Openanesthesia Flashcards
The brain doesn’t need to herniate for diagnosis of
Brain death
In brain death usually have vasogenic and cytotoxic edema
Need
COMA
Apnea
No brain stem reflexes
TCA overdose
Check ECG
Give sodium bicarbonate if QRS duration > 100 ms
Carbon monoxide poisoning mainly due to
Cyanide
Give high flow oxygen
Needlestick injury
Mainly due to hepatitis B
Central line infection risk lowered with
Single linen catheter
Using chlorhexidine daily
Use of single lumen catheters
Routine dressing changes does not lower the risk
Clonidine
Alpha 2 agonist
Prolongs sensory block when added to local anesthetics
Liocaine vs lidocaine with epi
Duration to onset
Delayed when you give epi bc it lowers the pH and thus more ionized molecules
Lumbar plexus comes from
Ventral primary rami of L1-L4 with contribution from T12-L5
Nitroglycerin more of a
Venodilator than arterial dilation
Sodium nitroprusside leads to cyanide toxicity leading to
Metabolic acidosis
Desflurane less at higher altitude because
Partial pressure goes down of desflurane so have to give more
Patent duct is arteriosus
Post procedure closure can injure recurrent laryngeal nerve leading to hoarseness
From pulmonary artery to aorta
Minimize ventilator associated pneumonia by putting patient
Supine and head up
ANOVA vs T test
2 or more means vs just 2 means. Paired T test looks at the same group
Sensory above vocal cords which does tounge and epiglottis
Superior branch of internal laryngeal nerve
Glossopharyngeal nerve innervates the pharynx
Autonomic reflexives most likely if lesion is above which dermatome
T7
Headache dizzy nausea at what percent of carboxyhemoglobin concentration
Above 15%
HIT
Igg to heparin platelet factor 4 complex
Don’t give Coumadin as it can cause necrosis
Can give fondaparinux
LMWH vs UFH
LMWH is more efficious with less side effects
Amiodarone works by prolonging
Repolarization
Made side effects are Bradycardia and hypotension
Blocks calcium and potassium channels
Tirofiban
Glycoprotein 2b/3a inhibition
Hctz works in the
Distal convoluted tubule and blocks sodium chloride transporter and causes increased calcium
Severe sepsis
MAP<70
Systolic<90
SIRS
Temp heart rate respiratory rate WBC count
LMWH heparin preferentially inhibits
Factor 10a
Vitamin K epoxside inhibition is done by
Warfarin
Only abductor of vocal cords
Posterior cricoarytenoid innervated by recurrent laryngeal nerve
Salicylate toxicity
Metabolic acidosis with respiratory compensation
Causes of postherpetic neuralgia
Age > 60
Severe acute pain
Female
Post ganglionic sympathetic which receptor
Norepinephrine. Pre ganglionic is acetylcholine release as neurotransmitter
Fat embolism
Hypoxia Increased a a gradient Tachycardia Hypotension Petechial rash on upper body
HOCM basics
Avoid tachycardia increases contractolity
Decrease after load/preload
Keep left ventricle with blood to avoid outlet obstruction
As temp of blood decreases
Solubility increases and partial pressure of gases decrease
Contraindication of intraaortic balloon pump
Aortic regurgitation
Peripheral vascular disease
Aortic dissection
Balloon inflates during diastole
Largest branch of lumbar plexus =
Femoral nerve
Lumbar plexus block usually spares which nerve
Sciatic
In central diabetes inspidus
Maintain euvolemia and check serial sodium levels
Phenobarbital acts on hepatic enzymes by
Increasing their action
Cerebral venous sinus thrombosis
Heparin first line
If that doesn’t work go to endovascular therapy
Neurohypophysis
Sure of damage leading to central diabetes insipidus
Compression hematoma can be seen 24 hours after
Thyroidectomy
Treatment for organophosphate poisoning
Pralidoxime and atropine which crosses BBB
Narrowest part of pediatric airway is the
Glottis opening
Larynx position in adults is at
C4-C5
C3-C4 in infants
Protein kinase G decreases release of which ion?
Intercellular calcium
Blood volume of child over 12 months old
70-75 ml/kg
65-70 ml/kg for an adult male
Phrenic nerve stimulators improve
Atelectasis
Initial precedex first three minutes affect on hr, cardiac output, blood pressure
Bp increases, cardiac output and hr decrease
Precedex is much more alpha2 than clonidine
Acute herpes zoster most affects
Thoracic spinal nerve roots first than ophthalmic division of V1 distribution around eye
Carbon dioxide cylinder color
Nitrogen cylinder color
Gray
Black
Epiglottis induction
Maintain spontaneous ventilation and do mask induction with Sevoflurane
New onset a fib with uncontrolled heart rate is an
Active cardiac condition leading to delay of surgery
Neuromuscular blockade in the icu
Polyneuropathy and myopathy increase, might help with severe ARDS
Garlic causes
Inhibition of platelet aggregation
So does ginseng
Should stop 7 days before surgery
Cyanide toxicity from nitroprusside is due to
Inactivation of cytochrome oxidase
During inspiration with tamponade there is increased right sided filling
Causing intraventricular septum to shift to left side of heart
During pregnancy
FRC decreases
Vital capacity stays the same
In pregnancy before induction
Preoxygenate for 3 minutes
Decreased MAC
More tissue edema so will likely use smaller endotracheal tube. Also more difficult mask ventilation
High magnesium makes you have more sensitivity to
Nondepolarizing and depolarizing muscle relaxants
Chest compressions
Depth of 2 inches
Rotate every 2 minutes, 100 compressions per minute
MRSA rates are decreased by
Daily chlorohexidine usage
FENa of 3% of greater leads to
Acute tubular necrosis
BUN: creatine is a ratio of 15:1 or less
SID if less than 40 =
Acidosis
Phase 2 block with succ
> 4mg/kg is given
Hypercalcemia =
Short QT interval
PEEP affect on afterload and preload
Decrease RV preload and increase RV afterload
LV collapse is specific
For pericardial tamponade
Do t give succinylcholine to patient with guillemots barre because it can lead to
Life threatening hyperkalemiA
In pregnancy minute ventilation goes up
50% in first trimester
Patients with mylomeningocele are most likely to have
Chiari malformations
Treatment of HIT
Direct coagulation inhibitor
HIT usually seen at
5-10 days. Before this the drop in platelet count likely multifacyitial and not due to HIT
Intraortic balloon pump inflates at
Diastole
T wave
For A fib DC cardioversion and SVT
Synchronized biphasic at 100J
Chloroprocaine is broken down by
Plasma Esterase
MEP most affected by
Volatile anesthetics
St Johns Wart
MAO inhibitor
Supraclabicular block affects which dermatome
C5-T1
The block occurs at the origin of the divisions
Etomidate inhibits
11 beta hydroxylase
Patient who smokes may have a carboxyhemoglobin
8-10%
Normal is 1-3%
MRSA pneumonia is treated with
Vancomycin
Window to be in A fib is
48 hours. After you need to either cardiovert or TEE
C wave due to
Tricuspid bulging
A wave in CVP is during
Diastole
Light anesthesia
More oxygen is consumed so mixed venous goes Down
Portal triad
Hepatic artery, portal vein, biliary duct
Blood flow In liver is not the same as oxygen delivery
Percentage of oxygen delivery to liver via hepatic artery
50%
Portal blood is deoxygenated so need more to flow to match oxygen of hepatic artery
02 content equation
1.39 x hgb x sat 02 + pressure 02 x 0.003
Hepatomegaly is seen with
CHF
Leukemia
Renal failure
Not in hypovemic shock
Liver can store blood in
High volume states
Liver cirrhosis causes dysfunctional cells to
Acquire vasoconstrictor phenotype this increase endothelin, thrombocytes, norepinephrine
Nitric oxide is most important vasodilator and is decreased
Liver failure see decrease in
Factor 7, decrease in albumin,
are
Increase in Ammonia levels
In fasting state liver breaks down glycogen stored in hepatocytes
Broken to form glucose
Creatinine is used in the
MELD score but not child pugh
GGT is elevated in
Biliary tract disease
ALT is a marker of hepatocellat injury in the
Liver
PT/INR
Synthetic function of the liver
Liver failure is associated with
Hypoglycemia bc liver metabolizes insulin so now you have too much
Liver has no effect
On factor 8 levels
PBC and primary sclerosing cholangitis increase
Direct bilirubin
Wilson’s disease = too much copper
Treat with penicillamine
In normal liver ammonia is converted to
Urea and then excreted from urine
Lactulose increases the acidity of the colon
If acidified ammonia turns into ammonium ion which cant go into the blood and is excreted through the stool
Sepsis increases morphine clearance due to
Elevated cardiac output
Benzodiazepines are metabolized by liver without need for
Blood flow
Macrolides like erythromycin are inducers of p450 3a4 which also biotransforms
Midazolam
P450 2D6 metabolizes
Codeine
GFR =
RBF x filtration fraction
125 ml/min normal GFR
Normal oxygen extraction in the body is highest at the
Renal medulla at 79%
Sodium reabsorption in distal nephron is Mediated directly by
Aldosterone
Renin converts
Angiotensinogen to angiotensin 1
Low perfusion to afferent arteriole drives it
Vasopressin acts in the
Collecting duct
Stage 3 renal failure
Commencement of renal replacement therapy
Stage 2 if creatinine doubles
RBF represents
25% of cardiac output
Cimetidine decreases tubular secretion of
Creatinine
How many of the kidneys nephrons need to be affected to see rise in creatinine
50%
Angiotensinogen is produced in the
Liver
50-70% of renal vasodilation is from
Nitric oxide
Angiotensinogen 2 causes both afferebt and efferent
Vasoconstriction and decreased blood flow. GFR is largely preserved
ANP is released by
Atrial myocytes in response to atrial distension and
Dilates afferent arteriole, constricts efferent arteriole and increases RBF and GFR
Kidneys can Control amount of
Bicarbonate reabsorbed and eliminate hydrogen ions,
In respiratory alkalosis excrete more bicarbonate bc you are alkalotic
Cause of non anion gap acidosis
Diarrhea, renal tubular acidosis, acetazolamide, spirnolactone
Prolonged vomiting or suction on gastric tube =
Metabolic alkalosis
Normal SID =
40-44
Non anion gap metabolic acidosis
Aspirin ingestion
Salicylate toxicity
Metabolic acidosis and respiratory alkalosis
Propofol is made into inactive metabolites in the liver and
Unchanged in the kidneys
Normeperidine is an active metabolite of
Meperidine and can accumulate in renal failure leading to seizures
H2 receptor antagonists are excreted by the
Kidneys
Vecuronium
Primarily eliminated by biliary clearance
Cisatacurium
Degraded by Hoffman elimination
Atracurium breakdown
Degradation by non specific esterases
Which morohine metabolite responsible for delayed respiratory depression
Morphine 6 glucoronide
Mannitol is renal protective
In cadaveric kidney transplant recipient
Eplerenon
Aldosterone antagonist
NSAIDs lead to
Prerenal azotemia
Fenoldopam is a selective D1 agonist
10 times more potent than dopamine
Loop diuretics work at
Thick ascending limb
Acetazolamide inhibits
Carbonic anhydrase
Thiazides work at
distal convoluted tubule
With uremia
See hyperphosphatemia, hyperkalemia, hypermagnesium
Uremia means
Urine in the blood
See asterixis and hiccups
BUN above 70
Treat with dialysis
Max amplitude on TEG looks at
Clot strength which is a product of platelets and fibrinogen
Venous embolus leads to large increase in
Dead space
TAP block inferior border of triangle of petit
Iliac crest
Anterior is the external oblique muscle
T5 spinous process
Is right next to the T6 transverse process
Posterior approach to sciatic nerve block
PSIS, sacral hiatus, and greater trochanter
One anterior and two
Posterior spinal arteries
Anterior 2/3 of spinal cord done by artery of adamkewitz
Distal aortic cross clamp can lead to spinal cord ischemia and paraplegia
Highest sensitivity to detect a pheochromovytoma
Plasma metanephrines
Decrease catacholamines in peripheral nerves using
Metyrosine
Stops conversion of tyrosine to dips by blocking tyrosine hydroxylase
Max desirable cuff pressure of tracheostomy cuff is
25 mm Hg
Too high causes mucosal edema too low causes aspiration
Chang in pulmonary with aging
Decreased elastic recoil thus higher residual volumes
Post tonsillectomy hemorrhages usually occur within first
6 hours
Ach binds to which subunit of the nicotinic AcH receptor on the skeletal muscle
Alpha
Motor nerve depolarization to voltage gated calcium channel to release of Ach to ligand gated sodium channels to
Muscle depolarization
Most ACHR are at
Neuromuscular junction
StrOke, burns, prolonged icu stay increases leads to upregulayion of receptors
Renal failure does not increase number of Ach receptors
Ach at the neuromuscular junction is terminated by
Break down by acetylcholinesterase
NACH receptors have 5 subunits. Two molecules of Ach bind to two alpha subunits
This leads to a conformational change that allows sodium influx and potassium efflux
It will not open if only one Ach binds the receptor
Atropine inhibits
Muscarinic acetylcholine receptors
Which structure of skeletal muscle does not change in length as muscle contracts
A band
Which subunit is found in endplate nmj but not extrajunctional receptors
E
Resting potential of skeletal muscle cell
-90 mV
Neurons is usually -70mV
Cardiac pacemaker cells is -50
Tetanus leads to
Botulism toxin acts peripherally to induce flaccid paralysis secondary to inhibition of Ach release at the NMJ
Ach is synthesized from
Acetyl coA and choline in motor neurons by Avril of choline acetyl transverse
Ach binds to
Presynaptic nAchRs
NMDBs block both presynaptic and postsynaptic receptors
Succinylcholine side effects
Myalgia
Increased IOP
Anaphylaxis
Less potent neuromuscular blockers like rocirlnium act
Faster duration of action
Benzylisoquinolinium NMB =
Cisatracurium, atracurium, mivacurium
Atracurium causes
Histamine release
When drugs with different duration of actions are used for maintenance of neuromuscular blockade
Recovery will follow the pattern of the drug that was initially administered
If you give rocuronium then pancuronium, it will only go the length of roc bc you gave it first
Phase 2 blocks of succ acts like NMDBs
Causes post tetanic potentiation
Fasiculations with succinylcholine
Binds to presynaptic AchRs stimulating repetitive during and Ach release from motor nerve terminals, fasiculations
TOF does not require a
Baseline measurement
TOF ratio 0.7
75% of Achrs are still blocked
DBS is better than TOF
Because it is easier to detect fade
Giving intubation dose of succinylcholine to patient with dibucaine of 20 how long will they stay paralyzed
4 hours
Dibucaine is a
Local anesthetic
Lambert Eaton
Anti body against presynaptic voltage gated calcium channels, normal number of Ach receptors, proximal muscle weakness that gets better with exercise, sensitive to succ and NMDBs
In patients with myasthenia gravis
Avoid magnesium, calcium channel blockers or aminoglycosides
Myasthenia crisis will improve when you give
Edrophonium
Duchenne muscular dystrophy
X linked recessive,
Mannitol decreases
Time to peak effect
Water content of brain
45-60 minutes
Most sensitive indicator of uterine rupture
Fetal Bradycardia
Methotrexate is very
Teratogenic
Neuraxial anesthesia can be done on
Patients taking ASA or NSAIDS
Tumor lysis syndrome
At beginning of treatment can cause electrolyte shifts
Dorsal part of foot
Superficial peroneal nerve
Web space of 1st and 2nd space is done with deep peroneal
Obturator nerve is far
From fascia Iliaca injection point
ASIS and pubic tubercle are landmarks for
Fascia iliaca block
Anaphylaxis
High peak pressure
Hypotension
Blotchy marks on body
Nitroglycerin increases myocardial oxygen demand by
Lowering BP and increasing HR
Complication of removal of aicd lead or pacemaker leads is
Pericardial collapse and hypotension
Treat with thoractomy and drain pericardial effusion
1:1000 =
1 mg/ml
1:200000
= 1/1000/200000 =
0.005 mg/ml
Radius is most important to fluid flow according to
Pousielle s law
Radius is most important to fluid flow according to
Pousielle s law
Most common cause of bleeding in critically ill pts is
Peptic ulcer
1% lidocaine is
Concentration of 1000 mg/100 ml
TAP block
Sensory block of T10-L1
Propofol infusion syndrome
Acute bradycardia and metabolic acidosis with
All pleural punctures do not turn into
Pneumothorax
Opioid side effects
Biliary tract spasm
Nausea
Urinary retention
dose dependent bradycardia
Opioid side effects
Biliary tract spasm
Nausea
Urinary retention dose dependent bradycardia
Morphine codeine meperidine
