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NUAN603-Overview of Anesthesia > Overview of Anesthesia Lecture 3 > Flashcards

Overview of Anesthesia Lecture 3 Flashcards

1
Q

What should be obtained before administering IV agents?

A

Consent

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2
Q

Thiopental (Pentathol) dose

A

3-5 mg/kg/IV

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3
Q

What is the onset time for Thiopental (Pentathol)?

how about duration

A

15-30 seconds

5-10 minutes

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4
Q

What is the typical dose of Methohexital (Brevital) for IV administration?

what about for kids

A

1-1.5 mg/kg/IV

25 mg/kg RECTAL

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5
Q

onset and duration of methohexital (Brevital)

A

onset- 15-30 sec

duration- 5-10 min

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6
Q

What is the mechanism of action (MOA) of Dexmedetomidine (Precedex)?

A

Selective alpha-2 agonist

decreases need for narcotics

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7
Q

What are the side effects of Dexmedetomidine?

A

*Bradycardia
*Hypotension

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8
Q

What is a common use for Benzodiazepines in anesthesia?

A

Anxiolysis

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9
Q

What is the onset time for Midazolam (Versed)?

A

30-60 seconds

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10
Q

midaz dosing for induction

A

1-3 mg IVP

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11
Q

MOA midazolam and how is it metabolized

duration

A

(MOA)- attaches to the alpha subunit on the GABA(A) receptor to produce anesthesia-

Metabolism- CYP3A4 & CYP3A5

20-60 minutes

caution ages >65

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12
Q

What is the duration of action for Remimazolam (Byfavo)?

A

Ultrashort acting

good for procedures <30min

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13
Q

Remimazolam (Byfavo) dose for induction

A

2.5-5 mg IVP over 1 min

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14
Q

MOA for flumazenil (Romazicon)

how’s it metabolized

A

„ Mechanism of action (MOA)- competitive antagonist at the GABA-A receptor

metabolism- Liver

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15
Q

who should not receive Flumazenil (Romazicon)

A

chronic benzo users- can cause sz activity d/t it’s pure benzo antagonism

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16
Q

What is the dose and maximum dose for Flumazenil (RoMazicon)?

A

Dose: .2mg q1Min
MAX- 0.6-1.0 mg

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17
Q

Etomidate (Amidate) for IV induction?

onset/duration/MOA/metabolism

A

Induction: 0.2-0.3 mg/kg/IV

ONset- 15-45 sec
duration- 3-10 min

MOA- Works on GABAA receptor to produce unconsciousness, and reticular activating system

metabolism- liver

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18
Q

T/F- etomidate has analgesic properties

A

false- need to give separate analgesia

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19
Q

What is the mechanism of action for Ketamine (Ketalar)?

onset/duration

A

N-methyl-D-aspartate (NMDA) receptor antagonist
NMDA) receptor antagonist
-interferes w/ communication b/t limbic and thalamus systems

„ onset- 30-60 seconds
„ duration-5-10 minutes
„ Good analgesic- (somatic > visceral pain)
„ Increases CMRO2

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20
Q

indications/dosing/concentration for ketamine

and metabolism so we don’t have 10000 cards

A

„ Dose- 1-2 mg/kg/IV-
* (3-5 mg/kg IM KIDS)

„ Indications- induction or adjunct to MAC (usually adjunct)
* Concentration- usually 50 mg/ml

metabolism- hepatic microsomal enzymes

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21
Q

T/F- ketamine causes respiratory depression and is bad for asthmatics

A

F

no respiratory depression- can offset propofol depression

good bronchodilatior for pt’s with reactive air-ways

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22
Q

other uses for ketamine besides sedation (4)

A

treats depression
SI
chronic pain
decreases opioid requirement

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23
Q

Fill in the blank: Propofol promotes _______ mediated inhibitory neurotransmission.

to produce sedation or LOC

A

GABAA

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24
Q

What is a significant concern when using Propofol?

