Principles of Anesthesia Flashcards
Anticholinergic Syndrome
[signs and symptoms]
tachycardia, mydriasis, dry mouth, delirium
Cholinergic Syndrome
[signs and symptoms]
bradycardia miosis, salivation, confusion
In a newborn, access to the vena cava can be gained by passage of a catheter through the _____
ductus venosus
Patient with previous MI is schedule for a cardiac surgery, when would this patient be at highest risk for another myocardial infarction?
3 day post-op
a change in [HCO3-] of 10 mEq/L from 24 will results in ____ pH units in the same direction
0.15
Pulmonary artery wedge pressure increases with sudden V waves appearing on monitor
What drug should be given?
Nitroglycerin
Indicates ischemia of posterior wall of LV leading to a prolapse of the mitral valve
PaCO2 will decrease about ___ mmHg for every 1 mEq/L decrease in [HCO3-] below 24
1
1mmHg change in PaCO2 from 40mmHg results in ____ unit change in pH in the opposite direction
0.008
0.9% NaCl
[components]
154 Na and 154 Cl
0.9% NaCl
[osmolality]
308
(isotonic)
1 oC changes CBF ____
5 - 7%
Recommendations for preoperative 12-lead EKG
Recommended for patients who:
- exhibit at least 1 clinical risk factor who are undergoing vascular surgery
- known CHD, PAD, or cerebrovascular disease undergoing intermediate-risk surgery
14G IV Catheter
[flow rate]
240 mL/min
16G IV Catheter
[flow rate]
180 mL/min
18G IV Catheter
[flow rate]
90 mL/min
1:200,000 mixture of epi corresponds to how much?
5 mcg/mL
1st Degree AV Block
[EKG characteristics]
PR conduction greater than 0.2 seconds
2-Chloroprocaine
[maximum dose]
12 mg/kg
20 mg Cortisol equals _____ Solu-Medrol
4 mg
20G IV Catheter
[flow rate]
60 mL/min
20mg Cortisol equals _____ Decadron
0.75 mg
22G IV Catheter
[flow rate]
36 mL/min
24G IV Catheter
[flow rate]
20 mL/min
5% Albumin
[osmolality]
300
(isotonic)
50 mg of Prednisone equals ______ Decadron
7.5 mg
a decrease in pH of 0.1 unit will result in ____ [K+] of ____ mEq/L
increase of 0.6 mEq/L
A-line
[cannulation site causing the most thrombi]
axillary
Abciximab
[drug class]
Glycoprotien IIa/IIIb inhibitor
Achalasia
[definition]
failure of smooth muscle to relax which can cause sphinters to remain closed
- achalasia of the rectum is Hirschsprung’s disease
Acromegaly
[airway considerations]
narrow upper airways
(will require smaller ETT)
acute hepatitis
[volatile agents of choice]
isoflurane and sevoflurane
- presevation of hepatic blood flow and oxygen delivery
Acute Kidney Injury
[risk factors (9)]
- age > 65
- male
- active CHF
- ascites
- hypertension
- emergency surgery
- intraperitoneal surgery
- renal insufficiency
- diabetes
acute vs recent MI
[time span]
acute within 7 days
recent within 30 days
Addison’s Disease
[anesthetic considerations]
adequate steroid replacement therapy perioperatively
Addison’s Disease
[etiology]
glucocorticoid deficiency
(primary adrenal insufficiency)
Addison’s Disease
[symptoms]
hyponatremia and hyperkalemia
hypotension
metabolic acidosis
Adenosine
[drug interactions]
- Dipyrdiamole
- needs smaller dose of Adenosine
- competitive antagonists
- caffeine, theophylline, amrinone
ADP inhiibtor
[example]
clopidogrel (plavix)
Adrenal Cortex
[secretions]
androgens, mineralcorticoids, and glucocortocoids
Adrenal Cortex
[hormones]
aldosterone, cortisol, androgens
Adrenal Medulla
[secretion]
catecholamines
(primarily epinephrine)
Adrenal Medulla
[hormones]
epinephrine and norepinephrine
Advantage of Milrinone over Amrinone for long term use?
thrombocytopenia
- Amrinone produces clinically significant thrombocytopenia, especially after prolonged use
Agents
[mL of vapor in each mL of liquid]
about 200 mL
iso < sevo < des
Albumin
[normal values]
3.5 - 5.5 g/dL
Allodynia
[definition]
pain caused by a stimulus that does not normally provoke pain
Amyotrophic Lateral Sclerosis
[etiology]
rapidly progressive disorder of upper and lower motor neurons
Alveolar Gas Equation solving for PaO2
PaO2 = (PB - 47)*FiO2 - (PaCO2/R)
Alveolar O2 Tension (PAO2)
[equation]
PAO2 = PiO2 - (PaCO2 / RQ)
- can estimate by multiplying FiO2 by 6
amphetamines
[effect on MAC]
acute use increases MAC, chronic decreases MAC
Amrinone
[drug class]
phosphodiesterase III inhibitor
Amrinone
[uses and effects]
positive inotropic and vasodilatory
no anti-dysrhythmic effects
Anaphylaxis
[blood test]
Tryptase
- neutral protease released from mast cells during analphyalctic, but not anaphylactoid reactions
- should be measured within 1 - 2 hours
Anatomic Dead Space
[approximation per kg]
2 mL/kg
Anion Gap
[normal value]
12 mEq/L +/- 4
Anion Gap
[equation]
Na+ - (HCO3- + Cl-)
Anion Gap
[normal values]
7 - 16 mEq/L
Ankle Block
[nerves]
deep and superficial peroneal
saphenous
posterior tibial
sural
Anterior Pituitary
[hormones]
ACTH, FSH, GH, LH, prolactin, and TSH
Anti-arrhythmic most likely to cause thyroid problems
Amiodarone
- chemical structure similar to thyroxine
Anti-Platelets
[3 classes]
COX inhibitors
Glycoprotein IIb/IIIa inhibitors
ADP inhibitor
Antibiotics
[which increase neuromuscular blockade]
aminoglycosides (strepto-, genta-)
lincosamides (clindamycin)
Anticholinesterase
[which agent crosses BBB]
physostigmine
Anticoagulants
[4 classes]
direct thrombin inhibitors
indirect thrombin inhibitors
vitamin K reductase inhibitor
direct Xa inhibitor
antithrombin III
[origin of synthesis]
liver
Aortic Regurge
[treatment]
diuretics and afterload reduction
(ACE inhibitors)
Aortic Regurge
[anesthetic goals]
maintian normal to high HR
- bradycardia and increases in SVR increase regurgitant volume
- tachycardia can contribute to myocardial ischemia
Aortic Regurge
[arterial waveform]
bisferiens pulse
Aortic Regurge
[drugs to avoid]
those that increase SVR
(phenylephrine)
Aortic Regurge
[monitoring signs]
large v waves on CVP waveform
and
pulsus bisferiens
Aortic Regurge
[pathophysiology]
left ventricular eccentric hypertrophy
largest end-diastolic volumes of any heart disease
Aortic Regurgitation
[arterial waveform]
bisferiens pulse
Aortic Stenosis
[anesthetic goals]
maintain heart rate and vascular resistance with normal to increased preload and afterload
- avoid bradycardia
- cardiac output is very rate dependent
aortic stenosis
[loss of atrial systole]
can precipitate congestive heart failure or hypotension
Aortic Stenosis
[neuraxial anesthesia]
relatively contraindicated
(epidural preferable to spinals)
Aortic Stenosis
[severe transvalvular gradient]
above 40 mmHg
Aortic Stenosis
[arterial waveform]
pulsus tardus and pulsus parvus
(delayed pulse wave with a diminished upstroke)
Aortic Stenosis
[effects on myocardial supply/demand]
increases demand because of hypertrophy
decreases supply due to increased systolic pressures
Aortic Stenosis
[peak velocities on an echo]
greater than 4.5 m/sec indicate severe aortic stenosis
Aortic Stenosis
[triad of symptoms]
dyspnea, angina, and syncope
Aortocaval Compression
[first occurance during pregnancy]
18 - 20 weeks gestation
Apnea-Hypopnea Index
[definition]
quantifies the number of apnea episodes that occur per hour
- apnea defined by periods of 10 seconds or more
Aprepitant
[other effects]
anxiolytic and antidepressant
aPTT
[factor(s) tested]
VIII and IX
aPTT
[normal values]
20 - 40 sec
Alternative to heparin for cardiopulmonary bypass
Argatroban
Argatroban
[mechanism of action]
direct thrombin inhibitor
Arterial Oxygen Tension
[approximation]
120 - Age/3
Artery of Adamkiewicz
[damage results]
ischemia for lower 2/3 of spinal cord causing paraplegia
Artery of Adamkiewicz
[origin]
T9 - T12
Ascites
[fluid replacement]
following removal of ascitic fluid, aggressive intravenous fluid replacement is often necessary to prevent profound hypotension and kidney failure
Ascities
[pathophysiology]
- Portal Hypertension
- increases hydrostatic pressure and favors transudation of lfuid across the intestine into peritoneal cavity
- hypoalbuminemia
- decreases plasma oncotic pressure and favors fluid transudation
- seepage of protein-rich lymphatic fluid
- renal sodium and water retention
Difference between Atracurium and Cisatracurium
Atracurium causes histamine release
Atrial Septal Defects
[anesthetic goals]
aovid large increases in SVR
Atrial Septal Defects
[common associated problems]
congestive heart failure and pulmonary hypertension
Atrial Septal Defects
[common location]
fossa ovalis
Autonomic Hyperreflexia
[temporary anesthetic prevention]
regional or deep general anesthesia
Autonomic Reflexia
[pathophysiology]
stimulation below injury leads to vasoconstriction below transection and a baroreceptor-mediated reflex bradycardia and vasodilation above transection
B-type Natriuretic Peptide (BNP)
[biomaker of which organ?]
heart
Balloon Angioplasty
[delay for surgery]
14 days
Bare-Metal Stent
[delay for surgery]
30 - 45 days
baroreceptor reflex
[effects of volatile agents]
depress normal response
- isoflurane and desflurane seem to have less effect
Baroreceptor Reflex
[response]

baroreceptors
[aortic arch innervation]
innervated by aortic nerve which then combines with the vagus nerve
baroreceptors
[locations]
carotid sinus and aortic arch
baroreceptors
[carotid MAP range]
80 - 160 mmHg
baroreceptors
[carotid sinus innervation]
sinus nerve of Hering
(branch of the glossopharyngeal nerve)
Bathmotropy
[definition]
muscular excitation in response to a stimulus
Beckwith-Wiedemann
[common features]
- macroglossia
- macrosomia
- omphalocele
- hypoglycemia
- large fontanelles
Beta-2 Agonist
[mechanism of action]
increases cAMP
Beta-2 Antagonists
[effects]
bronchoconstriction and peripheral vasoconstrction
- inhibits insulin release and glycogenolysis
Bivalirudin
(angiomax)
[uses]
anticoagulant for CPB in patients with HIT type III
Bleomycin
[adverse effet]
pulmonary fibrosis
“Bone Cement Implantation Syndrome”
[symptoms]
hypotension
arrhythmias
hypoxia (from pulmonary hypertension leading to right-to-left shunting)
Which portion of the upper extremity is NOT innervated by the brachial plexus?
posterior medial portion
Bradycardia seen in pediatrics due to Sux is caused by what mechanism?
