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SNRAObPedGer > OB Final Comprehensive > Flashcards

OB Final Comprehensive Flashcards

1
Q

EKG changes associated with aging

A

Left Ventricular Hypertrophy - Left axis deviation

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2
Q

Aging and Diastolic dysfunction: LV

A

LV is thicker and less compliant

Complete relaxation later in diastole

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3
Q

Aging and Diastolic dysfunction: Passive ventricular filling

A

Passive ventricular filling compromised

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4
Q

Aging and Diastolic dysfunction:atrial kick

A

Atrial kick becomes very important

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5
Q

Aging and PPVs

A

Greater sensitivity to PPV, hemorrhage, venodilators

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6
Q

Aging and perioperative pressure

A

Perioperative hypotension common

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7
Q

Changes with Aging Systolic

A

There is systolic hypertension

Progressive, gender independent

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8
Q

Systolic HTN due to

A

Due to fibrosis of elastic tissues

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9
Q

Ventricular wall tension

A

Raises ventricular wall tensions, workload

Causes hypertrophy of ventricle

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10
Q

It takes pts c/obstructive dz

A

twice as long to exhale: I:E is 1:2

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11
Q

ETCO2 look like

A

Shark fin

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12
Q

Obstructive airway shark pattern

A

Can be seen before actual attack

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13
Q

Shark fin CO2 waveform indicative of

A

Asthma, COPD, allergic reaction

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14
Q

MAC changes with aging

A

↓ 6% per decade of age over 40 yrs.

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15
Q

Calculating MAC reduction

A

Relative MAC or ED50 = 114% - 0.5* (age)

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16
Q

Treating Hypotension

A

Use direct acting vasopressors

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17
Q

For older adults, Therefore volume of distribution

for lipid soluble is _____

A

Greater for lipid soluble agents

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18
Q

For older adults, Therefore volume of distribution

for WATER soluble is _____

A

Decreased

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19
Q

For Older adults, Lipid soluble drugs take

A

longer to clear because of the larger volume of distribution

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20
Q

MAC of anesthetics is____in the elderly

A

↓

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21
Q

Most prominent pharmacokinetic effect of aging:

A

decrease in drug metabolism

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22
Q

Pharmacokinetics: Clearance and Vd

Metabolism

A

Decrease in clearance and increased volume of distribution at steady state

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23
Q

↓ intravascular volume leads to _____Vd of water soluble drugs = __________ = ___action = _____Dosage

A

↓ Vd for water soluble drugs = more drug remains available = ↑ action = need to ↓ dosage (i.e. Neuromuscular blockers)

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24
Q

Drug metabolism , there is

A

Modest reduction in phase I drug metabolism

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25
Q

Decreased liver mass

A

20-40% decrease in blood flow

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26
Q

Water soluble drugs

A

Decrease the dose

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27
Q

Lipid soluble drugs

A

Decrease the dose

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28
Q

Greater effects are seen when drugs encounter a

A

lower volume of distribution

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29
Q

Lipid soluble drugs take

A

longer to clear because of the larger volume of distribution

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30
Q

When choosing an anesthetic technique

A

Pay attention to doses (less is more = A minimal approach is more effective)

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31
Q

Need to ↓ dosage

A

(i.e. Neuromuscular blockers)

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32
Q

↑ sensitivity to

A

respiratory depression with non-narcotics

like benzodiazepines.

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33
Q

β adrenergic response in elderly

A

Marked ↓ in β adrenergic response in elderly

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34
Q

Activity of MAO and COMT

A

Increase

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35
Q

CBF in elder is

A

Decrease

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36
Q

Up regulation mechanisms

A

Depressed in elderly patients

Usually respond to ↓ in neurotransmitters

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37
Q

CSF volume is

A

Decreased in elderly, greater LA spread (reduce dose)

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38
Q

Epidural space volume is

A

Decrease

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39
Q

Law of laplace –> Cylinders Applies to ______, formula is

A

Applies to two situations Laplace
• Cyliners (veins/arteries)
• T = P X R

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40
Q

Law of laplace –> Spheres Applies to ______, formula is

A
  • Spheres (heart)

* T = (P X R)/2

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41
Q

Laplace, What does this mean?

