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
