Misc. Topics Flashcards
What are pharmacologic modalities used to treat postop shivering?
- meperidine
- clonidine
- dexmedetomidine
O2 consumption is decreased by what percent for every 1 degree celcius dec. in body temp?
5-7%
Where is the esophageal temp probe best measured?
- 1/3rd - 1/4th distal esophagus
- 38-42 cm past incisors
In a burn patient, when is it safe to give succs?
- within the 1st 24 hrs
In burn pts, should the dose of non-depolarizing neuromuscular blockers be increased, decreased, or unchanged?
- increased 2-3 fold
- d/t up regulation of extrajunctional receptors
What is the primary mechanism of heat loss in burn patients?
evaporation
What is normal intraocular pressure?
10-20 mmHg
What is the aqueous humor of the eye produced by?
ciliary process (posterior chamber)
What is the aqueous humor of the eye reabsorbed by?
canal of Schlemm (anterior chamber)
Do IV anticholinergics increase IOP?
No
Is ketamine a useful anesthetic agent for eye surgery?
- No
- It causes rotary nystagmus and blepharospasm
Is succs a suitable muscle relaxant for a pt with an open globe injury?
- succs inc. IOP by 5-15 mmHg for up to 10 min.
- no reports of blindness - OK to use in pt w/ open eye injury and full stomach
- Roc 1.2 mg/kg is also suitable
How do drugs reduce IOP?
- they reduce aqueous humor production or facilitate aqueous humor drainage (miosis)
What are drugs the decrease aqueous humor production?
- acetazolamide (carbonic anhydrase inhibitor) dec. aqueous humor production
- timolol (non-selective beta antagonist) dec. aqueous humor production
What are drugs that increase aqueous humor drainage?
- echothiophate - irreversible cholinesterase inhibitor that promotes drainage via canal of Schlemm
- it can prolong the duration of Succs & ester type LA
When using sulfur hexafluoride (SF6) bubble what are considerations with N2O?
- discontinue 15 min before the bubble is placed
- avoid 7-10 days after bubble is placed
What are alternatives to SF6 and what are the times to avoid N2O?
- silicone oil = 0 days
- air bubble = 5 days
- Perfluoropropane (C3F8) = 30 days
Where is LA injected for a TAP block?
- between the IOM and transverse abdominis muscle
Tricyclic Antidepressants, Selective NE Reuptake Inhibitors, and Selective Serotonin Reuptake Inhibitors can be used to treat chronic pain. Which has the most significant side effects?
- TCA
- cause QT prolongation and orthostatic hypotension
- Combo of SNRI and SSRI can precipitate serotonin syndrome
What procedures do thoracic paravertebral blocks provide analgesia for?
- breast surgery, thoracotomy, and rib fracture
What is a celiac plexus block used for?
- mgmt. of cancer pain of upper abdominal organs
- distal esophagus, stomach, liver, pancreas, small intestine, & colon (except descending colon)
What are complications of a celiac plexus block?
- orthostatic hypotension, retroperitoneal hematoma, hematuria, diarrhea, AAA dissection, back pain, retrograde migration of injectate
What is a Superior Hypogastric Plexus Block used for?
- mgmt. of cancer pain of pelvic organs
- uterus, ovaries, prostate, descending colon
What are complications of a Superior Hypogastric Plexus Block?
- retrograde migration of injectate (if neurolytic used)
What antibiotics are contraindicated during pregnancy?
- chloramphenicol
- erythromycin
- fluoroquinolones
- tetracyclines
What is the preferred method of skin prep prior to central line placement?
- chlorohexadine
- alcohol based products are flammable and must be allowed 2 minutes to dry
What procedure is associated with the highest risk of TB in healthcare personnel?
- bronchoscopy
- intubation is 2nd
What are the 2 most common S/E of zofran?
- Headache
- Diarrhea
What is the 1st sign of bone implantation syndrome in awake pt w/regional anesthesia and in the pt under GA?
- dyspnea and altered mental status
- dec. EtCO2
What is the first line treatment for bone implantation syndrome?
- 100% FiO2
- IV hydration
- phenylephrine for hypotension
What is the triad of fat embolism syndrome?
- resp insufficiency (hypoxemia, bilat infiltrates on CXR, ARDs)
- neurologic involvement (confusion to coma)
- petechial rash (skin of neck & axilla, oral mucosa, conjunctiva)
What is Samter’s triad?
- ASA exacerbated resp disease
- asthma
- allergic rhinitis
- nasal polyps
- these its can develop life threatening bronchospasm after administration
What is the #1 cause of anesthetic mortality?
- human error
- 51-77% of all anesthetic related deaths
What is the most common cause of equipment morbidity and mortality?
- human error
