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Basics of Anesthesia > Midterm > Flashcards

Midterm Flashcards

1
Q

Components of the preop assessment

A

name and DOB, verify site and procedure, labs, med history, anesthetic history, education, informed consent, H&P (airway exam)

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2
Q

What herbal meds increase bleeding time and when should the patient discontinue it?

A

garlic, gingko, ginseng- 7 days pre-op

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3
Q

Latex allergies are common in?

A

patients with spina bifida and multiple surgeries; common to also have allergy to tropical fruits

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4
Q

When should patients stop smoking before surgery and why?

A

4-8 weeks pre-op (decrease carboxyhemoglobin levels and prevent respiratory complications)- minimum 12 hours before

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5
Q

What does chronic alcoholism vs acute intoxication do in regards to anesthetics?

A

chronic alcoholism increases resistance to CNS depression, whereas acute intoxication does the opposite

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6
Q

components of airway evaluation

A

Mallampati (1 is best), thyromental distance 7 cm, intercisor distance 4 cm, good head and neck range of motion, good dentition, neck size

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7
Q

What are the effects of general anesthesia on the respiratory system?

A

decrease FRC (up to 2 weeks), alters V/Q, inhibits ilia, decreases surfactant, increased sensitivity

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8
Q

What are the high, intermediate, and low scores of STOP BANG?

A

5-8 high, 3-4 intermediate, 0-2 low

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9
Q

In terms of MET scores, what’s good and bad?

A

1- bad, 4- good

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10
Q

Cancel surgery if BP is over?

A

180/110

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11
Q

What antihypertensives should you continue and which ones should you stop?

A

continue beta blockers, stop ACEI (day of)

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12
Q

How long after an MI should you wait to have surgery?

A

60 days

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13
Q

What are the considerations of patients with OA, ankylosing spondylitis, and RA?

A

limited neck mobility, may be on steroids (may need stress dose), may be on NSAIDs/ASA- bleeding

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14
Q

What is an anesthetic consideration for someone with GERD?

A

may need RSI

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15
Q

What lab is the most accurate reflection of renal reserve?

A

creatine clearance

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16
Q

When should you delay surgery in regards to hyperkalemia?

A

over 5.5 (not absolute)

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17
Q

What labs should you check if someone is in renal failure?

A

K, creat, Hgb

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18
Q

Considerations about diabetics

A

stiff joint syndrome, may need Reglan (gastroparesis), may give half insulin the day of, try to do surgery in the AM to minimize fasting

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19
Q

What drugs should you use in hyperthyroidism and which ones should you avoid?

A

use beta blockers, avoid anticholinergics

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20
Q

What can you have within one hour of surgery?

A

meds with sip of liquid (150 mL for adults, 75 mL kids)

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21
Q

What can you have within two hours of surgery?

A

clear liquids

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22
Q

What can you have within 4 hours of surgery?

A

breast milk

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23
Q

What can you have within 6 hours of surery?

A

infant formula, nonhuman milk, light meal

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24
Q

Describe ASA classifications

A

1- normal; 2- disease w/o limitations; 3- disease w/ limitations; 4- severe dz with constant threat to life; 5- moribund, minimal chance of survival w/o surgery; 6- brain dead

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25
Q

What does the ASTM do?

A

makes anesthesia machine regulations about workstation and components

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26
Q

What does the FDA do?

A

anesthesia machine checkout, standards for gases

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27
Q

What does the DOT do

A

compressed gas regulations

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28
Q

What does the ICC do?

A

construction of cylinders

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29
Q

What does the CGA do?

A

sets safe practices for gas cylinders

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30
Q

What is the pressure in the breathing circuit limited to?

A

125 cm H20 or 12.5 kPa

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31
Q

What is the psi in each system on the ventilator?

A

high- 2000 psi; intermediate- 45-55 psi; low- 16 psi

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32
Q

What are the 5 tasks of oxygen?

A

ventilator driving gas, flush valve, O2 pressure failure alarm, O2 pressure sensor shutoff (failsafe), flowmeters

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33
Q

Describe a free floating valve

A

prevents gas leak- moves in direction pushed by gas

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34
Q

Describe a ball and spring valve

A

permits gas flow after concentration made (all or none)

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35
Q

Describe a diaphragm valve

A

decreases pressure (pressure regulator)

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36
Q

When should you change an O2 tank?