A

Propofol Infusion Syndrome (PIS)

caution w/ egg allergies/ lecithin/ peanut/soy- avoiid in peds

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25
Q

induction dose of prop

onset

duration

A

„ 2-2.5 mg/kg/IV for induction**-
__- 2.5-3.5 mg/kg/IV for PEDS
„ 20-200 mcq/kg/min infusion

  • Onset- 15-45 seconds
  • Duration- 5-10 minutes
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26
Q

whats this

A

2,6 diisopropylphenol

Propofol!

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26
Q

what do you give prior to prop during induction and WHYYY

A

„ can administer lidocaine prior to injection at 0.5 mg/kg/IV** like a minute before

 Binds to voltage-gated Na channels & prevents Na flow through the channel

„ If using lidocaine as part of induction to blunt sympathetic response: the dose is 1-1.5/mg/kg/IV

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27
Q

MOA for opioids

A

 A. Binding in specific areas in CNS- medulla, grey matter, locus serulious
 B. Binding in peripheral tissues and spinal cord-
 C. Receptors which mediate the action of opioid drug
„ Mu (Mu1= bradycardia)
„ Kappa
„ Delta
„ G-coupled proteins

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28
Q

What is a potential risk associated with opioid use in cancer patients?

A

Cancer recurrence

controversial

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29
Q

What does MAC stand for in anesthesia?

A

Minimum Alveolar Concentration

Or Monitored Anesthesia care

For 2 things we need to know you’d think they could come up with another name

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30
Q

goal of inhalational anesthesia

how do you know if you have MAC

A

o Induction
 Occurs when anesthetizing partial pressure achieved in brain is = to PP of the gas
„ brain is final site- for impact of selected agent
„ look at inspired and expired concentration

o Goal of Inhalational Anesthesia - Maintain brain concentration
„ monitor with agent monitor

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31
Q

what are the 3 characteristics of anesthesia

A

 Amnesia- don’t remember
„ Never say an absolute- there is a 0.1 percent chance that they could have recall during MAC

 Analgesia- pain free

 Akinesia- not moving

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32
Q

What is the weakness of Sevoflurane (Ultane)?

A

*Unstable in CO2 absorbers
*Can cause fires

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33
Q

What is the typical induction dose for Propofol?

A

2-2.5 mg/kg/IV

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34
Q

True or False: Isoflurane has a pungent odor.

A

True

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35
Q

What is the effect of adding N2O on MAC?

A

Reduces MAC by 2/3

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36
Q

______ MAC decreases risk of recall

A

.4-.5 MAC

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37
Q

What should be monitored to maintain brain concentration during anesthesia?

A

Inspired and expired concentration

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38
Q

What is the MOA of opioids?

A

Binding to morphine receptors

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39
Q

Fill in the blank: Ketamine is an excellent _______ for patients with asthma.

A

Bronchodilator

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40
Q

What is the concentration of Midazolam (Versed) for IV sedation?

A

1 mg/ml or 5 mg/ml

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41
Q

What is the primary action of Dexmedetomidine?

A

Decreases the need for narcotics

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42
Q

What is the duration of action for Remifentanil?

A

3-5 minutes

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43
Q

What is the typical dose for Sufentanil compared to Fentanyl?

A

0.25 mcg/kg/IV (ten times more potent than Fentanyl)

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44
Q

What is a side effect of Flumazenil in chronic Benzodiazepine patients?

A

Seizure activity

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45
Q

What is the ideal characteristic of an anesthetic agent regarding solubility?

A

Poorly soluble in blood

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46
Q

What is the relationship between MAC and potency?

A

MAC relates the agent to potency

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47
Q

What is the strength of Isoflurane?

A

Good muscle relaxation

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48
Q

What is the mechanism of action for Etomidate?

A

Works on GABAA receptor

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49
Q

What is one of the weaknesses of Desflurane?

A

Boils at room temperature

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50
Q

What are the three characteristics of anesthesia?

A

*Amnesia
*Analgesia
*Akinesia

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51
Q

What does the term ‘emergence’ refer to in anesthesia?