muscarinic stimulations at the sinus node
bronchiectasis
[common cause]
recurrent bronchial infections
Bupivacaine
[maximum dose]
3 mg/kg
C5 Isoenzyme Variant
[key concepts]
increased plasma cholinesterase
shorter duration of succinylcholine
Ca2+ ionized
[normal values]
4.65 - 5.28 mg/dL
Ca2+ total
[normal values]
8.5 - 10.5 mg/dL
Calcitonin
[effect on kidney]
decreases reabsorption of calcium and phosphate
Calcitonin
[effect on bone]
inhibits osteoclastic reabsorption
Carbonic Anhydrase Inhibitor
[mechanism of action]
inhibiots HCO3- and Na+ reabsorption
Carcinoid Syndrome
[clinical manifestations]
bronchospasm
dramatic swings in blood pressure
supraventricular arrhythmias
- “carcinoid syndrome is associated with right-sided heart disease caused by valvular and myocardial plaque formation, and, in some cases, implantation of tumors on the tricuspid and pulmonary valves”
Carcinoid Syndrome
[etiology]
secretion of vasoactive substances from an enteroepinephrine tumor (carcinoid)
Carcinoid Syndrome
[principal mediators]
serotonin
kallikren
histamine
Cardiac Action Potential
[phase 0 - cellular ion movement]
Na+ entry and decreased K+ permeability
Cardiac Action Potential
[phase 0 - event]
activation of voltage-gated Na+ channels
Cardiac Action Potential
[phase 1 - cellular ion movement]
K+ out
Cardiac Action Potential
[phase 1 - event]
inactivation of Na+ channels
transient increase in K+ permeability
Cardiac Action Potential
[phase 2 - cellular ion movement]
Ca2+ entry
Cardiac Action Potential
[phase 2 - event]
activation of slow Ca2+ channels
Cardiac Action Potential
[phase 3 - cellular ion movement]
K+ out
Cardiac Action Potential
[phase 3 - event]
inactivation of Ca2+ channels
increased permeability to K+
Cardiac Action Potential
[phase 4 - cellular ion movement]
K+ and Ca2+ in
Na+ out
Cardiac Action Potential
[phase 4 - event]
normal permeability restored
intrinsic leak of Ca2+ into cells
Cardiac Output
[changes in obesity]
increases about 100 mL/min for every kg of weight
- due to ventricular dilation and increased stroke volume as resting HR are not generally increased
Cardiac Output
[Fick’s Equation]
(CaO2 - CvO2) * 10
- VO2 can be approximated by 4 mL/kg
- CO2 = (1.36*Hb*SaO2) + (0.003*PaO2)
(6) Cardiac Risk Factors
(prediction of cardiac risk of non-cardiac surgery)
- high-risk surgery
- ischemic heart disease
- congestive heart failure
- cerebrovascular disease
- diabetic insulin therapy
- creatinine > 2 mg/dL
Cardiac Surgery
[post-operative hypertension cause]
possible denervation of carotid baroreceptors
- denervation of carotid body blunts the ventilatory response to hypoxemia
Cardiac sympathetic fibers
[origin]
T1 - T4
- travel to the heart through cervical (stellate) ganglia and from the ganglia as cardiac nerves
cardiac tamponade
[arterial waveform]
pulsus paradoxus
(exaggerated inspiratory decline in systolic BP)

Cardiac Tamponade
[arterial wave form]
pulsus paradoxus
Cardiac Tamponade
[CVP waveform]
loss of y-descent
may also have an accentuated x-descent
Cardiac Tamponade
[definition]
accumulation of fluid in pericardial space
Cardiac Tamponade
[hemodynamic features]
decreased cardiac output and stroke volume
increase in CVP
Cardiac Tamponade
[signs and symptoms]
tachycardia
sudden hypotension
jugular venous distention
muffled heart shounds
pulsus paradoxus
Cardiac Tamponade
[ventilation]
must maintain spontaneous ventilation
- positive pressure ventilation can further reduce preload, causing hypotension and possible cardiac arrest
Cardiac Tamponde
[hemodynamic goals]
increased preload, afterload, and HR
Cardiopulmonary Bypass
[signs of incorrect positioning of aortic cannula]
unilateral facial blanching
Cardiopulmonary Bypass
[signs of incorrect positioning of venous cannula]
facial edema
(bulging sclera)
Catecholamines
[activate which receptors?]
adrenergic
Central Chemoreceptors
[mechanism of action]
respond to changes in CSF [H+]
Central Line
[location with lowest risk of infection]
subclavian vein
Central Line
[risks of left IJ not seen in right cannulation]
damage to thoracic duct
- left IJ also has a more direct and less winding path to the superior vena cava
Central Pontine Myelinolysis
[cause]
rapid correction of hyponatremia
Cerebral Autoregulation
[CPP range]
50 - 150 mmHg
Cerebral Autoregulation
[definition]
intrinsic capability of the cerebral vasculature to adjust its resistance to maintain CBF constant over a wide range of MAPs
cerebral blood flow
[autoregulation during ischemia]
no autoregulation, flow directly dependent upon CPP
Cerebral Blood Flow
[correlation to PaCO2]
directly proportional between 20 - 80 mmHg
Cerebral Blood Flow
[effect by temperature]
5% per 1oC in temperature
Cerebral Blood Flow
[Normal range]
50 mL/100g/min
Cerebral Blood Flow
[rate at which EEG becomes isoelectric]
less than 15 mL/100g/min
cerebral blood flow
[rate at which ischemia appears on EEG]
less than 22 mL/100g/min
Cerebral Blood Flow
by what percentage does CBF change for each mmHg increase in PaCO2?
2%
Cerebral Blood Flow
[autoregulation]
maintained between MAPs of 60 - 160 mmHg
Cerebral Mass Lesions
[induction technique]
Propofol with hyperventilation
Cerebral Metablic Rate
[change for each 1oC decrease]
6%
Cerebral Metabolic Rate
[normal rate]
3 mL/100g/min
(50 mL/min)
Cerebral Oxygen Consumption
[normal rate]
3 mL/100g/min
- greatest in the grey matter of the cerebral cortex, generally parallels electrical activity
Cerebral Oxygen Delivery
[optimal hematocrit]
30%
Cerebral Perfusion Pressure
[autoregulation]
decreases in CPP result in cerebral vasodilation
Cerebral Perfusion Pressure
[at what pressures can disrupt the BBB}
150 - 160 mmHg
- may result in cerebral edema and hemorrhage
Cerebral Perfusion Pressure
[normal range]
80 - 100 mmHg
Cerebral Perfusion Pressure
[equation]
MAP - ICP
(or -CVP if greater than ICP)
Cerebral Perfusion Pressure
[normal range]
80 - 100 mmHg
Cerebral Protection
[hypothermia]
decreases both basal and electrical metabolic requirements throughout the brain
Cerebral Salt Wasting Syndrome
[triad of symptoms]
hyponatremia
volume contraction
high sodium content in urine
Cerebral Salt Wasting Syndrome
[treatment]
isotonic or hypertonic saline
Cerebrospinal Fluid
[pathway through ventricles]
lateral ventricles
[foramina of Monro]
third ventricle
[cerebral aquedcut of Sylvius]
fourth ventricle
[foramen of Magendie]
lateral apertures of fourth ventricle
[foramina of Luschka]
cerebellomedullary cistern
Chronic Bronchitis
[definition]
productive cough for 3 consecutve months for at least 2 years
Chvostek’s Sign
[definition]
painful twitching of the facial musculature following tapping of facial nerve
- result of hypocalcemia
Cirrhosis
[coagulopathies]
hyperfibrinolysis
Cirrhosis
[physiologic changes]
increased cardiac output
low peripheral vascular resistance
increased intravascular volume
- avoid vasodilators (milrinone)
Clonidine
[drug class]
alpha-2 agonist
Clopidogrel
[antidote]
platelets
Clopidogrel
[delay of surgery]
5 - 10 days
Clopidogrel
[mechanism of action]
ADP receptor blocker
(adenosine diphosphate)
Closing of the tricuspid valve is represented by what on the CVP?
C wave
Clotting Factors
[which has the shortest half-life]
Factor VII
- first factor to become deficient in patients with severe hepatic failure, warfarin therapy, and vitamin K deficiency
- PT is most sensitive to decreases in factor VII
CO poisoning
[half-life in HBO]
15 - 30 minutes
CO poisoning
[half-life on room air]
4 - 6 hours
CO poisoning
[half-life with 100% oxygen]
1 hour
Which gas is most soluble in water?
(CO2,N2, O2, air)
CO2
CO2
[tank color]
gray
Coagulation Factors
[factors not produced by the liver]
VIII and von Willebrand
Coagulation Factors
[vitamin K dependent]
prothrombin (factor II), and factors VII, IX, and X
Coagulation Test Abnormalities
[Factor VII deficiency]
increased PT
Coagulation Test Abnormalities
[Hemophilia]
increased PTT
Coagulation Test Abnormalities
[heparin therapy]
greatly increased PTT
increased PT
Coagulation Test Abnormalities
[vitamin K deficiency]
greatly increased PT
increased PTT
Cocaine
[which induction drugs should be avoided]
ketamine and pancuronium
potentiate cardiovascular toxicity
Codeine
[metabolism]
enzyme CYP2D6
Complex Regional Pain Syndrome
[difference between I and II]
Type II has a known etiology
Complex Regional Pain Syndrome
[features]
burning and continuous pain
cool, red, clammy skin
hair loss
atrophy and osteoporosis
Compression Factor
[definition]
part of the tidal volume produced by a mechanical ventilator that is prevented from reaching a patient by compression of the gas and expansion of the flexible tubing in the equipment.