A

half full -1000 psi

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37
Q

What is the psi and L of an oxygen tank?

A

2000/ 660 L

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38
Q

What is the psi and L of a nitrous tank?

A

745 psi / 1590 L

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39
Q

What is the psi and L of an air tank?

A

200 psi/ 625 L

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40
Q

What is the critical temp of oxygen?

A

-119 C

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41
Q

What is the critical temp of nitrous?

A

39.5 C

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42
Q

F to C

A

5/9(F-32)

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43
Q

C to F

A

(9/5 x C) + 32

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44
Q

How often do medical cylinders need to be tested, and who sets that regulation?

A

every 5 years; ICC

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45
Q

Describe the Joule Thompson effect

A

compressed gas escapes- process is adiabatic and cooling occurs (if cylinder is opened rapidly, temperature increases rapidly- why we “crack” cylinder)

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46
Q

What are the PISS configurations of all 3 cylinders?

A

air- 1,5
oxygen- 2,5
nitrous- 3,5

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47
Q

What does the free floating valve of the hanger yoke do?

A

prevents full cylinder or pipeline from emptying into empty cylinder

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48
Q

Do the Bourdon pressure gauges measure absolute or relative pressure?

A

relative

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49
Q

What does the oxygen pressure failure device do, and what are its limitations?

A

if PRESSURE drops below 30 psi, 2nd gas turns off- only senses pressure, only prevents problems upstream

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50
Q

What does the oxygen failure alarm do?

A

alerts to loss of oxygen pressure (<20 psi)- audible whistle

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51
Q

What should you do if you suspect a pipeline crossover?

A

disconnect pipeline, turn on cylinder, use low flows, conserve O2, manually ventilate, use TIVA

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52
Q

Describe the O2 flush valve

A

bypasses the vaporizers, delivers 35-75 L/min of oxygen- should use only on expiration

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53
Q

Describe the design of the flowmeters

A

Thorpe tube- has variable orifice- specific for each gas

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54
Q

Describe laminar flow

A

parallel, orderly; dependent on viscosity and Pouisueille’s law; Reynolds <2000

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55
Q

Describe turbulent flow

A

nonorderly; dependent on density and Graham’s law; Reynolds <4000

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56
Q

What changes flow from laminar to turbulent?

A

change in direction >20 degrees, corrugated tubing, increased velocity

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57
Q

What does the hypoxic mixture prevention device do?

A

keeps mandatory O2 flow 50-250 ml; limits nitrous to 3x that of O2

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58
Q

what kind of breathing system is the anesthesia machine?

A

semi-closed

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59
Q

What is the order of efficiency from best to worst of Mapleson circuits for spontaneous ventilation?

A

ADCB

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60
Q

What is the order of efficiency from best to worst of Mapleson circuits for mechanical ventilation?

A

DBCA

61
Q

What is the purpose of the reservoir bag and what is the characteristics of its connector?

A

prevents excessive pressure from getting to the patient- 22 mm female connector

62
Q

If you turn the APL clockwise, what are you doing?

A

increasing limiting pressure

63
Q

CO2 absorbers are a ? neutralizing a ?

A

base; acid

64
Q

How much CO2 is absorbed with NaOH?

A

26 L per 100 g

65
Q

What is the product of the first absorber reaction?

A

carbonic anhydrase

66
Q

Is the second absorber reaction fast or slow? And what are its products?

A

fast- water and heat

67
Q

Is the third absorber reaction fast or slow?

A

slow

68
Q

Compare soda lime to calcium hydroxide

A

soda lime absorbs more CO2 and forms more compound A and CO; whereas CaOH produces less but absorbs less CO2 (only 10.6 L perr 100 g)

69
Q

What is the mesh size of CO2 absorber granules?

A

4-8

70
Q

What is compound A formed from, and what is it toxic to?

A

sevo; kidneys

71
Q

What is carbon monoxide formed from?