Histamine release
Methtlnaltrexone
Peripheral opioid receptor antagonist
For opioid induced constipation
Opioid side effects
Biliary tract spasm
Nausea
Urinary retention dose dependent bradycardia
Methtlnaltrexone
Peripheral opioid receptor antagonist
Context sensitive half time
Time required for a 50% reduction in the plasma concentration of a drug after constant infusion
Onset of
Fentanyl
Morphine
Dilaudid
1-3
5-10
5-10
Minutes
Hydromorphone and meperidine can lead to
Seizures
Coedine is metabolized by
Cytochrome p4502D6 and undergoes demethylation to morphine
Methadone
U agonist
NMDA antagonist
Methadone may prolong QT
Tramadol
Reuptaje of norepinephrine/serotonin
Lower incidence of respiratory depression compared to U agonists
Don’t give meperidine to patients on
MaoIs
If you give neuraxial morphine ASA recommends monitoring for
24 hrs
Termination of effects of iv anesthetics is through
Redistribution
Termination of effects of iv anesthetics is through
Redistribution
Benzos enhance binding of
GABA to its receptor
Flumszinil works by
Competive inhibition
Flumazinil works with slower half life than midazolam
Might need to give flumazjnil again if resedated
Ach binds to the
Alpha subunits of the Ach receptor
Ach is released from storage vesicles after action potential and bind receptors on
Post junctional membrane
Muscle action potential after enough Ach is bound
Sch alsobinfs to
Alpha subunit of Ach receptor
Succ side effects
Myalgias
Increases intraoccular pressure
Psuedocholinesterase is produced in the
Liver
Rocironium and vecuronium mainly removes by
Biliary excretion
Mivacurium breakdown
Atracurium breakdown
Plasma esterases
Hoffman elimination
Pancuronium side effect
Tachycardia
Hypermagnesium
Hypercalcemia
Hypothermia
Prolong neuromuscular blockade
Ulnar nerve
Adductor pollicus
Facial nerve muscular twitch
Orbicularis ovuli
Esters are broken down by
Psuedocholinesterase found in plasma
Amides undergo bio transformation mainly in the liver
Esters are more likely to produce allergic reactions than slides bc of
PABA group
Higher the solubility or local anesthetic the greater the
Potency
More protein binding of local anesthetic =
Greater duration of action
Local anesthetic are
Weak bases
Most are unionized at pH 7.4
Most systemic absorption
Intercostal/caudal/epidural
First signs of local anesthetic toxicity
CNS like light headed tinnitus prrioral numbness
Don’t use concentrations of bupivicaine above
0.5%
Seizures from local anesthetic toxicity
Give diazepam 0.1 mg/kg
Give intralipid
Benzocaine/prilocaine
Methemoglobinemia
Prilocaine
O touludine
Preload helps contractility
Frank starling curve
Initropic activity
Increase cardiac output by increasing contractility
Amrinone infusion aead to
Thrombocytopenia
PDE inhibitors lead to
Inotropy and lusitropy
High epinephrine dosage is mainly
Alpha
Isoproterenol
Potent beta 1
Beta 2 agonist
Digitalis has very narrow
Therapeutic window
Nitroglycerin acts on NO increasing cGMP
Improves coronary perfusion with a reduction in myocardial oxygen consumption
Hydralazine relaxes
Smooth muscle
Takes 15 minutes to act
Affects arteriole more than veins
Low dose dopamine is NOT
Protective for the gut or acute kidney injury
Protein and lipid catabolism seen in
Burn patients
If von wildebrands and still have bleeding after giving DDAVP then give
Cryoprecipitate
Need to watch preterm infants for 24 hr after anesthesia due to risk of
Apnea
Give caffeine and it helps
Intermittent p waves with no change in or length
Mobitz type 2
Cancel surgery
Tibial nerve
Plantar flexion at ankle and foot inversion
Guillan Barre
TLC is lower
Restrictive lung disease
Fascia iliaca block for
Postop analgesia anterior and lateral thigh
In lambert Eaton you are more sensitive to depolarizing and
NMDBs
Pulmonary blood flow can improve by
Maintaining spontaneous ventilation this lowering intrathoracic pressure
Lidocaine spinal acts fast bc the pH is very close to the
Maternal pH
Dypiridamole is a
PDE inhibitor
IV fentanyl compared to morphine iv ratio
Fentanyl is a 100 times more potent
Lumbar facet arthropathy is diagnosed with medial branch blocks
Blocks
Give lidocaine 1.5 mg/kg
If more than 6 pvcs per minute start to show up
Biventricular pacing recommended if EF
Less than 35%
Most important factor determining Fa/Fi ratio is
Blood gas partition coefficient
Not alveolar ventilation
Cardioplegia during bypass electrolyte abnormality
Hyperkalemia
Therapeutic range of magnesium is
5-9
Respiratory paralysis at 15
Loss of deep tendon reflexes at 12
If you give too much mag give
Calcium gluconate
Clearance increases
Vd decrease with
Burns
Metabolic CMR02 decreases
50% with burst suppression
Etomidate
Increases seizure duration
Brain dead patients
Thyroxine, corticosteroids, vasopressin
Put anesthetic equipment passed the
5 gauss line
Peripheral alpha 2 from precedex causes
Transient increase in BP
Increased NO seen in
Septic shock
Lowering heart rate is best to decrease
Myocardial oxygen demand
Insensible fluid losses can occur with use of
Radiant heat warmers
Most anesthesiologists get radiation on the
Head
As low as reasonably achievable for
Radiation exposure
Radiation exposure
1/Distance ^ 2
Contraindications to MRI
ICD Pacemaker Cocear implant Ferrous implant Metal/bullet fragments
Pressure control ventilation leads to higher
Oxygenation especially in the morbidly obese
Anaphylaxis happens from reexposure to an
Antigen which causes immune mediated IgE receptor aggregation
Treatment of thyroid storm
Propranolol
Sensation to base of tounge
Internal branch of superior laryngeal nerve
10% of maternal cardiac output is given to
Uterus at term
PTU
Stops conversion of T4 to T3
Ketorolac analgesic effect from
Inhibition of cyclooxygenase
Cox2
Pain
Inflammation
Fever
What nerve block will block gag reflex
Lingual nerve
Magnesium inhibits release of
Ach at neuromuscular junction
In stellate ganglion block
Get sympathetic response to temp of arm goes up
IV regular insulin acts at peak effect within 10-15 minutes and has a duration of action
Of 45 minutes
For carotid endarterectomy need
Deep and superficial cervical plexus blocked
Deflation of tourniquet leads to decrease in
MAP and CVP
Most ICDs turn off with
Magnet
If getting asystolic with mono polar cautery switch to bipolar
Reduced total lung capacity seen with
Myasthenia gravis
Dypiridamole
PDE inhibitor
pPV see increase in
SVR
Cryoprecipitate contains
Fibrinogen
Factor 8
Factorv13
VwF
Quadricuspid aortic valve
Most common murmur is AI with mitral regurg
Cell salvage blood
No heparin plts etc
Hematocrit 50-80%
Can use the blood within 6 hrs
After someone gets 2 units whole blood uncrossmatched O-
Keep giving this blood due to risk of intravascular hemolysis frim
Donor RBCs mixed with recipient serum =
Crossmatch
Decreased volume of distribution increases
Plasma concentration of medications
Thus you need less drug as seen in cardiomyopathy
Inferior angle of scapula
T7
Mitral regurgitation gets better through use of
LVAD
Midesopheagal bicaval view
TEE
First step in drowned apnic patient
Jaw thrust with initiation of rescue breaths
First physiologic response to drowning is
Breath holding
Guillan Barre don’t use
Succinylcholine
Descending bellow ventilators have a disadvantage in that
You can’t tell if there is a leak bc they always descend
Neostigmine blocks
Plasma cholinesterase
Peripheral cholinergic agonist
Metochlopramide
Metochlopramide
Dopamine receptor antagonist
At what time of pregnancy does airway get worse
12 weeks
Increases in PVR are seen with
Hypoxia
Increased tidal volumes
Normal DLCO with
Morbid obesity
Reduction in intravascular volume seen in
Preeclampsia
Want to maintain SVR in tamponade to keep it
Tight
C section is a risk factor for
Amniotic fluid embolus
TURP syndrome occurs after
Rapid large volume absorption of hypotonic bladder irrigation
Leading to hyperglycemia hyponatremia hypoosmolality
Stopping gabapentin aprubtly can lead to
Seizures
Less resistance in
Non circle system than in circle system bc the circle system uses valves
Can reduce rates of postoperative cognitive decline by using a
BIS monitor
Beta agonist causes shift
Intracellular of potassium ions
Hypokalemia can lead to loss of
T waves
Mild hypoxia in patients undergoing one lung ventilation
Give PEEP to dependent lung
Infants
Lower FRC than adults
Quicker inhalation induction due to higher cardiac output
Left mainstem bronchus is much longer than the
Right- making it easier to put in
Ascending below expiration occurs as it goes
Up!!
Descending bellow is opposite
Alfentanyl acts fast bc of high
Unionized fraction
Carisoprodol is
SOMA
Has high abuse potential and is a skeletal muscle relaxant
Botox for
Chronic migraines
Botulism toxin blocks
Presynaptic release of Ach
YAG laser associated with
Venous air embolus
Capacity
Patient informed enough to make medical decisions
Posterior tibial nerve branches
Medial and lateral plantar nerves, medial calcaneal nerve. Does the heel of the foot
Femoral nerve is a branch of the
Lumbar plexus
Normal aortic valve area is
2.5-3.5 cm
UFH 10000 units SC q12 is for
Therapeutic anticoagilation of pregnant female post DVT
Femoral nerve =
Knee extension
Dorsum of foot
Superficial fibular nerve
Sciatic nerve block does not get the
Saphenous
Popliteal triangle
Semibranosuse
Biceps femoris
Popliteal crease are the landmarks
The popliteal nerve is more superficial than distal
Femur bone
Leviphed incrsss bp
And cardiac output
Vertebral arteries arise from the
Subclavians
If someone is taking oxycodone regularly you expect to see
Oxycodone and oxymorphone in the UDS
Tet spell
Right to left shiny deoxygenated
Halothane is
Soluble
Tip of tounge pain after LMA due to damage to
Lingual nerve
IJ venous cannulation can mess up
Vertebra artery
More likely reaction to blood from
Multiparous and those who have been exposed to getting blood before
Y wave
Tricuspid valve opens
A wave
Right atrial contraction
LVEDV biggest right after
QRS. Then systole begins after QRS
Hold antiepileptics prior to
Awake craniotomy
ARDS reduced compliance due to
Alveoli de-recruitment and collapse
Overtime stored levels of 2-3 dpg go down
And oxygen affinity for hgb goes up
SI joint dysfunction
Patrick’s test
Ideal point to measure CVP is at
Tricuspid valve
Central venous catheter
Pulmonary artery catheter
Right side of heart
Left side of heart
Check valves
Allow for unidirectional flow of gas
How much 02 required for N20 to flow
Need at least 30 psi
Max N20
25 ppm
Suction to the
Tip of the endotracheal tube
Highest volatile anesthetic trace concentration with N20 is
0.5 ppm
If lose tooth during intubation
Get radiographs
C02 laser can damage
Cornea
Can use regular plastic glasses
Pressure drop across a obstruction to find peak pressure is
4V squared
Chamber paced
First letter
Use if high gas flows
Will not take away trace volatile anesthetic
NdYAG laser
Penetrates tissue the most
Max Fi02 with NC
0.45
Deoxygenated hgb 660 nm
Worst is blue nail polish
Minimum macroshock to elicit v fib
100 mA
Line isolation monitor does not cause
Micro or macro shock
Alarms when grounding occurs in the OR
Too narrow or loose BP cuff will be
Falsely elevated
625 L 2000 psi
02 cylinder
If vaporizer tipped over
Can use after 30 min with dial turned on
Microshock is
Close to heart
Macroshock around body
Lowering the I to E ratio gives more
Inspiratory time and lowers peak pressures
Laminar flow is dependent on
Viscosity
High pressure anestgesia workstation
From oxygen cylinder to oxygen pressure regulator
V5 lead placement
Anterior axillary line midclavicular space
Pipeline source to anesthesia machine
Diameter index safety system
Calcium hydroxide is better than
Soda lime
Compound A not formed
CO is not formed
Widened pulse pressure seen with
Underdamped on a line
Plantar surface of medial forefoot
Posterior tibial nerve
Spontaneous type A
APL mask closer to mask
In type D fresh gas inlet closest to mask
Absolute criteria machine is obsolete
Abscence of vaporizer interlock system
Abscence of fail safe device
Abscence pin index safety system
Atracurium or mivacurium can cause
Histamine induced hypotension
Use of topical beta blockers can result in
Exacerbated hypotension
Defasiculatimg dose does not help
Polyuria polydypsia seen in
Hypercalcemia
Radiation is biggest cause of intraop hypothermia
Uniate skin surface rewarming is best
Don’t give hemabate to patient with
Pulmonary hypertension
Uptake of local anesthetic
Intercostal Caudal Lumbar Brachial plexus Peripheral nerve
Dobutamine
Inotrope and vasodilator
Supraclavicular block
Needle insertion 1cm superior to midpoint of clavicle
Causes phrenic Horner syndrome
High frequency ventilation
Don’t set tidal volume
Set Fi02
Frequency
Amplitude
Inspiratory time
Iv labetalol 1 to 7 alpha to beta
First line for HTN in preeclampsia along with hydralazine
Median nerve is more superior to
Ulnar nerve
Midhumeral fracture
Radial nerve
Pudendal nerve
Distal two thirds of vagina and anus
Biggest factor for PDPH is
Younger age
Initiate chest compressions on neonate is HR<50
When born
Lowest hgb in neonate st 8-12 weeks lowest value is
8
Increased preload increases MAP due to more intravascular volume from
Mannitol
Isoflurane maintains
Hepatic blood flow
V wave in CVP
Right atrium filling
Y descent is
Tricuspid valve opening and filling right ventricle
V wave
Right ventricle fillling
Large V wave resembles tricuspid regurgitation
Thoracoabdinal aneurysm requires aorta crossclamp
Can’t move lower extremities due to anterior spinal artery syndrome
Umbilical artery pH
7.26 is normal
Pc02 50
P02 20
BE -3
Anterior ischemic optic neuropathy involves
Optic disk
PION normal fundiscopuc exam and usually happens right after waking up
Left side double lumen tube
Bronchial lumen in left mainstem and tracheal above Carina
Proximal left upper lobe bronchus should not be seen after
Left side double lumen tube is put in
Right to left leading Shunt from tricuspid atresia slows
Inhalational induction
Closing capacity
Volume of air at which alveoli collapse increases with age
Compliance increases with age as well
Lambert Eaton syndrome
Proximal limb weakness
Don’t use neuromuscular blockers
HOCM
Slow HR
Adequate SVR
Maintain preload
Maintain myocardial contractility
Max amplitude on TEG represents clot strength
Strength
Transient neurological syndrome
Dose and concentration of lidocaine don’t matter
NSAIDs are best treatment
Lower pKa =
Faster onset of local anesthetic block
Baclofen
GABAb agonist
Benzos work at GABAa receptors
Crps type 2
Traumatic nerve lesion present
Ventricular wall thickness affects
Myocardial wall tension from LaPlace law
Decrease in uteroplacental blood flow due to
Uterine contractions
Can use caudal block for
Circumcision
Crps type 2
Get swearing in distribution
Known injury
Motor manifestations can occur over time
Parkinson’s
Tremor
Rigidity
Bradykinesia
Tidal volume increases in
Pregnancy
Total lung capacity and vital capacity stay the same
Closing capacity remains unchanged
Stable monomorphic VTach can give
IV amiodarone
Give one defibrillation shock for
V fib
Compare association of two categorical variables with
Chi square test
Neurogenic pulmonary edema from closed head injury increases both
Systemic and pulmonary circulations
Give octreotide during surgery in patient with
Carcinoid syndrome
Haldol is the agent of choice to treat
Delirium
Carbamazepine
Sodium channel blocker
Before doing long term ablative procedure do a
Local anesthetic gasserion ganglion block
For anterograde cardioplegia need a good
Aortic valve
Can’t do anterograde with aortic insuffiency must be retrograde
TRALI
Leukopenia and fever are seen
Interrogate pacemaker within 12 months of
Surgery
Nerve injured in lithotomy position
Common peroneal
Contraindications to MRI
Cochleae implant
Spinal cord stimulator
Aneurysm clip
Mechanical heart valve is not
LVEDP increases with
Age
Ginseng can lead to
Hypoglycemia
Sensory nerve injuries
Resolve in 4 wks
How long after subq heparin to put epidural
4 hrs
West zone 1
Alveolar
Arterial
Venous
In order
Don’t give topimax to patient with
Closed angle glaucoma
It increases IOP
Epidural hematoma treatment and symptoms
Decompressive laminevtomy
Symptoms are motor sensory deficits and bowel/bladder dysfunction
Aspiration first step
Put bed head down(trendelenberg)
Muscle relaxants do not cross
