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Stuff and Thangs > McGlam Anesth > Flashcards

McGlam Anesth Flashcards

1
Q

What should the hematocrit level be for surgery?

A

> 30% for men

>27% for females

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2
Q

What hemoglobin level is adeqaute for elective surgery?

A

Hgb levels >8 g/dL are adequate

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3
Q

What are the upper levels of hematocrit allowed for elective surgery?

A

Above 57% for men and 54% for women carries risk of bleeding and throbosis

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4
Q

When should a patient discontinue warfarin therapy before surgery?

A

3-5 days before the surgical procedure or as long as necessary to get the PT to normal.

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5
Q

What are the signs and symptoms of malignant hyperthermia?

A

High fever
Muscle rigidity
Cardiac arrhythmias
Acidosis

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6
Q

Which inhaled anesthetic is notorious for causing malignant hyperthermia?

A

Halothane

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7
Q

What deformities/disease states can put a patient at increased risk for malignant hyperthermia?

A

Myopathies!

Kyphosis/lordosis/webbed becking/ seratus weakness are all signs of myopathies!

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8
Q

What is the only diagnostic test for malignant hyperthermia?

A

Skeletal muscle biopsy looking for myopathy.

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9
Q

When is a preoperative ECG indicated?

A

In those over the age of 50 with a history of cardiac disease or hypertension.

Intubation causes increased hypertension.

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10
Q

Should antihypertensives be taken on the day of surgery?

A

Yes!

Intubation and anesthesiology can cause blood pressure to skyrocket.

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11
Q

How is intraoperative/ post operative elevations in blood pressure treated?

A

Nifedipine (10 mg) sublingual

For severe elevations one could use labetalol with nitro

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12
Q

How long should one wait to perform elective surgery after a patient has had an MI?

A

Postponed a minimum of 6 months following a MI

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13
Q

Patients with insulin dependent diabetes should alter regimen in what way preop?

A

Reduce insulin intake by 1/3 to 1/2 of intermediate acting insulin the morning of surgery.

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14
Q

Why would a diabetic patient undergoing surgery require sliding scale insulin?

A

The stress of surgery may result in hightened insulin requirements.

D5 at 1.5 to 2 mL/kg can be given as well.

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15
Q

Why are obese patients at risk during surgery?

A

they have increased oxygen demands with decreased lung capacity.

This decreases there pulmonary compliance.

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16
Q

What is strictly contraindicated in patients undergoing surgery with sickle cell anemia?

A

The use of a tourniquette!

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17
Q

What food are 2 year olds allowed to intake prior to surgery?

A

those up to 2 years of age can have milk feedings 4 hours before surgery.

Those older than 2 years can have clear liquids up to 4 hours peroperatively.

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18
Q

Pentobarbital and secobarbital are both what class of medications?

A

Barbituates

Provide sedation, relieve apprehension.

Minimal circulatory and repsiratory depression.

No analgesia.

Not used much today, have ultimately been replaced by benzodiazepines.

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19
Q

What drug is valium?

A

Diazepam!

A sedative hypnotic

20
Q

What drug is ativan?

A

Lorazepam!

A sedative hypnotic

21
Q

When are valium and ativan use indicated?

A

Diazepam and lorazepam use are great for anxiolytic agents but can also produce sedation.

22
Q

What is Versed?

A

Midazolam is a benzodiazepam that can act as an anxiolytic, hypnotic, and muscle relaxant.

It is commonly used as a sedative and is 3x stronger than diazepam.

23
Q

Which benzodiazepine is the most popular preanesthetic?

A

Versed!
Also known as midazolam
Highly predicatble, safe, anterograde amnesia.

Cleared by the liver and conjugated by the kidneys.

24
Q

Which two drugs can be given to produce concious sedation?

A

Droperidol (a benzo) and fentanyl (sublimaze)

25
Q

What is Demerol?

A

meperidine which is a narcotic.

1/10 the strength of morphine.

26
Q

What drug can be used to reverse the effects of narcotics?

A

Narcan also known as naloxone.

Nalmefene (revex) is a newer longer acting antidote.

27
Q

Which two drugs can be taken the night before surgery to prevent gastroesophageal reflux?

A

Cimetidine (Tagament)
and
Zantac (ranitidine)

These are H2 receptor antagonists

28
Q

In general terms, what is induction?

A

Induction is typically used intravenously and is rapidly acting.

Think thiopental which is usually rapid and smooth. However it is eliminated by the liver and excreted by the kidneys and can take quite awhile.

29
Q

Methohexital, an inducing agent is known to cause what side effect?

A

Coughing and singulitis

30
Q

What is deprivan?

A

Propofol!

31
Q

What is the most commonly used inducing agent?

A

Propofol!

32
Q

How is propofol metabolized?

A

Metabolized at the liver, much faster than thiopental and methohexital.

Induces smoother than barbituates but causes more cardiovascular and lung depression.

33
Q

What is the typical dose of propofol?

A

1.5 to 3 mL/kg

34
Q

What type of anesthesia does ketamine cause?

A

Disassociative anesthesia

Produces profound analgesia.

EXCELLENT selection for an uncooperative pediatric patient.

35
Q

What is etomidate used for?

A

Short acting IV induction agent.

Excellent cardiovascular stability.

36
Q

What is the minimum alveolar concentration?

A

The amount of inhaled anesthetic at one atmosphere of pressure that prevents movement and response to noxious stimulus in 50% of patients.

37
Q

What organ is halothane rouh on?

A

It is rough on the liver as its metabolites are slowly eliminated over a time of three months. as it can cause hepatic necrosis.

38
Q

Why is halothane considered the first choice inhalational agent for patients with bronchospastic diseases?

A

Because its a good bronchial dilator when a patient is anesthetized.

39
Q

Which disease would warrant a contrainication of enflurane use?

A

Kidney disease!

only 1/3 is metabolized by the liver.

40
Q

What is succinylcholine used for?

A

This is a muscle relaxant that facilitates intubation.

41
Q

What medication can reverse the effects of succinylcholine?

A

Neostigmine or pyridostigmine

These are both anticholinergic agents.

42
Q

What is a Bier block?

A

This is an intravenous regional anesthetic block.

Utilizes two different blood pressure cuffs below the knee.

43
Q

What is monitored anesthesia care?

A

The combination of local anesthesia and conscious sedation is known as monitored anesthesia care.

44
Q

What two drugs are most commonly used for concious sedation?

A

Monitored anesthesia care can be done using midazolam and fentanly to allay anxiety, to reduce pain, and produce amnesia without loss in conciousness.

One can also use medazolam and ketamine, propofol and ketamine, midazolam and remifentanil.

45
Q

What is local anesthetic toxicity for lidocaine?

A

4.5 mg/kg of body weight
or
300 mg

if epinephrine is added dose increases to 500 mg.

46
Q

What is the local anesthetic toxicity for marcaine?

A

175 mg

or

225 mg when epinephrine is added.

47
Q

What perservative in local anesthetics can cause allergic reactions?

A

Methylparaben

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