New Book Anesthesia Flashcards
ARDS
Acute onset
PAOP<18
Diffuse bilateral opacities
Pa02:Fi02<200 if 300 it is ALI
Mechanical ventilation is not a requirement
No hypercarbia not good with
Increased ICP
Pulmonary HTN
Thiopental
Large volume of distribution and insignificant hepatic metabolism
Therefore same duration in patient with liver disease
Factor 7 first to become deficient in
Liver disease
Vitamin K deficiency
Warfarin therapy
Liver disease
Thrombocytopenia
Low levels factor 2 5 7 9 10 11
Vitamin k deficiency
Increased tPA levels
Clinical uses factor 7
Hemophilia
Congenital missing factor 7
Reverse warfarin
Reversal of direct factor 10 inhibitors
ALP not raised by
Osteoporosis
Low albumin is indicator of
Poor hepatic function
Not good in acute disease due to long half life
Low SAAG
Malignancy
Nephrotic syndrome
Infection
AST/ALT ratio<1 in
Viral hepatitis
ALP
Excreted in bile
ALP is high but GGT is low in various
Bone diseases
Liver disease see increase in
CO
Decrease SVR
Increased O2 in mixed venous
Decreased portal vein/hepatic blood flow
Relieving ascites May lead to greater venous capacitance and thus
Hypotension
Hyperinflation with emphysema thus lose elastic recoil of alveoli by loss of elastic tissue and surfactant
Read it
Reasonable maneuvers to minimize PEEPi include
Low tidal volume
Reduce respiratory rate
Low I:E
Increase insporatory flow to delivery tidal volume in short time to reduce I:E and increase expiratory time
FEV1 less than 30% sign of
Very severe COPD
Stop smoking
6 to 8 wks before surgery is best
Neuraxial can preserve
FRC
Preserve RR
Hypotension
General anesthesia
Lower FRC
Atelectasis
Venovenousbypass
Pulmonary or air embolus and thrombosis possible
Rarely used
OSA leads to
Difficult mask ventilation
Lipophilic drugs
Higher volume of distribution
Longer to clear from body
For succ and cisatracurium use
TBW
Not broken down by organs so not IBW
Roc/Vec use
IBW
Obese individuals
Blood volume
Stroke volume
Cardiac output increase to provide circulation to adipose tissue
Left ventricular hypertrophy
Increased incidence of hypotension on induction
Decreased FRC in obese due to
Reduction in ERV and chest compliance!
DLCO is preserved in obese
Propofol maintenance dosing by
TBW
Kidney is autoregulation for
MAP 60 to 160
Renal system gets 20% of blood flow
Diabetes inspidus common after
Head injury
Mannitol leads to
Hyponatremia associated with high serum osmolality
Reversal agents same dosage in those with
Kidney disease
Morphine and meperidine have metabolites dependent on kidney for excretion
Best preserved mechanism for temperature regulation with general anesthesia
Sweating
Conduction lowest form of
Heat loss
Highest is radiation
Vasodilation from epidural leads to heat loss due to
Redistribution from core to periphery
More wound infections and coagulopathy with
Hypothermia
Postop hypothermia increases
Sympathetic nervous system activity
Hypothermia causes MAC to
Decrease
Thyroid storm is
Life threatening
Too much thyroid hormone increases
RR and TV
Increased CO
Increase basal metabolic rate up to 60 to 100%
MH vs thyroid storm
MH has metabolic acidosis, profound hypercarbia and muscle rigidity not found in thyroid storm
CPK is increased in MH but decreases in thyroid storm
Thyroid storm treatment start with
Restoring intravascular volume, glucose, and electrolytes
Don’t use ASA with
Thyroid storm
Propranolol is best for
Thyroid storm
Do surgical decompression for a
Hematoma
Airway obstruction immediately after Extubation after thyroidectomy due to
Bilateral recurrent laryngeal nerve injury
After 24 hours of thyroidectomy respiratory obstruction due to
Hypocalcemia
Thyroid storm can occur during intraop
Thyroidectomy
Most pheo
Solitary tumors at a single adrenal gland usually the right side
Pheo is part of
MEN type 2a or 2b
Alpha blocker therapy improves mortality in patients with
Pheo
Phenoxybenzamine is
Long acting 24-48 hours
Non competitive pre and post synaptic alpha blocker
Give 10mg q8
Orthostatic hypotension is an affect of
Alpha blockers
Don’t need to use steroids for
Pheochromocytoma