Placenta
Potency of benzos in order
Lorazepam
Midazolam
Diazepam
Refraction artifact =
Acoustic shadowing
Cervical spinal cord injuries mainly due to
Seated position
Tibial nerve
L4-S3
Etomidate lowers
Cortisol and aldosterone
Mixed venous would be elevated with
Cyanide toxicity
PVR = PAPmean-PAOP/CO x 80
PVR
Most likely to have another MI on post operative day
3
Normal FEV1/FVC ratio is
0.8
Direct current cardio version can’t be used on
Multifocal atrial tachycardia
Hyperchloremic metabolic acidosis seen with
TPN
Don’t get ketoacidosis with TPN
02 requirement for an adult is
3 to 4 ml/kg/min
More dead space will lead to higher
PaC02
Oxygen content =
1.39 x hgb x sa02 + 0.003x Pa02
Transpulmonary pressure x tidal volume =
Work of breathing
Normal VC
60 to 70 ml/kg
Carotid bodies respond to
Pa02
Pac02 increase by 10
PH down by 0.08
0.01 to 0.04 units/min is starting
Vasopressin dose
P50 shifts to right with
Sickle cell
Diffusion coefficient of a gas directly proportional to square root of gas solubility and
Inversely proportional to molecular weight of gas
With aging
FRC
Closing volume
Residual volume
Increase
Pa02 is higher at
Apex of lung
Metabolic alkalosis
Hardest to compensate for
FEF 25% to 75% is least dependent on
Patient effort
Carbon monoxide poisoning doesn’t include
Cyanosis
Alveoli at the base of lungs are better ventilated than those at the
Apex
Absolute contraindication to TEE
Esophageal obstruction Active upper gi hemorrhage Recent esophageal Perforated viscous Full stomach with unprotected airway
Esophageal Doppler
Monitor cardiac output continuously
Sustained HTN leads to
Concentric hypertrophy
Impaired ventricular relaxation leading to diastolic dysfunction
Labetalol 5-20 mg onset
1-2 min
Hydralazine time to onset
5-10 min
Joint cement leads to
Hypotension
An atomic dead space 2 cc/kg
2
Most important buffering system in human body is bicarbonate
Bicarbonate
Decreased Pa02 shifts oxyhemoglobin curve to the left
Less oxygen is released when you have less
Carboxyhemoglobin half life in someone breathing 100% oxygen is
1 hr
CDC guidelines don’t recommend changing
Central catheters
Best way to prevent air embolus
Mechanical ventilate with head down so air doesn’t go into venous system
Pregnancy shifts oxyhemoglobin curve to the
Right
Hypotension I’m setting of severe acidemia
Best choice vasopressin
With shunt there is a gradient between
Alveolar and arterial oxygen partial pressures
The two bradhiocephalic veins form the
SVC
30:2 ratio for single person doing
CPR
Amiodarone does decrease mortality after
MI
Milrinone not good for
Cirrhotic
NIPPV not good for patients with
ARDS
Cycle between high and low pressure release ventilation
APRV
STOPBANG score of 5 or more
Think pt is OSA
Don’t do in ambulatory surgery center if requirement of lots of opioids
If surgery is below umbilicus nothing needs to be done
To ICD or pacemaker
Turn ICD off of above ulbilicus and reprogram pacemaker
Sign of renal injury
Giving lasix with minimal Irvine output
Decreased risk of barotrauma
When patient is paralyzed
Cannabinol receptors usually located at
Immune system
Risk factor for cauda equina with spinal anesthesia
Lithotomy position
History spinal stenosis
Reduced insulin resistance by carbohydrate loading
Drink Gatorade two hours before procedure
What drug decreases POCD in cardiac surgery
Ketamine
Chronic alcohol use increases metabolism of
Midazolam
Don’t need to give as much propofol to older patients due to small
Compartment volume
Propofol causes bronchodilation by
Attenuating Vagal induced brinchocinstriction
Full fast and tight for
Pericardial tamponade
Succinylcholine
2 AcH molecules
Succ causes higher levels of hyperkalemia in septic patients
Storing blood
Increases potassium
Decresss 2-3 DPG causing left shift
E cylinder is considered part of the
High pressure anesthesia circuit
Higher partial pressure does not affect
Vapor pressure or partial pressure of the gas
But other gases partial pressure gets lower so the volume concentration of anesthetic gas goes up
Anesthetic depth only based on partial pressure of gas so it is not affected by altitude
Stage 2 anesthesia
Increased HR/BP
Most respiratory claims are due to inadequate
Ventilation
Vaporizers can compensate for change in
Altitude
Isoflurane MAC is 1%
Do not do bronchoscopy with lavage after
Aspiration event
Chronic renal failure
Anion gap metabolic acidosis
Maternal ephedrine administration is linked to
Fetal acidosis
Shivering increases
IOP and ICP
HPV does what to PA02-Pa02 gradient
Decreases it
Aspartate
Excitatory neurotransmitter
Serotonin is an inhibitory neurotransmitter
Pneumbra can be salvaged with
More perfusion
Diastolic murmur
Not good
Volatile anesthetics
Increases atelectasis
For mediastinoscopy need a
Right hand pulse ox
Heart transplant patients are
Preload dependent, they can’t increase HR to improve cardiac output
Need to use direct acting drugs such as epinephrine or isoproterenol. Indirect drugs like ephedrine won’t work
Methylene blue MOA
Inhibition of nitric oxide synthesis
At 3 months much better
Pain control if block was performed
Apnea-hyponea index
> 10 is a sign of OSA
Intercostal nerve block for rib fractures should be done
Inferior to the rib
Bleomycin for
Testicular cancer
Can cause pulmonary fibrosis/pneumonitis
Carotid endarterectomy
Central chemoreceptors gone for ten months so Pac02 resting increases by about 6 mmHg
Paravertebral nerve block can lead to
Pneumothorax
CVP
Can’t do if tricuspid vegetation
Put in SVC right atrial junction and measure post expiration
Entacapone prevents
Decarboxylation of levodopa
Ergotamine is contraindicated during
Pregnancy
Impulse generation at
atria and ventricles are due to sodium channels
Procainamide blocks
Sodium channels
Pancreatic cancer patients pain best managed with
Celiac plexus block
Rheumatic fever think
Mitral stenosis
More total body water in infants so require higher
Succinylcholine dosage
Respiratory alkalosis in
Pregnancy
What lung parameter stays the Same in pregnant vs non pregnant
Inspiratory reserve volume
TV increases by about 45%
What factor is decreased in liver disease
Protein C
Impulse at SA and AV node driven by
Calcium
C7 mediates
Triceps reflex
C5 is biceps reflex
C6 brachioradialus reflex
Drug that can cross placenta
Atropine
Anterior wall of LV
LAD
Pregnancy is an absolute contraindication to
Shock wave lithotripsy
GRH release decreases with stress of
Surgery
How does dexamethasone help with nausea
Inhibition of prostaglandin synthesis
Lipolysis glycogenolysis gluconeogenesis and increased insulin secretion by
Beta 2 receptors
Irradiation helps with
Graft vs host disease
Duchenne muscular dystrophy goes with
Rhabdomyolysis
Fontan has single ventricle anatomy but not
Physiology
Mixing pulmonic and systolic blood
Increase in FRC
When seated
Can measure LVEDV just after
QRS
Cerebral salt wasting
Hyponatremia
High urine sodium
Dry mucous membranes
Angel of petit
External oblique
Iliac crest
Latismus Dorsi
Elective surgery on kids should wait until at least
60 weeks post conceptual age
Pulmonary capillary wedge pressure high
With abdominal compartment syndrome
Propofol dosing
Maintenance on total body weight
Induction on Lean body weight
CRAO
Cherry red macula
Pulmonary HTN
mPAP>25
Beta agonist
Calcium mediated binding of action myosin to troponin c
Methohexital is safe for
ECT
Red wine and cheese
MAOi syndrome
Washed product
IgA deficiency
If positive mixture with RH antibody you are
Positive
Paramedian and midline approach both use
Ligamentum flavum
ICE-BS for systemic absorption local anesthetic
Intercostal
Caudal
Epidural
Brachial plexus
Pediatric local anesthetic toxicity give
1.5 mg/kg inttalipid
Prostaglandin e1 for
Hypoplastic left heart
CRAO is usually
Unilateral
Cherry red spot on macula
Student T test
Compare means of two groups normally distributed
More airway resistance seen in
Neonates than adults
Body pink extremities blue is 1 point on
Apgar scale
Most uncrossmatched blood u can give without moving to crossmatched is
1 unit
What has can be stored in bulk in liquid form
Nitrous oxide
Placenta accreta invaded up to the
Myometrium
Neonates require lower dosing of blank that adults
Opioids
But they require more propofol due to higher Vd
Oral tingling think
Hypoparathyroidism
AVNRT is suppressed by general anesthesia so do the ablation under
Conscious sedation
To see size of bronchopleiral fistula measure
Inhaled vs exhaled tidal volume
ST segment elevation V1-V6
LAD
TEE probe can affect and damage
Hypopharynx
Peds patient endotracheal tube size
Age/4 + 4
Distal Lomb of Y connector and endotracheal tube make up
Dead space
Pierre robin
Micrognathia glossoptitus airway obstruction
Hetastarch has high
Viscosity
IO big risk is
Oateomyelitis
Good for tibia in kids
TRALI most common after giving
FFP
Regional for carotid endarterectomy
C2-c4
Diploidia on puridostigmine think
Myasthenia gravis
Tarazosin and prazosin are good drugs for
Autonomic hyperteflexia
Infraclavicular block
Great for below the elbow
Doesn’t block phrenic nerve often
Frequently misses ulnar nerve
Suprarenal cross clamp
Decreased cardiac output
Dabigatran does not affect
Platelet function
Phenylephrine vasopressor of choice in patients with
Aortic stenosis
Up to 40% of blood flow from atrial kick
Face mask 6 liters Fi02
0.50
Partial rebreather 6 liters
Fi02 .6
Total rebreather at 8 L = 0.8
Laryngospasm
Extubation with light anesthesia
Secretions falling back into vocal cords
Little air movement if complete
Stridor if partial
Jaw thrust
Positive pressure at 100%
Succ 10 to 20 mg
If continues to be bad give 100mg succ and reintubate
Negative pressure pulmonary edema
Supportive treatment
Usually better in 24-48 hrs
No diuresus usually
Surgeries associated with PONV
Laparoscopic Middle ear Eye Shoulder Craniotomy
Everyone needs a ride home after
Anestgesia
Atropine delirium treat with
Physostigmine
Neostigmine pyridostigmine and edrophonium do not cross BBB
Magnets
No affect on pacemaker
Turns off ICD
Needs to be reprogrammed to asynchronous mode
Naloxone oral is poorly
Absorbed
Local anesthetics cause
Increased permeability to membrane to sodium blocked by local anesthetics
Cystic fibrosis
Dysfunctional transmembrane chloride channel in epithelial cells
Pulmonary HTN
Maintain preload
Maintain afterload to reduce hypotension
Avoid hypoxemia, hypercarbia, and acidosis
Guillan Barre can lead to
Hypotension
Endobronchial hemorrhage
Mitral stenosis
Pulmonary HTN
Lithotomy position
Damage common peroneal nerve
Inferior epiglottis to vocal cords innervation
Superior laryngeal nerve
Go through cricothyroid to get
Recurrent laryngeal nerve
Sevoflurane produces the most
Fluoride
Methylene blue selective inhibitor of
cGMP
Absolute contraindication of sitting craniotomy
Right to left shunt
Older ppl have age related
Decrease in beta cell responsiveness
Acetazolamide
Non anion gap metabolic acidosis
Decrease in serum bicarbonate
Ester local anesthetic metabolized by
Psuedocholinesterase
PABA derivative causes rxn
Each unit of FFP increases coagulation factors by
3 to 6%
Thawed FFP should be used within 5 days
Citrate toxicity much higher In FFP vs pRBCs
DLCO
Shows transfer of inhaled gas to erythrocytes in pulmonary capillaries
Polycythemia increases RBC mass and increases DLCO
Neurofibromatosis
Autosomal dominant
For zenker diverticulum
Have patient regurgitate contents prior to induction
Septal wall is more to the left on
Four chamber view
Xrays are
Teratogenic to pregnant patients
Quench
Sudden shutdown of magnet
During emergency
Helium will go into atmosphere taking away the oxygen
Give patient oxygen
Recommended treatment for factor 8 deficiency
Give recombinant factor 8
Repeat factor administration every 12 hours
Patients with preop FEV1 >40%
Low risk for periop complications
Also DLCO>40%
V02 Max is best to look for post thoracotomy outcome
Shivering is not seen in the
Elderly
Hypercalcemia can lead to
Hypotension
Chi square test
Looks at means of categorical variables
Pierre robin to relieve airway obstruction put patient in
Prone position
Levofloxacin can cause
Myasthenia crisis
Bowel perforation abx use
Zosyn
Give antifungal if immunocompromised
Esopgacetomy need
Rapid sequence induction
Metabolic syndrome =
Increased waist circumference
Even if overdampened the mean pressure is
Normal
Due to blood clots and air bubbles can cause overdampening
MAC increase
Hyperthermia
Chronic alcohol intoxication
Sevoflurane plus soda lime produces hydrogen
Which can be easily ignited and lead to fire
Leptin
Protein that decreases appetite and increases ventilation
Obesity hypoventilation syndrome compensated for respiratory acidosis
Flumazinil competitive antagonist at
GABAa receptors
If on chronic benzos and given it can lead to seizures
Neurolytic celiac plexus block causes
Diarrhea hypotension
Less common is paraplegia
In hyperthyroidism
SVR is decreased
Cardiac output is increased
Abdominal compartment syndrome
Compression of kidneys so urine output/renal blood flow/GFR drop
Lower venous return so cardiac output down, LVEDV down, stroke volume down, svr up
Intrathoracic pressure up
Leads to hypoexemia higher airway pressure lower compliance higher PA pressures and CVP readings
Musculocuraneous nerve
Lateral forearm
Patients with brain death get diabetes insipidus and present with high levels of
Sodium
Saphenous nerve
L2-L4 nerve group
Chronic anti epilepsy drug usage
More rapid clearance and resistance to neuromuscular blockers
SSEP monitor integrity of
Dorsal spinal columns
QT interval above what number is bad
> 500
RQ of 1 is due to pure
Carbohydrates metabolism
RQ of 0.7 goes with pure fat metabolism
Intercostobrachial nerve can lead to
Tourniquet pain
Sex has no affect on
MAC values
Clonidine and precedex decrease MAC value
Medullary segments of nephron get much less blood flow than the
Cortex
Fa/Fi ratio of halothane goes up
The least
Desflurane the fastest bc of low solubility
PE
D shaped interventrivular septum
Motor evoked potentials
Most sensitive to somatosensory evoked potentials
12 hour before epidural with LMWH prophylactic
For enoxaparin 1 mg/kg every 12 hours need to wait
24 hours
LR contains
Potassium
Hypotonic
Does not cause lactic acidosis
pH of 6.5
Therapeutic blood concentrations of fentanyl are achieved after 13 hours with a
Patch
Epidural hematoma
Severe back pain
Neurological deficits
Use CT to diagnose or MRI
Bicarbonate lost in urine with
Acetazolamide leading to hyperchloremic metabolic acidosis
High FGF increases predictability of concentration delivered to pt but also increases
Waste gas and contributes to contamination of atmosphere
Dopamine causes release of
Norepinephrine
Migraine with aura
Reversible focal neurological symptoms
Transient neurological symptoms usually precede a headache
SIADH treatment
Fluid restriction
Autonomic hyperteflexia
Bradycardia
Headache
Hypertension
Sacral nerves do
Bladder and urethra
Tibial for
Foot inversion
NSAIDs
Renal afferent arteriole constriction can lead to HTN
NSAIDs
Cause hyperkalemia/hyponatremia
Neurogenic =
Central diabetes insipidus
Absolute contraindication to ECT
Pheochromocytoma
Pregnancy/AICD is not
Hypotension from spinal anesthesia due to
Deactivation of preganglionic sympathetic fibers
Increased atrial stretch
Increases heart rate
Peak levels of tumescent lidocaine at
Twelve to fourteen hours
35 to 55 mg/kg is max
Tracheal intubation for pts
With congenital diaphragmatic hernia
Cyclosporine leads to
Increased serum creatinine
Obesity hypoventilation syndrome vs OSA
Daytime awake hypercapnia and hypoxia
Dexemetetomidine does not produce
Burst suppression
Volatile anesthetics do lead to burst suppression
Sentinel events include
Retained foreign body post surgery
Patient committing suicide within 72 hr hospital admission
Chronotropy =
Heart rate
Chronic meth use
Depletion of neurotransmitters, mainly epinephrine and norepinephrine
Less painful injection of lidocaine when what is added to it
Sodium bicarbonate
Mandibular teeth
Inferior alveolar nerve
Patients are not ventilated while on
Cardiopulmonary bypass
Ventilation changes need to be made based on oxygenater flow
If PaC02 is high oxygenater flows need to be increased
Dexamethasone helps decrease flow of blood from intravascular to
Extravascular space
Methohexital increases
Seizure duration.
