sec

74
Q

Intrinsic pathway factors

Extrinsic pathway factors

Common

A

8, 9, 11, 12

3, 7

2, 5, 10

75
Q

Spinal anesthesia in infants vs adults

A

More rapid onset and shorter duration in infants d/t:

  • high CO
  • high vascular pia matter
  • loose myelination (little barrier to drug diffusion across spinal cord)
76
Q

Where does the spinal cord and dural sac terminate prior to 2 years of age?

A

SC: L3

Dural sac: S3

77
Q

High spinal in infants vs adults

A

Infant: apnea

Adults: CV collapse
- infants have immature sympathetic nervous system

78
Q

What happens to the values if the BP cuff is moved more distally?

A

Pulse pressure increases (DBP decreases)

79
Q

Order of accuracy for automated sphygmomanometers

A

MAP > SBP > DBP

80
Q

Bobbin rotameter, typically used to indicate current flow rate for gas is also known as ______

A

Variable area meter

  • As the flow and pressure beneath the bobbin increases, the bobbin will rise
  • As the bobbin rises, the cross-sectional area around it increases
81
Q

The ________ plexus innervates most of the abdominal viscera (stomach, liver, pancreas, spleen, intestines). What happens if you block it?

A

Celiac plexus

- Sympatholysis -> splanchnic vasodilation -> hypotension

82
Q

How does ventricular hypertrophy affect wall tension? Based on which law?

A

Reduces
- LaPlace’s law
Wall Tension = (P*r) / (2h)
- Thickness of the ventricular wall (h) is inversely proportional to the tension

*The ventricle hypertrophies to compensate for inc wall tension. It becomes MORE dependent on atrial contraction to maintain LVEDV.

83
Q

Three main determinants of myocardial oxygen demand

A
  1. Wall tension
  2. HR
  3. Contractility
84
Q

Antidote for Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban)

A

Andexanet alfa

  • recombinant derivative of factor Xa
  • Acts as a decoy receptor and binds factor Xa inhibitors
85
Q

Half life of bivalrudin (direct thrombin inhibitor)?

A

25 min in nl renal fxn

3 hrs in dialysis dep pts

  • If overdose -> ride it out man. Supportive tx
86
Q

Antidote for Dabigatran (pral direct thrombin inhibitor)

A

idarucizumab

87
Q

Baroreceptors are located where?

A

Carotid Sinus and aortic arch

  • hypotension and bradycardia
  • innervated by branch of the glossopharyngeal nerve
88
Q

What is contained in the carotid body?

A

chemoreceptors

- monitor pH, PO2, pCO2

89
Q

Why do respiratory acidosis/alkalosis affect change more than metabolic derangements to cerebral blood flow?

A

CO2 readily crosses BBB, while H+ do not

90
Q

What metabolic derrangement should you watch out for in children with pyloric stenosis?

A

Alkalosis -> postop apnea via central control of ventilation

- Serum alkalosis can lead to CSF alkalosis, the imbalance can persist even after correction of serum

91
Q

Atropine and glycopyrrolate are ______

A

anticholinergics

92
Q

What should you do if venous air embolism is suspected?

A

surgeons should flood operative field with nl saline
- 100mL of air in circulation can cause airlock in the RV -> disrupt forward blood flow -> stroke, MI, Death

  • High flow O2 (FIO2 100%)
  • Left lateral decubitus
  • Head down (trendelenburg)
93
Q

Normal fetal pH is ___

- Why the heck is that important?

A

7.35 (lower than mom, 7.43)

The diff in pH can produce phenomenon, “ion trapping” and can accumulate basic drugs in the fetus

94
Q

4 main factors determining placental transfer of drugs

A
  1. Size
  2. Degree of lipid solubility
  3. Protein binding
  4. Maternal drug concentration
95
Q

Drugs that are highly bound to plasma proteins are (more/less) likely to cross the placenta

A

less (ie: succinylcholine and nondepolarizing muscle relaxants)

96
Q

Important Drugs that do NOT cross the placenta:

A

He Is Going Nowhere Soon

Heparin
Insulin
Glycopyrrolate
Non-depolarizing muscle relaxants
Succinylcholine
97
Q

Pipeline Pressure of oxygen, nitrous oxide, and air supplying anesthesia machine?

A

50 psig

98
Q

Maternal Cardiac Output is highest when?

A

Immediately following delivery (2.5x prepregnancy)

  • Increase in preload (removal of vena cava compression)
  • Uterine contraction = autotransfusion
  • No fetus = less demand for blood flow to uterus
99
Q

Maternal cardiac output is increased by __: at the end of

  • 1st trimester:
  • 2nd trimester:
  • 3rd trimester:
A
  • 1st trimester: 35%
  • 2nd trimester: 50%, stroke vol increases
  • 3rd trimester: 50%
100
Q

Spinal cord perfusion pressure equation?

- How to improve SCPP during aortic surgery?

