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Basics Exam 2 > Module 5- Maintenance > Flashcards

Module 5- Maintenance Flashcards

1
Q

After intubating, what should we check for?

A

End tidal CO2

Listen to lungs

Misting in the tube

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2
Q

Benefits of TIVA

A

Faster recovery
Decreases N/V

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3
Q

What is a complication of TIVA administration

A

Awareness

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4
Q

If your patient is HOTN, what are some steps to help alleviate?

A

Decrease agent, give fluids & vasopressors

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5
Q

TXA is a synthetic

A

Anti-fibrinolytic that enhances the formation of a stable clot

Decreases the needs for transfusion

Seizure risk is dose related (4mg)

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6
Q

What does TXA stand for?

A

Tranexamic Acid

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7
Q

What is the MAP goal

A

Keep within 20% baseline

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8
Q

Colloids are composed of

A

Large molecular weight

whole blood, plasma & albumin

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9
Q

Crystalloids are composed of

A

Low molecular weight

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10
Q

What are examples of Isotonic solutions?

A

NS
LR
Plasmalyte
Normosol

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11
Q

What are examples of Hypotonic solutions

A

0.45%
5% Dextrose in water
Plasma-Lyte

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12
Q

What are examples of Hypertonic solutions

A

Dextrose 5% in NS
3-7.5% saline

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13
Q

What is the typical bolus dose of Phenylephrine

A

50-100mcg IV

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14
Q

What is the infusion dose of Phenylephrine

A

10-80mcg/kg/min

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15
Q

What is the Ephedrine bolus dose?

A

5-10mg IV

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16
Q

Which medication is 2nd line when treating HOTN

A

Norepinephrine for patients resistant to Neosynephrine/Ephedrine

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17
Q

What is the overall goal of maintenance?

A

Maintain Stage 3 surgical anesthesia (unconsciousness, amnesia, immobility 7 unresponsiveness to stimulation) while also maintaining respiratory & hemodynamic stability

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18
Q

What is the hypothesis of how Volatile anesthetics work?

A

Interact with multiple ion channels in the brain

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19
Q

What are the components of the anesthetic state?

A

Amnesia
Sedation
Analgesia
Immobility

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20
Q

What factors are related to the speed of induction?

A

Characteristics of the agent

Ventilation factors

Circulatory factors

Temperature

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21
Q

With Blood: gas solubility, if it is greater than 1 then

A

it prefers the blood

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22
Q

With Blood: gas solubility, if it is less than 1 then

A

It reaches the lungs first

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23
Q

Oil:gas is associated with

A

Potency

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24
Q

B:G solubility indicates the

A

Speed of anesthesia update & elimination

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25
Q

B:G solubility indicates the proportion of the anesthetic that remains in the

A

Blood versus the fraction that diffuses into the tissues

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26
Q

Higher B:G solubility means

A

Slower brain & spinal cord uptake, leading to slower anesthesia

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27
Q

Which agent has a high B:G solubility

A

Isoflurane

(more of the drug remains in the blood & less enters the tissues quickly)

Slower induction

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28
Q

Which agent has low solubility

A

Desflurane

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29
Q

With low solubility agents like Desflurane, less drug

A

Stays in the blood & more rapidly diffuses into the tissues

Quicker onset of anesthesia

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30
Q

Anesthetic gases move

A

Down concentration gradient, meaning they move from an area od high concentration to low

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31
Q

When is uptake slowed

A

As tissue compartments become saturated

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32
Q

Faster breathnig/ventilation leads to a

A

Quicker loss of consciousness at the start & quicker emergency at the end of anesthesia

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33
Q

Poor lung function

A

Hinders effectice inhalation drug administration

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34
Q

How can you compenstate for a low soluble gas

A

Increase agent concentration (overpressurize)

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35
Q

How can you compensate for high soluble agents

A

Increase ventilation

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36
Q

VRG is comprised of

A

Heart, Liver, Kidney & brain

Blood supply goes here more quickly

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37
Q

Increased Cardiac output

A

Slows the onset of inhalation anesthetics

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38
Q

A higher cardiac output

A

Removes more anesthetic from thelungs, delaying the rise in lung & brain concentration