usually 3-5 mL/cmH2O
Compression Factor
[equation]
[(MVdelivered - MVmeasured) / RR )] divided by PIP
Conn’s Syndrome
[clinical features]
hyperaldosteronism
hypertension and low blood potassium levels
Constrictive Pericarditis
[associated problems]
jugular venous distension
hepatomegaly
ascites
Conus Medullaris
[definition]
end of the spinal cord
Coronary Perfusion Pressure
[equation]
arterial diastolic pressure - LVEDP
Coronary Perfusion
[characteristics]
LV perfused almost entirely during diastole
RV perfused during both
Correlation of Cr to GFR
inversely proportional
Corticospinal Tract
[type of pathway]
motor
- therefore is not involved in SSEP transmission
Cranial Mass Lesions
[premedication]
avoid sedative and opioids
- risk of hypercapnia secondary to respiratory depression increasing ICP
Creatinine
[normal values]
0.6 - 1.2 mg/dL
Cricothyroid Muscle
[innervation]
external branch of the superior laryngeal
Cromolyn
[drug class]
mast cell stabilizer
Croup
[signs and symptoms]
inspiratory stridor
mild fever
age < 2 yo
rhinorrhea
“barking cough”
CSF volume is _____ to spinal level
inversely related
Cushing’s Response
[definition]
increases in BP with bradycardia due to increases in ICP
Cushing’s Response
[definition]
increased ICP resulting in increased blood pressure, irregular breathing, and bradycardia
(cushing’s triad)
Cushing’s Syndrome
[etiology]
excess glucocorticoids
Cushing’s Syndrome
[anesthetic considerations]
patients may be volume overloaded and have hypokalemic metabolic alkalosis
- careful positioning due to osteoporosis
- may require supplemental steroids
Cushing’s Syndrome
[symptoms]
muscle wasting and weakness
osteoporosis
central obesity
glucose intolerance
hypertension
Cutaneous innervation of the plantar surface
[which nerve]
posterior tibial
Guess this disorder:
premature infant that is cyanotic but is relieved by coughing
choanal atresia
Dalteparin
[delay for neuraxial anesthesia]
if low dose, for thromboprophylaxis, 12 hours
if high dose, to treat DVT, 24 hours
Dantrolene
[expected side effects]
diuresis
- formulated with mannitol to promote diuresis
- myoglobinuria accumulates in renal tubules and can cause kidney failure if urine output is not maintained
dead space
[average mL/kg]
2 mL/kg
Deadspace
[explain the difference between etCO2 and arterial PaCO2]
due to lack of gas exchange, etCO2 will be less than from an arterial blood gas
- examples:
- morbid obesity, pulmonary embolism, and COPD
Defibrillation
[joules/kg]
2 joules/kg
- second dose should be 4 joules/kg
- do not exceed 10 joules/kg or 100 joules
Defibrillators
[biphasic vs. monophasic]
biphasic require lower energy for equally effective defibrillation
Demeclocycline
[uses]
antibiotic that interferes with ADH
often used for treatment of SIADH
Dermatomes
[level of C6]
Thumb
Desflurane
[cardiovascular effects]
increased HR
decrease SVR and CI
Diabetes - Type II
[definition]
insulin resistance
Diabetes - Type I
[definition]
insulin deficiency
Diabetes Insipidus
[signs and symptoms]
hypernatremia
hyperosmolality
polyuria
urine hypoosmolality
Diabetes Insipidus
[treatment]
hypotonic saline and vasopressin
Diabetes
[triad of symptoms]
polyuria, polydipsia, and polyphagia
Diabetic Ketoacidosis
[initial treatment]
isotonic fluids, potassium, and insulin infusion
- goal to decrease blood gluocse by 10%/hour
- as glucose moves intracellularly, so does potassium; therefore, monitor both levels frequently
Diastolic Dysfunction
[Pressure-Volume Loop]

heart failure with normal ejection fraction
diastolic heart failure
Diastolic Heart Failure
[definition]
failure of the left ventricle to relax during diastole
- signs and symptoms of heart failure without a decrease in ejection fraction
- problem with filling
DIC
[pathophysiology]
activation of coagulation cascade by the release of thromboplastin or by direct activation of factor XII
Digoxin
[cardiac effects]
negative chronotrope and positive inotrope
- direct inhibition of AV node
- inhibits Na/K ATPase pump leading to an increase in [Ca2+] and thereby increasing contractility
Diltiazem
[dose for irregular-narrow tachycardia]
0.25 mg/kg
Direct Thrombin Inhibitors
[examples]
argatroban
dabigatran (pradaxa)
Direct Xa inhibitor
[examples]
ribaroxiban (xarelto)
apixaban (eliquis)
Dopamine
[infusion rate]
2 - 10 mcg/kg/min
Down Syndrome
[common cardiac problems]
atrioventricular septal defects
Dromotropy
[definition]
rate of transmission of cardiac nerve impulses
Droperidol
[treatment for which disorder]
Wolff-Parkinson-White
Drug-Eluting Stent
[delay for surgery]
1 year
Duloxetine
(cymbalta)
[drug class]
selective serotonin and norepinephrine reuptake inhbitor (SNRI)
dural sac
[extends to what length]
S2
Average blood loss for vaginal delivery
400 - 500 mL
Ebstein’s Anomaly
[definition]
abnormal placement of leaflets on tricuspid valve
- congenital heart defect
- blood leaks back through the valve into the right atrium
ECT
[ways to increase seizure duration]
hyperventilation
intravenous caffeine (125-250 mg)
ECT
[contraindications]
recent myocardial infarction
recent stroke
intracranial mass
increased ICP
ECT
[seizure activity measurement without EEG]
isolated limb tournaquet
- tourniquet is inflated around one arm prior to injection of succinylchline, preventing entry of NMB and allowing observation of convulsive motor activity in that arm
Electroencephalography
[which agents produce burst suppression]
Desflurane and Sevoflurane
(> 1.2 and 1.5 MAC)
- do not produce electrical silence
Eisenmenger Syndrome
[definition]
long-standing left-to-right cardiac shunt causes pulmonary hypertension and eventually reverses the shunt to a cyanotic right-to-left shunt
Eisenmenger Syndrome
[effect on PaO2]
larger shunt fraction and therefore lower PaO2
EKG
[each large box represents how many seconds]
0.2 sec
EKG
[leads showing myocardial ischemia in circumflex coronary artery]
I and aVL
EKG
[leads showing myocardial ischemia in LAD]
V3 - V5
EKG
[leads showing myocardial ischemia in RCA]
II, III, and aVF
Elevated ICP
[preferred agent]
Sevoflurane
- preserves autoregulation of CBF and produces limited vasodilation
Elevated ICP
[ventilation strategies]
maintain PaCO2 between 30-35 mmHg
- avoid PEEP and high airway pressures
emergent patient with C7 spinal cord transection due to MVA
[anesthesia concerns]
risk of hypothermia
- lack thermoregulation below level of injury
EMLA cream
[components]
2.5% lidocaine and 2.5% prilocaine
Emphysema
[genetic cause]
alpha-antitrypsin deficiency
ephedrine
[cocaine]
avoid ephedrine in acute cocaine intoxication
(may not work in chronic users due to depleted catecholamine)
Epidural
[what makes the “snap”]
ligamentum flavum
Epiglottitis
[signs and symptoms]
inspiratory stridor
age between 2 and 6
rapid onset < 24 hours
high fever
difficulty swallowing
Epinephrine
[max dose]
5 ug/kg
Equation for amount of PRBC to increase Hct
EBV * (Hctdesired - Hctstarting) divided by Hct of PRBC
Esters
[intrathecal injection]
depends on redistribution
- CSF lacks esterase enzymes
Esters
[metabolism]
pseudocholinesterase
ESWL
[dermatome spinal level]
T6
Etiology behind SIADH, DI, and Cerebral salt wasting syndrom
- SIADH
- excessive amonts of ADH
- hyponatremia
- Diabetes Insipidus
- absent AHD or injury to hypothalamus
- hypernatremia
- Cerebral Salt Wasting
- release of brain natriuretic peptide in SAH
- hyponatremia
Etomidate
[effect on SSEPs]
increases amplitude and latency
expiratory reserve volume
[average adult value]
1100 mL
Extension of the neck can cause _____ displacement of the tube
cephalad
will go into the pharynx
Factor VIII
[how much to give]
equal to plasma volume
- example
- solve for blood volume
- knowing hematocrit is about 40%, plasma must be 60%
- multiply 0.6 x blood volume to get plasma volume
Fat Embolism Syndrome
[triad of symptoms]
dyspnea, confusion, and petechiae
(usually occurs within 72h following long-bone fracture)
FDA Pregnancy Ratings
[Class A]
controlled studies show no risk
FDA Pregnancy Ratings
[Class B]
no evidence of risk in humans
FDA Pregnancy Ratings
[Class C]
risk cannot be ruled out
FDA Pregnancy Ratings
[Class D]
positive evidence of risk
- examples: midazolam and diazepam
FDA Pregnancy Ratings
[Class X]
contraindicated in pregnancy
Femoral Nerve
[origin]
L2 - L4
Femoral Nerve
[needle stimulation]
quad contraction with patellar elevation
Fenoldopam
[similar alternative drug]
Sodim Nitroprusside
Fetal Heart Rate
[early decels]
fetal head compression causing vagal stimulation
Fetal Heart Rate
[normal range]
110 - 160 bpm
Fetal hemoglobin has a _____ affinity for O2 than does maternal Hgb
greater
Fetal Hemoglobin
[P50 at term]
18 mmHg
Maximum FiO2 that can be administered to a mother without increasing the risk of retinopathy of prematurity
- 0
* the fetal PaO2 does not increase above 60 mmHg because of the high O2 consumption of the placenta and uneven fetal blood flow distribution
FEV1/FVC
[definition]
ratio of the forced expiratory volume in the first second of exhalation to the total forced vital capacity
- effort dependent
FEV1/FVC
[normal value]
greater than 80%
Find the Left Ventricle peak pressure
peak velocity of 4 m/sec
BP of 130/80
4 * V2
4 * 42 = 64
64 * systolic pressure = peak pressure
First sign of magnesium toxicity
decreased deep tendon reflexes
Fluoxetine
(Prozac)
[considerations]
potent inhibitor of CYP2D6 enzymes
- codeine, oxycodone, and hydrocodone will not work
Fondaparinux
{arixtra)
[mechanism of action]
factor Xa antagonist
Fontan Procedure
[cardiac anomolaies]
used to treat decreases in pulmonary blood flow
Pulmonary atresia, stenosis, tricuspid atresia, and hypoplastic left heart syndrome
Fontan Procedure
[definition]
anastomosis of the right atrial appendage to the PA
Fulminant Hepatic Failure
[definition]
a. k.a. acute liver failure
* usually from viral hepatitis or a hepatotoxin
Functional Residual Capacity
[composed of which lung volumes?]
expiratory reserve and residual volume
Gastroschisis
[definition]
herniation lateral to umbilicus which is not contained in a sac
- higher risk of hypothermia and infection compared to omphalocele
GFR < 25 mL/min
[state of renal health]
overt renal failure
GFR of 30 mL/min
[current state of renal health]
moderate renal insufficiency
GFR of 40 - 60 mL/min
[state of renal health]
mild renal insufficiency
GFR
[at what age does function reach that of adult]
2 years
- 30% at birth
- 50% by 10 days of life
- 75% by 6 months
Sensory innervation to the pharyngeal walls and the tonsils
glossopharyngeal nerve
Glottis
[level in the adult vs pediatric]
pediatric C3
adult C5
Glucose
[normal value]
90 - 120 mg/dL
Glycoprotein IIb/IIIa inhibitor
[examples]
abciximab
eptifibatide
tirofiban
Guillain-Barre Syndrome
[definition]
sudden onset of ascending motor paralysis, areflexia, and paresthesias
Halothane has a similar vapor pressure to which other volatile agent?
Isoflurane
Halothane
[cardiovascular changes]
no change in HR or SVR
decreased CI
Heart Failure
[compensatory mechanisms]
increased preload
activation of sympathetic nervous system
renin-angtiotensin-aldosterone system
increased release of AVP
Heart Rate
[effects on diastolie]
increases in HR reduces diastole more than systole
- impaired ventricular filling at HR > 120 beats/min
Heart Rate
[equation for normal intrinsic rate]
118 - (0.57 x age)
Heart Rate
[receptors slowing rate]
M2 cholinergic receptors
- enhanced vagal activity slows the heart rate via stimulation of M2 cholinergic receptors
Heart Transplant
[anesthetic management]
direct-acting agents
- isoproterenol or epinephrine should be readily available
Heart Transplant
[EKG]
usually two sets of P-waves
one represents the recipient’s own SA node (which is left intact) and the other representing the donor’s SA node
Heart Transplant
[innervation]
no direct autonomic influences
- absence of vagal influences causes a relatively high resting heart rate (100-120 bpm)
- myocardial ischemia is often silent
Hematocrit
[normal range]
35 - 50%
Hemoglobin Dissociation Curve
[rightward shift]
lowers O2 affinity making more oxygen available to the tissues
Hemoglobin
[average for full-term infant]
15 - 20 g/dL
can drop down to 10 g/dL at 2-3 months
Hemoglobin
[normal P50]
26 mmHg
- P50 is the PaO2 required to produce 50% saturation of hemoglobin
Hemoglobin
[normal range]
12 - 18 g/dL
Hemolytic Uremic Syndrome
[key concepts]
most common acquired causes of acute renal failure
- often caused by E. coli
- Triad:
- hemolytic anemia
- thrombocytopenia
- acute nephropathy
- treated with dialysis
Hemophilia A
[missing clotting factor]
factor VIII
Hemophilia A
[coagulation test]
PTT
Hemophilia B
[missing clotting factor]
IX
Heparin Resistance
[cause]
anti-thrombin III deficiency
Heparin Resistance
[treatment]
fresh frozen plasma or recombinant anti-thrombin III
Hepatorenal Syndrome
[intraoperative management]
colloid infusions rather than crystalloid
Hetastarch
[anticoagulant mechanism]
intereference of Factor VIII
- also reduces levels of vWF and availability of glycoprotein IIb/IIIa, and it can become directly incorporated into the fibrin clot
Hgb A1C
[normal values]
5.0 - 7.5 %
Primary cause of severe hypotension with high spinal
Decreased CO secondary to decreased preload
- sympathetic blockade, venodilation, arterial dilation, and a decrease in HR all contribute to hypotension
HIV treatmet drugs (-avir)
[drug interactions]
increased sensitivity to midazolam
How does acetazolamide work in opthalmology?
inhibits carbonic anhydrase
decreases the production of aqueous humor and lowers the intraocular pressure
how long should surgery be delayed after a stroke?