Labetalol
Alpha blocker and beta blocker
Hypotension or hypertension possible post
Pheo removal
HTN if some of the pheo is still present
Hypoglycemia is also possible but not hyperglycemia
Recurrence of signs of MH post dantrolene mean you need additional dose of
Dantrolene
Dantrolene vials contain
Mannitol
Most specific early sign of MH is
Muscle rigidity
Most sensitive sign of MH is
Hypercarbia
Dantrolene blocks
Calcium release from SR
Drug of choice in treatment of MH
MH hyperventilate with C02
Hyperventilate with 100% oxygen at flows of 10 L/min
Cocaine blocks reuptake of
Norepinephrine serotonin dopamine
Don’t give just beta blocker to patient with
Cocaine abuse
Restoration of p50 of Hgb within a few days of quitting
Smoking prior to surgery
Will also reduce carboxyhemoglobin levels
Opioids given before to asthma patients can prevent
Bronchospasm
Management of intraop bronchospasm
Deepen anesthesia with volatile agent
Beta agonists
Minimize barotrauma
Epinephrine especially if anaphylaxis triggered bronchospasm
Young adult post Extubation male think
Negative pressure pulmonary edema
Post Extubation pulmonary edema
Bilateral fluffy infiltrates
Don’t do diuresis
Aortic dissection first steps include
Aggressive blood pressure control with nitroprusside and labetalol infusions
Profound systemic hypotension likely to occur after removal of
Aortic cross clamp
Decreased arterial pH or worsening acidemia leads to
Activation of chemoceptors
Cerebral hyperperfusion syndrome
When blood flow to brain exceeds metabolic demand
Baroceptor leads to decreased
Heart rate
BP
Cardiac output and increase in venous dilation
Downregulation of beta receptors
CHF
Decreased blood viscosity improves
Systemic blood flow
Higher hematocrit leads to
Reduction in peripheral blood flow
Hematocrit
Percentage composition of whole blood composed of erythrocytes
CPP=
MAP-ICP
Dobutamine is not a good choice of pressor without evidence of heart failure bc it predisposes to
Arrhythmia
Tricuspid valve insuffiency with
PE
Nitroprusside inhibits
HPV this lowering Pa02
ADH released in response to
Surgical stress
SBP goes up as you travel further from
Aorta
FFP indicated for
Treatment of micro vascular bleeding for inr>1.5
Don’t give preventatively or as volume expander
Bleeding into closed space such as brain eye or spine demands immediate reversal of
Antucoagulation
If on ASA or clopidogrel give platelets to reverse
Usually if < 50000 you transfuse
DDAVP for
Central diabetes insipidus
Helps uremic renal failure patients prevent bleeding
Hetastarch
Impairs renal function
Can cause coagulopathy leading to increased surgical blood loss
Von wildebrand can affect
PTT but not PT
PT
Normal 11 to 14 seconds
5 7 10 factors are a part of it
Warfarin affects
PT time
VWD
If you just found out delay the surgery and get a hematology consult
VWD type 3 is severe
Treat by giving vWf and factor 8
Dextran has
Anticoagulant properties
Check for TRALI by
Sending a specimen to blood bank for antibody antigen cross match
All blood products carry
Infectious risks
Most common noninfectious adverse reaction from blood product transfusion
Transfusion related immunomodilatoon
Leukoreduction
Remove wbcs from red blood cells
Isovolumetric relaxation
After closure of aortic valve until mitral valve opens associates with lowest ventricular volume
Late stages of phase 4 of SA node action potential
ICaT
L type Calcium channels open and cause depolarization during
Phase 0 of SA node action potential
Slowest rate of conduction of all cardiac tissues is
AV node
Starling law compares
Cardiac output to LVEDP
If no other variables it should be linear, the heart pumps what it gets
Increase in contractility shifts frank starling curve to the
Left
Increase in afterload causes Frank starling curve to go
Down and to the right
Preload affects
Same line on frank starling curve
Afterload and contractility form new lines
Most myocardial oxygen consumption during
Isovolumetric contraction phase
Lambert Eaton affects both
Depolarizing and no depolarizing blockers and makes you more sensitive to them