Critically hypotension is class4 when blood loss greater than
40%
Lingual nerve block abolishes
Gag reflex
Artery of Adamkowitz
T9-T12
Fibrinogen
Factor 8
VwF is found in
Cryoprecipitate
Intrascalene block
100% ipsilateral phrenic nerve block
TXA
Blocks plasminogen to plasmin conversion
Can cause seizures
Most common TEF
Blind esophageal pouch with distal tracheo-esophageal fistula
Calibrate oxygen sensor
Once daily!
Gold standard spot for getting cute temperature
Pulmonary artery
Post bronchoscopy should watch patient for
4 hrs
During hypothermia
Solubility of C02 increases, thus lowering the partial pressure of C02 and raising the pH
Interferon B 1
For MS
Causes flu like symptoms and elevation in ALT
Need increased dose of neuromuscular blockade to achieve same effect on
Burn patients
Small for gestational age can lead to
Hypoglycemia
Usual newborn weight is
3-3.5 kg
Below this you are small for gestational age
Use small doses of D5 or D10 for
Hypoglycemia in small children
Want endotracheal tube past the level of the
Fistula if patient has a TEF
RVAD inflow and outflow cannula placed
Inflow is in right atrium
Outflow within pulmonary artery
GOAL is to bypass right ventricle
Pregabalin can cause
Fluid retention and weight gain
First line drugs for fibromyalgia
Pregabilin
Duloxetine
TCAs
Best nerve block for pelvic pain
Superior hypogastric
Less like hypotension in
Neonatal spirals. They also require a higher dose due to more CSF volume than adults
High block level and asymmetric block is seen with
Subdural injection
Plasma volume
Increases in pregnancy
Red cell volume goes up less leading to a decrease in hematocrit
Max safe dose of lidocaine without epi
5 mg/kg
Flumazinil
GABA antagonist
Precentral gyrus =
Primary motor cortex
V fib and tachycardia during cardiac arrest preferred drug is
Amiodarone
BMI>50 shouldn’t be done at
Ambulatory surgery center
First step in V fib secondary to LAST is
Airway management
Carcinoid mainly found in
GI tract
Made up of neuroendocrine cells
Anhydrosis, impotence, early satiety all go with
Autonomic neuropathy in diabetic patients
Hepatic stellate cells regenerate after
Injury
They are derived from neural crest cells
80 * (MAP-CVP)/CO
SVR
Blocking brachial plexus often blocks
Phrenic nerve (C3-C5)
Gentle passive rewarming with hypothermic patient with
TBI
In TBI patients corticosteroid can lead to increase in
Mortality
Adenosine is increased if portal vein thrombosis in order to
Increase hepatic arterial flow
Morphine metabolites are excreted by the
Kidneys
Low Fi02 lowers risk of free radical injury in patient on
Bleomycin
Bleomycin is associated with pulmonary
Fibrosis
Pringle maneuver to reduce blood flow to
Liver
Seplenic sequestration due to portal HTN in ppl with ESLD leads to
Thrombocytopenia
Factor 7 half life is very low at
4-6 hours
Variable intrathoracic airway obstruction
Anterior mediastinal mass or tracheomalacia
Expiratory curve is flattened
Cerebral aneurysm rupture or SAH complication after =
Vasospasm
Happens after 3-10 days look out for new neurological complications
Fascia iliaca nerve block blocks the
Femoral nerve
Multiple sclerosis avoid which medication
Succinylcholine
1 avl V5 V6 =
Left circumflex artery
Vasospasm first line
IV normal saline
Main cause of liver transplantation
Hep C
Calcium gluconaye contains less calcium than calcium
Chloride. Need to give calcium chloride through central access
Hyperkalemia is common with
Compartment syndrome
At 1 Mac anesthesia you see
Theta waves
Hunter syndrome associated with
Coronary artery ischemia
Gestational age
Number of weeks until baby born
Postnatal is time since birth
Postconceotual age = gestational plus postnatal
Neonate with
High pulse pressure
Tachycardia
Respiratory distress
Tachypnea systolic murmur
This is a PDA
Post splenectomy higher chance of infection with
Hemophilus influenza type B
ANP is released after stimulus from
Atrial diatension such as after a fluid bolus
Decreased physiologic dead space with higher
I:e ratio
Like 1:1
Diseases with high likelihood MH
Central cord
King dunborough syndrome
Velocity of gas increases
Pressure decrease = Bernoulli equation
End tidal c02 not possible with
Jet ventilation but need to look out for hypercarbia
High velocity low pressure system
BIPAP tidal volume =
Peep high- Peep low
Fondapariunax inhibits factor
10a
Can restart 6 hr after epidural removed
MAC requirement decreased in older ppl
Isoflurane MAC in 40 yo 1.2%
In 80 yo 0.9%
Third degreee Burns are painless and dry
Second degree burns are moist and painful
Head and neck in rule of 9s for burn
Total altogether is 9% both the head plus neck
Rivaroxabin
Factor 10a inhibitor
Dabigatran
Oral thrombin inhibitor
Rivorpoxaban reversal is
PCC
Bolus dosing of bupivicaine is 2 mg/kg and 0.2 mg/kg for epidural
Infusion
Weak pulse and altered mental status =
Low perfusion to brain
Can be seen in patient with SVT
Cold pack is best for children then do cardio version .5-1 J/kg
TCAs
Sedation urinary retention
Nortriptyline is least sedating one
Vancomycin for
Penicillin resistant gram positives
For resistant psuedomonas give
Zosyn/ aminoglycoside or flouroquinolone
Air embolus
First give Fi02 of 100%
Laryngospasm occurs during
Inspiration
Higher risk of laryngospasm for how long after URI
2 wks
Posteromedial papillary muscle rupture MI
Large V waves due to quick atrial filling from incompetent mitral valve
Y wave on PAC
Passive filling of LV
A wave
Atrial comtraction
X descent is atrial relaxation
V wave ventricle contraction
Y descent is passive filling of left ventricle
More arterial C02 when sodium
Bicarbonate is given
Glipizide
Increase insulin secretion from pancreatic beta cells
Nitroprusside
Both venous and arteriolar vasodilation
Nitroglycerin is much more venous than arterial
Decrease in calcium leads to
Smooth muscle relaxation
Promethazine
Histamine antagonist
Aprepirant
NK1 receptor antagonist
Chlorhexidine alcohol is best to use before
CVC placement
Stop tirofiban 8 hours prior to placing
Epidural
Methohexital is gold standard for ECT bc it lowers
Seizure threshold
Etomidate increases the seizure duration
Obese patients have
Increased gastric volume and decreased gastric pH
Giving sodium bicarbonate lowers
Ionized calcium
Increase ph
Increase arterial C02
Increases lactate temporarily
Ace inhibitors can lead to
Angioedema
Diastole phases
Isovolumetric relaxation
Rapid filling
Diastasis
Atrial Systole
Diastolic can’t fill correctly heart
Systolic can’t eject properly
75-80% of filling is during
Rapid filling phase
Bradycardia
Hypotension
Coronary artery dilation
In response to MI or reperfusion
Behold Jarish Reflex
Bainbridge stretch leads to increase in
HR
Clindamycin increase
Neuromuscular blockade
Ectothiophate increases
Succinylcholine blockade
Right arm
Left arm
Left leg
3 lead ECG
3 lead ECG great for detecting
V fib
Fluoxetine can lead to no inhibition of
Cytochrome P450
Cocaine use chronically can lead to
Thrombocytopenia
Stopping smoking decreases surgical site
Infections
For CDH in newborn
Spontaneous ventilation
Fentanyl to blunt pulmonary HTN
No paralysis
Last to be blocked by local anesthetics
A alpha fibers
Large and myelinated
Iron isn’t safe in
MRI
Xenon acts via
inhibition of NMDA receptors
Decreased GI ulceration with
COX-2
Sevoflurane can prolong
QT interval
All inhaled anesthetics prolong
QT interval
Same with all pressors except phenylephrine
During ECT get a parasympathetic surge at beginning which shows up as
Bradycardia
Medial clavicle =
C4
Highest risk of hyperkalemia after burn injury is after
2 weeks
After suprarenal aortic clamp what decreases
Cardiac output
NMS
Related to antipsychotic medications
Will have high CPK level
Decrease which drug dose with cirrhosis
Thiopental
Give fluids for
Suction events in LVAD
Usually bc patient is hypovolemic
Pyloric stenosis electrolytes
Hypocholemic hypokalemic metabolic alkalosis
Increased preload and cardiac output in
Pregnancy
Mitral valve repair can injure
Circumflex artery
Fascia iliaca block blocks
Femoral nerve and lateral femoral cutaneous
IABP increases
Coronary perfusion pressure
Acute intermittent porphyria
Diffuse abdominal pain
Proximal muscle weakness
Urinary retention or dark urine
Don’t give barbiturates like thiopental to pt with AIP
100 uA leads to
Mucroshock if applied to heart and can lead to v fib
Forceps delivery more likely
Intracranial hemorrhage
Precedex
No amnestic effects
Meet Extubation criteria faster with
Desflurane than Sevoflurane
NASH is associated with
Insulin resistance
Residual volume increases with
Age
Vital capacity decreases with aging
Epinephrine to check for
Intravascular placement
Samarium 153 is a radio pharmaceutical good for
Bone metastasis from prostate cancer
Subcutaneous emphysema can lead to hypercapnia but not
Hypoxia
Normal saline contains no
Potassium
High thoracic spinal lowers
Vital capacity
Hyperthermia increases
MAC
PEA use
Epinephrine not defibrillation
Dorsum of foot sensation
Superficial peroneal
Static ultrasound is located in
Internal jugular vein
Fetal scalp pH less than 7.2 is indication for
Emergency delivery of baby
Intrapartum asphyxia
PH < 7.0
Base deficit of 12 or more = intrapartum asphyxia
HIT can lead to
Thrombosis
Best to look at myocardial bloody supply of all 3 major coronary arteries
Transgastric midpapillary short axis
Celiac plexus block for
Pancreatic cancer
Celiac plexus block
Inferior aspect of anterolateral T12 vertebral body
Leukocyte reduction helps against
Nonhemolytic febrile transfusion reaction
Risk of vasospasm after SAH peaks at
5-7 days
Atelectasis
In more than 90% of people getting GA
Occurs during spontaneous/PPV
Nitrous oxide doesn’t increase it
More atelectasis = more intrapupmonary shunt
Carbamazepine autoinduction of
Cytochrome system enzymes
Leads to agranulocytosis
TIPS procedure good for patient with
Refractory ascites
Most North America liver failure is
Drug induced
High risk of ICP elevation in
Liver transplant patients
Fentanyl patch can lead to acute
Respiratory depression
Forced air blankets increase transdermal fentanyl uptake
RSBI<105 is a good indicator for successful
Extubation
LIM prevents against
Macroshock, but not microshock
Oculocardiac reflex afferent is
CN 5
Do not give 100% oxygen to neonates even for an instant
Can lead to problems
Correct hypothermia want above 36 Celsius
Give IV dextrose if glucose below 45
Chest compressions if HR below 60
Infants higher risk for local anesthetic toxicity compared to adults due to
Low levels of plasma binding proteins such as alpha 1 acid glycoprotein
Sevoflurane
Emergence delirium
Precedex opioids help in children
Haloperidol does not help
Carbohydrate RQ is
1
Fat is 0.7
Protein is 0.8
Decreased cardiac output in neonates both to mothers on
Cocaine
Creatinine clearance
Most accurate for renal function
Urine creatinine x urine flow rate/serum creatinine
If under 50 weeks post conceptual age monitor for how long after surgery
12 hours
Post op apnea and Bradycardia risk in preterm newborn highest at
0-6 hours post surgery
Metyrosine
Inhibits release of catecholamines
Critical illness neuropathy
More lower limbs
Desmopressin for
Von wildebrands disease
Management of cardiac tamponade want to maintain preload
No vasodilation
Used levophed to keep the pressure up
CRPS type 2 has an identifiable
Nerve injury
Intermittent edema/sweating in hand
D shaped intraventricular septum =
PE
Ferrous to ferric state in
Methemoglobinemia
Sodium nitrate for
Cyanide poisoning
Aortic stenosis radiates to
Neck and apex
Mitral stenosis is best heard when
Patient exhales
Normal mitral valve area is
4 to 6 cm
Lower than this will lead to sob
Critical if less than 1 cm
Mitral stenosis
Need to maintain preload
No sinus tachycardia
Maintain SVR when cardiac output is limited
Need adequate contractility
Reduce PVR
Level C personal protection after mass casualty
Respirator!