4 - 6 weeks
what percentage of receptors may still be blocked during a “5-sec head lift”
50%
How would a right mainstem intubation affect the rate of increase in arterial partial pressure of volatile agents?
reduced for poorly soluble agents
Hunt and Hess grading scale
[uses]
classifies severity of subarachnoid hemorrhage
- ranges from I - V
- 1 - asymptomatic
- V - deep coma
Huntington’s Disease
[considerations]
decreased levels of pseudocholinesterase
Huntington’s Disease
[definition]
inherited disorder of brain cell death
Hydralazine
[associated disorder]
systemic Lupus erythematosus
Hyperbaric Oxygen Chamber
[effect on MAC]
decrease
- increase in partial pressure of agents at higher barometric pressures
Hypercalcemia
[potential causes]
- decreased renal Ca excretion
- hyperthyroid or parathyroid
- vitamin D intoxication
Hypercalcemia
[treatment]
fluid load with normal saline
diuresis with lasiix
[also pamidronate (Aredia) or etidronate (Didronel)]
p-wave flattening, wide QRS, and peaked t-waves
[electrolyte disorder]
hyperkalemia
Hyperkalemia
[potential causes]
- Acute/chronic renal failure
- hypoaldosteronism
- spironolactone
- RAAS inhibitors
- succinylcholine
- acidosis
Hyperkalemia
[EKG changes]
peaked t-waves
wide and low p-waves
fusion of QRS and t-waves
Hypernatremia
[potential causes]
- diabetes insipidus
- diarrhea
- osmotic/loop diuretic
- hyperaldosteronism
- Cushing’s syndrome
- IV HCO3
Hyperosmolar Hyperglycemic State
[most likely candidates]
- greater than 65 y.o.
- type II diabetic
- blood glucose > 600
- serum osmolality > 320
- lethargic, polyuria, polydipsia
Hyperosmolar Nonketotic Coma
[definition]
hyperglycemic-induced diuresis leading to dehydration and hyperosmolality
- severe hyperglycemia causes hyponatremia
- for each 100 mg/dL increase in plasma gluocse, plasma sodium concentration lowers by 1.6 mEq/L
Hypersensitivity Reactions
[Type 1]
involves antigens and IgE
- release of basophils and mast cells with the release of histamine
- examples: anaphylaxis
Hypersensitivity Reactions
[Type 2]
anti-body dependent and cell-mediated
- ABO incompatibility
Hypersensitivity Reactions
[Type 3]
immune-complex reactions
- antigens and antibodies combine to form insoluble complexes which deposit in microvasculature
Hypersensitivity Reactions
[Type 4]
delayed reaction involving antigens and lymphocytes
- involves killer T-cells
- example: contact dermatitis and transplant rejection
Hyperthyroid
[best induction drug]
thiopental
- decreases conversion of T4 to T3
Hypertrophic Obstructive Cardiomyopathy
[best pressure support choice]
phenylephrine
- direct acting vasoconstrictor with minimal cardiac effects
- levophed, milrinone, dopamine, and dobutamine are relatively contraindicated
Why would you hyperventilate during local anesthetic toxicity?
hyperventilation induces alkalosis and converts local anesthetics to the pronated (ionized) form, which is less likely to corss the cell membrane
Hypocalcemia
[EKG changes]
QTc prolongation
Hypocalcemia
[potential causes]
- hypoparathyroidism
- rapid blood transfusion
- malabsorption
Hypokalemia
[potential causes]
- diuretics
- mineralcorticoids
- trauma
- beta agonists
- insulin
- hypercalcemia or hypomagnesemia
- alkalosis
Hypokalemia
[EKG changes]
- prolonged PR
- T-wave flattening
- ST segment depression
- increased P-wave amplitdue
- increasingly prominent U-wave

Hypomagnesemia
[EKG changes]
tall t-waves with depressed ST segment
Hyponatremia
[effect on MAC]
increase MAC requirement
Hyponatremia
[potential causes]
- renal tubular acidosis
- hypoaldosteronism
- vomitting
- SIADH
- hypothyroidism
- cortisol deficiency
- CHF
- cirrhosis
Hyponatremia
[3% NaCl equation for correction]
kg * 0.6 * (Nadesired - Nacurrent)
(total body water) * (Na - Na)
- gives the mEq/L amount
- infuse no faster than 100 mL/hour
hypoparathyroidism secondray to parathyroid removal will result in hypocalcemia how many hours post-op?
24 - 72 hours
Hypoplastic Left Heart Syndrome
[anatomical anomalies]
aortic valve atresia and underdevelopment of the left ventricle
Hypotension following TURP
[differential diagnosis]
- hemorrhage
- TURP syndrome
- bladder perforation
- myocardial infarction
- septicemia
- DIC
Hypovolemic shock
[hemodynamic changes]
low cardiac output caused by decreased preload from hypovolemia and low LVDP
Hypoxemia
[5 causes]
low FiO2
hypoventilation
right-to-left shunt
V/Q mismatch
diffusion abnormality
Hypoxia
[effect on MAC]
decreases MAC requirement
- PaO2 less than 38 or severe anemia will decrease MAC
Hypoxic Pulmonary Vasoconstriction
[definition]
local response of pulmonary arterial smooth muscule that decreases blood flow in the presence of low alveolar oxygen pressure
(maintains normal V/Q relationships by diverting blood from underventilated areas)
Ibuprofen
[length of anti-platelet effect]
3 days
If a needle is introduced 1.5 cm inferior and 1.5 cm lateral to the pubic tubercle, to which nerve will it lie in close proximity?
obturator nerve
inability to adduct the leg; diminished sensation over the medial side of the thigh
[nerve injury]
obturator
Indirect Thrombin Inhibitors
[examples]
heparin
fondaparinux (arixtra)
Indirect-acting sympathomimetics
[how it works]
enter neurons and displace norepinephrine from postganglionic sympathetic nerve fibers
Inhalation of CO2 increases Ve by _____
2 - 3 L/min/mmHg
Innervation of Heart
[“sidedness”]
right sympathetic and right vagus nerves affect SA node
left sympathetic and vagus nerve affects AV node
inspiratory reserve volume
[average adult value]
3000 mL
Inspiratory stridor in children
[possible causes]
80% croup
5% epiglottitis
Insulin
[glucose change from 1 unit]
25 - 30 mg/dL
Insulin
[(2) fast examples]
lispro and aspart
When performing an interscalene block, you note diaphragmatic movement. You should now _____
redirect needle in a posterior direction
interscalene block
[nerve spared]
ulnar nerve
Intra-Aortic Balloon Pump
[inflation should occur at what time]
diastole
immediately after closure of aortic valve
Intracranial Hypertension
[range]
above 15 mmHg
Intracranial Hypertension
[mmHg]
above 15 mmHg
Intracranial Pressure
[definition]
supratentorial CSF pressure measured in the lateral ventricles
Intracranial Pressure
[normal range]
10 mmHg or less
Intraocular Gas Expansion
[avoidance of nitrous]
N2O must be discontinued 15 min prior to bubble
avoid for 5-10 days after surgery
Intraocular Pressure
[normal range]
12 - 20 mmHg
Ischemic Heart Disease
[common causes]
coronary arterial vasospasm or thrombosis
severe hypertension or tachycardia
aortic stenosis or regurge
hypoxemia or anemia
Isoflurane
[cardiac output]
will not reduce CO at MAC < 1
- unlike the other agents
IV contrast induced AKI
[prophylaxis treatment]
N-acetylcysteine
IV dye acts like what diuretic?
Mannitol
Ketamine
[IM dose]
3 - 5 mg/kg
Kidney Stones
[medical management]
alpha blockers (Flomax, Cardura, Hytrin)
or
CCB (nifedipine)
Korsakoff’s Syndrome
[definition]
acute onset of severe memory impairment without any dysfunction in intellectual abilities
Korsakoff’s Syndrome
[prevention]
Vitamin B supplements
Lactated Ringers
[components]
Na, Cl, Ca, K, and lactage
Lactated Ringers
[osmolality]
272
(isotonic)
largest vertebral interspace
L5 - S1
Lasers
[amber glasses]
required for argon and krypton
Lasers
[glasses for CO2]
clear
Lasers
[green glasses]
Nd:YAG
(red glasses for potassium titanyl phosphare:Nd:YAG)
Left Atrial Hypertrophy
[EKG changes]
double notched p-wave in lead II and negatve deflection in V1
- since the left atria is larger, there is a slight conduction delay, causing the left and right atria to depolarize at diferent times
Left Ventricular Assist Device
[monitoring considerations]
unable to measure BP with cuff
- non-pulsatile flow, even pulse ox can be difficult
Left Ventricular Hypertrophy
[EKG leads showing ST abnormalities]
I, aVL, and V4-V6
Left Ventricular Hypertrophy
[common cardiac finding]
S4 gallop
Left Ventricular Hypertrophy
[common causes]
hypertension and aortic stenosis
Left-Sided Heart Failure
[definition]
failure to properly pump blood out to the body
(can be systolic or diastolic)
Left-to-Right Shunting
[congenital defects]
ventricular and atrial septal defects
patent ductus arteriosus
Left-to-Right Shunt
[effect on volatile agents]
no effect
Level of blockade for Orchiectomty
T10
Lidocaine
[coagulation effects]
decreases platelet aggregation while enhancing fibrinolysis
Lidocaine
[maximum dose with epinephrine]
7 mg/kg
Lidocaine
[maximum dose]
4.5 mg/kg
Lithotripsy
[contraindication]
inability to position the patient so that lung and intestine are away from the sound wave
Lithotripsy
[regional concerns]
T6 sensory level
(renal innervation is derived from T10-L2)
saline should be used instead of air
(air in the epidural space can dissipate shock waves and may promote injury to neural tissue)
Liver Transplant
[anhepatic phase procedure]
vessels are clamped and liver is completely excised
Liver Transplant
[neohepatic or postanhepatic procedure]
revascularization and biliary reconstruction
Liver Transplant
[preanhepatic procedure]
liver is dissected so that it remains attached only by the inferior vena cava, portal vein, hepatic artery, and common bile duct
Liver
[synthesis of which coagulation factors]
III, IV, and VIII
antithrombin III
protein C and S
LMWH
[anticoagulation test]
Anti-Xa Assay
Local Anesthetic Toxicity
[drugs to avoid]
vasopressin
CCB
beta blockers
epinephrine > 1 ug/kg
Local anesthetics
[addition of Bicarb]
quickens onset
decreases duration
reduces pain with skin infiltration
local anesthetics
[epi has the least effect on which agents?]
lipid soluble
- lidocaine is prolonged much more than bupivacaine
Local Anesthetics
[rate of systemic absorption by site]
intravenous
tracheal
intercostal
paracervical
epidural
brachial plexus
sciatic
subcuntaneous
Local Anesthetics
[vasoconstrictors]
prolongs duration and decreases absorption
- more pronounced on shorter-acting agents
Local Anesthetics
[which agent is a weak acid with a pKa of 3.5]
benzocaine
Local Anesthetics
[which one can be given in an epidural with littel effect to fetus?]
Chloroprocaine
- rapidly metabolized and very little is able to cross the placenta
Loop Diuretics
[examples]
Lasix (furosemide)
-ide
Loop Diuretics
[mechanism of action]
binds to the Na-K-2Cl protein
diminishes osmotic gradient
Loop Diuretics
[Site of action]
ascending loop of Henle
Losartan
(minoxidil)
[adverse effects]
pulmonary hypertension
pericardial effusion
cardiac tamponade
Lovenox
[stop before surgery]
24 hours
Lung Transplant
[treatment of hypotension]
vasopressors
- avoid large luid boluses
- loss of lymphatic drainage predisoses lung to pulmonary edema
Lusitropy
[definition]
cardiac muscle fiber relaxation
Lusitropy
[definition]
myocardial relaxation or diastole
Luxury Perfusion
[refers to what situation in the brain]
vasoparalysis
“patients at high risk of A-fib following cardiac surgery can be treated with prophylactic _____”
Amiodarone
Macroshock
[minumum required for V-fib]
100 mA
Magnesium
[mechanism of action]
decreases release of acetylcholine in NMJ
main sensory innervation to superior and inferior parts of the hard and soft palate
[nerve]
trigeminal nerve
Malathion
[key concepts]
organophosphate
may prolong duration of succinylcholine
Malignant Hypertension
[definition]
greater than 210/120 mmHg
often associated with papilledema and encophalopathy
Mapleson Circuit
[best for controlled ventilation]
D
Mapleson Circuit
[best for spontaneous ventilation]
A
Median Nerve
[motor response to stimulation]
flexion of the wrist, pronation of the forearm
MELD score
[definition]
Model for End-stage Liver Disease
- used by UNOS to prioritize patients on the waiting list for liver transplant
- based on bilirubin, creatinine ,and INR
MELD score
[range]
1 - 4
1 being the lowest, 4 being the highest
membrane potential
[ventricular cell]
-90 to -80 mV
MEN
[acronym]
Multiple Endocrine Neoplasia
Meperidine is contraindicated in patients taking which drug for Parkinson disease?