A

At the same radius and internal pressure, a sphere has half the wall tension as a cylinder

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42
Q

La place, variable

A
  • T = tension in newtons per meter
  • P = pressure
  • R = radius of cylinder or sphere in meters
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43
Q

Elderly patients

A

Cannot compensate by increasing CO and HR. They

compensate by vasoconstriction

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44
Q

Elderly patients cannot? how do they compensate?

A

Cannot compensate by increasing CO and HR. They

compensate by vasoconstriction

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45
Q

Elderly and RV

A

↑ RV,

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46
Q

Elderly and TLC

A

stays the same TLC,

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47
Q

Elderly and RR

A

↑ respiratory rate

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48
Q

Elderly VC and FEV1

A

↓ VC and FEV1

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49
Q

•Heart rate changes are

A

usually blunted in elderly

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50
Q

HR changes Affects ability to

A

compensate for volatiles causing vasodilation

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51
Q

HTN and elderly

A

Aorta to arterioles stiffen = HTN

• Pressure must ↑ to stretch stiffer vessel

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52
Q

Vital signs changes

A

RR increase

BP increase

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53
Q

Max HR should =

A

220 – age

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54
Q

Max HR normally

A

↓ approximately 1 beat/min/year after 50 yo

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55
Q

Men and women both gain adipose tissue

A

Men gain 12kg of fat

• Men lose 8kg of muscle

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56
Q

Muscle and elderly

A

Reduction in muscle mass limits drug removal by muscle

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57
Q

Skeletal muscle mass

A

Progressive, generalized ↓ of skeletal muscle mass

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58
Q

Total body water and elderly

A

Total body water is ↓

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59
Q

ALbumin and elderly

A

↓ Albumin Production

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60
Q

Elderly and bony thorax

A

↓ of elasticity of bony thorax

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61
Q

ELderly and lung compliance

A

While lung compliance ↑ → air trapping

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62
Q

Elderly and alveolar gas surgace

A

↓ alveolar gas surface area

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63
Q

Elderly and nervous system response

A

• ↓ in nervous system response to hypoxemia and hypercarbia

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64
Q

Elderly and parenchymal compliance

A

↑ parenchymal compliance

• Takes longer to passively exhale

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65
Q

Vital capacity (VC) and elderly

A

↓ because of the ↓ in IC and the ↑ in residual

volume.

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66
Q

Elderly and dead space

A

Increase

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67
Q

Most dramatic change with aging is the

A

↑ in closing volume (CV) and closing capacity (CC) such
that in very old pts, closing capacity exceeds functional
residual capacity

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68
Q

• Responses to hypoxemia

A

Decrease

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69
Q

GFR and Cr clearance are

A

↓

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70
Q

• Renal mass is

A

↓

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71
Q

Renal blood flow

A

↓

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72
Q

Serum Cr

A

remains the same

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73
Q

Creatinine production is

A

↓

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74
Q

Explain GFR and muscle mass

A

GFR decreases (should really increase Cr but because there is decrease in muscle mass so less cr)

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75
Q

Parkinson Pathophysiology•

A

Adult onset degenerative disease of the CNS (extra pyramidal system), characterized by the loss of dopaminergic fibers normally present in the substantia nigra of the brain

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76
Q

The cause is unknown, and males between

A

The ages of 40 –70 are most typically afflicted.

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77
Q

Parkinson’s and autonomic dysfunction

A

Autonomic dysfunction (risk for aspiration)

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78
Q

Parkinson short

A

Decrease Dopamine in the basal ganglia

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79
Q

Parkinson’s and BP

A

• Labile blood pressure and cardiac dysrhythmias from the

disease and the treatment (levodopa, MAO inhibitors)

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80
Q

Medication exacerbations with levodopa

A

Be aware of possible orthostatic hypotension,

cardiac dysrhythmias associated with levodopa

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81
Q

Hemodynamics monitoring for Parkinsons : anesthetic management may need

A

Arterial line

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82
Q

Medication exacerbations with levodopa : Avoid those 2 meds

A

Avoid droperidol and metoclopramide

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83
Q

Phenothiazines, butyrophenones, and metoclopramide

A

exacerbate symptoms because antagonism of dopamine in the basal ganglia

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84
Q

Antagonism of dopamine in the basal ganglia 3 meds

A

Phenothiazines, butyrophenones, and metoclopramide

85
Q

Ketamine and Parkinson effect:

A

Exaggerated sympathetic response

86
Q

Anticholinergics and Parkinson

A

control the tremors

87
Q

Post Operative Cogniitive dysfunction

A

Increased risk from Bypass and Cataract Surgeries

10-60% Hip fractures

88
Q

Post op delirium Causes

A 
***Advanced Age a strong predictor***
• Polypharmacy
• Anticholinergics
• Intra op hypotension
• Perioperative Arterial Hypoxemia
• Opioids or benzodiazepines
• Central Cholinergic System always
89
Q

What is the most important risk factor for delirium?

A

Co existing dementia most important risk factor

90
Q

Causes of Delirium (PIA HAH)

A 
• Psycho active drugs
• Infections
• Alcohol withdrawal
• Hypoxemia
  Acute physical stress
• Hypotension
91
Q

Cortical Dementias

A

Alzheimer’s, Pick’s, Frontal Lobar degeneration

92
Q

Sub cortical Dementia

A

Parkinson’s, Huntington’s, Creutzfeldt Jacob

93
Q

Progeria also known as

A

Hutchinson-Gilford Syndrome

94
Q

Progeria is associated with

A

Premature Aging

95
Q

Genetic with Progeria

A

Autosomal Recessive Disorder

96
Q

Mean Survival for Progeria

A

13 years

97
Q

Progeria Death by

A

25 common

98
Q

Progeria difficult airway due to

A
  • Micrognathia

* Mandibular Hypoplasia

99
Q

Fetal shunt in the liver blood flow through the

A

Ductus venosus

100
Q

When Ductus Venosus closes remnant is

A

LIGAMENTUM VENOSUS

101
Q

When Ductus Arteriosus closes it becomes

A

LIGAMENTUM ARTERIOSUM

102
Q

DUCTUS venosus shunt is

A

Liver

103
Q

What are the 4 shunts

A

Ductus Venosus : Joins IVC blood, blood bypasses liver
Foramen Ovale : right atrium to Left atrium
Ductus Arteriosus: pulmonary artery to Aorta
Placenta

104
Q

What is the ratio of R to left contribution in fetal circulation

A

2:1 Right to left ration

Right is 2x LV output because of R to L shunt

105
Q

Functional closure of shunt happens

A

Immediately after birth

106
Q

Order of shunt

A 
Ductus venosus
IVC
Foramen Ovale
Ductus Arteriosus 
Umbilical arteries (return to placenta)
107
Q

1st stage pain comes from

A

T10-L1(L2) DERMATOMES

108
Q

2nd second stage pain is mediated by

A

THE SACRAL PLEXUS

T12-L1, S2-S4

109
Q

This nerve block provides sensory to perineum

A

The Pudental Block

110
Q

Not always completely anesthetized with epidural

A

The Pudental NERVE

111
Q

Dull, diffuse midline define

A

Visceral

112
Q

Sharp, pricking, throbbing,and/or burning sensation

A

Somatic

113
Q

1st stage of labor

A

onset of true labor until cervix is completely dilated (10 cm)

114
Q

2nd stage of labor

A

period after cervix dilated to 10cm until the baby is delivered.

115
Q

1st stage subdivisions

A

 Early labor phase: time of onset until cervix dilated
3cm
 Active labor phase: cervix dilates from 3cm to 7cm
 Transition phase: cervix dilates from 7cm to 10 cm

116
Q

1st stage Dull pain transmitters are the

Cervical dilation mediated by

A

unmyelinated C fibers

117
Q

Onset perineal pain is associated with

A

2nd stage.

118
Q

4 types of Placenta Previa

TPML

A

Total
Partial
Marginal
Low-lying placenta

119
Q

What is a TOTAL placenta previa?

A

Internal cervical OS covered completed by placenta

120
Q

What is a PARTIAL placenta previa>?

A

Internal cervical OS partially covered by placenta

121
Q

What is a MARGINAL placenta previa?

A

Edge of placenta at margin of internal os

122
Q

What is a low lying placenta?