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39
Q

Pediatric patients & their characteristisc

A

Higher CO (distribution to VRG faster)

Increased Vd

Less muscle mass (allows more anesthetic to cooncentrate in vital organs aiding quicker brain update)

IA is less soluble in the blood (faster actioon)

Increased RR (speeds induction)

Requires higher MAC (1.5-1.8 x higher)

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40
Q

Hypothermia & acidosis

A

Increases tissue solubility & agent potency

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41
Q

Hypothermia causes a decrease in

A

Alveolar ventilation & tissue perfusion, which slows induction due to reduced drug delivery to the brain

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42
Q

Hyperthermia & alkalosis

A

Increases anesthetic requirements 7 cardiac output, leading to slower induction as more anesthetic is required & is removed from the lungs faster

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43
Q

Amphetamine use will ____ MAC

A

Increase MAC

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44
Q

Prexedex & MAC

A

Will decrease MAC requirements by 40%

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45
Q

O:G of Des

A

18.7

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46
Q

O:G of N2O

A

1.4

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47
Q

O:G oof Sevo

A

50

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48
Q

O:G of Iso

A

99

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49
Q

Induction % of N2O

A

50-70

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50
Q

Induction % of Iso

A

1-4

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51
Q

Induction % of Des

A

3-9

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52
Q

Induction % of Sevo

A

4-8

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53
Q

What should be avoided during maiintenace

A

100% O2

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54
Q

What is the goal O2 saturation with Air + O2

A

Goal above 94%

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55
Q

What mix of FGF supply can be given to minimize CV depression & also provides analgesia

A

N2O + O2

(50-60% N2O)

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56
Q

What are the risk of N2O

A

N/V

Not idea for Lap, ENT, eye cases

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57
Q

PONV risk factors

A

Non-smoker
Female
IA
Opioids
Age
Hx PONV
Motion Sickness
Etomidate
Ketamine

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58
Q

TIVA Propofol infusion dose

A

100-150mcg/kg/min

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59
Q

Sufentanil is used for

A

Moderate to severe pain for longer cases

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60
Q

Sufentanil in comparison to Fentanyl

A

Less Respiratory depression

More potent than fentanyl

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61
Q

What is the onset of Sufentanil

A

1-3 min

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62
Q

What is the duration of Sufentanil

A

2-4 hrs

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63
Q

Remifentanil is good because

A

It is short aacting
good for quick cases
Rapid on & off

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64
Q

How is remifentanil metabolized

A

Hydrolysis by non-specific plasma & tissue esterases

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65
Q

What is the infusion dose of Remifentanil

A

0.5-0.25mcg/kg/min

66
Q

When is TIVa appropriate?

A

Neuromonitoring
Hx PONV
Geriatric pt to reduce POCD
Family hx of MH

67
Q

Remifentanil is organ

A

Independent metabolism

68
Q

Since remifentanil is short acting, what needs to be on board

A

Long acting opioid

69
Q

Sufentanil has a pain control tail that lasts

70
Q

When should Sufentanil be descontinued

A

30-45 min before wake up

71
Q

What is the dose of Remifentanil

A

0.05-0.2mcg/kg/min

72
Q

What is the dose of Sufentanil

A

0.2-0.5mcg/kg/hr

73
Q

What is the MAC dose of Propofol

A

20-100mcg/kg/min

74
Q

What is the TIVA dose of Propofol

A

80-150mcg/kg/min

75
Q

What is the MAC dose of Ketamine

A

0.1-0.3mg/kg/hr

76
Q

What is the PRN bolus dose of Ketamine

77
Q

What is the infusion dose of Precedex

A

0.2-0.7mcg/kg/hr

78
Q

What si the PRN bolus dose of Precedex

A

0.25-0.75mcg/kg

79
Q

What wil your end tidal look like once a neuromuscular blocker is wearing off

A

Cirari breaths

80
Q

What is the PRN bolus dose of Rocuronium

A

0.1mg/kg IV

81
Q

What is the PRN bolus dose of Vecuronium

82
Q

What is the PRn bolus dose of Cisatracurium

A

0.01mg/kg IV

83
Q

What is the PRN bolus dose of Atracurium

84
Q

What patient population should you use caution with when administering Roc

A

Liver, ETOH (monitor twitches more)

Induced liver enzyme

85
Q

How is ToF delivers?

