Miscellaneous topics 6 Flashcards
What are the respiratory presentation of anaphylaxis?
bronchospasm- decreased EtCO2, decreased SaO2, increased peak inspiratory pressure
laryngeal edema
increased mucus production
What are the GI effects of anaphylaxis?
abdominal cramping
N/V
diarrhea
What are the skin effects of anaphylaxis?
flushing
urticaria (hives)
erythema
pruritus
Type 1 is a _____________ mediated reaction
IgE
The best lab test to determine if an allergic response has occurred is
tryptase
Type 2 is a ______________ mediated reaction
IgG and IgM
High risk groups for a latex allergy include
spina bifida/myelomeningocele, atopy, health care workers and allergy to banana, kiwi, mango, papaya, pineapple, and tomato
Other common allergens in the OR include
chlorhexidine, protamine, contrast media, colloids, blood products, opioids, hypnotics, and local anesthetics
Cisplatin, a chemotherapeutic agent, can cause
acoustic n. injury + nephrotoxicity
Vincristine & vinblastine, a chemo drug, can cause
peripheral neuropathy
Bleomycin, a chemo drug, can cause
pulmonary fibrosis (keep FiO2 <30%)
Doxorubicin, a chemo drug, can cause
cardiotoxicity
5-fluorouracil, a chemo drug, can cause
bone marrow suppression
Methotrexate, a chemo drug, can cause
bone marrow suppression
A history of severe N/V can impact
volume status and electrolyte balance
____________ may be a reason to avoid an oral airway, nasal airway, LMA, or esophageal temperature probe.
Mucositis (ulceration of mucous membranes)
What are the five key GI hormones?
Gastrin
secretin
cholecystokinin
gastric inhibitory peptide
somatostatin
The universal “off” switch for digestion is this hormone:
somatostatin
This hormone increases stomach acid and stimulates chief cells to secrete pepsinogen:
gastrin
This hormone instructs the pancreas to secrete bicarbonate and the liver to secrete bile:
secretin
This hormone slows gastric emptying and stimulates pancreatic insulin release:
gastric inhibitory peptide (K cells)
Barrier pressure is reduced by things that
reduce LES tone (cricoid pressure, anticholinergics, pregnancy)
increase intragastric pressure (pregnancy)
__________ is increased in the patient with Zollinger-Ellison syndrome
Gastrin (gastrin secreting tumor–> increased stomach acid–> gastric ulceration)
Gallbladder pain after a fatty meal is caused by
increased CCK release
The treatment for carcinoid tumors is
somatostatin
___________ is a drug that increases barrier pressure
metoclopramide
Which agent primarily targets the chemoreceptor trigger zone?
a. ondansetron
b. scopolamine
c. dexamethasone
d. hydroxyzine
a. ondansetron
What are the 6 types of antiemetics?
5-HT3 antagonists
Neurokinin-1 antagonists
dopamine antagonists
antihistamines
anticholinergics
steroids
What type of anesthetic reduces the risk of PONV?
TIVA & regional anesthesia
_____________ should be administered during induction to be effective
Dexamethasone
Ondansetron should be administered
30 minutes before emergence
Dopamine antagonists include
butyrophenones, phenothiazines, metoclopramide
Dopamine antagonists can cause
extrapyramidal symptoms
These drugs are contraindicated in the patient with Parkinson’s disease:
dopamine antagonists
Metoclopramide is contraindicated with
bowel obstruction
Propofol at _____- produces an antiemetic effect
10-20 mg
Ephedrine given ___________ may reduce PONV by
25 mg IM by maintaining BP and cerebral perfusion
Transdermal scopolamine is best applied
> 4 hours before the induction of anesthesia; lasts for 72 hours
The vomiting center resides in the
nucleus tractus solitarius (medulla)
Sensory input to the vomiting center arises from
the chemoreceptor trigger zone, GI tract, and vestibular system
The GI tract gives rise to these receptors involved in vomiting:
5-HT3
NK-1
The CTZ gives rise to these receptors involved in vomiting:
5-HT3
NK-1
DA-2
noxious chemicals
The vestibular apparatus gives rise to these receptors involved in vomiting:
H1
M1
Patient risk factors for PONV include
female gender
nonsmoker
history of motion sickness
previous episodes of PONV
age is loosely associated (youth> elderly)
Anesthetic risk factors for PONV include
halogenated anesthetics
nitrous oxide (>50%)
opioids
etomidate
neostigmine
Surgical risk factors for PONV include
long surgical duration (> 1 hr)
GYN procedures
laparoscopy
breast
plastics
peds procedures: strabismus, orchiopexy, T&A
The most common side effects of ondansetron are
headache and/or diarrhea
5HT3 antagonists and butyrophenones can prolong
the QT interval (droperidol has a black box warning for QT prolongation)
Motion induced nausea is the result of
M1 & H1 stimulation in the vestibular system of the inner ear
Patients undergoing _______ should receive antiemetic agents that target the vestibular system
middle ear surgery
Prochloroperazine produces significant
sedation
A nonpharmacologic method of reducing PONV is
the P6 acupressure point- pressure point located 3 finger breadths below the wrist on the inner forearm