A

Stage 3 -> Stage 2 -> Stage 1

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52
Q

Fill in the blank: The ideal anesthetic agent should be _______ and non-toxic.

A

Poorly soluble in the blood

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53
Q

What is the effect of Nitrous Oxide on B12 metabolism?

A

Limits B12 metabolism

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54
Q

What is a contraindication for using Nitrous Oxide?

A

„ Middle ear surgery- b/c expansion of gas
„ Laser surgery- b/c laser is an oxidizer = risk of fire
„ Pulmonary hypertension= Increases PVR
„ History of n/v
„ Laparoscopic abdominal procedures- distention of bowel then surgeon can’t see anything.
* Takes about 2 hours for it to occur
„ Greenhouse effect- trivial <0.05%

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55
Q

T/F - all inhaled anesthetics carry the risk of MH

A

true

except for N20 but that barely counts

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56
Q

What is the typical concentration of Ketamine for IV induction?

A

50 mg/ml

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57
Q

What is the effect of opioids on cancer cell activity?

A

May stimulate cancer cell activity

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58
Q

What is the primary role of anesthetic agents in surgery?

A

Induction and maintenance of anesthesia

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59
Q

What are the strengths of Sevoflurane?

A

Similar to isoflurane, can be used for mask induction in pediatric or adult patients

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60
Q

What are the weaknesses of Sevoflurane?

A

Unstable in CO2 absorbers, can cause fires, metabolized to fluoride, costly, trigger for MH

Compound a for extended low flow

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61
Q

What evidence exists regarding inhalational agents and cancer?

A

Some evidence suggests inhalational agents may stimulate cancer cell activity

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62
Q

How is Xenon manufactured?

A

By fractional distillation of liquefied air

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63
Q

What is the MAC of Xenon?

A

71%- not potent, can only give 29% O2

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64
Q

What is the blood/gas solubility coefficient of Xenon?

A

0.115

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65
Q

What is the cost of Xenon?

A

$10 per liter

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66
Q

What is a notable side effect of Xenon?

A

High incidence of nausea/vomiting, diffuses into closed gas space

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67
Q

What do muscle relaxants do?

A

Interfere with physiological sequence of neuromuscular transmission, optimize surgical conditions

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68
Q

Physiology of neuromuscular transmission at the NMJ

godspeed

A

o Physiology of Neuromuscular Transmission at Neuromuscular Junction (NMJ)
 1. Presynaptic nerve terminal: contains vesicles with 100 K molecules of acetylcholine (Ach)
 2. Influx of Ca: Release of Ach (5,000-10,000 molecules) into NMJ
 3. Ach diffuses across cleft: binds to postsynaptic nicotinic receptor-
 4. Nicotinic receptor composed of large protein with 5 subunits in a ring
 5. At rest - Na/K pump maintains Na outside: K inside producing transmembrane potential of -90 mv
 6. Both alpha subunits occupied- Na channel opens**
 7. Na/Ca in, K out- T.M.P -45 mv (threshold potential)
 8. Action potential= muscle contraction

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69
Q

Are muscle relaxants anesthetics?

A

No

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70
Q

What is the first step in the physiology of neuromuscular transmission?

A

Presynaptic nerve terminal contains vesicles with 100 K molecules of acetylcholine (Ach)

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71
Q

What triggers the release of acetylcholine at the NMJ?

A

Influx of Ca

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72
Q

What happens when Ach binds to the postsynaptic nicotinic receptor?

A

Na channel opens

73
Q

What is the transmembrane potential at rest?

74
Q

What occurs when both alpha subunits of the nicotinic receptor are occupied?

A

Na channel opens

75
Q

What is the threshold potential for action potential?

76
Q

What metabolizes acetylcholine?

A

Acetylcholinesterase/true cholinesterase or specific cholinesterase

77
Q

How is succinylcholine metabolized?

A

 Succinylcholine- metabolized by butyrylcholinesterase, also known as plasma cholinesterase or pseudocholinesteras

„ metabolism restores membrane permeability (repolarization)

78
Q

What is the typical concentration of succinylcholine?