A

4 Separate stimuli every 0.5 seconds at 2Hz for 2 secoonds

86
Q

What is fade?

A

As paralysis progresses with a non depolarizing agent, the twich response decreases in size

87
Q

With 4 of 4 twitches, what percent of blockade can still be present?

88
Q

With 75-80% of block, how many twitches will you have

A

3 twitches

89
Q

With 80-85% of block, how many twitches will youo have

A

2 twitches

90
Q

With 90-95% of block, how many twitches will you have

91
Q

What is the ideal percentage of paralysis thats needed or procedures

A

85-95%, which corresponds to 1-2 twitches

92
Q

What percent of paralysis is avoided

A

100%, which helps prevent overdosing of the relaxant & reduces the risk of residual parlysis upon reversal

93
Q

What should be kept in mind with Lidocaine administration

A

Other areas it may be used

94
Q

What is the bolus dose of Lidocaine?

A

1-1.5 mg/kg IV

95
Q

What is the infusion dose of Lidocaine?

A

1-2 mg/kg/hr

96
Q

Dexamethasone can provide

A

Anti-inflammatory & anti-emetic properties

97
Q

What is the IV dose of Dexamethasone

A

4-12 mg

(up to 16 per Elmore)

98
Q

What is Preemptive Analgesia

A

Giveing analgesia before noxious stimuli to decrease pain response (prevent ventral sensitization)

99
Q

What is ERAS

A

Enhanced Recovery After Surgery

Protocol incorporate preventive analgesia to reduce opioid use. minimaze S/E, lower post-op pain scores & shorten hospital stay

100
Q

How do you calculate estimated fluid deficit

A

Maintenance fluid requirement x Fasting houors

101
Q

Replacement surgical losses for superficial trauma

A

1-2mL/kg/hr

102
Q

Replacement surgical losses for Minimal trauma

A

2-4mL/kg/hr

103
Q

Replacement surgical losses for Moderate Trauma

A

4-6mL/kg/hr

104
Q

Replacement surgical losses for Severe Trauma

A

6-8mL/kg/hr

105
Q

Replacement ratio for Crystalloids

106
Q

Replacement ratio for Colloids

107
Q

Goal-directed fluid therapy enhances patient outcomes through a

A

systematic evaluation of fluid responsiveness & optimization of oxygen transport

108
Q

What is the test dose of a fluid bolus

109
Q

How often should you re-assess fluid therapy

A

Every 5-10min

110
Q

What is pulse contour analysis

A

Quantifies changes in arterial, capnography, or pulse oximetry waveforms related to respiratory variations & pleural pressure

111
Q

What is Plethysmography variability Index

A

Assesses variability in the plethsmographic waaveform

112
Q

What is SVV

A

Stroke volume Variation: measures the fluctuation in stroke volume with the respiratory cycle

> 15%= give fluids, stop when <15%

113
Q

What is systolic pressure variation

A

Evaluates changes in SBP with respiration

114
Q

What is PPV?

