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RUSVM Anesthesiology-Spring '18 > New Final Exam Material > Flashcards

New Final Exam Material Flashcards

1
Q

Aggressive fluid replacement, regular insulin therapy, dextrose and K supplementation are required before emergency anesthesia for which condition?

A

Diabetic ketoacidosis

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2
Q

When should surgery be scheduled for a diabetic patient?

A

First thing in the morning

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3
Q

How much insulin should be given on surgery morning?

A

1/2 the normal dose

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4
Q

What is your main concern before induction in terms of glucose?

A

Hypoglycemia- this is because you have fasted the patient and also given some insulin, so they may have a shortage of glucose in circulation

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5
Q

This class of drugs can cause hyperglycemia via inhibition of insulin release or stimulation of glucagon release.

A

Alpha-2 agonists: SHOULD NOT BE GIVEN TO DIABETIC PATIENT

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6
Q

How often should you check BG during surgery with a diabetic patient?

A

q. 30-60 minutes

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7
Q

What is your goal BG level during anesthesia for a diabetic patient?

A

150-250 mg/dl

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8
Q

T/F: In a patient with an insulinoma, you should give frequent glucose supplementation.

A

FALSE- your patient is used to low BG, don’t overdo it.

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9
Q

What is the main concern we worry about with an insulinoma patient?

A

Hypoglycemia

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10
Q

What are the two types of diabetes insipidus and what is the difference?

A

Central DI and Nephrogenic DI
Central: ADH deficiency
Nephrogenic: Kidney doesn’t respond to ADH

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11
Q

What is our main concern with DI?

A

Sodium content

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12
Q

Why is it important that you never restrict water from a DI patient?

A

They will become hypernatremic

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13
Q

What is an underlying disease that is often seen with hyperthyroid patients?

A

Renal disease is often unmasked when hyperthyroid patients are treated

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14
Q

What is the best drug that can be used to treat symptoms of a thyroid storm?

A

B-blocker- thyroid storm initiates catecholamine release

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15
Q

What are some drugs that should be avoided in hyperthyroid patients?

A

Ketamine, routine anticholinergics, ACP, and alpha-2 agonists

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16
Q

What medications should be used to manage HR in hyperthyroid patients?

A

Opioids and benzodiazepines

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17
Q

What is the primary concern for Addison’s pre-op?

A

Blood glucose and electrolytes

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18
Q

What drug should you avoid with Addison’s patients?

A

Etomidate- causes adrenocortical suppression

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19
Q

What is an important consideration post-op for Addison patients?

A

Restart chronic PO steroids ASAP

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20
Q

What are the common clinical issues for hyperadrenocorticism?

A

Hypertension, hypercoagulability, hepatomegaly, poor immune function and wound healing

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21
Q

What is a tumor of the adrenal medulla that releases epinephrine and norepinephrine?

A

Pheochromocytoma

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22
Q

What drug is used to stabilize BP and HR several weeks pre-op for pheocromocytoma removal?

A

Phenoxybenzamine

23
Q

What drugs should be avoided in patients with pheochromocytoma due to the tachycardia and vasoconstriciton effects?

A

Ketamine, Alpha-2 agonists and pre-anesthetic atropine

24
Q

What is an important side effect to remember once the pheochromocytoma has been removed?

A

Sudden drop in catecholamines- bradycardia and hypotension

25
Q

What is the main side effect of anesthesia on the kidneys?

A

Decrease GFR and RBF w/ dose-dependent fashion

26
Q

Why should ketamine be avoided in cats with renal failure?

A

This drug requires renal excretion

27
Q

Why should NSAIDs be avoided in renal failure patients?

A

Decrease prostaglandin production- renal ischemia

28
Q

What should be the maintained MAP for a renal failure patient intra-op?

A

70-80 mmHg

29
Q

What conditions need to be stabilized in a cat with urethral obstruction?

A

Hyperkalemia (Ca gluconate) and hypovolemia (isotonic IV fluids)

30
Q

What is the cushing reflex?

A

Severe increase ICP –> poor cerebral perfusion –> SNS response –> hypertension –> reflex bradycardia –> irregular breathing pattern

31
Q

What are your two treatment choices for decreasing ICP?

A

Mannitol and hypertonic saline

32
Q

T/F: Vomiting increases ICP

A

True- this is why opioids can be a problem with brain injury patients

33
Q

Which class of drugs are relatively safe for brain injuries (minimal CBF and ICP effects)?

A

Alpha-2 agonists

34
Q

Which injectable anesthetics are safe for ICP?

A

Propofol, etomidate and alfaxalone

35
Q

Which injectable anesthetic is contraindicated for increased ICP?

A

Ketamine- increases ICO and CBF

36
Q

T/F: All volatile anesthetics at >1 MAC increase CBF and ICP via cerebral vasodilation

A

TRUE

37
Q

Which anesthetic gas has the largest effect on ICP?

A

Halothane- don’t use for neuro patients

38
Q

When is mannitol given if you suspect increased ICP?

A

BEFORE induction

39
Q

What are some factors that increase anesthetic risk with liver disease patients?

A

Low albumin –> ascites
Decreased coag factors –> excessive hemorrhage
Decreased gluconeogenesis –> hypoglycemia
Increased ammonia –> encephalopathy

40
Q

Which drug class may worsen signs of hepatic encephalopathy?

A

Benzodiazepines

41
Q

Which fluids are not recommended for liver diseased patients?

A

LRS- lactate requires hepatic metabolism

42
Q

What drugs are contraindicated for liver disease patients?

A

ACP (inhibits platelet aggregation), alpha-2 agonists, barbiturates (protein bound), halothane (decreases hepatic blood flow), succinylcholine, guaifenesin

43
Q

What occurs with reperfusion of compromised tissue in the GI tract?

A

Release of inflammatory mediators –> vasodilation, decreased inotropy, ventricular arrhythmias

44
Q

What is the most common form of megaesophagus in dogs?

A

Acquired idiopathic

45
Q

What is the main concern of megaesophagus?

A

Regurgitation

46
Q

Why should you avoid prolonged fasting with megaesophagus patients?

A

These patients are bound to throw up, so if there is no food in the stomach-the gastric material will be more acidic and damage the esophagus

47
Q

Which induction agent should be used because of rapid induction?

A

Propofol

48
Q

What is the most common cause of hemoabdomen (not trauma related)?

A

Secondary to hemangiosarcoma

49
Q

Why should you not resuscitate a patient with a hemoabdomen to normal awake BP?

A

Can disrupt clots that have formed

50
Q

What cardiac dysfunction is commonly observed in patients with splenic disease?

A

Ventricular arrhythmias- LIDOCAINE

51
Q

What are some biochem abnormalities seen with GI foreign body?

A

Hypochloremic metabolic alkalosis

52
Q

What is a common concern with a GDV patient?

A

Hypotension

53
Q

Which drug can be used in mesenteric volvulus patients as a free radical scavenger?

A

Lidocaine

RUSVM Anesthesiology-Spring '18 (20 decks)

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