Selegiline
(eldepryl)
Mepivacaine
[maximum dose with epinephrine]
7 mg/kg
Mepivacaine
[maximum dose]
4.5 mg/kg
Which oral diabetic drug does NOT produce hypoglycemia?
Metformin
Methadone
[mechanism of action]
opioid agonist and NMDA antagonist
Methemoglobinemia
[signs]
SaO2 of 85%
Methergine
[contraindications]
hypertension
asthmatics
coronary artery disease
Methylmethacrylate
[adverse effects]
fat embolism
vasodilation and reduction in SVR
hypercoagulable state due to thromboplastin
Methylnaltrexone
(relistor)
[uses]
opioid antagonist that does not cross the CNS
- can treat opioid-induced constipation without reversing analgesia
MgSO4
[sign indicating toxicity]
loss of deep tendon reflexes
(occurs at 10 mEq/L)
MgSO4
[therapeutic range]
4 - 8 mEq/L
(4 - 10 mg/dL)
Microshock
[minimum required for Vfib]
100 uA
(0.1mA)
Mitral Regurge
[anesthetic goals]
maintain higher HR
- avoid increases in afterload
Mitral Regurge
[“4 F’s of anesthetic management]
full, fast, and forward
(increased preload, increased heart rate, and decreased afterload)
Mitral Stenosis
[sequelae]
a-fib and pulmonary hypertension
Mitral Stenosis
[anesthetics goals]
maintain sinus rhythm
avoid tachycardia
- also avoid large increases in CO, hypovolemia, and fluid overload
Mitral Valve Prolapse
[heart sounds]
late diastolic click preceded by mid-diastolic murmur
Mixed Venous O2 Tension
[normal mmHg]
40 mmHg
mixed venous oxygen saturation
[estimation of ____]
cardiac output
Mixed Venous Oxygen Saturation
[normal value]
65-75%
Mixed Venous Oxygen
[factors causing a high value]
increased CO or decreased O2 consumption
- hypothermia
- cyanide poisoning
Mixed Venous Oxygen
[factors causing a low value]
increased comsumption and decreased elivery
- hypoxia
- low cardiac output
- anemia
Morphine
[parenteral vs oral conversion]
1:3
most common cause of mortality associated with administration of blood
TRALI
Most common inherited coagulopathy
von Willebrand disease
(affects 1 in 500 people)
Most common electrolyte imbalance
Na
Most common reason for hypoxia in PACU
ventilation/perfusion mismatch
Most common transfusion-related infection
Hepatitis B
Motor innervation to the cricothyroid membrane
[nerve]
external branch of the superior laryngeal
motor innervation to the intrinsic muscles of the larynx, except cricothyroid muscle
[nerve]
recurrent laryngea
Multiple Endocrine Neoplasia Type II
[triad of disorders]
medullary carcinoma of the thyroid
hyperparathyroidism
pheochromocytoma
Multiple Endocrine Neoplasia
[etiology]
tumors in several endocrine organs
- Type I
- gastrinomas, insulinomas, chromophobes (pituitary), and parathyroid tumors
- Type II
- medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism
Multiple Sclerosis
[neuraxial anesthesia]
avoid spinals
epidurals or other peripheral nerve blocks are of less concern
Musculocutaneous Nerve
[motor response to stimulation]
flexion of the forearm at the elbow
Myasthenia Gravis
[anesthetic considerations]
prone to respiratory depression
(avoid or minimize narcotics and benzos)
voltaile agents may provide sufficient muscle relaxation
unpredictable response to Sux, may need larger doses
Myasthenia Gravis
[cardiovascular agents that may potentiate weakness]
beta blockers
lidocaine
procainamid
verapamil
quinidine
Myasthenia Gravis
[Misc. drugs that may potentiate weakness]
lithium
phenytoin
magnesium
NDMR
Myasthenia Gravis
[pharmacological treatment]
pyridostigmine
Myasthenia Gravis
[antibiotics that may potentiate weakness]
ampicillin
ciprofloxacin
Erythromycin
Gentamycin
Sulfonamides
Myasthenia Gravis
[etiology]
autoimmune destruction of post-synaptic acetylcholine receptors and the NMJ
Mydriasis
[definition]
dilation of pupil
Myocardial Ischemia
[most vulnerable]
endocardium
- subjected to the greatest intramural pressures during systole
Myocardial O2 Consumption
[normal resting]
8 mL/100g/min
Myocardial Oxygen Consumption
[primary determinants in order]
heart rate > afterload > preload
Myocardial Oxygen Demand
[characteristics]
increases in demand require an increase in coronary blood flow
- myocardium cannot compensate for reductions in blood flow by extracting more oxygen from hemoglobin
Myocardial Oxygen Demand
[factors]
heart rate
contractility
ventricular wall tension
Myocardial Oxygen Supply
[factors that decrease demand]
decreased:
heart rate
contractility
ventircular size
ballow counter pulsation
Myocardial Oxygen Supply
[factors that increase supply]
increased:
oxygen content
coronary blood flow
coronary perfusion pressure
Myotonia Congenita
[anesthetic considerations]
avoid Succinylcholine
- causes sustained muscle contraction and may produce massive release of K+ leading to cardiac arrest
Myotonia Congenita
[definition]
delayed relaxation after voluntary muscle contraction
Myotonic Dystrophy
[definition]
multisystem disorder characterized by slowing of relaxation after muscle contraction
N2O
[frost developing on tank]
rapid flow from cyclinder to anesthesia machine
Naltrexone
(ReVia)
[uses and treatments]
blocks euphoric effets of heroin
Nasal Cannula
[maximum FiO2]
0.45
Neohepatic Phase
[considerations]
reperfusion syndrome and reperfusion injury
What drug can lead to abdominal pain in the PACU?
Neostigmine
Nephron - P-cells
[function]
secrete K+ and participate in aldosterone-stimulated Na+ reabsorption
Nephron
[two cell types]
principal (P-cells) and intercalated (I-cells)
Nerve Fibers
[which ones carry pain impulses?]
C and A-delta
Neurogenic Diabetes Inspidius
[difference compared to nephrogenic DI]
can be treated witih desmopressin
Neuroleptic Malignant Syndrome vs Malignant Hyperthermia
[key difference]
muscle relaxants will cause paralysis in NMS, but not in MH patients
Neuroleptic Malignant Syndrome
[differential diagnosis]
malignant hyperthermia and serotonin syndrome
Neuroleptic Malignant Syndrome
[etiology]
dopamine blockade in the basal ganglia and hypothalamus
- secondary to metoclopromide or meperidine use
Neuroleptic Malignant Syndrome
[symptoms]
muscle rigidity, fever, and autonomic instability
New York Association’s Classification of Heart Disease
[categories]
I - asymptomatic
II - symptomatic with moderate activity
III - symptomatic with minimal activity
IV - symptomatic at rest
Nitrogen
[tank color]
Black
Nitrous Oxide
[renal effects]
decreased renal blood flow secondary to increased renal vascular resistance
- decreased GFR and urine output
Norepinephrine
[infusion rate]
0.1 - 0.5 mcg/kg/min
normal or increased PR interval
short QT interval
[electrolyte abnormality]
Hypercalcemia
Normal oxygen saturaton of newborn
1 minute after may be as low as 60%
5 minutes 80-85%
may only reach 95% by 10 minutes
Normal resting coronary artery blood flow
75 mL/100g/min
(250 mL/min)
4% of cardiac output
numbess over the lateral aspect of the thigh
[nerve injury]
lateral femoral cutaneous nerve
O neg blood is given because there is no ____
A/B antigens
O2 Partial Pressure (PiO2)
[equation]
PiO2 = (PB - PH2O) x FiO2
(760mmHg - 47mmHg) x 0.21) = 149 mmHg
Obstructive Hydrocephalus
[cause]
intratentorial mass obstructing CSF flow through 4th ventricle or cerebral aqueduct
Octreotide
[drug type]
somatostatin derivative of human growth hormone
Octreotide
[treatment]
carcinoid syndrome
may relieve vasoactive symptoms and restore hemodynamic stability
Oculocardiac Reflex
[clinical manifestations]
bradycardia
- may also lead to junctional rhythm, ectopic beats, AV block, and asystole
Oculocardiac Reflex
[anesthetic management]
retrobulbar block may block afferent limb, preventing arrythmias
Oculocardiac Reflex
[risk factors]
most often in young patients undergoing strabismus surgery
Omphalocele and Gastroschisis
[anesthetic considerations]
- NG tube before induction
- fluid replacement with crystalloid and colloid
- often suffer from hypoproteinemia
- avoid nitrous
Omphaloceles
[definition]
abdominal herniation occuring at the umbilicus
- contained in a sac
- often associated with Down’s, diaphragmatic hernia, and cardiac and bladder malformations
Opioid-induced Sphincter of Oddi spasm
[treatment]
naloxone and glucagon
Outflow Obstruction
[congenital defects]
coarctation of the aorta
aortic and pulmonic valve stenosis
Oxygen Content (CaO2)
[equation]
(0.003 x PO2) + (SO2 x Hb x 1.31)
oxygen requirement for a newborn
7 - 9 mL/kg/min
Oxygen requirement for adult
3 - 4 mL/kg/min
Pacemakers
[upper tracking rate]
prevents rapid venricular rate in response to a rapid atrial rate
- only availble in DDD and VDD pacemakers
PaO2 of 95 mmHg
[saturation]
almost 100%
PaO2
[correction by temperature]
measured PaO2 should be decreased about 6% for each oC cooler than 37
PaO2
[normal values on AGB]
75 - 105 mmHg
PAOP < LVEDP
[when would this occur?]
aortic insufficiency
decreased left ventricular compliance
PAOP > LVEDP
[when would this occur?]
mitral stenosis
left atrial myxoma
pulmonary venous obstruction
elevated alveolar pressure
Paradoxical Air Embolism
[heart defect]
patent foramen ovale
Parasympathetic Neurons
[preganglionic neurons originate from which CN?]
III, VII, IX, and X
and sacral segments 2-4
Parathyroid Hormone
[effect on bone]
increases reabsorption of calcium and phosphate
Parkinson Disease
[premedication for tremor]
diphenhydramine
Parkinson Disease
[treatment of hypotension]
direct-acting vasopressor
Parkinson Disease
[contraindicated drugs]
Droperidol and metoclopromide
Parkinson Disease
[etiology]
progressive loss of Dopamine in the nigrostriatum
Parkland Formula
[equation]
4 mL/kg for each %BSA burned
- 2/3 of this should be replaced ith isotonic crystalloid during the first 8 hours, the rest over the next 16
Patient is taking both aspirin and clopidogrel. How should these be managed prior to surgery.
(s/p bare-metal stent)
stop clopidogrel and continue aspirin
Pulseless Electrical Activity
[5 H’s]
hydrogen ion (acidosis)
hypo- or hyper-kalemia
hypoxia
hypovolemia
hypothermia
Pulseless Electrical Activity
[5 T’s}
toxins
tamponade
tension pneumo
coronary thrombosis
pulmonary thrombosis
First signs of high spinal block in pediatric patients
respiratory depression leading to hypoxia and associated bradycardia
Children maintain stable hemodynamics until what percentage of blood loss?