79
Q

What is the typical dose of succinylcholine for adults/kids?

A

1-1.5 mg/Kg/IV (70-100 mg) adult

 Kids- 2-3 mg/Kg/IV
„ 4-6 mg/Kg/IM

everyone usually gets 100 mg unless they are hefty

80
Q

What is the onset time for succinylcholine?

A

30-60 seconds

81
Q

What is the typical duration of succinylcholine?

A

5-10 minutes

82
Q

What can prolong succinylcholine’s effects?

A

High doses or abnormal metabolism

decreased enzyme levels

late stage preggo

liver/renal failure, dialysis, MI, CHF

Burns, oral contraceptives, malnutrition, steriods

83
Q

What is a common side effect of succinylcholine?

A

Fasciculations

84
Q

What can succinylcholine cause in patients with burns or neurological injuries?

A

Hyperkalemia

85
Q

What is a treatment for hyperkalemia caused by succinylcholine?

A

10% Calcium Chloride IV, hyperventilation, insulin, D50 Glucose, albuterol, dialysis

86
Q

what is the dibucaine number for

A

tests for abnormal genes that prolong the effects of succ

„ 1 in 500 patients- one normal and one abnormal gene (heterozygous)
„ 1 in 2,000-5,000 patients- two abnormal genes (homozygous)-

usually not done unless fam hx

87
Q

dibucaine of 70-80 is……

A

normal
typical homozygous

duration of succ - 5- 10 min

88
Q

heterozygous enzyme for succ means

A

dibucain is. 50-69

succ lasts longer 20-30 min

89
Q

atypical homozygous enzyme for succ

A

16-30
succ will be in there for 4-8 hrs

sorry pacu- must wait it out

90
Q

what is another use for succ other than induction

A

laryngospasm

0.2-0.5 mg/Kg/IV
„ If positive pressure doesn’t break the spasm or the jaw lift doesn’t work

91
Q

What is malignant hyperthermia?

A

A condition triggered by succinylcholine, leading to severe muscle contractions

92
Q

What is the incidence of anaphylaxis related to neuromuscular blockers in the USA?

A

15.3 per 100k procedures

93
Q

What is the primary risk associated with succinylcholine in children?

A

Hyperkalemic rhabdomyolysis

mortality is 40-50%

treat as same as hyperkalemia

94
Q

What is the dose of succinylcholine for laryngospasm?

A

0.2-0.5 mg/Kg/IV

95
Q

What can occur during succinylcholine overdose?

A

Phase II block

„ Cholinesterase inhibitor will prolong Phase I block
 Inhibiting Achase- leads to an increase at NMJ which intensifies depolarization

 Decreases hydrolysis of Succinylcholine by inhibiting pseudocholinesterase from breaking it down.

96
Q

What are nondepolarizing muscle relaxants?

A

Competitive Ach receptor antagonists

97
Q

how much can succ increase serum potassium

who’s that bad for apart from everyone

A

.05-1 meq/l

  • can be dangerous in burn patients, neurological patients (spinal cord injury, Guillain-Barre, CVA, muscular dystrophy, MS), massive trauma, prolonged immobility & severe sepsis- WHY?
    „ Can increase more than .5-1 in these peeps
    „ d/t upregulation of ach receptors- they have more receptors can release more potassium
     stay open 10x longer than normal cells
     risk can last up to 1 year- DO NOT GIVE THEM SUCC
97
Q

Succ CV S/E

A
  • Succinylcholine stimulates all Ach receptors in SNS/PSNS
  • Initially hypertensive and tachycardic
  • Bradycardia in kids (higher vagal tone) & with second dose in adults- impact on SA node
    „ Kids will need atropine/glyco pre-op to offset risk
    „ Transient but significant enough you’ll need to treat
98
Q

What is the duration of action for intermediate-acting nondepolarizers?

A

35-45 minutes

99
Q

What is the metabolism of atracurium?