A

Placenta is implanted in lower uterine segment –> Placental edge does not actually reach internal os but in close proximity to it

123
Q

VASA Previa is

A

rare condition where fetal vessels from placenta cross entrance of birth canal

124
Q

3 typical causes of Vasa previa

A

Bi-lobed placenta
Velamentous insertion of umbilicord
Succenturiate (accessory lobe)

125
Q

Placenta Accreta vera is

A

Adherence of basal plate of placenta directly to uterine myometrium without penetrating the decidua layer

126
Q

Placenta Accreta increta is

A

Chorionic villi invade myometrium

127
Q

Placenta accreta percreta is

A

Invasion through MYOMETRIUM into SEROSA and even adjacent ORGANS (bladder)

128
Q

Weight estimation (less than 8 )

A

Wg (kg) = 2 x age (years) + 9 if less than 8

129
Q

Weight estimation (more than 8 )

A

age (year) x 3

130
Q

Weight double by

A

6 months

131
Q

Pediatric tongue

A

larger in proportion to mouth

132
Q

Pediatric Epiglottis

A

Floppier more U shaped

133
Q

Vocal cord pediatric

A

Upward slant

134
Q

Larynx of pediatric

A

Anterior, superior and located between C2-C4

135
Q

Pediatric

A

Obligate Nose breathers

136
Q

Premie EBV

A

100

137
Q

Newborn EBV

A

90

138
Q

3 months to 1 year

A

80

139
Q

3 months to 1 year EBV

A

80

140
Q

1 year + EBV

A

75

141
Q

Adult EBV

A

65-75

142
Q

ABL

A

EBV (starting - final / starting)

143
Q

Distance for ETT

A

age (years) /2 +12
weight (kg)/5 + 12
ETT ID x 3

144
Q

Succinylcholine dose is

A

1-2mg/kg IV

4mg/kg IM

145
Q

Methohexital dose is

A

1-2mg/kg IV

146
Q

Propofol dose is

A

3mg /kg IV

147
Q

Ketamine IV

A

1mg/kg IV

148
Q

Etomidate

A

0.2-0.3 mkg/kg

149
Q

Ketamine IM

A

3-4 mg/kg

150
Q

Midazolam dose IV/IM

A

0.1mg/kg

151
Q

MAX MIDAZOLAM

A

12 MG

152
Q

Ketamine PO and rectal dose

A

6-10mg/kg

153
Q

Ketamine IM dose for GENERAL INDUCTION

A

6-10MG/KG

154
Q

Fentanyl dose is

A

1MCG/KG

155
Q

Morphine

A

0.1mg/kg

156
Q

Midazolam dose intranasal

A

0.2mg/kg

157
Q

Versed+ ketamine

A

0.4 and 4 mg for successful separation

158
Q

Airway position and levels

Airway cartilages

A

Airway Anterior , C2-C3

159
Q

Afferent signaling provided by

  1. Peripheral arterial
  2. Upper airway
  3. Chest wall
A

+ central brainstem chemoreceptors
+intrapulmonary receptors
+ muscle mechanoreceptors

160
Q

Nose, pharynx, larynx contain what?

what can they cause?

A

pressure, chemical, temperature, and flow receptors

 Can cause apnea, coughing, changes in ventilation

161
Q

Pulmonary receptors in lung parenchyma
What kind of receptors are they ? aka_______
Where are they located?
What do they balance?
These receptors may be involved and Cause what reflex?
That reflex Prevents what?

A

 Slowly adaption receptors (stretch receptors)
 In airway smooth muscle
 Balance of inspiration/expiration
 Might cause Hering-Breuer reflex
 Prevents overdistention of lungs via vagal stimulation/ and prevents COLLAPSE OF THE LUNGS

162
Q

Rapidly adapting receptors located where ?
Triggered by ___________
such as _____________

A

 Between airway epithelial
 Triggered by noxious stimuli
 Dust, smoke, histamine

163
Q

Parenchymal receptors located __________

next _________

A

Juxtacapillary receptors

• Next to alveolar blood vessels

164
Q

Parenchymal receptors respond to what? (3)

A

• Respond to hyperinflation, chemical stimuli in pulmn.

