Peri-operative care 8.9

Question 1

P1

Answer 1

normal, healthy 0.1%

Question 2

P2

Answer 2

mild systemic disease 0.2%

Question 3

P3

Answer 3

severe systemic disease 1.8%

Question 4

P4

Answer 4

severe systemic disease that is a constant threat to life 7.8%

Question 5

P5

Answer 5

moribund patient, not expected to survive without operation 9.4%

Question 6

P6

Answer 6

organ donor

Question 7

ASA risk Index 1

Answer 7

unstable coronary syndromes

Question 8

ASA risk index 2

Answer 8

decompensated HF, new HF, class IV HF

Question 9

ASA risk index 3

Answer 9

significant new arrythmias

Question 10

ASA risk index 4

Answer 10

severe valvular disease

Question 11

Pre-anesthetic meds

Answer 11

Benzodiazepines, Barbituates, anithistamines, phenothiazine, butyrophenes

Question 12

IV anesthetics

Answer 12

barbituates, etomidate, opioids, ketamine, propofol

Question 13

Benzodiazepines actions

Answer 13

reduce anxiety, “calming” effects

Question 14

BZD agents

Answer 14

Diazepam, Lorazepam, midazolam

Question 15

Barbituates actions

Answer 15

sedation and reduce apprehension

Question 16

Barbituate agents

Answer 16

phenobarbital, thiopental

Question 17

Barbituate ADR

Answer 17

cardiac and respiratory depression

Question 18

Etomidate actions

Answer 18

potent ultra-short acting hypnotic without analgesic properties. Conscious sedation or rapid sequence induction for cardioversion

Question 19

Etomidate pearl

Answer 19

must follow with analgesic and muscle relaxant drugs

Question 20

Etomidate dose

Answer 20

IV 0.3 mg/kg–>sleep for 5 mins

Question 21

Etomidate ADR

Answer 21

hypotension, carbon dioxide retention, suppresses corticosteroid synthesis at adrenal cortex

Question 22

Opioid action

Answer 22

inhibit nociceptive reflexes and induce analgesia through action at mu receptors. Inhibit release of neurotransmitters

Question 23

Opioid ADR

Answer 23

respiratory depression, NV, constipation

Question 24

Ketamine actions

Answer 24

dissociative anesthesia

Question 25

Ketamine ADR

Answer 25

hallucinations, bad dreams, increased muscle tone

Question 26

Propofol

Answer 26

Oil emulsion at room temperature, rapid onset and effective for induction and maintenance

Question 27

Propofol ADR

Answer 27

apnea, hypotension, injection site pain

Question 28

inhaled anesthetics

Answer 28

nitrous oxide, sevoflurane, Isoflurane, desflurane

Question 29

inhaled anesthetics actions

Answer 29

used for induction and/or as adjuvant

Question 30

inhaled anesthetic ADR

Answer 30

NV, malignant hyperthermia, caution with renal/hepatic dysfunction

Question 31

Local anesthetics actions

Answer 31

inhibit sodium channels, used for infiltration or nerve block

Question 32

Amino amides

Answer 32

lidocaine, bupivicaine, Prilocaine, Dibucaine

Question 33

Amino esters

Answer 33

Benzocaine, cocaine, procaine, tetracaine

Question 34

purpose of epinephrine

Answer 34

allows for lower doses that last longer

Question 35

Amino amides/esters ADR

Answer 35

increased plasma concentrations, CNS effects, cardiac effects, respiratory arrest, burning sensation, skin discoloration, tissue necrosis, neuritis

Question 36

Regional anesthesia

Answer 36

epidural and spinal

Question 37

Risk factors for increase peri-op pain

Answer 37

post-op pain, anxiety, genetics, opioid tolerance, female gender

Question 38

NSAIDs and COX inhibitor actions

Answer 38

reduce opioid requirements by reducing inflammatory response

Question 39

NSAIDs

Answer 39

ketorolac, ibuprofen, naproxen

Question 40

COX 2 inhibitors

Answer 40

celecoxib

Question 41

Risk Factors for PONV

Answer 41

female, motion sickness, non-smoking status, post-op opioids, inhaled anesthetics, high dose neostigmine

Question 42

Dexmedetomaine

Answer 42

used for sedation in ICU or brief procedures

Question 43

PONV tx options

Answer 43

serotonin agonists (ondansetron), neurokinin inhibitors, steroids (dextramethasone), anithistamines (dimenhydrinate), butyrophenones (Droperidol), BZD