Quiz 3

Question 1

should chronic cardiac meds be give preoperatively for caridac surgery

Answer 1

Yes (with rare exceptions)

Question 2

place what on pt first before pulse ox?

Answer 2

cerebral oximetry

Question 3

Fentanyl (dose, distribution)

Answer 3

• 3-10 mcg/kg
• 98% redistributed from plasma in first hour
• Large volume of distribution

Question 4

Sufentanyl (dose, and compare to fentanyl x5)

Answer 4

• 0.1-1 mcg/kg
• 7-10 times more potent than fentanyl
• Higher pKa & only 20% ionized
• Half as lipid soluble
• Lower volume of distribution
• Faster recovery time

Question 5

Remifentanyl (dose, onset, misc x2)

Answer 5

• 0.5-1 mcg/kg
• Onset time 1 min & recovery time of 9-20 min
• Widespread extrahepatic hydrolysis by nonspecific tissue & blood esterases
• Requires careful provision of postoperative pain**

Question 6

Propofol (dose, physiologic changes, misc x2)

Answer 6

• 1-2 mg/kg
• Capable to drop SVR, MAP, CI, & SV***
• Extensive redistribution allowing rapid recovery
• Use with caution or reserve for HD stable cardiac patients with good ventricular function

Question 7

Etomidate (dose, physiologic changes x4)

Answer 7

• 0.2 mg/kg
• Produces a small decrease in MAP & SVR and an increase in HR & CO
• May initiate myoclonus*
• Increase incidence of epileptiform activity in patients with know seizure disorders*
• Can induce adrenal suppression, but this phenomenon is unusual

Question 8

Thiopental (dose, misc x2, physiologic effects)

Answer 8

• 2-4 mg/kg
• Rapid onset & can be used safely in HD stable patients
• Rapid redistribution
• Cardiovascular effects: decreases preload, myocardial depressant, increases HR via barorecptor reflex

Question 9

Ketamine (dose, misc x2, physiologic effects x3)

Answer 9

• 2 mg/kg
• Unique cataleptic trance known as dissociative anesthesia
• Unconsciousness in 20-60 sec
• Increases HR, MAP, & plasma Epi levels (dependent on intact sympathetic reserve & robust myocardium)*
• Advantageous in hypovolemia, major hemorrhage or cardiac tamponade*
• Caution: increases ICP & coronary demand from sympathetic stimulation

Question 10

negatives of Desflurane in cardiac surgery (4)

Answer 10

• bad smell
• airway irritant
• no mask induction
• tachycardia

Question 11

inhalation anesthetics generally good d/t? (3)

Answer 11

• Modest levels of myocardial depression
• Predominant effect is dose-dependant vasodilation reducing BP & SVR
• Dose-dependent reflex tachycardia

Question 12

paralytics (short, interm, long)

Answer 12

Short acting:
-succinylcholine

Intermediate acting:

• cisatracurium - renal problems
• rocuronium
• vecuronium

Long acting:
-pancuronium (vagolytic effects tend to counter the vagotonia & bradycardia induced by higher doses of opioids)

Question 13

drug dosing in induction alterations including: Anticipated Difficult Airway, Emergency Situations, Decompensated States

Answer 13

Remifentanil 1mcg/kg, Etomidate 0.2mg/kg, Succinylcholine 1.5mg/kg