A

Pulse Pressure Variation: Assesses fluctuation in pulse pressure

115
Q

What are the advantages of fluid responsiveness measures

A

Real time data
Minimal Invasive/Non invasive
Post-Op monitoring

116
Q

What are the benefits of using Crystalloids

A

Quickly restores circulating vascular volume

Helps Preserve blood flow in the microcirculation

Decreases hormone-mediated vasoconstriction

Addresses plasma hyperviscosity due to acute hemorrhage

Low risk allergic reaction

easier metabolized & cleared by kidneys

Maintains electrolyte balance despite plasma losses

117
Q

What are the limitations of Crystalloids

A

Isotonic will distribute evenly throughout the extracellular space, leading to a temporary increase in plasma volume

75-85% can move into interstitial space

20-25% stays in

Beneficial for about 30min

118
Q

Low molecular weight causes

A

Hemodilution & reduction in capillary oncotic pressure

119
Q

LR components

A

Less Na+ but has other electrolytes like Ca+ (factor 4, which binds to anticoagulant in blood)

120
Q

Which fluids are not used in kidney patients

A

LR & Plasmalyte since they contain K+

121
Q

What can be given in the setting of hemodilution which affects oncotic pressure

122
Q

What colloid isn’t used for neuro patients

A

Albumin due to increased ICP & oncotic pressure

123
Q

What is albumin?

A

A fractionated blood product derived from pooled human plasma

Heat treated to reduce disease transmission risk

124
Q

What is often used for volume expansion in active loss situations where transfusion isn’t needed

125
Q

Albumin can minimize

A

Tissue edema

Best to use in small doses

126
Q

What is the risk of Albumin

A

More expensive

Cause pulmonary edema

Binds various substances

127
Q

What should be repleted when giving albumin

A

Calcium if given about 1L (1.2mm/L)

128
Q

What is the Maximum allowable blood loss (MABL) calculation

A

EBV x initial HCT- final/initial

129
Q

Giving blood can

A

Reduce immune function

Risk of infection, transfusion reactions & volume overload

130
Q

What is TACO

131
Q

What is TRALI

A

Lungs, happens within 6hours

No evidence of HF or overload

132
Q

Which patient population should have a higher HGB

A

Coronary artery disease for O2 carrying capacity

133
Q

BIS provides

A

A measure of sedation

134
Q

How does BIS work?

A

Processes EEG/EMG signals to measure hypoxic state

135
Q

BIS of 95-100

136
Q

BIS 75-95

A

Light sedation

137
Q

BIS 60-75

A

Moderate sedation (low risk of recall)

138
Q

BIS 40-60

A

General Anesthesia

139
Q

When is BIs inaccurate?

A

In the very young <1yr or in the very old

140
Q

Can BIS differ from the side of the head

141
Q

How does BIS read in the devolopmentally delayed

142
Q

Ketamine & BIS

A

Will read high

143
Q

BIS can have what effects when considering NMB

A

BIS can have limited utility when avoiding NMB

144
Q

BIS is not always feasible for use in

A

Head & Neck surgery

145
Q

Can BIS be used during MRI?

146
Q

Mg+ & Bear Hugger effects on BIS monitoring

147
Q

Does BIS tell you about respiratory depression?

148
Q

Fentanyl can decrease response to

A

Changes in CO2

149
Q

Can you use Propofol with Moderate Sedation cases?

150
Q

What is the dose of Midazolam in sedation cases

151
Q

Minimal/light sedation dose of Midazolam

A

0.5-2mg IV

152
Q

Minimal/light sedation dose of Ketamine

A

10-25mg IV

153
Q

Minimal/light sedation dose of Fentanyl

A

25-50mcg IV

154
Q

Minimal/light sedation dose of Dexmedetomidine

A

0.25-0.75mcg/kg

155
Q

Moderate sedation dose of Midazolam

A

0.5-5mg IV

156
Q

Moderate sedation dose of Ketamine

A

10-25mg IV 1-3mg/kg IM

157
Q

Moderate sedation dose of Fentanyl

A

25-100mcg IV

158
Q

Moderate sedation dose of Dexmedetomidine

A

0.25-0.75 mcg/kg IV

159
Q

Moderate sedation dose of Propofol

A

25mcg/kg/min

160
Q

What is Deep sedation/GA + Natural airway (BIG MAC)

A

MAC case where patient is so deep that they do not respond to voice or noxious stimuli

Need OPA/NPA/CPAP

Propofol 50-150mcg/kg/min

Basics Exam 2 (3 decks)

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