Chemical resistant boots/gown/outer gloves
WPW can lead to
SVT
WPW you see delta waves on ECG
Lower PONV with
Carbohydrate loading
Also helps with insulin resistance
Capacity
Ability to understand nature and consequences of a decision
VSD
Left to right shunting of blood
Increased contractility increases resistance to right ventricular outflow thus you don’t want this for VSD
On the same line keep preload up so doesn’t get hypovolemic
Greatest decrease in myocardial contractility is seen with
Halothane
Mean of a sample representing actual population mean is shown through
Standard error
Peak of T wave is at
Ventricular systole
Full term neonate blood volume
85 ml/kg
Premature neonate is 95 ml/kg
Lowest mineralocorticoid activity
Dexamethasone
Dexamethasone has highest glucocorticoid activity
Increased hematocrit can be associated with higher EPO
Levels
Pa02 less than 60 leads to more EPO release and higher red cell mass
As you get older
Higher lung compliance
Lower chest wall compliance
Highest bioavailability of midazolam
Intramuscular
Atrial systole big part of filling with
Aortic stenosis
Relationship between two categorical variables
Chi square test
Barbiturate coma
Lower cerebral metabolic rate and ICP by 50%
Tumescent high dose is
55 mg/kg
Hydroxyethal starch lowers
Factor 8 levels
TBI causes hypernatremia due to
Diabetes insipidus
Major buffering in blood is from
Hemoglobin
Bain ridge
Tachycardia after increase in intravascular volume
Bezold jarisch- vasodilation and bradycardia
EMG is markedly reduced with use of
Neuromuscular blockade
SSEP
Stimulates a peripheral nerve
MEP
Very fast response corticospinal tract
SSEPs need to be averaged and are not fast
Modern ICDs have
Cardioverter defibrillator and a pacemaker
Most common cause of jaundice and hepatic dysfunction during pregnancy is due to
Viral hepatitis
High pressure leads to
Concentric hypertrophy
Carbamazepine two black box warnings
Agranulocytosis
Skin rxn like Stevens Johnson
90% of acetaminophen goes through
Liver to sulfate and glucoronide conjugated and excreted from kidneys
Lithium
Causes prolongation of neuromuscular blockade
Causes increased sensitivity to volatile anesthetics so your MAC is lowered
Peripartum cardiomyopathy occurs
During end of pregnancy or months after delivery
Acromegaly
Too much growth hormone
Leads to diastolic heart dysfunction
Mitral stenosis can lead to
Atrial fibrillation
SVR decreases during
Pregnancy
Elevated progesterone during pregnancy reduces
Smooth muscle tone
Decrease SVR
Ultimately decreases MAP
Put pulse ox on right hand during
Mediastinoscopy
Separation anxiety in children behind ya about age
10 months
Hypothyroidism
Postop ileus
Hyponatremia
Hypotension
ANOVA for finding means
Of more than two groups
Propofol
Context sensitive half life o 8 hour propofol infusion is 40 min
Hepatic metabolism 60% of total propofol clearance
GABA agonist
Fentanyl has very high
Context sensitive half life
First apply PEEP to operative lung
Before CPAp to non ventilated lung
In extreme measure you can clamp
Pulmonary artery to non ventilated lung to only give blood flow where needs
Hypophysectomy
To remove pituitary adenomas
Remifenanyl primarily metabolized by
Liver
TBI fluid of choice
Normal saline
Give reduced opiates post op to children with
OSA
ASD leads to
Pulmonary HTN
Retrograde cardioplegia best
In AI bc doesn’t distend LV
Cardioplegia is
High potassium solution that causes diastolic arrest of the heart
No ace inhibitor in
Pregnancy
Cos atracurium
Hoffman elimination
Distal tube of endotracheal tube In TEF position
In between fistula and carina
Late decelerations occur after
Peak of uterine contractions
Glycopyrolate
Does not cross BBB
Tirofiban
Glycoprotein 2b/3a inhibitor
Single shot spinal with MORPHINE
Need to monitor every hour for first 12 hours then every 2 hours for the next 12 hrs
Hypoxia pulmonary vasoconstriction
Increased intracellular calcium
Claudication can be
Vascular or neurogenic
Dantrolene
Inhibits ryanodine receptors Lessing to less release of intracellular calcium
Each leg=
16% in Parkland formula
Neostigmine crosses the
Placenta
Choanal atresia first 4-6 wks by blocking nares
Associated with CHARGE and deafness
Botulism toxin blocks
Presynaptic Ach release
Cricothyroid innervated by
Vagus
PVR is lowest at
FRC
Achondroplasia =
Atlantoaxial instability
Awake fiber optic is a good choice
Remifentanyl volume of distribution and clearance are decreased in elderly
Patients
ED95 of rocuronium
The dose of rocuronium that gives a 95% reduction of twitch height
Stellate ganglion block helps with
Ramsay Hunt
Doubling catheter diameter increases
Fluid flow by 16 times
Factor 3/8 is not made by
Liver
Duchennes
Reduced EF is seen
X linked recessive disorder
5-10 cm proximal to popliteal crease is where
Sciatic splits
Sciatic is derived from L4-S3
For pulseless electrical activity
Continue chest compressions
Epinephrine
ASA developed to
Facilitate comparison of anesthetic data
Bioavailability of oral midazolam is the
Lowest
Pneumotaxic area helps move inspiration to
Expiration
Alveolar concentration and mixed venous concentration of blood determines uptake of
Volatile anesthetics
Hypokalemic periodic paralysis stimulated by
Hyperglycemia
Total spinal more likely and difficult intubation with
Ankylosising spondylitis
If all leaflets are open likely not
Aortic stenosis
I’m patient with severe AI want to increase BP
Use epinephrine
Law of Laplace
Wall tension=
Pressure x radius/2 x thickness
Dopamine leads to release of
Endogenous norepinephrine
Compartment syndrome
Lower cardiac output
What contributes to complications after tumescent liposuction
Large volume liposuction
Multiple procedures in addition to liposuction
Replacement of volume of aspirate with iv saline
Large grounding pad to lower
Current density
Haldane affect
Property of hemoglobin where deoxygenation increases its ability to carry C02
Fentanyl patch
50% gone in 16 hrs
Intrascalene block
Phrenic nerve block
Number needed to treat
1/ARR
Caudal anestgesia at
S4-S5
Local anesthetic into intrathecal space first sigh in neonate
Apnea
ST elevation
Need cardiac catheterizatoon
ED50
Dose required to achieve a drugs effect in 50% of exposed patients
Most frequent in SLE
Asymptomatic pericarditis
Reversible cause of A fib
Hypokalemia
Hypomagnesium
Sartorial movement in femoral nerve block
Go deeper/more lateral
High spinal leads to decrease in
Expiratory reserve volume
If giving office based anesthetic need to have a
Backup energy source
Bradycardia during induction
Typically occurs in patients with trisomy 21
PEEP can impede
Venous return
Williams syndrome is associated with
Hypercalcemia
Popliteal block doesn’t block
Saphenous nerve
BUN/plasma creatinine decrease in
Pregnancy
Renal blood flow/GFR increase by about 50%
Being of female age increases risk of
Myalgias In female patients given succinylcholine
Infants have increased
Volume of distribution for most drugs
Milrinone
PDE3 inhibitor
Decreases SVR and PVR
Decrease afterload
Increases cAMP
Can lead to atrial fibrillation after cardiac surgery
Febrile non hemolytic transfusion reactions are the most common
Transfusion reactions and due to donor leukocytes
Down syndrome patient more likely to have
Hypothyroidism
Subglottic stenosis and airway obstruction
More likely to have congenital heart defects
Pregnant patient
Elective surgery should be postponed until after delivery
If need to be done perform surgeries in 2nd trimester
NPO guidelines are for all forms of
Anesthesia including regional
Spina bifida occulta
Can still do epidural just away from site of lesion
In MH
Dabtrolene dose 2.5 mg/kg
If emergent surgery continue with IV agents
Treat hyperkalemia with calcium
Rocuronium
Classified as an intermediate acting neuromuscular blocker
Most important determinant of cerebral vasospasm is
Volume of hemorrhage
After MI
Troponin I and T stay elevated for 7-10 days
LDH 6 days
CKMB and total CK for 2 days
Orbicularis oculi of facial nerve for blinking
Peribulbar block covers this
Retrobulbar does not
Withdrawal from painful stimulus is
General anesthesia it is not purposeful
Air bubble in blood gas line
Increases in Pa02 decrease in PaC02
Sustained IAP above 20 is
Abdominal compartment syndrome
Pulsos paradoxes also seem with
Tamponade
Asthma
Obesity
PE
Most important single determinant of postop apnea is
Post conceptual age
Aspiration
Still need positive pressure ventilation
Hashimoto thyroiditid
Hypothyroid
Increased SVR because beta activity goes down
Thoracic epidural
Paramedics approach is easier
Decreases mortality in patients with multiple rig fractures
Atropine
Smooth muscle relaxation
Increase SA node conduction increasing HR
Increases body temp
Decrease in cardiac output won’t affect
Isoflurane
The most of it already goes in blood
Bipap and CPAP for
Mixed hypoxemic/hypercarbia girls of respiratory failure
Bipap contraindication include AMS Aspirationrisk Pneumothorax Hemodynamic instability
Critical illness myopathy
Higher levels of CPK
Platelets much more likely to cause TRALI then
PRBCs
Increased risk of trali getting blood from mothers
Multiparous
Deficiency of C1 esterases inhibitor
Angioedema
Spinal leading to bradycardia hypotension
Bezold Jarisch reflex
Baroceptor reflex
Bradycardia in response to increase in mean arterial pressure
Seen when given bolus dose of phenylephrine
Mediated by carotid sinus and aortic bodies
Best place to get temp measurement
Nasopharynx
Tympanic membrane
Distal esophagus
Pulmonary artery
Penicillin allergic
Use clindamycin or vancomycin
Most eyewear is protective for
C02 lasers
Burns cornea
Mitral regurgitation
Want HR high using dobutamine or epi
Will look like a high EF but that’s bc some of blood goes into left atrium
Norepinephrine mainly alpha and increases SVR which u don’t want
Succinylcholine
Low placental transfer
Desflurane decreases uterine tone less than
Sevoflurane
TLC is higher in
Adult vs neonate
Static compliance =
Tidal volume/pplateau-peep
Myotonic dystrophy must avoid
Succinylcholine
VAE risk increased if
Head is 15 degree above level of right atrium
Routine testing of blood is for
HIV htlv and west Nile
Not CMV as most ppl have it so it is normal flora
Preeclampsia with high BP and rales think
Pulmonary HTN and start with IV nitroglycerin
Midazolam
Doesn’t affect thermoregulatory control
Place ancillary roll
Caudal to axilla
Doppler probe to detect venous air embolus should be in
Right atrium
Mitral valve diastolic dysfunction look at with
Four chamber midesophageal
Also best for looking at wall motion abnormalities
Which view shows all three coronary distributions
Midesopageal four chamber view
Peds patients PONV
Length of surgery greater than 30 min
Patient age > 3
Stribusmis surgery
Hx of PONV
Peak effect of dilaudid is ten
Minutes
Apnea hypopnea greater than 10 bad in
Peds
Fentanyl
Long context sensitive half life due to high volume of distribution
Sufentanil has shorter context sensitive half life than
Alfrntanyl
Effect size of logistic regression
Odds ratio
Kidney disease problems come giving dilaudid due to accumulation of
Hydromorphone 3 gluconronide
If tracheal cuff overinflated can lead to
Vocal cord paralysis
Common trachealcuff high volume low pressure
Increase respiratory rate increases
Airway resistance
Large sudden decrease in CSF will lower ICP but will increase
Transmural pressure which can rupture aneurysm
LAD and RCA seen in
Midesopaggeal two chamber view
First thing after taking out drowning patient is
Rescue breaths
During embolization of AvM can
Induce hypotension
Succ lidocaine and roc can be used to break
Laryngospasm
Epinephrine does not help
Thumb and middle finger is
C6
C7 is middle and index finger
Indication for intubation and ventilation
Vital capacity less than 15 ml/kg
Cyanide toxicity
Sodium thiosulfate
Undergoes renal elimination
CPB
High pressure in arterial cannula should be treated as aortic dissection
Medical error
Unintended health care outcome caused by a defect in delivery of care to patient
Which of the following is blocked with intrascalene block
Roots trunks
Usually spares ulnar nerve
Intrascalene nerve block blocks phrenic
100%
Intrascalene what is not blocked
C8-T1
Supraclavicular block
Spinal of the arm
Arm elbow hand forearm
Infraclabicular block
Axillary nerve block
Low risk of pneumothorax
Esterases metabolized by
Plasma esterases
Max dose bupivicaine
3 mg/kg max
Amides broken down by
Liver
Most to least local anesthetic absorption
IV
Intercostal
Caudal
Epidural
Local anesthetic
Blocks fast sodium channels in purkinje fibers
Local anesthetic toxicity
Give lower dose of epi
In acillary nerve block if ulnar is twitching redirect more
Superiorly
Musculocutandous
Lateral forearm
Adverse event
Undesirable experience to patient with use of medical product
Absolute contraindication to TEE
Perforated viscous Esophageal stricture Esophageal tumor Esophageal perforation/esophageal diverticulum Acute gi bleed Previous esophagectomy
LMA higher likelihood of
Aspiration
Baclofen withdrawal syndrome
Fevers
Seizures
Blood pressure variability
Rhabdomyolysis with bloody urine
Pelvic pain need to block
Superior hypogastric block
Not pudendal
CABG can’t take penicillin give
Vancomycin
Don’t give aspirin to patient with
Thyroid storm
Sucralfate lowers risk of
Ventilator associated pneumonia
Increase LVAD speed for higher
Cardiac output with LVAD
To prevent CLASBI recommended if putting an emergent central line to
Put a central line in another site within 24 hours
Lorazepam is not affected by
Age
Initial pacemaker placement start with
VOO mode
Amiodarone and cpr help with local anesthetic toxicity
Yes they do
Hypercapnia following giving oxygen to COPD patients is due to
Ventilation perfusion mismatch
You take away hypoxia pulmonary vasoconstriction
Streptokinase increases the
PTT
Helps activate plasminogento make plasmin breaking up clots
Synchronized cardio version in infant
1 J/kg is starting shock dose
Intercostobrachial does
Medial aspect of forearm
If on subq heparin need to check
Platelet count before removal
Rocephin
Can cause drug induced hemolytic anemia
ETC02 monitor should have an
Audible alarm
Valsalva
Intrathoracic pressure and central venous pressure increases and venous return decreases
Succinylcholine has very little
Placenta transfer
Tramadol is broken down by CYP2D6 into
More potent opiate
Hyperoxia can lead to
Retinopathy of prematurity
Micrognapthia
Retrognathia
Treacher Collins
can be potential difficult airway
Max nitrous oxide concentration in or is
25 ppm
RSBI less than 105 is predictive of
Weaning success
Terminal branch of femoral nerve is
Saphenous and does sensory to medial calf
Interop TXA
Can lead to postop seizures
Peds spinal cord goes to same level of adult at
2 years old
Ends at L1-L2 Dural sac ends in S2
H2 blocker
Decrease gastric volume and increase gastric pH
Large Vd of fentanyl leads to long
Context sensitive half life
Emergence after single dose of propofol is due to
Distribution of propofol from the brain to the skeletal muscle
Transtracheal lidocaine blocks
Recurrent laryngeal nerve
Bupivicaine cardiac toxicity due to
Delay in ventricular repolarization
Low volume of distribution means it goes all over like
Morphine
Recurrent laryngeal and superior laryngeal help block
Cough reflex
Cryoprecipitate
Factor 8, fibronectin, fibrinogen
No factor 5
Most sensitive to gas is
MEPs
During sternotomy which rib is fractured most often
1st
Affects C8-T1 nerve roots
Kidney has best
Cold ischemia time