25 - 35%
local anesthetics for spinals in infants compared to adults
pediatrics require a greater dose, but have a shorter duration
Pericardial Effusion vs. Tamponade
[most important difference]
pressure
Pericardial Tamponade
[Beck’s Triad]
low blood pressure
muffled heart tones
jugular venous distension
pH and HCO3- changes per 10 mmHg PaCO2
0.08 decrease in pH
1 mEq/L increase in HCO3-
Phenylephrine
[reflex bradycardia]
due to increasing SVR
Phosphate
[normal values]
2.5 - 4.5 mg/dL
Pituitary Gland
[surrounding cranial nerves]
III, IV, V1, and VI
Placenta Accreta
[definition]
placenta attaches itself deeply into the uterine wall
Placenta Percreta
[definition]
placenta attaches itself through the utuerus, often extending to nearby organs
Placenta Previa
[definition]
placenta covers the opening of the mother’s cervix
Placenta
[insulin and glucose transfer]
insulin does not cross the placenta; however, glucose does making larger babies
Blood Products
[which is most likely to cause bacterial sepsis]
platelets
- occurs in 1 per 12,000
Platelets
[mm3 per unit increase]
5,000 - 10,000
(for a typical 70kg patient)
Popliteal block
[supplemental block for ankle/foot surgery]
saphenous nerve
Porphyria
[contraindicated drugs]
Etomidate
barbiturates (thiopental)
antieleptics
many benzos
Porphyria
[management]
maintain adequate nutrition
possibly avoid light
fix electrolyte disturbances
maintain euvolemia
Hematin therapy
Porphyria
[etiology]
Heme is composed of iron and porphyrins
porphyrias result from defects in the heme biosynthetic pathway, producing accumulations of prophyrin
Portopulmonary Hypertension
[diagnostic criteria]
mPAP > 25 mmHg
PVR > 240 dyn*sec/cm5
Posterior Pituitary
[hormones]
oxytocin and ADH
Preanhepatic Phase of Liver Transplant
[considerations]
blood loss and surgical compression of major vessels
- carefully manage hyponatremia
- rapid correction may promote development of central pontine myelinolysis
- citrate toxicity (hypocalcemia)
- due to rapidly transfused blood, check calcium carefully and administer calcium chloride as neccessary
- especially after liver is removed
Preductal Arterial Blood sampling
[location]
right radial artery
Preeclampsia
[definition and symptoms]
hypertension and proteinuria
- greater than 140/90
- occurs after the 20th week of pregnancy
- proteinuria > 300 mg/d
Pregnancy
[cardiovascular changes]
increasd blood/plasma volume, CO, HR, and SV
decreased BP and pulmonary resistance
Pregnancy
[changes in epidural]
decreased CSF
decreased potential volume in epidural space
increased epidural pressure
- the first two enhance the cephalad spread of local anesthetics
Pregnancy
[hematologic changes]
decreased Hb and platelets
increased clotting factors (up to 250%)
shifts O2Hb curve to the left
Pregnancy
[Renal changes]
increased GFR
Pregnancy
[respiratory changes]
increased MV, tidal volume, and oxygen consumption
decreased FRC, airway resistance, and PaCO2
Pregnancy
[SVR changes at term]
decreased
Pregnancy
[time of greatest cardiac output]
immediately after delivery
- can increase 75% above prelabor values
- due to increased venous return to the heart
Pressure-Volume Loop
[effects of afterload]
If afterload is reduced, stroke volume and ejection fraction increase, and end-systolic volume decreases

Pressure-Volume Loop
[aortic regurge]

Pressure-Volume Loop
[aortic stenosis]

Pressure-Volume Loop
[effects of preload]
changes in preload affect stroke volume
- end-systolic volume is unchanged if afterload and inotropy are held constant

Pressure-Volume Loop
[Inotropic effects]
Decreasing inotropy increases end-systolic volume while decreasing stroke volume and ejection fraction

Pressure-Volume Loop
[mitral regurge]

Pressure-Volume Loop
[mitral stenosis]

primary determinant of local anesthetic potency
lipid solubility
Primary Fibrinolysis
[causes]
alpha-2 antiplasmin deficiency or an impaired clearance of tPA
Procaine
[maximum dose]
12 mg/kg
Protamine
[what happens when given without heparin?]
anticoagulation
Prothrombin TIme (PT)
[factor(s) tested]
VII
Prothrombin Time
[measurement]
fibrinogen, prothrombin, and factors V, VII, and X
Prothromin Time
[normal range]
11 - 14 seconds
Pseudocholinesterase
[half-life]
12 hours
PT
[normal values]
10 - 14 sec
Pudenal Nerve
[origin]
S2 - S4
Pulmonary Artery Catheter
[contraindications]
complete LBBB
Wolff-Parkinson-White syndrome
Ebstein’s malformation
Pulmonary Artery Catheter
[change in BP when entering into right ventricle]
increase in systolic pressure
Pulmonary Artery Catheter
[change in BP when entering pulmonary artery]
increase in diastolic pressure
Pulmonary Embolism
[ABG findings]
hypoxemia and hypocapnea
(respiratory alkalosis)
Increased lung compliance due to loss of elastic recoil of the lung
Pulmonary Emphysema
Pulmonary Vascular Resistance
[equation]
(PAP - PCWP) / CO * 80
Pulmonic Stenosis
[anesthetic goals]
maintain normal to slightly high HR
avoid increases in PVR
Pulmonary Vascular Resistance is the least at which lung volume?
Functional Residual Capacity
Pt is here for a TIPS procedure, what physiologic findings to consider?
liver failure
(decreased albumin)
QTc prolongation
[lenth of time considered prolonged]
> 0.45 seconds
Most important determinant of intracellular osmotic pressure
Potassium
Which EKG findings may make diagnosis of an MI more difficult?
left bundle branch block
- LBBB changes how the ventricles depolarize and also leads to its own ST segment and t-wave changes
“You note a heart rate of 32 in sinus bradycardia, with a blood pressure of 72/44, and a respiratory rate of 16.” What is your first intervention?
0.5 - 1 mg Atropine
“On a preoperative EKG, you note delta waves preceding the QRS complex. During the procedure the patient’s heart rhythm changes into a-fib followed by wide-complex irregular tachycardia. The patient is otherwise stable. What is the best initial option in management?”
procainamide and amiodarone
- Wolff-Parkinson-White
- AV node blocking drugs are contraindicated
What effect does alkalosis have on serum potassium, serum calcium and shifting of the oxygen hemoglobin dissociation curve?
decrease in K and Ca
left shift in O2Hg curve
Narrow Complex SVT with stable blood pressure
[first treatment]
vagal maneuver (valsalva or carotid massage)
Adenoside 6 mg
Radial Nerve
[motor response to stimulation]
extension of all digits as well as the wrist
Radiation Exposure
[max REM per year]
5
RBC
[normal range]
3.8 - 5.7 x108/uL
typical EKG rhythm in severe CAD of the right coronary
complete heart block
- RCA supplies blood to the AV node in 90% of patients
recurrent laryngeal nerve
[unilateral damage]
hoarseness
recurrrent laryngeal nerve
[bilateral damage]
airway obstruction during inspiration
- complete transection would cause vocal cords to remain 2-3mm apart
- partial bilateral paralysis would cause the cords to close completely
Relative potency compared to morphine:
Meperidine
Alfentanil
Dilaudid
Fentanyl
Remifentanil
Sufentanil
Meperidine: 0.1
Alfentanil/Dilaudid: 10
Fentanyl: 100
Remifentanil: 300
Sufentanil: 1,000
Remifentanil
[metabolism]
nonspecific esterases
Renal Blood Flow
[normal autoregulation range]
80 - 180 mmHg
Renal Corpuscle
[function]
ultrafiltration of blood
Renal Transplant
[absolute contraindications]
infection and cancer
Reperfusion Syndrome
[symptoms]
hypotension
right heart failure
arrhytmias with possible cardiac arrest
residual volume
[average adult value]
1200 mL
Resistance during laminar flow is dependent on _____
gas viscosity
resistance during turbulent flow is dependent on _____
density
Retrobulbar Block
[CN nerves blocked]
CN III, IV, and VI
Rhematoid Arthritis
[cardiovascular effects]
pericardial thickening and effusion
conduction defects
aortic regurgitation
Rheumatoid Arthritis
[pulmonary effects]
interstitial pulmonary fibrosis
pleural effusion
Rheumatoid Arthritis
[airway concerns]
atlantoaxial instability
limited TMJ mobility
Right-Sided Heart Failure
[definition]
back-up of blood into the right heart and pulmonary circulation
Right-to-Left Shunting
[congential defects]
tetralogy of fallot
transposition of the great vessels
hypoplastic left heart
pulmonary and tricuspid atresia
“Robin Hood Phenomenon”
[definition]
blood flow directed from a normal region of the brain to an ischemic region
Romano-Ward Syndrome
[characteristics and treatment]
prolonged QT interval
- left stellate ganglion block
- shortens QT intervals
Ropivacaine
[maximum dose]
3 mg/kg
At high altitudes, the flow of a gas through a rotameter will be _____
greater than expected at high flows, but accurate at low flows
S3 Gallop
[how and where to hear it]
cardiac apex using the bell
- apex best located in left lateral decubitus position in the 5th intercostal, midcalvicular line
Heart sound correlating to congestive heart failure
S3 Gallop
SA node
[arterial supply]
RCA (60% of people) or LAD (40% of people)
Sacral Plexus
[develops into which nerves]
sciatic nerve
(common peroneal, tibial, and sural)
Saddle Block
[definition]
“pudendal block”
low lumbar and sacral anesthesia, mostly in OB
Saddle Block
[Key Points]
hyperbaric solution (glucose/dextrose)
Sarin Gas
[signs and symptoms]
DUMBELS
diarrhea
urination
miosis
bronchoconstriction
emesis
lacrimation
salivation
Sciatic Block
[landmarks]
posterior superior iliac spine
greater trochanter
sacral hiatus
Nerve Injury
[weakness of all muscles below the knee]
Sciatic nerve
Secondary Hyperthyroidism
[expected enzyme levels]
low TSH and high free T4/T3
Seizures from Hyponatremia
[treatment]
hypertonic saline
Seizures
[physiological effects]
initial parasympathetic discharge followed by a more sustained sympathetic discharge
sensory innervation below the vocal cords to the carina
[nerve]
recurrent laryngeal
sensory innervation of the larynx above the vocal cords
[nerve]
internal branch of the superior laryngeal nerve
Sensory innervation of the mucous membranes of the nose
[nerve]
trigeminal
Sensory innervation to posterior third of tongue
[nerve]
glossopharyngeal
sensory of occipital portion of the skull
[nerve]
cervical plexus (C2 and C3)
Septic Shock
[hemodynamic changes]
Hypotension with normal cardiac output and low end-diastolic volume
Sequence of highest to lowest level block
sympathetic > sensory > motor
- Sympathetic block may be 2-6 dermatomes higher than sensory
- Sensory may be 2-3 dermatomes higher than motor block
- However, epidural anesthesia tends to have identical levels for sensory and sympathetic
Serotonin Syndrome
[treatment]
supportive and 5-HT antagonist
(cyprohepatadine)
Serum Albumin
[normal levels]
3.5 - 5.5 g/dL
Sevoflurane
[effects on HR]
decreases until about 1 MAC at which time it produces dose-dependent increases
SIADH
[treatment]
fluid restriction
Sickle Cell Crisis
[causes]
hypoxemia
acidosis
dehydration
hypothermia
Sickle Cell Hemoglobin
[P50]
31 mmHg
Sinus Arrhythmia
[cause]
cyclic changes in vagal tone
Sinus Arrhythmia
[definition]
cyclic variation in heart rate corresponding to respiration
- increases with inspiration
Soda Lime
[amount of CO2 absorbed]
23L CO2 per 100g absorbent
Sodium Bicarb
[adverse effects]
paradoxic cerebrospinal fluid acidosis
hypernatremia
hypercarbia
Sodium Nitroprusside
[infusion rate causing cyanide toxicity]
greater than 2 ug/kg/min
Sodium Nitroprusside
[first signs of cyanide toxicity]
tachyphylaxis
metabolic acidosis
elevation of mixed venous PO2 values
Spinal Anesthesia
[alpha-agonists]
have analgesic properties and prolong duration
- examples: clonidine, epinephrine, and phenylephrine
- may also enhance hypotension
spinal cord ending
[adult vs pediatric]
adult L1
pediatric L2
Spinal Cord Injury
[level of paraplegia]
above L4
Spinal Cord Injury
[level of quadriplegia]
above T1
Spinal Cord Injury
[level of required ventilation]
C3 - C5
Spinal Cord Injury
[most common sites]
C5-6 and T12-L1
Spinal Shock
[pathophysiology]
hypotension and bradycardia
Spironolactone
[mechanism of action]
aldosterone antagonist
Spondylosis
[definition]
degeneration of spinal column
SSEPs
[afferent input is carried through which spinal cord tract?]
dorsal columns
Stable wide-complex tachycardia
[best drug choice]
amiodarone and procainamide
Starling’s Law of the Heart
[components]
cardiac output and left ventricular end-diastolic volume
Stellate Ganglion Block
[indication of successful block]
warm sensation over arms and face
Stellate Ganglion Block
[risks and complications]
- bradycardia
- recurrent laryngeal nerve paralysis
- brachial and subarachnoid block
- seizure
- phrenic nerve block
Stellate Ganglion Block
[symptoms]
Horner syndrome
stellate ganglion
[lies in close proximity to which artery?]
vertebral
Stroke Volume
[components]
preload, afterload, and contractility
Succinylcholine
[mechanism of termination]
diffusion into extracellular space
- pseudocholinesterase is not present at the NMJ, so termination of action is actually once it diffuses into the extracellular fluid
Succinylcholine
[mechanism for tachycardia]
stimulation of nicotinic receptors at autonomic ganglia
Superior laryngeal nerve
[bilateral damage]
hoarseness and predisposition to aspiration
Supplementary nerve block with popliteal for surgery on achilles tendon
Saphenous
Supraclaviuclar Block
[which section of the brachial plexus is blocked?
