Miscellaneous

Question 1

What level is needed for laparoscopic surgery?

Answer 1

T4 to T5

Question 2

What is the dose of intralipid for LAST?

Answer 2

1. 5 mL/kg bolus
2. 25 mL/kg/min infusion

Question 3

How do patients with myasthenia gravis respond to muscle relaxants? Lambert-Eaton?

Answer 3

MG: sensitive to non-depolarizing agents, resistant to depolarizing agents

LE: sensitive to all agents

Question 4

How do you distinguish a myasthenic crisis from a cholinergic crisis?

Answer 4

pupils will be large during a myasthenic crisis and small during a cholinergic crisis

Tensilon test (edrophonium challenge)

Question 5

What are the predictors of post-op ventilation in a patient with myasthenia gravis?

Answer 5

pyridostigmine dose > 750 mg/day

vital capacity < 4 mL/kg

maximal inspiratory pressure < 25 cm H₂O

disease duration > 6 years

co-existing pulmonary disease

Question 6

What familial conditions are associated with MH?

Answer 6

central core disease

multiminicore disease

King-Denborough

Question 7

What is the dose of dantrolene? How is Ryanodex given?

Answer 7

2.5 mg/kg

Ryanodex is 250 mg diluted into 5 mL (mannitol must be given separately)

Question 8

What are the components of MH treatment?

Answer 8

dantrolene 2.5 mg/kg

agressive cooling with cold fluids and ice packs

treat acidosis with bicarbonate

treat hyperkalemia

maintain urine output w/ mannitol or furosemide

check ABG, elecrolytes, coags, CK

Question 9

What does the dibucaine number represent? Normal values?

Answer 9

% of pseudocholinesterase inhibition:

wild type: 70-80

heterozygous: 50-60
mutant: 20-30

Question 10

How should fluid resuscitation be estimated in a burn patient?

Answer 10

Parkland formula

4 mL/kg/% body surface burned

1/2 given over first 8 hours

1/2 given over next 16 hours

Question 11

What is normothermia for a burn patient?

Answer 11

38.5 ^oC

Question 12

Why shouldn’t dextran and hetastarch be used for fluid resuscitation?

Answer 12

impair coagulation by coating platelets

impair crossmatching by coating RBCs

anaphylaxis

Question 13

What is the anesthetic significance of the Cobb angle in scoliosis?

Answer 13

curves > 60^o are associated with poor pulmonary function

Question 14

What is the most common ABG abnormality seen with thoracic scoliosis?

Answer 14

decreased PaO₂

(likely V/Q mismatching)

Question 15

What is the usual time course of TRALI?

Answer 15

onset: 1-6 hours
resolution: about 72 hours

Question 16

How does OSA affect ECT?

Answer 16

hypercarbia can worsen the tachycardia and hypertensive response to seizure

seizure duration may be shorter if hypocarbia can’t be established

Question 17

How is OSA categorized by apnea-hypopnea index?

Answer 17

AHI

6-20: mild

21-40: moderate

>40: severe