It can be the longest
Balloon of intraaortic balloon pump filled with
Helium
After giving roc
Diaphgram is the most resistant
It is the last to go and first to come back
SIADH characterized by
Hyponatremia
High urinary sodium
Low serum URIC acid
Suggamadex messes up
Oral contraceptives
Decreased sensitivy to depolarization why
Volatile anesthetics increase paralytics
Prolong NMDB
Hypothermia
Loss of elastic recoil of lung as you
Age
Epinephrine tends to decrease level of
Potassium
Conversion of angiotensin 1 to 2 occurs in the
Lungs
Even with cardiovascular commorbidity if case is emergent
You have to do it without further cardiac testing
T3
Helps with BP and improved survival of transplanted organs
Absolute contraindication to TEE
Esophageal diverticulum
Most common complication following SAH
Recurrent hemorrhage
Starting periop beta blockade increases risk of
Stroke
Mannitol is safe to use during
Pregnancy
Drug of choice to treat hypotension in pregnant patient with compromised placental circulation
Phenylephrine
Usually get tachycardia with
Fat embolus
Dobutamine/milrinone can help with RV dysfunction
From fat embolus
In severe septic shock
Initiate empiric antibiotic therapy within first hour even if cultures haven’t been obtained
Mild preeclampsia after 20 wk gestation
Proteinuria greater than 300 mg in 24 hours
BP > 140/90
Fever anemia pain from
Vasopculsive crisis in patient with sickle cell
AIN
Abdominal and neurologic problems not anemia
Very common in patients with sickle cell
Cholelithiasis
Spina bifida
More likely latex anaphylaxis
Rivoroxaban
Inhibits factor 10a
Cilostazol inhibits
PDE3
Contraindications to shock wave lithotripsy
Systemic anticoagulation
Pregnancy
Bleeding disorder
An AICD is not a contraindication
What drug decreases lithium level
Mannitol
High fi02 leads to
Atelectasis
Fi02 denitrogenation leads to atelectasis
PEEP prevents atelectasis
Decrease in SVR and no change in CVP in
Pregnant patient
C Section decreases rate of
Vertical transmission of HIV
Rapid administration of desmopressin for vWF leads to
Hypotension and flushing
After pediatric tonsillectomy black box warning not to give
Codeine
Cisplatin causes
Renal toxicity
Acute normovolemic hemodilution
Replace whole blood with fluids
Due to less viscosity it increases cardiac output
Left atrial appendage
2 view mid esophageal
Between LA and LV
For atrial flutter best is
Amiodarone
To estimate GFR need to know patients
Sex
Omphalocele more likely to have
Congenital anomalies than gastroschisis
Allodynia is causing pain from a source that normally doesn’t cause
Pain
More plasma cholinesterase in
Obese patients
Heparin insulin NDMB
Do not cross placenta
Preop celecoxib reduces
Opioid consumption
Most volatile anesthetic in air is
2 PPM
Bioavailability of midazolam most from
Intramuscular
Lithium increases length of time of
Rocuronium
GLP1
Exenatide most common complication is vomiting
Carcinoid syndrome associated with
TR
Respiratory depression in patients on chronic opioids due to
Narrow therapeutic window
Gabapentin/TCAs don’t help with
Shingles
These have a role in postherpetic neuralgia
Compliance is increased in
Obstructive lung disease
Sciatic least absorption of
Local anesthetic
Closing capacity doesn’t change in
Pregnant patient- same with vital capacity
FRC decreases
Inspiratory capacity increases
Don’t give mannitol to patient with
ESRD
Tidal volume based off
Ideal body weight
Remifentanyl is clearer faster in children than
Adults
Post obstructive pulmonary edema
Post laryngospasm
Don’t give diuretics
Fondapariunx is excreted by the
Kidney
Microshock stopped by
Equipment ground wires
Acute intermittent porphyria
Don’t give ketamine
TAP block for
C section
Supraclavicular block can miss
Ulnar nerve distribution
Most extrahepatic metabolism of propofol done by the
Kidney
C02 regularly crosses BBB
Ions do not
Neck over flexion In seated position leads to
Quadriplegia
Activation of carotid baroceptors during endarterectomy leads to
Bradycardia which stops after surgeon stops manipulation
Restructivelung disease
Decreased lung compliance
Multi level spine surgery at risk for
Venous air embolus
Sciatic nerve is not a branch of the
Lumbar plexus
Lumbar plexus made up of
T12-L4 nerve roots
Fascia iliaca block involves
Femoral and lateral femoral cutaneous nerves
Alternative to femoral or lumbar plexus block
Test doses usually show
Sinus tach if intravascular but if on beta blocker you will see systemic HTN
C2-C4 for regional anesthesia for
Carotid endarterectomy
Fetus has more
Hemoglobin to adapt to maternal hypoxia
Risk factors for PPH
Age>40
Hypertension
Obesity
Greatest risk of substance abuse in physicians is from
Family history of drug or alcohol dependence
Myelomininhocele
Goes with Chiari type 2 malformation
Premature blood volume
90-100 ml/kg
Post tonsillectomy secondary bleeding happens at
5-10 days
Modifiable risk factors for delirium
Benzodiazepine usage and blood transfusion!
French gauge system is 1/3 of a mm so
Higher French gauge equals a bigger device
Subclavian is preferred over IJ central line to prevent
CLABSI
RSBI<105 is correlated with
Weaning success
TKA protocol
Much less quad weakness with adductor vs femoral nerve block
Fetal hemoglobin will give accurate readying for
Pulse ox
Carboxyhemoglobin
Methoglobin
Methylene blue will not
Tran’s pulmonary pressure x tidal volume =
Work of breathing
Normal vital capacity
60 to 70 ml/kg
Acute increase in PaC02 by 10 will result in decrease in pH of
0.08 pH unit
PEEP means
Capnography curve will be a little up
Thalassemia or sickle cell move hemoglobin dissociation curve to the
Left!
As you get older closing volume stays the
Same!
Work of breathing total let 02 consumption
2%
Decreased Pa02
Shifts hemoglobin curve to left
You don’t have it so can’t release it
Half life of carboxyhemoglobin if breathing 100% 02 is
1 hr
Acidosis does not cause
Vasoconstriction
Aniodarone decreases mortality after
MI
It prolongs QTc
Beta adrenergic receptor antagonists don’t cause
Orthostatic hypotension
Atropine
Decreased secretions
Mydriasis
Physostigmine crosses
BBB
Meperidine has some
Anti cholinergic properties
Norketamine is not as potent as
Ketamine
Prolonged elimination time of benzos on patients getting
Protease inhibitors
Aprepitant has
Anti nausea
Anti depressant
Anxiolytic effect
Not analgesic
Ectothiophatevinhibits
Psuedocholinesterase
If only one twitch on TOF
More than 85% depression
Postganglionic sympathetic nerve fibers
Release norepinephrine
Calcium does not enhance
Neuromuscular blockade
Erythromycin
Does not augment neuromuscular blockade
Most common side effect of flumazinil is
Nausea/vomiting
Ketorolac
Nonselective inhibitir of both cox-1 and Cox-2
Exhibits a dose cieling effect o analgesia
AIP
Etomidate is contraindicated
Remifentanyl reaches steady state in
1 hr
Rocuronium has the
Fastest onset of the NMDBs
Acute decrease in serum potassium causes
Hyperpolarization of cell membranes. This causes resistance to depolarizing NMDBs and resistance to NMDBs
50% of neuromuscular blockade could take place and still have
5 second head lift
MAC if sevo highest at 0-1 months
Others are highest at 1-6 months
Volatile anesthetics
Decrease TV and increases RR
Low flow techniques rebreathing leads to
More rapid depletion of C02 absorbent
Sevoflurane vapor pressure
160
N20 tends to increase
Cardiac output
Isoflurane maintains
Cardiac output
Decreases MAP
May attenuate bronchosoasm
Hip pain on internal rotation
Give local anesthetic into hip joint
Best invasive treatment for trigeminal neuralgia
Microvascular decompression of facial nerve
L2
Genitofemoral nerve
After 2 yrs most ppl with CRPS
Resolve
Uterine cancer pain
Superior hypogastric
A beta
Large myelinated
Fastest speed
C fibers
Unmyelinated
Diffuse burning or aching sensation
Seen more in visceral pain
Hyperalcesja
More pain than it should cause
Dysthesia abnormal sensation that isn’t pleasant
Stellate ganglion
Base of transverse process of C6
Horner syndrome seen if successful
Celiac plexus block for
Upper gi malignancy
Chronic or acute pancreatitis
Big side effect orthostatic hypotension
Next is diarrhea
Superior hypogastric
For pelvic pain
Myofascial pain syndrome
Active trigger point
Palpable taut band
Treatment is physical therapy
Next is trigeer point injection
Fibromyalgia
Trigger points in 11 of 18 sites at body
SNRIs are approved for this including cymbalta
Herpes zoster mainly seen in
Thoracic distribution
Carbamazepine
Sodium and calcium channel blocker
Can lead to skin disease like Steven johnson
Parenthesias not seen in
Disc herniatiion
Nalbuphine
Mixed opioid agonist antagonist
Benadryl helps with spinal itching
Morphine intrathecal can last
12 to 24 hrs
5 mg epidural morphine is equal to 0.3 mg intrathecal morphine
Intrascalene block doesn’t get
Ulnar nerve
Intrascalene blocks phrenic nerve
100%
Regional blocks
Cardiovascular adrenergic and metabolic response
Cauda equinA
Low back pain
Bilateral lower extremity weakness
Saddle anesthesia
Loss of bowel bladder control
Due to polling of local anesthetic in depehdeht areas of spine within subarachnoid space
No psuedocholinesterase in CSF so
Ester local anesthetics leave by getting absorbed in systemic circulation
Cardiac toxicity
Bupi highest than ropi then lidocaine
With high spinal
Decrease in venous dilation is predominant cause of hypotension
Nerve blocks may decrease incidence
Phantom limb pain
Phenylephrine and epi
Will prolong spinal
Largest vertebral interspace
L5-S1
Epidural abscess is more
Radicular pain
Epidural hematoma has severe back pain
Artery of Adamkowitz comes from
T9-T12
Anterior spinal artery comes off vertebral
Ester local anesthetics have
Shorter half life
Retrobulbar block acts on CN
3-6
Vertebral artery lies near
Stellate ganglion
Median nerve most medial in
ANTECUBITAK FOSSA
If you get a parenthesia that is sustained when putting in epidural you are in nerve root so
Pull out and redo don’t inject
Plantar surface of foot innervation
Posterior tibial nerve
No meperidine to patient on
MAOis
If both recurrent laryngeal nerves transected it causes cords to be in
Intermediate position bc it affects both abductors and adductors
Intercostal structures from cephalad to caudad is
Vein artery nerve
If coughing or SOB during supraclavicular block placement think
Pneumothorax
Femoral nerve lateral to
Artery and vein
Proper placement makes patella elevate and quad muscle contraction
Most common complication of supraclavicular block is
Phrenic nerve block
Shoulder is not done by
Brachial plexus
Supraclavicular block is at level of
Divisions
Instrascalebe block occurs at the roots/trunks
Pelvic organs are supplied by
Hypogastric plexus not celiac
Sural only does
Lateral side of foot
TENS works by
Activation of inhibitory neurons
Thumb corresponds to
C6
Increasing the dose best for
More depth of local Anesthtic
Nerve blocks with alcohol or phenol are never
Permanent
Vagus nerve does not have
Pain fibers
Most visceral pain is from
C fibers
Major nerve blocks like axillary last
A long time
Like 6-12 hrs
Must have popliteal and
Saphenous for surgery under foot
Sensory innervation back of head from
C2 and C3 roots which are terminal branches of cervical plexus
Phrenic nerve
C3-C5
Central pain is the cause if someone has a good block but they are still in
Pain such as malingering
Hyperventilation leads to respiratory alkalosis so higher pH leads to more
Unionized fraction of local anesthetic
Peripheral nerves always enveloped in
Schwann cells
Tidlodipine before epidural need to wait
14 days
7 days for plavix
Must pass dura for
Subarachnoid block
In epidural space bupi is four times more potent than
Lidocaine
Stellate ganglion block does not
Increase HR
Adduction of thumb is
Ulnar not abduction
TAP block blocks
Subcostal ilioinguinal iliohypogastric
If you hit phrenic nerve you activate diaphragm and should redirect your
Needle posteriorly
Pure S form of local anesthetic
Decrease in potency and shorter duration of action
Epidural hematoma treatment
Decompressive laminectomy
Benzocaine is the only
Weak acid of the local anesthetic
Myelin enhances ability of
Local anesthetic to block conduction
Musculocutabeius is below and lateral to
Axillary artery
Awake intubation block CN
5, 9, 10
Gi gu procedures don’t need
Prophylaxis for endocarditis
Nor do valvular disease unless in setting of heart transplant
HIT
Antibodies to PF4
If patient has HIT and needs emergent bypass
Wait until disappearance of antibodies and use heparin
One MET equals
Energy expended during 1 minute of rest which is roughly 3.5 ml of oxygen per kg body weight
Right to left flow
TOF, Eisenmeiger syndrome
Left to right shunt is a PDA
Starling curve
Left ventricular work on y axis
Left ventricular pressure on x axis
PA catheter often migrates into
PA
Noted as an increase in the PA pressure
Anticholinesterase drugs
SA and AV node slowing
Bronchocpnstriction
Peristalsis
Fontan procedure
Anastomosis of RA to the PA
Helps with high pressure congenital defects
50% reduction in metabolic rate if
Temp lowered rib to 28 to 30 degrees C
IABP inflates
In diastole
Just after closure of aortic valve
Myocardial oxygen consumption from most to least
Heart rate > afterload > preload
Drugs that can be given via endotracheal tube
ALONE
Atropine Oxygen Lidocaine Naloxone Epi
Tetralogy of fallot
VSD
Overriding aorta
RVH
When shocking patient want leads to be located on
QRS
Don’t shock during repolarization
Normally pressure in pericardial sac is less than in
CVP
Prolonged QT can use
Beta blockers
LVAD
Blood taken from apex of heart and returned to circulation via aorta
No blood exists in aortic valve during systole so can’t measure BP with NIBP
In normal heart
20% of cardiac output is from atrial kick
Bisfrrens pulse = two systolic peaks
Seen with significant AR on arterial waveform
Want to maintain SVR in patient with
TOF so use ketamine
MS looks like opposite of
Aortic stenosis on the flow volume chart
150 mg IV aniodarone over ten minutes for stable
V tach
Paced is first then
Sensed
Normal myocardial oxygen consumption is
8 ml/100 g/min
Phenylephrine has minimal direct affect on myocardial
Contractility
High Peep can lead to
Barotrauma and this pneumothorax
Hallmark of PA catheter rupture Is
Hemopytsis
Regular insulin does not cause
Protamine rxn because it doesn’t contain protamine
1 mg heparin =
100 units
Give 1.3 mg per 1 mg of heparin to reverse
Dipyridamole
Patients need reduced dose of adenosine
Bladder and PA temp is measured which helps
Estimate rewarming
Tran’s gastric mid papillary short axis view of LV best to look at
MI
Giving bicarbonate can lead to
Hypercarbia
It lowers potassium levels
Decrease in SVR exacerbates
Right to left shunt leading to TET spells
Sildenifil in the same class of meds as
Milrinone
Milrinone effects PDE3
Sildenifil PDE5
No drug reverses effect of
Plavix
Nitric oxide inhibits
HPV and not a good choice with OLV
In DOO don’t want HR too high as can lead to
R on T
Milrinone does not produce thrombocytopenia and increases level of
cAMP
Milrinone lowers
PVR
For elective surgery wait
1 month for bare metal stent and 12 months for DES for elective procedure
If procedure must be done continue aspirin
Get ECG if pt has
Cardiovascular or respiratory risk factors
Don’t do routinely for preop no matter what age
For airway case to prevent fire
No nitrous
Lower fi02
Fire
Pull tube
Stop flow of all gases
Pour saline into patients airway
If fire somewhere other than airway
Stop all gases first!