Trunks/Divisions
Sural Nerve
[area of coverage]
covers the lateral side of the foot
SVC Syndrome
[considerations]
start IV in lower extremities
Lhermitte Sign
[definition]
occurs when head flexion causes shooting sensations down the back and into the lower limbs
- due to posterior column disease
Syringomyelia
[etiology]
progressive cavitation of the spinal cord
Systolic Dysfunction
[Pressure-Volume Loop]

Systolic Heart Failure
[definition]
left ventricle loses ability to contract
TAP Block
[nerves blocked]
subcostal, ilioinguinal, and iliohypogastric
Tapentadol
(nucynta)
[drug class]
opioidu agonist and norepinephrine reuptake inhibitor
- contraindicated with MAOIs and SSRIs
Tardive Dyskinesia
[cause]
long-term doaminergic antagonist use
- elderly women and those with psychoactive disorders are at higher risk
Tardive Dyskinesia
[definition]
involuntary movements of the face and extremities
- irreversible
TEE
[best view for myocardial ischemia]
transgastric mid-papillary LV short axis view
- shows the myocardium supplied by all three major coronary arteries
TEE
[smallest detection of air]
0.25 mL
Tracheoesophageal Fistula
[anesthetic concerns]
- ETT must be distal to fistula
- copious pharyngeal secretions
- avoid positive pressure
- avoid next extension and instrumentation after repair
Tracheoesophageal Fistula
[most common type]
IIIB

Tetracaine
[mechanism of termination]
systemic absorption
- hydrolyzed by cholinesterase enzymes which are not present in CSF, must be absorbed first
Tetralogy of Fallot
[anatomical anomalies]
right ventricular outflow obstruction
right ventricular hypertrophy
VSD with over-riding aorta
Tetralogy of Fallot
[anesthetic goals]
maintain intravascular volume and SVR
- avoid increases in PVR, acidosis, or excessive airway pressures
- avoid MR that release histamine
Tetralogy of Fallot
[induction]
Ketamine
maintains or increases SVR, therefore does not aggravate the right-to-left shunting
Tetralogy of Fallot
[isoproteronol]
avoid
reduces afterload and therefore increases right-to-left shunt
Thiazides
[mechanism of action]
inhibits Na+ reabsorption
Thiazides
[site of action]
early distal convoluted tubule
Thiopental
[induction considerations]
adding an acidic muscle relaxant will cause precipitation and may lead to pulmonary embolism
Thyroid Storm
[clinical signs]
fever, tachycardia, and hypotension
(altered consciousness in awake patient)
Thyroid Storm
[differential diagnosis of MH]
thyroid storm does not have the following:
- muscle rigidity
- elevated creatinine kinase
- metabolic and respiratory acidosis
Thyroid Storm
[treatment]
beta blockers
glucocorticoids
thionamide (methimazole)
iodine
Thyroid
[hormones]
T3, T4, and Calcitonin
Time Constants
[percentages at 1, 2, and 3]
63%
84%
95%
TIPS procedure
[treatment]
portal hypertension
TIPS
[acronym]
Transjugular Intrahepatic Portosystemic Shunt
Tirofiban
[mechanism of action]
Blocks binding of fibrinogen and vWF to glycoprotein IIb/IIIa receptor on platelet surface
Total Thyroidectomy
[post-operative concerns]
hypocalcemia
may manifest as laryngeal stridor 24-96 hours after the procedure
Tracheal Capillary Pressure
25 - 35 mmHg
TRALI
[key features]
wide A-a gradient
noncardiogenic pulmonary edema
leukopenia
Trans-tracheal block
[drug choice[
4mL of 4% lidocaine
Transplant Lung
[innervation]
no longer cough reflex below carina
- respiratory pattern is unaffected
Transplanted Heart
[atropine]
no effect
- blocks parasympathetic branches of ANS
Transposition of the Great Arteries
[anatomical anomalies]
aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle
- Survival is only possible through a foramen ovale and PDA
Transposition of the Great Vessels
[rate of induction]
slower inhalational induction and faster intravenous
Transsphenoidal Hypophysectomy
[postoperative considerations]
avoid CPAP
Trauma-Induced Coagulopathy
during periods of tissue hypoperfusion, thrombomodulin released by the endothelium complexes with thrombin
- prevents cleavage of fibrinogen to fibrin
- activates Protein C
- reduces further thrombin generatoin through factors V and VIII
Treacher Collins
[airway]
mandibular hypoplasia
Treatment of dystonic reactions due to Droperidol
(twisted and rigid neck, eye movements)
diphenhydramine
(anticholinergic that crosses BBB)
Tricuspid Regurge
[management goals]
increase HR and preload
decrease afterload
avoid any increases in PVR
Tricuspid Regurge
[pathophysiology]
slight elevation in mean right atrial and central venous pressures
Tricuspid Regurge
[ventilation goals]
avoid PEEP and high mean airway pressures
(goal to maintain high CVP and decrease/maintain afterload)
“Triple H” Therapy
[definition]
hypervolemia, hemodilution, and hypertension
“Triple H” Therapy
[treatment]
2nd treatment of vasospasms after nimodipine
Protein measured in diagnosis of acute ischemia
Troponin
- level was associated with length of ischemia
- peaks within 12-48 hours, but rise can be seen within 8 hours
Trousseau’s Sign
[definition]
carpal spasm following inflation of arm tourniquet above systolic pressure for 3 min
- results from hypocalcemia
TURP Syndrome
[causes]
absorption of large amounts of fluid
(usually hyposmolar)
TURP Syndrome
[treatment]
fluid restriction and furosemide
TURP
[adverse effects]
TURP Syndrome
Coagulopathies
Bladder perforation
septicemia
TURP
[coagulopathy]
DIC and primary fibrinolysis
Type II pneumocytes
[function]
secrete surfactant in alveoli
Ulnar Nerve
[motor response to stimulation]
flexion at the wrist, 4th, and 5th fingers and adduction of the thumb
Umbilical Cord Blood
[normal arterial values]
7.25 pH
50 PCO2
20 PO2
22 HCO3-
unable to oppose thumb and little finger
[nerve damage]
median
- frequently injured at AC during IV cannulation or through neurottoxic drugs
Vasopressin
[infusion rate]
0.01 - 0.04 units/min
Vasospasm
[treatment triad]
3 H’s
hypertension, hypervolemic, hemodilution
VD/VT
[equation]
( PACO<span>2</span> - PECO<span>2</span> ) / PACO2
normally 33%
Venous Admixture
[definition]
amount of mixed venous blood that would have to be mixed with pulmonary end-capillary blood to account for the difference in O2 tension
Venous Admixture
[equation Qs/Qt]
(CCO2 - CaO2) / (CCO2 - CVO2)
Venous Air Embolism
[monitoring]
TEE and precordial Doppler
Venous Air Embolism
[pulmonary artery pressure]
rises progressively
- when the amount of entrained exceeds the rate of pulmonary clearance
Venous Air Embolism
[heart sounds - late manifestation]
“mill wheel” murmur
Verapamil
[dose for irregular-narrow tachycardia]
2.5 - 5 mg over two minutes
Virtally all pain arising in the thoracic or abdominal viscera is transmitted via _____
Sympathetic nervous system in unmyelinated C fibers
Vital Capacity
[normal value mL/kg]
60 - 70 mL/kg
Vitamin K reductase Inhibitor
[example]
warfarin
Volatile Agents
[cardiogenic shock and Fa/Fi]
Isoflurane will be affected most
Volatile Agents
[uptake equation based on first minute]
the amount of volatile agent taken up in the first minute is equal to the amount taken up between the squares of any two consequtive minutes
von Willebrand’s disease
[treatment]
desmopressin (DDAVP)
cryoprecipitate or factor VIII concentrate
- Recombinant factor VIII cannont be used because it does not contain vWF
Warfarin Therapy
[emergency treatment]
fresh frozen plasma
- vitamin K should be avoided as it may lead to a hypercoagulable state
Weakness of the muscules that extend the knee
[nerve injury]
femoral nerve
Web space between the great and second toe
[innervation]
deep peroneal nerve
West Zone 1
[pressure ranking]
PA > Pa > PV
West Zone 2
[pressure ranking]
Pa > PA > Pv
West Zone 3
[pressure ranking]
Pa > Pv > PA
What effect does Propofol have on the CO2 responsiveness on the cerebral vasculature?
does not have any affect at clinical doses
what part of the tubule reabsorbs the most water
proximal convuluted tubule
when is the fetus most susceptible to the effects of teratogenic agents?
3 - 8 weeks
(during organogensis)
Which antibiotic may cause hearing loss?
Gentamycin
which coefficient is most closely associated with MAC?
oil/gas
which diuretic is associated with hyperchloremic metabolic acidosis?
acetazolamide
(carbonic anhydrase inhibitors)
which diuretic is associated with ototoxicity?
loop diuretics
Which diuretic may lead to hyperkalemia
Spironolactone
(potassium sparing)
Which drug prodces strong pulmonary arterial dilation with the least amount of systemic artery dilation?
nitric oxide
which lab test would be most useful in evaluating if a s/p thyroidectomy patient is euthyroid?
TSH
which muscle relaxant inhibits the reuptake of norepinephrine by the adrengeric nerves?
pancuronium
which narcotic can be used as the sole agent fr a C-section
(without any local)
meperidine
which pressor is best in presence of acidemia?
vasopressin
which vein is just proximal to the SVC?
brachiocephalic vein
Why do infants require a higher dose of Sux?
higher volume of distribution
Why does Fentanyl have a faster onset than morphine
more ionized
Wide Complex Tachycardia with normal BP
[what to do]
cardiovert using biphasic defibrillation
- next step amiodarone or procainamide
Withdrawal
[postoperative drug treatment]
Clonidine
Wolff-Parkinson-White
[EKG findings]
delta wave and shortened PR interval
Wolff-Parkinson-White
[treatment in a hemodynamically stable patient with regular narrow complex tachycardia]
vagal maneuvers or adenosine
Wolff-Parkinson-White
[treatment in a hemodynamically stable patient with regular wide complex tachycardia]
procainamide or amiodarone
Wrist Drop
[nerve damage]
radial
You give a pt Calcium then a precipitate forms, what was given prior?