A

des, iso, enflurane

72
Q

How do you reduce the amount of Compound A made?

A

use at least 2 L/min FGF, lower concentrations of sevo, fresh CO2 absorber

73
Q

What are some signs of CO2 absorber exhaustion?

A

hypercarbia, acidosis, inreased RR, SNS discharge, dysrhythmias

74
Q

What does vapor pressure depend on?

A

temperature- if you add heat, more molecules enter vapor phase

75
Q

Difference between flow over and draw over vaporization methods?

A

flowover- stream passes over liquid; draw over uses patient breath

76
Q

How do the variable bypass vaporizers compensate for changes in temperature?

A

bimetallic strip (opens more when cold, closes more when hot)

77
Q

Which way do the vaporizer knobs turn?

A

counter clockwise

78
Q

What prevents using more than 1 agent at a time?

A

interlock system

79
Q

What is the Tec 6 heated and pressurized at?

A

39 degrees and 2 atm/1300 psi

80
Q

What did we add to the machine that minimizes the risk of incorrect concentrations of gases?

A

gas analyzer

81
Q

What would happen if you put sevo in an iso vaporizer?

A

lower output (and vice versa)

82
Q

What would happen if you put iso in a halothane vaporizer?

A

nothing- similar VP

83
Q

Does the Tec 6 compensate for changes in altitude?

A

no

84
Q

What bellows is better?

A

ascending- shows disconnect

85
Q

What happens with a leak in the bellows?

A

increased FiO2, barotrauma

86
Q

Which drive mechanism is more likely to have FGF decoupling?

A

piston

87
Q

How do you calculate TV if your ventilator does not have decoupling and does not compensate for compliance?

A

(TV+FGF) - compliance

88
Q

How do you calculate compliance?

A

compliance x PIP

89
Q

How do you calculate FGF per breath?

A

FGF divided by I:E ratio divided by RR

90
Q

Should you use a cylinder for your driving gas?

A

no

91
Q

Describe volume control

A

delivers preset TV, time initiated

92
Q

In VC, what do plateau pressure and PIP reflect?

A

plateau pressure- compliance; PIP- resistance

93
Q

Describe pressure control

A

Delivers programmed pressure- TV variable- may need to alter I:E ratio

94
Q

What ventilation method is good for emergence?

A

SIMV

95
Q

What are advantages and disadvantages of the non-diverting gas monitor?

A

advantages- fast, no scavenging needed; disadvantages- circuit weight, increased DS, needed cleaning, only measured O2 and CO2

96
Q

Describe diverting gas analyzers

A

siphons 50-250 ml/min of gas up to main unit- requires zero calibration, but needs scavenging and has a greater difference between PaCO2 and EtCO2

97
Q

Does infrared analysis measure O2?

A

no- measures CO, nitrous, and halogenated agents

98
Q

What part of the machine uses paramagnetic O2 analysis?

A

O2 analyzer- O2 is the only paramagnetic gas

99
Q

What should you be able to do with the suction catheter?

A

occlude and hold at waist height

100
Q

What are some hazards of suctioning?

A

hypoxemia (avoid during stage 2), trauma, infection, increased ICP, negative pressure pulmonary edema

101
Q

Electrical currents usually not perceived if less than…

A

1 mA

102
Q

What is the threshold for electrical current with and without skin?

A

skin- 100 mA; without- 100 microA

103
Q

Why are ORs ungrounded?

A

does not allow for completed circuit through which equipment may be grounded

104
Q

When does the line isolation monitor alarm?

A

2-5 mA

105
Q

What could be some causes of hypoxia?

A

short gas supply, O2 leak, air entrapment

106
Q

What could be some causes of hypoventilation?

A

disconnection, supply issues, leaks, increased scavenger suction

107
Q

What could be some causes of hypercarbia?

A

absorbent failure, unidirectional valve problem, coaxial leak, increased dead space

108
Q

What could be some causes of high airway pressure?

A

spill valve or APL malfunction, plastic left on, O2 flush valve

109
Q

What could be some causes of anesthetic agent overdose?

A

tipped vaporizer, transfilled, overfilled, failed interlock

110
Q

What could be some causes of inadequate anesthetic delivery?