Remove all drapes flammable and burning material from patient
Extinguish fire
If neuraxial infection suspected
Remove catheter and culture tip
Blood tests and cultures
Imaging studies
I’d abscess start abx and get surgical consultation
Supine patient don’t abduct arms greater than
90 degrees
Try to avoid flexion of elbow
Chloroprocaine not used in regional due to risk of
Thrombophlebitis
Diaphragm
C3-C5
Pain blockade onset
Sympathetic then pain then propioception
Small unmyelinated
Next is unmyelinated c
Large myelinated blocked last
Turbulence if Reynolds number greater than
2000
Mapleson D
Fresh gas is right next to mask
Volatile anesthetic
Increase rr
Decrease tv
Make sure
Vaporizer cap closed
Volatile gases
Increase cbf
Decrease CMR02
Desflurane causes HTN and tachy temporarily
Anesthetic potency marker
Oil: gas partition coefficient
MACbar to blunt autonomic response is
1.6 MAC
Neuromuscular blockade is more likely to less go
Awareness
Same with chronic use of alcohol opioids
Or in high risk like trauma when can’t keep to deep
Hearing is the last sense to be lost in
Anesthesia
Benzos have no
Analgesic activity
Precedex has
Analgesic activity
Analgesic from u
Receptor
Periaquadictal gray in brain
Spinal cord - substantia gelatinosa
Dilaudid peak effect is at
15 minutes
Less response to opioids after
Opioid induced hyperalgesia
Usually from remifentanyl
Bradycardia is common with remifentanyl
Morphine 6 glucoronide is
Excreted from kidneys
Meperidine
Anticholinergic symptoms
Morphine/meperidine
Renally excreted
CO equals
HR x SV
Tourniquet deflation
MAP CVP go down
Everything else like potassium lactate etc02 go up
First step in aspiration
Head down and suction
Then positive pressure
Most intracranial volume is
Intracellular content
Most blood flow goes to
Liver
Median nerve runs between
Flexor carpi radialis and palmaris longus
Low albumin leads to
Hypocalcemia
Hypermagnesium
Lasix calcitonin volume
Alpha 1 hydroxylase in kidneynoncteweee vitamin d and higher
Calcium
Identify carboxyhemoglobin with a
Cooximiter
Hyperbaric oxygen if
Neurologic impairment
Cohb>25%
Cardiac abnormalities from carboxyhemoglobin
EEG is gold standard for monitoring in
Carotid endarterectomy
Dry mouth
Bulbar paint
Diplopia ptosis
Botulism
C tetani
Reaches spinal cord via retrograde Axonal transport
Blocks neurirransmission
Increased muscle tone
Painful spasms
Cross clamp higher up
Has more pronounced effect
Acute HTN above clamp
Hypotension below clamp
Microshock is around
Heart
Macroshock is protected by
Isolated power supply
Methohemoglobinemia from
EMLA made up of lidocaine and prilocaine
Epiglottis due to
H influenza
After SH6 in eye avoid nitrous for
10 days
Extothiopate increases duration of
Succinylcholine
Turbulent flow depends on the
Density
Larger airways like upper bronchi are more
Turbulent
Use leukoreduced blood in
Immunocompromised patients
Hypothyroid
Arrhythmia
Seizure from
Lithium toxicity
More allergies to
Ester local anesthetics
Following spinal with lidocaine in lithotomy position leads to
Transient neurologic symptoms
Cardiovascular effect of bupiv
Hypotension, AV block, arrhythmia
Volatile anesthetics
Increase QT time
For spontaneous ventilation
A>D
Milrinone increases
cAMP
MG goes with
Thymoma
Respiratory or oropharyngeal weakness
IVIG and plasmapharesis
Duchenne
X linked recessive
Males exclusively
High CK levels
SCC of lungs with
Lambert Eaton
Lower Ach release
AV block you need to inhibit
Ventricle sensing on pacemaker
Atrial bradycardia means
Atrium need to be paced on pacemaker
Substance P
Excitatory neurotransmitter in dorsal horn leading to pain
Equalization of diastolic pressures in
Tamponade
Prominent y descent seen in
Tamponade
Avoid succ ketamine droperidol in
Pheo patients
Droperidol can lead to HTN
Hypophosphatemia
Left shift of curve
Rate limiting enzyme in porphyrias
Ala synthetase
Greater risk in pneumonectomy
FEV1<50% predicted
RV/TLC>50%
Uterine and umbilical arteries 2
Take deoxygenated blood to placenta
1 umbilical and uterine vein carry’s oxygenated blood away
Psuedocholinesterase increased in
Obesity
Low calcium high phosphate low albumin in
Renal failure
Time constants
1 = 63%
2= 86%
3=95%
Hypercarbia In
TPN
LIM helps against
Macroshock only
V fib threshold
100 uA
Donor red blood cell antigens
Cause if delayed transfusion reaction
More vaporizer output at
Decreased partial pressure
2% lidocaine
2 g/100ml or 20mg/ml
Vital capacity is area in between
Flow volume loop in flow volume loop
Vital capacity is area in between
Flow volume loop in flow volume loop
Dilutional anemia
Decreases oxygen delivery
Cyanide toxicity
Good oxygen delivery it just doesn’t function correctly
Right to left shunt affects
Desflurane more than isoflurane
Anterior cardiac vein runs with the
RCA
Regular insulin
Onset 15 minutes
Peak at 1 hr
Case control
Looks after intervention given
Opposite of cohort
Case series
One isolated event
Serum albumin down in
Pregnancy
Bohr effect
Right shift
Hyperventilation
Hypocalcemia
HFJV allows
Passive expiration
Creates autopeep
Serum albumin down in
Pregnancy
Bohr effect
Right shift
Hyperventilation
Hypocalcemia
HFJV allows
Passive expiration
Creates autopeep
Posterior approach of lumbar plexus also gets
Obturator nerve
PPV
Neonate HR<100
Higher cardiac output means
Block onset in spinal is faster in infants than adults
Spinal cords end at L3 if age less than
2 yo
More secretions when Ach binds
Muscarinic receptor
Benzos
Do cross BBB
Causes neonate sedation hypotonia cyanosis
Hypermagnesium
PotentiatesvNMDBs
Respiratory arrest>15
Cardiac arrest>25
Treatment is calcium
Women getting invasive procedure who are pregnant should get
Rhogam prior
Gilbert due to decrease In
Hepatic gluconyktransferase
Autosomal dominant
Lidocaine crosses
BBB
Nitrous oxide
Inhibits Dna synthesis
Dp/dt looks at
Contractility of heart
E/A for diastolic function
Late decels occurs after
Contraction
Mid esophageal two chamber view
LV on bottom
LAD on right
RCA in left side
Reactive non stress test is good
Can look for uteroplacental insufficiency
Contraction stress test
Need 3 contractions in 10 minutes
Positive CST fetus not getting enough blood flow
Magnesium doesn’t stimulate
Nmda receptors
Mag does cause sedation
Ritodrine causes
Tachycardia
Neostigmine does cross
BBB
No fetal bradycardia from
Maternal smoking
Great auricular artery also known as artery of adamkowitz originated from
T9-T12
Single anterior spinal artery
First 2/3 of spinal cord
Platelets can lead to
RH sensitization
Platelets can’t be
Refrigerated
Plasma highest risk for
Trali
Post transplant kidney injury during transplant gets better with
Mannitol
TAP block also gets
Intercostal
Glycine leads to
Hyperammonia
In sickle cell patient getting surgery avoid
Hypo, hyperthermia, hypoxemia, hypotension, hypovolemic acidosis
Ventricle hypertrophy
Reduces wall tension
Peribupbar block
Lower risk of retrobulbar hemorrhage or optic nerve damage
Blunt oculocardiac reflex with
Peribupbar and retrobulbar block
Need to watch 4-5 hours after giving
Racemic epi for dusk of rebound effect
What helps against succ myalgia
Vitamin c
Lidocaine
Calcium
Low ite scores and males more likely for
Substance abuse
MS exacerbation
Post partum
Can turn inaccurate monitor
Accurate. If it’s imprecise it’s useless
Full term infant neutral zone
32 to 35 degreee
If FRC is lower
Increase atelectasis
Spinal
Unopposed parasympathetic effects
More GI secretions
Guillan Barre associated with
SIADH which causes hyponatremia
Larynx position in infant
C3-C4
Infant vocal cords
Angled or slanted
Arterial pressure variation good to look for
Volume status
Diabetes insipidus need to
Expand intravascular volume in brain dead
Hyperkalemic periodic paralysis due to defect in
Sodium channel
Sympathetic blocks don’t help with
Postherpetuc neuralgia only acute
Starting insulin with TPN high likelihood of
Hypoglycemia
Deep sedation May have airway issues
Issues
Always need postop care for
MAC cases
Tetanus
Inhibit neurotransmitter release from inhibitory neurons of CNS
Stops gaba/glycine release
Botulism
Inhibits ACH release at neuromuscular junction
Phantom limb pain is
Neuropathic
Don’t use mannitol for
Cardiogenic pulmonary edema
Peep increases
FRC
Pneumothorax doubles in 10 minutes
With nitrous
CPAP is good for child with
Epiglottis want to keep airways open
Epiglottis
Extrathoracic airway obstruction
Carotid bodies
No baroceptirs
The carotid sinus does leads to bradycardia
Early onset VAP
Methicillin sensitive staph
Nitrous oxide
No uterine relaxation
Methanol turns into toxic formaldehyde by what enzyme
Alcohol dehydrogenase
Hypocalcemia
Hypomagnesium with
Citrate toxicity
Want to keep Fi02 down with ARDS
ARDS
Nitroglycerin
Decreases preload due to venous pooling
Nicardipine reduces afterload no affect on
Preload
Meperidine blunts shivering response and this
Reduces total body oxygen demand
Endovascular cooling is fastest way to
Cool patient
If critical temp of anesthetic is higher it exists as a
Gas
If critical temp is below room temp it will always exist as a
Gas and can’t liquify
Angiotensin 2 constructs efferent arteriole to maintain
GFR
Renin turns
Angiotensinogen into angiotensin 1
Child blood volume
70-75 ml/kg
AV nodal blockade think
PDA
To activate nicotinic receptor it’s
2 Ach molecules and 1 succ
Atropine=
Helps with fetal Brady
RAAS starts working after
20 minutes
Heat loss through breathing circuit
Evaporation
Right lower lobeposterior segment
Most secretions
Hypoxic ventilator drive
CN 9
MH has more muscle rigidity rise in etc02 and temp increase than
Thyroid storm
Unstable SVT
Sunchronized cardiobersion
Hyperparathyroidism
Normal anion gap acidosis
NMDB does not stop succc
Increase in IOP
PVR lowest at
FRC
Surfactant decreases
Surface tension as alveoli shrink
Transmural pressure
Atmospheric plus intrapleural pressure
Surfactant
Type 2 alveolar cells
In turbulent flow radius is to the
Fifth power
Laminar flow is to the 4th power
Expiratory flow
Goes upward on diagram
Mid sized bronchi
Most resistance
Pulmonary artery catheter measured best at
West zone lung 3
This spot airway pressure isn’t higher to mess it up
Nitroprusside nitric oxide
Mess up HPV
What organ gets most cardiac output at rest
Lungs
Closure of AV valves
Isovolumetric contraction
PR interval
Atrial depolarization and AV nodal conduction
Slowest rate of conduction
AV node
Frank starling
Cardiac output and LVEDV
Decrease in contractility shifts frank starling to the
Right
Isovolumetric contraction
Most myocardial oxygen consumption
Most blood is in
Veins and venules
CO x TPR
MAP
More pulmonary blood volume leads to decrease in
PVR
Tissue edema due to heart failure due to
Increased capillary hydrostatic pressure
Renin secretin will be increased by
Norepinephrine
More bradykinin with
Ace inhibitors
Liver makes
Psuedocholinesterase
Epinephrine increases
cAMP levels
Angiotensin 2
Stimulation of thirst
Don’t want lactated ringers when giving
Blood
Store platelets at room te
Temp
Best filter to prevent macro aggregate delivery during transfusion
170 microns
Type and screen
ABO and RH type
Antibody screen
Type and crossmatch
Urticaria due to blood reaction give
Diphenhydramine
Acute hemolytic transfusion rxn
Fever
Citrate is metabolized by the liver into
Bicarbonate
TACO
Diuretics helps
Not in TRALI
Central cord disease high risk of
MH so use TIVA
Pyloric stenosis
Hypokalemic hypocholermic metabolic alkalosis
Testicular torsion is a medical emergency so have to go in
Regardless
FRC and tidal volume are unchanged throughout
Life
Mandibular hypoplasia
Pierre robin
Gastroschisis
Abdominal wall defect lateral to midline
CDH usually
Left sided
Maintain spontaneous ventilation
Most common TEF
Esophageal atresia with distal fistula
Inhalation induction best for
TEF
Position tube below
Fistula in TEF
Infants have higher
CSF volume than adults and require more volume of local
Closure of ductus venosus not important for establishing
Fetal circulation
Treat TET spell by increasing
SVR
Don’t give epi bc will cause more contractility narrowing RVOT
RVOT is narrowed in
TET spell
Don’t give epi
Neonate blood volume
90 ml/kg
Oculocardiac reflex from pressing on eye involves CN
5 and 10
Necrotizing enterocolitis treatment includes
Medical management
Stop enteral feeds
Erythropoiesis
Suppressed after birth
And less made leading to physiologic anemia
Duchenne
Get ECHOto check for cardiomyopathy
Vecuroium action prolonged in
Infants
Higher ECF volume
Umbilical vein
From placenta to fetus
Normal umbilical vein
PH 7.35 pC02 40 PO2 30
Low fi02 maintains PVR in situations of
VSD
Extrathoracic obstruction
Vocal cord paralysis or croup
Isoflurane nitroprusside inhibit
HPV
Highest blood levels local anesthetic
Intercostal
Post thoracotomy outcome best seen with
VO2 Max
FEV1<2L sign of
High risk for pneumonectomy
Transplanted lung has lower
PVR
Absolute one lung ventilation for
Bronchopleural fistula
First step with desaturation in two lung is
Reinflate deflated lung
Increase Pa02 with one lung ventilation
With CPAP to nondependent lung
RR/TV =
RSBI best to plan for Extubation
Decreased RV, VC
Increased FEV1/FVC1 ratio
Restrictive lung disease
Anterior spinal artery syndrome
Loss of motor function and pinprick sensation with urinary incontinence
Artery of Adamkowitz
T9-T12
Chylothorax
Thoracic duct injury
Prolonged serosanguinous drainage
Improved V/Q due to
Nitric oxide post lung transplant
Harder to get off ventilators when on
SIMV
Hypoxemia due to v/q mismatch
Emphysema
Dead space decreased when supine
Supine
Postop pulmonary dysfunction strongest risk factors
Location of surgery
History of dyspnea
Epinephrine has low
Beta 2
Beta 2 works on
cAMP
Opioid receptors
G protein coupled receptors
Opioid receptors are antagonized by
Naloxone and naltrexone
M6G is more potent than
Morphine
IV morphine dose opioid naive
2.5 to 10 mgs
Spinal
1/10 epidural dose
Neuraxial morphine
12 to 24 hrs
Order or lipophilicity
Sufentanil to fentanyl to alfentanyl yo morphine
Fentanyl has a long context sensitive
2 hours after 1 hour of infusion
Remifentanyl equipotent with
Fentanyl
Opioids
Histamine release
Biliary colic
Vasodilation
Delayed gastric emptying
Naloxone/naltrexone
Potent antagonists at mu opioid receptors
Don’t use naltrexone for PONV
Don’t form tolerance to
Miosis and constipation
Treat cocaine overdose with a
Benzodiazepines
Garlic inhibits platelet aggregation and should be discontinued
7 days prior to surgery
St Johns Wart does affect
Coagulation status