A

SCPP = MAP - Intrathecal/CSF pressure

  • Either Increase MAP or reduce CSF pressure using lumbar CSF drain
101
Q

Blood supply to the anterior 2/3 of the spinal cord? What is it supplied by?

A

1 anterior spinal artery (ASA)
- Supplied by radicular arteries from intercostal branches and aorta

*largest radicular artery = arteria radicularis magna aka artery of Adamkiewicz

102
Q

Blood supply to posterior 1/3 of spinal cord?

A

2 posterior spinal arteries (PSA)

103
Q

Which evoked potentials are the most resistant neuromonitoring modality to the effects of volatile anesthetics?

A

Brainstem auditory evoked potentials
- Useful for surgery involving vestibulocochlear nerve
-

104
Q

Thyromental distance < __ may predict difficult intubation

Sternomental distance < __

Interincisor distance < __

A

< 6.5 cm

< 12.5cm

< 3cm

105
Q

Which conditions will succinylcholine cause severe hyperkalemia and cardiac arrest? (7)

A
  1. Major denervation injuries
  2. spinal cord transections
  3. peripheral denervation
  4. prolonged immobilization, myotonia, musc dystrophy
  5. stroke
  6. trauma
  7. burns
106
Q

How can succinylcholine cause hyperkalemia?

A

Certain conditions result in increased production (up-regulation) of acetylcholine receptors at the NMJ and extrajunctional receptors
-More receptors -> exaggerated depolarization -> exaggerated efflux of lethal amts of potassium

107
Q

Can succinylcholine be administered to normokalemic patients with renal failure?

A

yes, rise in K+ is same, 0.5 mEq/L inc that normalizes in 15min

108
Q

___ is typically considered the most common blood product associated with TRALI

A

Plasma

109
Q

Can platelets lead to Rh sensitization?

A

Yes

  • small amts of RBCs and leukocytes present
  • consider giving Rh Immunoglobulin (RhoGAM) to women
110
Q

Binding of ACh to muscarinic receptor will (Increase/Decrease) gastric acid secretion

A

Increase

111
Q

The parasympathetic nervous system (PNS) arises from CNs ___

A

III, VII, IX, and X

112
Q

Muscarinic stimulation is characterized by:

A
  1. Bradycardia
  2. Bronchoconstriction (wheezing)
  3. Miosis
    4, Salivation
  4. GI Hypermotility
  5. Increased gastric acid secretion

*Too much and you get Organophosphate poisoning

113
Q

Organophosphate poisoning

A

Increased repeated ACh receptor stimulation
SLUDGE-Mi

Salivation
Lacrimation
Urination
Defacation
GI upset
Emesis
Miosis
114
Q

Antimuscarinic meds

A

Atropine
Scopolamine
Glycopyrrolate

*Atropine and Scop can cross the BBB

115
Q

Complications of Invasive mechanical Ventilation

A
  1. Ventilator induced lung injury (VILI) (volutrauma, barotrauma, atelectrauma, biotrauma)
  2. Ventilator associated pneumonia (VAP)
  3. Ventilator induced diaphragmatic dysfunction (VIDD)
  4. Ventilator induced systemic weakness
116
Q

Volume control

- Main goal

A

to ensure that the delivered min ventilation is maintained at the specific “target” level

  • specific TV
  • variable P
117
Q

Minute ventilation

A

MV = TV x RR

the amt of air moved in/out of lungs per minute

118
Q

Pressure control

- main goal

A

to ensure that the inspiratory airway pressure is maintained at the specific target level

  • airway pressure = peak pressure = plateau pressure
  • variable TV and flow rate
119
Q

How does inspiratory flow behave in Pressure control mode?

A

Inspiratory flow decelerates throughout inspiration

- once pressure target is met, the inspiratory flow must decrease to avoid exceeding that target pressure

120
Q

Controlled mandatory ventilation

  • How does it interact with pt?
  • Inspiratory trigger is based on?
  • Risk?
A

Does not interact w/ pt

Inspiratory trigger is only based on RR set

Sig risk of pt-ventilator asynchrony and ventilator induced diaphragmatic dysfunction (VIDD)

*historical mode

121
Q

Assist control ventilation

  • How does it interact with pt?
  • Reduced Risk?
A

Ventilator is triggered by pt effort
Set rate serves as back up respiratory rate

Reduced risk of pt-ventilator asynchrony and ventilator induced diaphragmatic dysfunction (VIDD)

122
Q

Synchronized Intermittent Mandatory Ventilation (SIMV)

  • How are breaths delivered?
  • How does it interact w/ pt?
  • Can it be augmented?
A

Provides set # of mandatory breaths
Delivered breaths are synchronized to pt effort

Btwn mandatory breaths, ventilator allows for spontaneous breathing

Can be augmented w/ Pressure support ventilation

123
Q

Pressure support ventilation

  • How are breaths delivered?
  • How does it interact w/ pt?
  • How is it used?
A

No set rate, all breaths triggered by pt
Breaths terminated based on flow reaching threshold value

Reduces work of breathing through ETT
Used to facilitate breathing trials

124
Q

Airway pressure release ventilation (APRV)