A

entrapment, faulty vaporizer, empty vaporizer

111
Q

What is the most important part of the scavenging system?

A

interface- protects patient from positive or negative pressure from scavenging

112
Q

In a closed scavenging system, when do the positive and negative P valves open?

A

positive- 5 cmH2O

negative- -0.25 cmH2O

113
Q

What should your reservoir bag look like in the scavenging system?

A

partially filled

114
Q

What are the allowable trace gas levels?

A

nitrous- 25 ppm
halogenated agents- 2 ppm
both- nitrous 25/halogenated 0.5

115
Q

Oxyhemoglobin absorbs more ? light and deoxygenated Hgb absorbs more ?

A

infrared; red

116
Q

What is the “law” of pulse oximetry?

A

Beer Lambert

117
Q

Is pulse oximetry in real time?

A

no- 15 second delay

118
Q

What are some things that could cause a false higher SpO2 reading?

A

carboxyhemoglobin and methemoglobin

119
Q

What can cause methemoglobin?

A

congenital issues or acquired (nitrobenzenes)

120
Q

What is the treatment of methemoglobinemia?

A

methylene blue

121
Q

Hgb has ? x affinity for CO than O2

A

200

122
Q

What population has a normal 5-6% level of carboxyhemoglobin?

A

smokers

123
Q

What drugs cause a transient decrease in SpO2?

A

methylene blue, indigo carmine

124
Q

What is oxygraphy used for?

A

measure preoxygenation efficiency

125
Q

What is the normal FiO2 and FeO2

A

21% and 16%

126
Q

Describe phases of capnography

A

1- inspiratory baseline
2- expiratory upstroke
3- expiratory plateau- uneven emptying
4- inspiration

127
Q

normal alpha and beta angle

A

100-110; 90

128
Q

What is the dividing point between the upper and lower airway?

A

cricoid cartilage

129
Q

At what cervical levels are the hyoid, thyroid, and cricoid cartilages?

A

C3; C4-5; C6

130
Q

What nerves innervate the muscles of the larynx, pharynx, and soft palate?

A

vagus, glossopharyngeal, and spinal accessory

131
Q

What innervates all muscles that move the VC, (except for the cricothyroid muscle)?

A

RLN

132
Q

What innervates the motor function of the cricothyroid muscle?

A

external branch of SLN

133
Q

What innervates the sensory portion of the larynx above the vocal cords?

A

internal laryngeal nerve (branch of the SLN)

134
Q

What innervates the sensory portion of the larynx below the vocal cords?

A

RLN

135
Q

What are the RLN and SLN branches of?

A

vagus nerve

136
Q

What does the R RLN wrap around?

A

brachiocephalic artery

137
Q

What does the L RLN wrap around

A

aorta

138
Q

Describe RLN and SLN injury

A

SLN and unilateral RLN damage causes hoarsness, whereas bilateral RLN damage causes stridor

139
Q

What does the only motor branch of the glossopharyngeal nerve innervate?

A

stylopharyngeus

140
Q

What arteries supply blood to larynx?

A

SLN- branch of superior thyroid artery; RLN- branch of inferior thyroid artery

141
Q

Which muscles pull the pharynx down?

A

omohyoid, sternohyoid, sternothyroid

142
Q

How many cartilagenous rings make up the trachea?

A

16-20

143
Q

What are the “false” vocal cords?

A

vestibular folds

144
Q

What abducts the vocal cords?

A

posterior criocoarytenoids

145
Q

What adducts the vocal cords?

A

lateral thyroarytenoids

146
Q

What is the only intrinsic muscle not innervated by the RLN, and what is it innervated by?

A

cricothyroid- external laryngeal branch of X

147
Q

What innervates the diaphragm

A

C3-5- phrenic nerves

148
Q

What are some signs of correct ETT placement?

A

bilateral breath sounds and chest rise, positive end tidal CO2, O2 sat, tube condensation, CXR, blood gas

149
Q

What are some techniques for airway management?

A

head tilt (leave pillow), jaw thrust, Sellicks (cricoid pressure), RSI

Basics of Anesthesia (8 decks)

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