A

Ester hydrolysis (66%) and Hoffman elimination (33%)

100
Q

atracurium

dose for induction

A

.4-.5 mg/kg/IL over 30-60 sec

101
Q

what is the only long acting NDMR

A

pancuronium- 85 min

102
Q

vecuronium

tubing dose

metabolism

onset

A

 Dose: intubation- 0.08-0.1 mg/Kg/IV-
 Maintenance- 0.01 mg/Kg/IV
 Infusion- 1.0-2.0 mcq/Kg/min** (M & M pg. 212)

 Metabolized- 40-50% hepatic & 50-60% renal

onset- 2.5 minutes

103
Q

Tell me the things about cisatracurium (Nimbex)

A

 Dose- 0.1 mg/Kg/IV-

 Maintenance- 0.03 mg/Kg/IV

 Infusion- 1.0-2.0 mcq/Kg/min** (M & M pg. 212)\

 Metabolized- Hoffman elimination (77%) & renal- 16%-
„ Hoffman – temperature and pH dependent
* **Good for renal / liver failure pts **

 No Histamine release
 Onset 3 minutes

104
Q

What is the dose of rocuronium for intubation?

onset

metabolism

duration

A

0.45-0.6 mg/Kg/IV

good for RSI- onset is 60-90 sec

 Metabolism- >70% eliminated by biliary excretion & 10-25% by kidney

duration 50 min

good for RSI

105
Q

What is the primary side effect of rocuronium?

A

Possible anaphylactic reaction

banned in many countries in Europe

106
Q

What is the duration of action for pancuronium?

A

85 minutes

107
Q

Pancuronium intubation dose

A

.08-.1 mg/kg/ IV

108
Q

What is the main side effect of pancuronium?

A

Hypertension and tachycardia
(inhibits M2 receptor at SA node & stimulates catecholamine release)-

109
Q

What is the order of potency among volatile agents?

A

Des>Sevo>Iso>N2O

110
Q

What are some antibiotics that interact with muscle relaxants?

A

*Aminoglycosides
*Tetracycline
*Polymixins

111
Q

What are common anticholinesterase drugs?

A

*Neostigmine
*Physostigmine
*Edrophonium

112
Q

What is the mechanism of action of anticholinesterase drugs?

A

Inhibit acetylcholinesterase, allowing accumulation of Ach at NMJ

113
Q

What are the muscarinic side effects of cholinesterase inhibitors?

A

*Bradycardia
*Increased secretions
*Pupil constriction
*Bronchoconstriction

114
Q

What is the dose of Narcan (Naloxone) for opioid reversal?

A

0.5-1 mcg/kg/IV

115
Q

What is the mechanism of action of Sugammadex?

A

Encapsulates rocuronium & vecuronium, forming a rigid complex

116
Q

What is the dose of Sugammadex for reversal of rocuronium?

A

 TOF 2/4- 2 mg/kg/IV

 TOF 0/4: PTC > 1- dose is 4 mg/kg/IV

 RSI dose with rocuronium at 1.2 mg/kg–
 Sugammadex dose-16 mg/kg/IV given 3 mins after roc dose

117
Q

What is the renal and liver elimination percentage for the discussed medications?

A

75% Renal, 25% Liver

118
Q

What is the recommended IV dose of Atropine per 1 mg of Pyridostigmine?

119
Q

What is the preferred IV dose of Glycopyrrolate per 1 mg of Pyridostigmine?

A

0.05 mg/IV

120
Q

What is the primary use of Sugammadex?

A

For reversal of rocuronium & vecuronium

121
Q

What is the mechanism of action (MOA) of Sugammadex?

A

Encapsulates rocuronium & vecuronium & forms a very rigid complex

122
Q

What is the IV dose of Sugammadex for TOF 2/4?

A

2 mg/kg/IV

123
Q

What is the IV dose of Sugammadex for TOF 0/4 with PTC > 1?

A

4 mg/kg/IV

124
Q

What is the RSI dose with rocuronium?

125
Q

What is the Sugammadex dose when given 3 minutes after rocuronium?