  • How is it designed?
  • What does it improve?
A
  • Designed to maintain prolonged inspiratory phase at elevated pressure
  • Prolonged inspiratory phase increases mean airway pressure and improves oxygenation
  • Spont ventilation is permitted during inspiratory phase to improve shunt
  • Intermittent pressure “releases” are given to facilitate CO2 exchange
125
Q

High frequency oscillatory ventilation

  • What does it do?
  • How does it affect TV and mean airway pressure?
  • Cons?
A

Ventilation provided at very rapid rate

TV is very low
Mean airway pressure is maintained

Poorly understood mechanism, requires multidisciplinary team

126
Q

CPAP supports (Hypoxemia/Hypercarbia)

A

Hypoxemia

*Can also be supported with Invasive ventilation with PEEP and recruitment maneuvers

127
Q

BIPAP supports (Hypoxemia/Hypercarbia)

A

Hypercarbia

*Can also be supported with invasive ventilation with variety of basic and advanced modes of vent

128
Q

Which antihypertensives also cause direct cerebral vasodilation? (5)

A
  1. CCB (nicardipine)
  2. nitroglycerin
  3. hydralazine
  4. nitroprusside
  5. adenosine
129
Q

Which muscle relaxant has an active metabolite that is nearly as potent as the parent drug?

A

Vecuronium
- 3-desacetyl-vecuronium 80% potency

*one lady with renal failure continued to remain paralyzed 13 days following vecuronium infusion

130
Q

Closing capacity

A

volume remaining in lungs during expiration when alveoli BEGIN to close
- comprised of closing volume (CV) + residual volume (RV

The need for greater lung inflation to prevent small airway collapse is reflected by increase in CC with age.

131
Q

Physiologic changes in elderly respiration

A
  1. Increased chest wall stiffness
  2. loss of muscle mass
  3. flattening of diaphragm
  4. increased compliance (decreased stiffness) of lung parenchyma
  5. Volume at which small airways collapse increases (closing capacity surpases FRC and eventually TV)
132
Q

How does mannitol prevent renal injury post transplant?

A

Osmotic diuretic that

  • Induces renal vasodilation
  • Renal prostaglandin release
  • scavening of free radicals

*may cause vol overload CHF or renal failure

133
Q

MELD score vs Childs Pugh score

A

MELD

  • I Crush Several Beers Daily
  • INR, Cr, Sodium, Bilirubin, Dialysis

Childs Pugh

  • Pour Another Beer At Eleven
  • PT, Ascites, Bili, Albumin, Encephalopathy
134
Q

Peribulbar block vs Retrobulbar block

A

Peribulbar block has decreased risk of retrobulbar hemorrhage and dmg to optic n.
- but it has a longer onset time (9-12 min) and lower incidence of complete akinesia

135
Q

Which alpha 2 agonists can cross the BBB?

A

Dexmedetomidine and clonidine

  • Able to bind to presynaptic alpha-2 receptors, which decrease norepi release, leading to decrease in sympathetic tone
  • This is responsible for cv effects such as bradycardia and CNS effects of sedation
136
Q

________ measurement is a cheap, rapid, and reliable means of assessing the functional capacity of a pts ability to form a clot

A

Activated clotting time (ACT)

*great to use following the admin of heparin during vascular or CT surgeries

137
Q

The respiratory rhythm originates in the cerebral medulla.

The inspiratory phase of ventilation originates in the __________.

The expiratory phase of ventilation originates in the _______________

A

Inspiration: dorsal group of medulla

  • Lower pontine (excitatory)
  • Upper pontine (inhibitory)

Expiration: ventral respiratory group in the medulla

138
Q

A full E-cylinder contains ___ L Oxygen at ____ psig

A

660 L

1900 psig

139
Q

How to calculate time remaining on oxygen E-cylinder?

A

_ L O2 / 3

Then / _ LPM

140
Q

Most posterior n. in axillary sheath closest to the humerus

A

radial n

141
Q

Nerve located in the coracobrachialis muscle, just deep to the biceps brachii,
- NOT within the axillary sheath

A

Musculocutaneous n

142
Q

Which nerves are contained in the axillary sheath, and surround the axillary artery?

A
  1. ulnar n
  2. median n
  3. radial n.

*note: musculocutaneous not found in sheath

143
Q

How does glycine toxicity result following a TURP?

A

Glycine metabolized to ammonia –> neuro sx (visual changes, encephalopathy and coma)

144
Q

A premature and full term newborn has an estimated blood volume of ___ and ____

A

premature infant: 100 ml/kg

full term: 85 ml/kg

145
Q

Adult female and male has an estimated blood volume of ___ and _____

A

Female: 60 ml/kg

Male: 65 ml/kg

146
Q

____________ can decrease ketamine induced emergence delirium

A

BDZ, propofol

147
Q

_______ (type) tracheostomy tube are necessary when positive pressure ventilation is required

A

cuffed

Anesthesia based on Nebuchanedzzer II (38 decks)

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