circ., interstitial congestion

165
Q

Chest wall Receptors are
Located in?
Sense changes in
Also have

A
  • Mechanoreceptors
  • In muscle spindle endings and tendons of resp. muscles
  • Sense change in length, tension, and movement
  • Joint properioreceptors
166
Q

Aryepiglottic fold (paired)

A

❑Epiglottis to arytenoids

167
Q

❑False cords

A

Vestibular folds (Thyroid cartilage to arytenoids)

168
Q

❑Interarytenoid fold (single)

A

Bridge

169
Q

❑True vocal cords

A

Thyroid cartilage to arytenoids

170
Q

Larynx position in kids

A

❑Higher @ C3-4
❑Higher in premature infants
❑Adult @ C4-5

171
Q 
The Larynx of Peds
One bone =
How many cartilages?
What are the single cartilages? 
Single:
Paired:
A

Hyoid
11
thyroid, cricoid, epiglottic
arytenoid, corniculate, cuneiform, triticeal

172
Q
  • Arytenoid rest on ______

* Suspended by

A

rest on top, connects with superoposterior part of cricoid cartilage

173
Q

To access high epidural assess

A

C6 , around thumb

174
Q

1st stage of labor mediated by what fibers

A

Unmyelinated C fibers

175
Q

Fetal blood flow

A 
Umbilical veins
Ductus venosus
Foramen Ovale
Ductus Arteriosus 
Umbilical Artery.
176
Q

Majority of blood flow to uterine

A

intervillous space

177
Q

Low fetal O2

A

Placental HIGH O2 consumption

Admixture of Oxygenated and Unoxygenated blood.

178
Q

3 parameters increased in the elderly (RESP)

A

Residual volume
FRC
Closing Capacity

179
Q

Elastic recoil of lung in the elderly

A

Loss of elastic recoil

180
Q

In the elderly , loss of elastic recoil leads to

A

Air trapping

181
Q

Why is there no change in TLC

A

Decreased VC
Increase RV
No net change

182
Q

Venous capacitance is______Which leads to

A

decreased (greater lability with BP in OR,

183
Q

Hypertrophy of LV is

A

Eccentric

184
Q

BP and aging

A

Increase BP

185
Q

Pulse pressure and aging

A

Increase

186
Q

Baroreceptor sensitivity is

A

DECREASE

187
Q

Parasympathetic Tone is _______therefore response to anticholinergic is ______

A

Decreased (decrease response to anticholinergic such as atropine)

188
Q

Onset of postop Cognitive dysfunction

A

Weeks to month after surgery

189
Q

Ease of identificiation delirium vs post op cog

A

Delirium easy

Post op Cog dys subtle and difficult to pinpoint

190
Q

Most significant risk factor for post op cog

A

Advanced age

191
Q

Neuraxial change in the elderly EPIDURAL why?

A

Greater spread of LA; reduction of epidural space

192
Q

Neuraxial change in the elderly SPINAL why?

A

Greater spread of LA; reduction of in CSF VOLUME

193
Q

Higher rate of false negative test dose with EPInephrine why?

A

Decrease beta receptor sensitivity

194
Q

Aldosterone sensitivity

A

decreased.

195
Q

Pseudocholinesterase and aging

A

decreased

196
Q

Larger VD for

A

Lipophillic drugs (may prolong their elimination)

197
Q

Smaller Vd for

A

Hydrophillic drugs

198
Q

Decrease CO prolongs circulation time which leads to

A

Faster Inhalation inductions

SLOWER IV INDUCTION

199
Q

Lung compliance and aging

A

Increase

200
Q

Chest wall compliance

A

Decrease

201
Q

Local anesthetics dose should be

A

Decreased

202
Q

Spinal anesthesia duration is

A

longer

203
Q

Airway protective reflexes in elderly are

A

Decreased

204
Q

Residual volume to lung capacity ration

A

Increased.

205
Q

No significant change in PharmoK. Profile of

A

NMB such as atracurium

206
Q

Uncuff formula

A

Age/ 4 + 4

207
Q

Cuff formul

A

Age/4 + 3

208
Q

Insertion distance

A

Age/2 + 12
Weight/5 + 12
ID x 3

SNRAObPedGer (25 decks)

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