A

16 mg/kg/IV

126
Q

What is the onset time for Sugammadex?

127
Q

What is the MOA of Metoclopramide?

A

Dopamine antagonist

128
Q

What is the recommended IV dose of Metoclopramide?

129
Q

What is the MOA of Droperidol?

dose

A

Dopamine antagonist

.625-1.25 mg IV

130
Q

What is the FDA black box warning associated with Droperidol?

A

Prolonged QT; need pre-op EKG

131
Q

What is the IV dose of Ondansetron?

132
Q

What is the MOA of Ondansetron?

A

Serotonin antagonist (5-HT3 receptor antagonist)

133
Q

What is the recommended dose of Decadron for PONV?

134
Q

What is the MOA of Barhemsys?

A

Dopamine D2 & D3 receptor antagonist

135
Q

What is the prevention dose of Barhemsys?

136
Q

What is the treatment dose of Barhemsys?

137
Q

What is the MOA of Toradol?

A

Non-selective competitive inhibition of cyclo-oxygenase (COX-1 and COX-2)

138
Q

What is the IV dose of Toradol?

A

30 mg/IV Q 6 hrs.

139
Q

What is the maximum 24 hr. dose of OFIRMEV?

140
Q

What is the IV dose of Caldolor?

A

400-800 mg/IV over 30 minutes, Q 4-6 hrs.

141
Q

What is the MOA of Ephedrine?

A

Noncatecholamine sympathomimetic agent

142
Q

What is the typical IV dose range for Ephedrine?

A

2.5-10 mg/IV

143
Q

What is the MOA of Neosynephrine?

A

Direct acting alpha-1 adrenergic agonist

144
Q

What is the IV bolus dose of Neosynephrine?

A

50-100 mcg/IV

145
Q

What is the IV dose of Epinephrine for hypotension?

A

5-20 mcg/IV bolus

146
Q

What is the IV dose of Labetolol?

A

2.5-10 mg/IV over 2 minutes

147
Q

What is the MOA of Esmolol?

A

Short-acting selective Beta-1 antagonist

148
Q

What is the IV dose of Esmolol?

A

0.2-0.5 mg/kg/IV

149
Q

What is the MOA of Hydralazine?

A

Smooth muscle vasodilator

150
Q

What is the typical IV bolus dose of Hydralazine?

A

5 to 20 mg IV every 15 to 20 minutes

151
Q

What is the MOA of Nitroprusside?

A

Arteriolar & venous smooth muscle relaxant

152
Q

What is the onset time for Nitroprusside?

A

60-120 seconds

153
Q

What is the first step in the induction sequence for general anesthesia?

A

Apply monitors, then Pre-oxygenate

154
Q

What is given after pre-oxygenation in the induction sequence?

A

Fentanyl/midazolam

155
Q

What should be done before administering Propofol in the induction sequence?

A

Lidocaine prior to Propofol

156
Q

What is checked after administering Rocuronium?

A

Check TOF in 2-3 mins

157
Q

What is turned on after Rocuronium administration?

A

Turn on inhalational agent

158
Q

classifications of opioid receptors

159
Q

fentanyl- indication

MOA

dosage dependent upon procedures (low, med, high)

A

 Intraoperative anesthetic dose: 2-50 mcg/kg/IV
 Indication- analgesia

 Concentration- 50 mcq/ml
„ Low- 1-3 mcq/kg/IV
„ Moderate- 5-10 mcq/kg/IV
„ High- 20-50 mcq/kg/IV up to 75 for CABG

 MOA- agonizes Mu receptors to produce analgesia

160
Q

sufentanil is _______ stronger than fentanyl

A

10x

 Intraoperative Anesthetic Dose: 0.25 mcg/kg/IV

161
Q

T/F- fentanyl, sufentanil, morphine, and dilaudid antagonize delta receptors

162
Q

Remifentanil

metabolism

concern

A

 Unique in its metabolism- plasma erythrocyte and tissue esterase’s

 Concern-
„ opioid induced hyperalgesia (OIH)- high postop opioid requirements

  • Wears off Very quickly (3-5 min)
  • Treat- ketamine or magnesium sulfate
163
Q