Bicarb
[Cl-]
[normal values]
95 - 105 mEq/L
[HCO3-]
[normal values]
22 - 28 mEq/L
[K+]
[normal values]
3.5 - 5.3 mEq/L
[Mg+]
[normal values]
1.3 - 2.4 mEq/L
[Na+]
[normal values]
135 - 145 mEq/L
Anticholinergic Syndrome
[treatment]
physostigmine
MAC-BAR
[definition]
blocks autonomic response to painful stimuli
(> 1.7 MAC)
Opioid Receptor
[most responsible for supraspinal analgesia]
Mu-1
Opioid Receptor
[most resonsible for spinal analgesia]
Mu-2
Opioid Receptor
[physical dependence]
Mu-2
Opioid Receptor
[dysphoria]
kappa
Which opioid has a similar structure to atropine and LA?
meperidine
Chronic Bronchitis
[Hematologic changes]
polycythemia
Chronic Bronchitis
[EKG and chest X-ray]
right atrium and ventricular hypertrophy
cardiomegaly
Obstructive Lung Disease
[TLC]
increased TLC
cardiogenic shock
[effect on mixed venous oxygen saturation]
decrease
PaCO2
[effect on hepatic blood flow]
increaseing PaCO2 will increase hepatic blood flow
Which CCB has the greatest coronary artery vasodilating effects?
Nicardipine

venous air embolism
Methemoglobin
[saturation]
Saturation of 85%
Carboxyhemoglobin
[saturation]
produces falsely high saturations
High Anion-Gap Metabolic Acidosis
[causes acronym]
Cat Mudpiles
High Anion-Gap Metabolic Acidosis
[“C” causes]
carbon monoxide
cyanide
congenital heart failure
High Anion-Gap Metabolic Acidosis
[“A” causes]
aminoglycosides
High Anion-Gap Metabolic Acidosis
[“T” causes]
theophylline
High Anion-Gap Metabolic Acidosis
[“M” causes]
methanol
High Anion-Gap Metabolic Acidosis
[“U” causes]
uremia
High Anion-Gap Metabolic Acidosis
[“D” causes]
diabetic ketoacidosis
(can also be from alcohol or starvation)
High Anion-Gap Metabolic Acidosis
[“P” causes]
paracetamol/acetaminophen
High Anion-Gap Metabolic Acidosis
[“I” causes]
iron
High Anion-Gap Metabolic Acidosis
[“L” causes]
latic acidosis
High Anion-Gap Metabolic Acidosis
[“E” causes]
ethanol
High Anion-Gap Metabolic Acidosis
[“S” causes]
salicylates
(ASA and aspirin)
Normal Anion-Gap Metabolic Acidosis
[mnemonic for causes]
ABCD
- Addisons (adrenal insufficiency)
- Bicarbonate loss (diarrhea, vomiting)
- Chloride excess
- diuretics (acetazolamide)
Aliskiren
[drug class]
direct renin inhibitor
Which drug would be inefficient in heart block?
Atropine
- only increases the SA rate and
Pacemaker
[common location of ventricular leads]
right ventricular apex
Hypertrophic Obstructive Cardiomyopathy
[hemodynamic goals]
increase preload and afterload
slow HR
alcohol or tobacco
[which is a coronary risk factor?]
tobacco use
Pulmonary Hypertension
[PAP > _____]
25 mmHg
Orifice Flow
[definition]
special case of turbulent flow where the diameter is larger than the length
- example: tracheal obstruction
What can be used to detect all leaks in the low-pressure circuit of any contemporary anesthesia machine?
negative-pressure leak test
General anesthesia results from interruption of nervous system activity EXCEPT _____
peripheral sensory receptors
Locus Ceruleus
[definition and key concept]
nucleus in the pons involved with physiological responses to stress and panic
- no affect by general anesthesia
Indels
[definition]
insertion or deletion of one or more nucleotides
Haplotypes
[definition]
nucleotide polymorphisms inherited in blocks
most common inherited prothrombotic risk factor
[mutation in which coaulation factor]
factor V
“Factor V Leiden”
After cardiac surgery, what is the incidence of significant neurologic mobidity?
1 - 3%
Malignant Hyperthermia follows what pattern of inheritance?
autosomal dominant
Point mutation in which gene may interfere with Propfol’s mechanism of action?
Beta-3 subunit of GABAA receptor
Elimination Half-Life
[definition]
time it takes the amount of drug in the bdoy to decrease by 50%
the kidney primarily excretes _____
(solubility and polarity)
water-soluble polar compounds
the smaller the volume of distribution, the _____ the half-time of elimination
longer
What is the half-time of elimination of a drug that undergoes first-orer elimination with a rate constant of 0.1 minute?
6.93 minutes
Isovolumetric contraciton occurs after _____ valve closure
mitral
- isovolumetric contraction only occurs in the Left Ventricle
resting coronary blood flow
{in mL/min]
250 mL/min
Croup
[imaging]
“steeple sign}
epiglottitis
[imaging]
thumb sign
Croup
[medical name]
laryngotracheobronchitis
the last two digits of the pH should equal HCO3- + _____
15
(pH of 7.34 should have a HCO3- of 7.49)
Lactated Ringer
[plasma distribution]
equal to extracellular fluid
20% * kg
D5W
[plasma distribution]
60% * kg
chronic vomiting leads to ____
hypochloremic alkalosis
chronic diarrhea leads to _____
hyperchloremic acidosis
aldosterone promotes _____ of Na in the kidney
reabsorption
aldosterone promotes exchange of ____ for ______
exchange of Na for potassium and hydrogen
metabolic alkalosis is associated with _____ [K]
decreased
metabolic alkalosis is associated with compensatory _____
hypoventilation
(hypercarbia)
Sodium Bicarb
[initial dose]
kg * 0.3 * (24 - actual HCO3)
____________________________
2
aldosterone ____ potassium excretion
increases
acidosis shifts potassium ____
extracellularly
insulin causes an _____ shift of potassium
intracellular
how many paired sympathetic ganglia?
22
Explain the parasympathetic innervation of the heart
mainly in the SA and AV nodes
(no innervation in the ventricles
symphathetic = _____
parasympathetic = _____
(adrenergic or cholinergic)
adrenergic - SNS
cholinergic - PNS
in the PNS, the postganglionic receptors secrete _____
Ach
the preganglionic neurotransmitter is ____ in both the SNS and PNS
Ach
in the adrenal medulla, the preganglionic neurotransmitter is ____
Ach
which cells are responsible for the release of catecholamines in the adrenal medulla?
chromaffin cells
muscarinic receptors in the myocardium are stimulated by _____ and inhibit the release of _____
Ach
norepinephrine
which catecholamine is the most potent venoconstrictor?
norepinephrine
activation of presynaptic Beta-2 receptors have the same physiologic response as antagonist to _____
alpha-2 receptors
Beta-2 receptor
[catecholamine sensitivity]
primarily epinephrine
Beta-2 receptor
[catecholamine sensitivity]
equally sensitive to epi and norepi
arterial baroreceptor refle can be best demonstrated by the ______
valsalva maneuver
if exaggerated and prolonged hypotension develops, patient may be at risk for autonomic instability
Valsalva Maneuover
[explain]
BP increases momentarily as the intrathoracic blood is forced into the heart (preload)
sustained pressure decreases venous return, reducing cardiac output and blood pressure
relex vasoconstriction and tachycardia ensue
Fenoldopam
[characteristics]
direct renal vasodilator
selective dopamine-1 agonist
has diuretic properties
first-line agent in treating hypotension in the septic patient
norepinephrine
Thiopental
[induction dose]
3 - 5 mg/kg
Which induction drug may facillitate the interpretation of SSEPs?
etomidate
- increases the amplitude which can be useful when signal quality is poor
Which induction drug should be avoided in the presence of tricyclic antidepressants?
ketamine
Propofol
[elimination half-life]
1 - 3 hours
Propofol
[dosing]
should be based on lean body weight
Propofol increases which waves on an EEG?
Beta waves
Dexmedetomidine
[infusion rate]
0.2 - 0.6 mcg/kg/hr
Serum Lipase
[indication]
acute pancreatitis
Poliomyelitis
[diagnosis]
febrile with asymmetric paralysis
diagnosis by virus culture
Guillain Barre Syndrome
[diagnosis]
febrile illness with loss of sensation
diagnosis by CSF analysis and electrophysical studies
Myastenia Gravis
[diagnosis]
fluctuating weakness
diagnosed by the “tensilon” test
Chlorpromazine
[key facts]
D2 antagonist
anti-psychotic
- may lower seizure threshold
- prolongs QT interval
- potentiates depressant effects of narcotics
Cefazolin
[mechanism of action]
inhibiting bacterial cell wall synthesis
(gram positive)
Autonomic Hyperreflexia
[level of transection]
T6 or above
urgent warfarin reversal
FFP
Vancomycin
[mechanism of action]
inhibits bacterial cell wall synthesis
(gram positive including MRSA)
Excess lactated ringers
[most likely acid-base disturbance]
metabolic alkalosis
Pulmonary Hypertension
[induction medications to avoid]
ketamine and etomidate
- suppress pulmonary vasodilation mechanisms leading to pulmonary vasoconstriction
Hypocalcemia
[effects]
muscular spasm and rigidity
hyperventilation
congestive heart failure
Clindamycin
[mechanism of action]
binds 50S ribosomal subunit
Methemoglobinemia
[treatment]
methylene blue
4x4 sponge
[how much blood can it hold]
10 mL
Cryoprecipitate
[components]
8, 13, fibrinogen, and vWF
Which test is best for determining the presence of an unstable clot?
D-dimer
DIC
[effect on coaguation tests]
no effect on PT or PTT
Platelet pheresis pack
[contains how many platelets?]
30,000 - 60,000 cells/mcL
Plasma-Lyte
[which common electrolyte is not found?]
Calcium
Plasma-Lyte
[osmolarity]
295
Severe Acidemia
[effects]
decreased contracility due to decreased response to catecholamines
hypotension
hyperventilation
hyperkalemia
Lactated Ringers
[which common electrolyte is not found]
magnesium
massive transfusion
[acidosis or alkalosis?]
metabolic alkalosis
Biot’s Respirations
[definition]
regular and rapid breaths followed by apnea
Kussmaul’s Sign
[definition]
elevation of JVP seen during inspiration
carcinoid tumors
[signs and symptoms]
cutaneous flushing
bronchospasm
diarrhea
hypotension
(more likely to have right heart failure)
Hemophilia A
[treatment]
cryoprecipitate
purified factor VIII
(can give FFP but not as effective)
Hespan vs. Hextend
[difference]
Hespan in a normal saline
hextend is a lactated ringers
PRBC
[average hematocrit]
70-80%
Rhematoid Arthritis
[pulmonary disorders]
restrictive lung disease
most common cause of post-renal azotemia in an elderly male
prostatic hypertrophy
which antibiotics are ototoxic?
amioglycosides
(gentamicin)
restrictive lung disease
[pulmonary tests]
decreased TLC
normal to increased FEV1/FVC
3 main obstructive lung diseases
asthma, emphysema, and bronchitis
multiple sclerosis
[intraoperative management]
maintain normothermia
- increased core body temps and stress are known to precipitate exacerbations
what type of receptors are found in the neuromuscular junction?
nicotinic
maximum Na correction rate
0.5 mEq/hour
type of acidosis with excessive NS infusion
hyperchloremic metabolic acidosis
Renin
[origin]
juxtaglomerular cells in the kidney
Angiotensinogen
[origin]
liver
pulmonary hypertension
[ekg findings]
right axis deviation
tall p-waves in lead II
RBBB
hyperlipidemia
[electrolyte effects]
falsely low sodium levels
quick onset of versed can be attributed to _____
high lipid solubility
spironolactone
[mechanism of action]
inhibits aldosterone at the DCT
Lasix
[mechanism of action]
blocks Na reabsorption in the ascending Loop and DCT
TRALI
[antibody confirmation]
lymphocytotoxic
normal human plasma osmolarity
280
Cricoid Pressure
[force in lbs]
8 - 10lbs
Propofol infusion syndrome
[treatment]
charcoal hemoperfusion
supportive care
pulmonary embolism
[most common signs]
tachypnea and rales
Brugada Syndrome
causes sudden cardiac death in apparently normal hearts
- EKG shows ST elevation in V1-V3
Cauda Equina
[originates at what level?]
L1
“millwheel murmur”
acute venous air embolism
ventilatory drive in a COPD patient is normally in response to ____
hypoxemia
Mannitol
[mechanism of action]
increases osmotic pressure of the glomerular filtrate increasing water excretion
Hypothyroid patients are more likely to be _____glycemic
hypoglycemic
Thyroid Storm
[treatment]
propranolol
methimazole
dexmethasone
iodine