Reverse tirofiban by giving
Platelets
1 mg of protamine per
100 units heparin
Precedex IV loafing dose
1 ug/kg first 10 min
Then 0.2 to 0.7 ug/kg/hr
12 hour before neuraxial after giving
Subq lovenox
Ketorolac has
Anti inflammatory, antipyretic, analgesic properties
Elimination half life of acetaminophen is
2-4 hours
Nitroglycerin predominately produces
Venodilation
Dopamine is an endogenous precursor of
Norepinephrine
At low doses dobutamine produces
Vasodilation
At high doses vasoconstriction
Phenylephrine
Pure alpha1 agonist
Max dose of epinephrine when given with local anesthetic
40 ml of a solution with epinephrine 1:200000
Volatile anesthetics have biggest effect on
MEPs
Vertebral cause if
Seizure
Mid diastolic murmer
Mitral stenosis
Patients with mitral stenosis often present in
Atrial fibrillation
Pulmonary artery pressure can show
Appropriate volume resuscitation
Prior to coming off bypass
Temp greater than 36 C Confirm mechanical ventilation resumes Confirm enough in CPB reservoir to maintain map and ci as you come off Get ABG PH>7.3 K< 5.5 Hct >24
CPB can be hand cranked if
Electricity off
Can do CAbG off bypass if one vessel like a single LAD with no hemodynamic instability or
High risk for stroke like calcified aorta
Most thrombogenic component of bypass machine is
Oxygenater
CPB most common complication
Short term memory loss
Majority of intraventricular septum supplies by the
LAD
Left current laryngeal nerve loops around whAt major vessel Of mediastinum
Aorta
Right recurrent laryngeal loops around
Right subclavian
Cardiac skeleton insulates
The atria from the ventricles
Organ getting most cardiac output at rest
Lungs
100% of cardiac output goes through the lungs
Brain gets 15%
Kidneys 20%
Sympathetic activation of the SA node leads to
Increased permeability of resting membrane to sodium and calcium ions
LV diastolic dysfunction
Increased E wave on Doppler with reducer A wave
Venous return is augmented by
Decreased venous resistance
How much blood in veins and venules
60%
Bronchospasm most likely during
Intubation
First treatment in bronchospasm that works fastest
Deepen the anesthetic
Need SSEP for
Elective spine cases
Hypocarbia from hyperventilating can lead to
Hypocalcemia
Bradycardia and hypotension think
Carotid sinus
Normal ACT is about
107
Factors that prolong act
Hypothermia
Thrombocytopenia
Hemodilution
Muscarinic activation
Bradycardia
Bronchoconstrict
Miosis
Gi hypermotility
Precedex metabolism occurs in the
Liver
Concentric hypertrophy helps by lowering
Wall tension
Biracial artery goes with
Median nerve
PVR is highest at
Extremes of lung volumes
Dp/dt
Left ventricular contractility
E/A ratio
Diastolic measurement
Progressive distal muscle weakness in
Charcot Marie tooth disease
Decrease these to lower auto peep
RR
TV
Gas flow rate
Decrease plateau pressure with
Decrease peep and decrease tidal volume
Sickle cell avoid
Hypo/hyperthermia
Hypoxemia
Hypotension
Post transplant kidney injury lower when giving
Mannitol
Etomidate
Higher risk of superficial thrombophlebitis compared to propofol
Endovascular is better for
Descending aorta but not proximal aorta
COPD goes with
MAT
Base excess calculated in
ABG
PC02
Severinghouse electrode
SVR
MAP/CO x 80
Nitrous oxide inhibits
DNA synthesis
Eccrine sweat gland
Sympathetic preganglionic to nicotinic receptor to sympathetic postganglionic to muscarinic receptor
Full term newborn
80-90 ml/kg
Factors that result in variable clotting time include
Hemodilution, hypothermia, platelet count below 50k
Pacemaker leads are put in the
Endocardium
Axillary artery
Radial nerve lateral
Musculoskeletal nerve
Pyloric stenosis
Chloride exchanges with bicarbonate in stomach
Bicarbonate is absorbed and chloride lost
Nicardipine causes
Direct cerebral vasodilation
After starvation brain will obtain most its energy from
Ketone metabolism
Most T3 is formed peripherally by
Partial deiodination of thyroxine
More thyroid hormone causes increase in
Metabolic rate
CDH ok for
Gentle ventilation with permissive hypercapnia using low tidal volume
No spinal cord stimulator for
Soma to form patient
Coagulopathy sepsis
Carboprost does not help with
Uterine relaxation
1-beta =
Power
CYP2D6 converts
Codeine to morphine
Pulmonic valve better visualized on
TTE than TEE
Hypnosis with blood pressure occurs faster than
Time to decrease of blood pressure
Neonates have decreased
CYP2D6
Don’t need preop ecg for
Renal insuffiency age diabetes
Alpha 2 ligands
Gabapentin, pregabalin bind to alpha2 subunit of voltage gated calcium channel prevent release of nociceptive neurotransmitters
Eye blocks are not used in cases
Lasting longer than 90 minutes
Patients younger than 15 yo
Or inability to follow commands or lie still
Retrobulbar hemorrhage from eye block
Excellent motor block but also
Closure of upper eyelid
Propotosis
Palpable increase in IOP
Oculocardiac reflex
Bradycardia
Arrhythmias
Cardiac asystole
If arrhythmia from oculocardiac reflex
Stop stimulating and give 0.007 mg/kg atropine
High spinal but pt
In trendelenberg
Contraindications to spinal
Coagulation abnormalities Severe hypovolemia Increased ICP Infection at site Severe valve disease
Regional spots
C8 pinky finger Nipple T4 Inferior angle scapula T7 Umbilicus T10 Perineum S2-S4
Spinal cord ends at
L1 in adults
More pruritis when giving opioids in
Intrathecal space
Don’t do epidural if On heparin can lead to
Spinal hematoma and spinal cord injury
Discontinue chronic warfarin 4-5 days before spinal procedure and
Evaluate INR
No contraindication to epidural with
Aspirin or other NSAIDs
Stop plavix 7 days before
12 hours to epidural since last dose of
LMWH prophylactic
For treatment LMWH weight 24 hours
14 days for
Ticlodipine before doing epidural
Spinal hematoma symptoms
Severe back pain
Progression of numbness/weakness
Bowel/Bladder dysfunction
Intrascalene doesn’t get
Ulnar nerve and is good for shoulder procedures
Supraclavicular for elbow forearm and hand
If on supraclavicular you hit subclavian artery go posterolateral
Axillary doesn’t get
Musculocutaneous
Radial is below and ulnar above in
Axillary nerve block
Variables must be mutually exclusive to run a
Chi square test
Looks if observed distribution is based on chance alone
Participating in one category should not participate in another category
A fib don’t give esmolol if patient
Has severe COPD or diabetes mellitus
Digoxin has
Low therapeutic index
Amiodarone takes about
7 hours to achieve rate control without preexcitation
Amiodarone is considered a second line agent
Ethosuximide blocks
T-type calcium channels
Soft palate to epiglottis is the
Oropharynx
High volume low pressure
ETT cuffs
Carbon dioxide cylinder is
Gray
Majority of intraventricular septum supplies by the
LAD
Left current laryngeal nerve loops around whAt major vessel Of mediastinum
Aorta
Right recurrent laryngeal loops around
Right subclavian
Cardiac skeleton insulates
The atria from the ventricles
Organ getting most cardiac output at rest
Lungs
100% of cardiac output goes through the lungs
Brain gets 15%
Kidneys 20%
Sympathetic activation of the SA node leads to
Increased permeability of resting membrane to sodium and calcium ions
LV diastolic dysfunction
Increased E wave on Doppler with reducer A wave
Venous return is augmented by
Decreased venous resistance
How much blood in veins and venules
60%
Bronchospasm most likely during
Intubation
First treatment in bronchospasm that works fastest
Deepen the anesthetic
Need SSEP for
Elective spine cases
Hypocarbia from hyperventilating can lead to
Hypocalcemia
Bradycardia and hypotension think
Carotid sinus
Normal ACT is about
107
Factors that prolong act
Hypothermia
Thrombocytopenia
Hemodilution
Muscarinic activation
Bradycardia
Bronchoconstrict
Miosis
Gi hypermotility
Precedex metabolism occurs in the
Liver
Concentric hypertrophy helps by lowering
Wall tension
Biracial artery goes with
Median nerve
PVR is highest at
Extremes of lung volumes
Dp/dt
Left ventricular contractility
E/A ratio
Diastolic measurement
Progressive distal muscle weakness in
Charcot Marie tooth disease
Decrease these to lower auto peep
RR
TV
Gas flow rate
Decrease plateau pressure with
Decrease peep and decrease tidal volume
Sickle cell avoid
Hypo/hyperthermia
Hypoxemia
Hypotension
Post transplant kidney injury lower when giving
Mannitol
Etomidate
Higher risk of superficial thrombophlebitis compared to propofol
Endovascular is better for
Descending aorta but not proximal aorta
COPD goes with
MAT
Base excess calculated in
ABG
PC02
Severinghouse electrode
SVR
MAP/CO x 80
Nitrous oxide inhibits
DNA synthesis
Eccrine sweat gland
Sympathetic preganglionic to nicotinic receptor to sympathetic postganglionic to muscarinic receptor
Full term newborn
80-90 ml/kg
Factors that result in variable clotting time include
Hemodilution, hypothermia, platelet count below 50k
Pacemaker leads are put in the
Endocardium
Axillary artery
Radial nerve lateral
Musculoskeletal nerve
Pyloric stenosis
Chloride exchanges with bicarbonate in stomach
Bicarbonate is absorbed and chloride lost
Nicardipine causes
Direct cerebral vasodilation
After starvation brain will obtain most its energy from
Ketone metabolism
Most T3 is formed peripherally by
Partial deiodination of thyroxine
More thyroid hormone causes increase in
Metabolic rate
CDH ok for
Gentle ventilation with permissive hypercapnia using low tidal volume
No spinal cord stimulator for
Soma to form patient
Coagulopathy sepsis
Carboprost does not help with
Uterine relaxation
1-beta =
Power
CYP2D6 converts
Codeine to morphine
Pulmonic valve better visualized on
TTE than TEE
Hypnosis with blood pressure occurs faster than
Time to decrease of blood pressure
Neonates have decreased
CYP2D6
Don’t need preop ecg for
Renal insuffiency age diabetes
Alpha 2 ligands
Gabapentin, pregabalin bind to alpha2 subunit of voltage gated calcium channel prevent release of nociceptive neurotransmitters
Eye blocks are not used in cases
Lasting longer than 90 minutes
Patients younger than 15 yo
Or inability to follow commands or lie still
Retrobulbar hemorrhage from eye block
Excellent motor block but also
Closure of upper eyelid
Propotosis
Palpable increase in IOP
Oculocardiac reflex
Bradycardia
Arrhythmias
Cardiac asystole
If arrhythmia from oculocardiac reflex
Stop stimulating and give 0.007 mg/kg atropine
High spinal but pt
In trendelenberg
Contraindications to spinal
Coagulation abnormalities Severe hypovolemia Increased ICP Infection at site Severe valve disease
Regional spots
C8 pinky finger Nipple T4 Inferior angle scapula T7 Umbilicus T10 Perineum S2-S4
Spinal cord ends at
L1 in adults
More pruritis when giving opioids in
Intrathecal space
Don’t do epidural if On heparin can lead to
Spinal hematoma and spinal cord injury
Discontinue chronic warfarin 4-5 days before spinal procedure and
Evaluate INR
No contraindication to epidural with
Aspirin or other NSAIDs
Stop plavix 7 days before
12 hours to epidural since last dose of
LMWH prophylactic
For treatment LMWH weight 24 hours
14 days for
Ticlodipine before doing epidural
Spinal hematoma symptoms
Severe back pain
Progression of numbness/weakness
Bowel/Bladder dysfunction
Intrascalene doesn’t get
Ulnar nerve and is good for shoulder procedures
Supraclavicular for elbow forearm and hand
If on supraclavicular you hit subclavian artery go posterolateral
Axillary doesn’t get
Musculocutaneous
Radial is below and ulnar above in
Axillary nerve block
Variables must be mutually exclusive to run a
Chi square test
Looks if observed distribution is based on chance alone
Participating in one category should not participate in another category
A fib don’t give esmolol if patient
Has severe COPD or diabetes mellitus
Digoxin has
Low therapeutic index
Amiodarone takes about
7 hours to achieve rate control without preexcitation
Amiodarone is considered a second line agent
Ethosuximide blocks
T-type calcium channels
Soft palate to epiglottis is the
Oropharynx
High volume low pressure
ETT cuffs
Carbon dioxide cylinder is
Gray
Hypercarbia can lead to
Respiratory acidosis which is a known cardiac depressant which can lead to arrhythmias
RV is perfused throughout
Cardiac cycle
LV mainly during
Diastole
Normal PCWP
6-12
CI is increased to compensate for low
SVR in septic shock
LFCN block need to identify
ASIS
Pyloromyotomy need to intubate fast so
Give succ
Succ activates muscarinic receptors in sinus node leading to
Bradycardia
TEE best for detecting
Myocardial ischemia
Acute stoppage of TPN leads to
Hypoglycemia
CSF volume is higher in infants on a
Ml/kg basis than adults
Bradycardia more likely in adults due to
Affecting cardiac accelerating fives T1-T4
Termination of spinal cord occurs at
L3 in infants
Dural sac ends at S3
Enoxaparin monitored by measuring
Factor 10a levels
Preeclampsia leads to
Abnormal myometrial spiral arteries with increased vascular tone
Increases uterine vascular resistance and decreases uterine blood flow
Fentanyl shorter duration of action is due to
Greater lipid solubility compared to morphine
SIADH treatment is
Free water restriction
Cerebral salt wasting treat both with free water and sodium
Usually CSW patients are hypovolemic while SIADH are euvolemic
Midazolam bioavailability
IV, subcutaneous, intramuscular, intranasal, rectal, oral
Mivacurium is hydrolyzed by
Psuedocholinesterase
Plasma administration most likely to lead to
TRALI
Metoprolol contraindicated in
Acute heart failure bc it’s a negative inotropy
PVR is highest at
Extremes of lung volumes
If treating acute malignant hyperthermia don’t give another
Calcium channel blocker
Functional closure of foramen ovale occurs
The day of birth
Uremia will result in higher concentration of free fraction
Unbound midazolam
Desmopressin May improve
Platelet dysfunction in uremic patients
Decreased stroke volume and cardiac output when standing
Upright
Water moves freely across
BBB
Higher peak pressures after steep trendelenberg with desat think
Endobronchial intubation and pull the tube back a few cm
Glucagon released by
Alpha cells and inhibits hepatic glycolysis
Anterior mediastinal mass
Fear complete airway obstruction
Inability to maintain gas exchange and cardiovascular collapse from compression of vital structures
Before patient comes off pump
Calcium to increase myocardial contractility and reverse potassium cardioplegia
AV block leading to low heart rate need
Temporary epicardial pacemaker not atropine
Ventricular pacing for
Complete AV block
Sem
Standard deviation/square root sample size
