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Anesthesia > Lecture 5/10 > Flashcards

Lecture 5/10 Flashcards

1
Q

What percentage of body weight in males is water? Females?

A

Total Body Water=60% of body weight in males and 55% of body weight in females. Up to 80% body weight in infants. Less in obese; fat contains little water

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2
Q

How much of total body water is intracellular?

A

two thirds

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3
Q

How much of total body water is extracellular?

A

one third

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4
Q

Of the extracellular water, how much is extravascular?

A

2/3-3/4

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5
Q

Of the extracellular water, how much is intravascular?

A

1/4-1/3

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6
Q

What is the approximate intravascular volume of a 60 kg female?

A

3.8 L

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7
Q

What is the approximate intravascular volume of a 70 kg male?

A

5 L

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8
Q

What factors can be used to preopratively assess fluid status?

A

mental status, h/o intake and output, blood pressure: supine and standing, heart rate, skin turgor, urinary output, serum BUN/osmolarity

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9
Q

Orthostatic hypotension is defined as….

A

systolic blood pressure decrease of >than 20 mm Hg from supine to standing (10% decrease normal 12-20% is borderline)

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10
Q

What percentage fluid deficit is indicated by orthostatic hypotension?

A

6-8%

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11
Q

In the presence of orthostatic hypotension, a failure of heart rate to increase may indicate….

A

autonomic dysfunction or antihypertensive drug therapy (beta-blockers)

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12
Q

What factors must you consider for perioperative fluid requirements?

A

maintenance fluid requirements, compensatory fluid bolus, NPO and other deficits: NG suction, bowel prep, Third Space losses, replacement of blood loss, special additional losses

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13
Q

How do you calculate maintenance fluid requirements?

A

1.5 ml/kg/hr for adults or 4:2:1 rule (4 ml/kg/hr for the 1st 10 kg of body weight, 2 mL/kg/hr for 2nd 10 kg, 1 mL/kg/hr for every kg thereafter)

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14
Q

How much is a customary compensatory fluid bolus early in anesthetic?

A

500 mL in 70 kg patient

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15
Q

How much fluid should be given to compensate for a bowel prep?

A

1 L

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16
Q

NPO deficit is calculated by…

A

number of hours NPO x maintenance fluid requirement (but usually start the hours at wake up time)

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17
Q

How do you calculate third space losses for superficial surgical trauma?

A

1 ml/kg/hr

18
Q

How do you calculate third space losses for minimal surgical trauma (head and neck, hernia, knee surgery)?

A

2 ml/kg/hr

19
Q

How do you calculate third space losses for moderate surgical trauma (hysterectomy, pelvic surgery)?

A

3 ml/kg/hr

20
Q

How do you calculate third space losses for major surgical trauma (major intestinal surgery, major orthopedic procedures, open abdominal aortic aneurism repair)?

A

4 ml/kg/hr

21
Q

How much blood loss can be ignored before replacing with fluids?

A

1.5-2 cc/kg

22
Q

Blood loss after 1.5-2 cc/kg should be replaced with crystalloid at a ratio of? With colloid?

A

3:1 crystalloid, 1:1 colloid

23
Q

Hetastarch has what adverse effect?

A

mild coagulopathy when used over certain doses, rare allergic reactions. Can also elevate serum amylase

24
Q

Hypertonic saline solutions may be used for…

A

cerebral edema. Draws water out of cells

25
Q

How is oxygen delivery calculated?

A

oxygen delivery (DO2) = oxygen content (CaO2) x Cardiac Output (CO)

26
Q

What is the main determinant of oxygen content in the blood?

A

hemoglobin

27
Q

How is cardiac output calculated?

A

CO = HR x SV

28
Q

How is oxygen content calculated?

A

Hgb x 1.39 x O2 Sat + PaO2 x 0.003. If PaO2=100, Hgb=15, and O2 sat 1, 0.3 ml O2/dl blood

29
Q

What is the transfusion trigger?

A

Think oxygen delivery. Tolerance of acute anemia depends on: maintenance of intravascular volume, ability to increase cardiac output, increases in 2,3 DPG to deliver more of the carried oxygen to tissues.

30
Q

What is cross matching blood?

A

major: donors erythrocytes incubated with recipients plasma, minor: donor’s plasma incubated with recipient’s erythrocytes. Blood unit is reserved for that patient, but can be re-matched for another patient

31
Q

What is the difference between a type and screen and a type and cross?

A

Type and screen is a test done on the patient in which the recipient blood has been tested for ABO/Rh antigens and screened for common antiboides (not mixed with recipient blood). Blood is not reserved. In a type and cross, blood is reserved

32
Q

What is type specific transfusion?

A

Only ABO-Rh is determined

33
Q

If you don’t have time but must transfuse blood, what do you give?

A

O Rh negative packed cells

34
Q

What are the blood components as divided for transfusion?

A

packed red blood cells, platelet concentrate, fresh frozen plasma, cryoprecipitate, albumin, plasma protein fraction, leukocyte poor blood, factor VIII, antibody concentrates

35
Q

1 unit of pRBC’s raises the Hgb….

A

1 gm/dL

36
Q

Why can’t you use LR when transfusing pRBC?

A

LR has calcium which may cause clotting if mixed with pRBC

37
Q

What is contained in fresh frozen plasma?

A

coagulation factors except platelets

38
Q

What are the types of transfusion reactions?

A

febrile, allergic, hemolytic

39
Q

What are the complications of blood therapy?

A

transfusion reactions, transmission of viral diseases, decreased 2,3 DPG, citrate (calcium binding, metabolism to bicarb), hypothermia, microaggregates, coagulation disorders (massive transfusion may lead to dilution of platelets and factor V and VIII)

40
Q

How do you get autologous blood for transfusion prior to surgery?

A

1 unit donated every 7 days (up to 4 units) last unit donated >72 hrs prior to surgery

41
Q

What are alternatives to blood products?

A

hematopoetic growth factors, isovolemic hemodilution, surgical technique, intra-operative blood salvage, coagulants, blood substitutes, hyperbaric oxygen therapy

Anesthesia (10 decks)

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