IV tylenol

MOA

dose

advantages

A

 MOA- unclear- inhibition of cyclooxygenase (COX), with a predominant effect on COX-2
 Advantages-postoperative pain relief, decreased use of opioids & reduced incidence of PONV
 Dose- 1000 mg/IV Q 6hrs.
 Maximum 24 hr. dose- 4000 mg
 Timing of administration-
 Not approved for children <2 yrs. of age
 Give @ end of case

164
Q

Toradol

MOA

Dose

S/E

A

 MOA- non-selective competitive inhibition of cyclo-oxygenase (COX-1 and COX-2)
 Dose- 30 mg/IV Q 6 hrs. (studies showing that 15 mg just as effective)
 Reduce dose in elderly
 May be contraindicated in patients with renal insufficiency & aspirin induced asthma
 May prolong bleeding time**- questionable- always ask surgeon before administering

165
Q

why do you give an anticholinergic with an anticholinesterase inhibitor during emergence?

A

An anticholinesterase inhibitor (like neostigmine) is used to reverse neuromuscular blockade, while an anticholinergic

(like atropine or glycopyrrolate) is given to prevent unwanted side effects of increased acetylcholine, like bradycardia and excess salivation. The two work together to safely reverse the blockade without causing parasympathetic issues.

166
Q

what is the dose combo for neostigmine and glyco for reversal?

A

neostigmine (anticholinesterase)- 0.04-.08mg/kg up to 5 mg TOTAL

Glycopyrrolate- 0.2 mg IV per 1 mg Neostigmine

167
Q

what is the reversal combo doses for neostigmine and atropine

A

neostigmine (anticholinesterase)- 0.04-.08mg/kg up to 5 mg TOTAL

atropine- 0.4mg/IV per 1 mg neostigmine

168
Q

you are tring to reverse a child…. which meds do you give and in which order?

A

Atropine 1st!!! b/c kids rely on HR for their CO- then neostigmine (will counteract the bradycardia)

atropine- 0.04 mg/1mg Neostigmine
neostigmine- .04-.08 mg/kg/IV

169
Q

reversal combo doses

pryidostigmine w/ atropine

A

pryidostigmine - .1-.25 mg/kg/IV up to 20 mg

atropine- 0.1mg IV/ 1 mg pryridostigmine

170
Q

reversal combo doses

pryidostigmine w/ glyco

A

pryidostigmine - .1-.25 mg/kg/IV up to 20 mg

glyco- 0.05mg IV/1mg pyridostigmine (preferred)

171
Q

what are side effects of anticholingerics

A

MUSCARINIC

Bradycardia/hypotension
bronchospasm, secretions, hypoxia
pupillary constriction (Miosis)
increase salivation, intestinal spasm, increased bladder tone

172
Q

what is the MAC and B/G solubility coefficient of N2O?

173
Q

what is the MAC and B/G solubility coefficient for forane?

174
Q

what is the MAC and B/G solubility coefficient for desflurane?

175
Q

What is the MAC and B/G solubility coefficient for Sevoflurane?

176
Q

nondepolarizers can be prolonged/potentiated by various factors such as:

(theres 8 name a few)

A

volatile agents (Des>sevo>iso>n20)
antibiotics
antidysrhythmics
local anesthetics
diurietics- lasix
dantrolene/lithium
electrolytes (increased mag, hypo cal, hypokal)
hypothermia and being female

177
Q

what will you use to reverse your nondepolarizing muscle relaxant if you don’t have sugammedex?

A

neostigmine and robinol

178
Q

what is the typical induction sequence?

A

apply monitors
preoxygenate
give fent/midaz
lidocaine prior to prop
tape eyes, mask ventilate
give roc- wait 2-3 to check TOF
turn on inhalation agent
careful intubation

NUAN603-Overview of Anesthesia (8 decks)

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