Quiz 3 - Induction of Anesthesia in Cardiovascular pt Flashcards
When preparing for a cardiovascular case, what drugs should you hang?
One inotrope
One vasopressor
One vasodilator
all preprogrammed and ready to use
When preparing for a cardiovascular case, what kinds of bolus meds should you have drawn and ready?
One Inotrope
One Vasopressor
One Vasodilator
Plus adrenergic blocker
When preparing for a cardiovascular case, what other meds should you have ready for bolus?
Antiarrythmic drugs
Anticoagulants and reversal agents
(heparin and protamine)
Should you have a pt stop their chronic cardiac meds before surgery?
no, except in rare incidences
In the preinduction setting, what last minute checks should you make?
SOAP S - Suction O - Oxygen A - Airway equipment P - Pharmacy
What monitors should you have set-up for the cardiovascular pt?
Basic monitors (BP, ECG, pulse ox) Invasive monitors (Art line)
What meds should you use for induction on the cardiovascular pt?
Standard induction drugs
- Hypnotic
- Opioids
- Muscle relaxants
- Maintenance meds
How are induction drugs selected for the cardiovascular pt?
Depend on pts condition and the preference of the attending anesthesiologist.
Have routine drugs available for induction including rescue drugs
Why are high dose opioids not generally used for surgical cases?
Due to long postoperative intubation times otherwise they provide good stress response suppression and hemodynamic stability during surgery.
What’s the common dose for Fentanyl?
3-10 mcg/kg
What is a common dose for Sufentanil?
0.1-1 mcg/kg
Provides faster recovery time than fentanyl
Common dose of Remifentanil?
0.5-1mcg/kg
Requires careful provision of postop pain
What are some common hypnotics?
Propofol Etomidate Thiopental Ketamine Scopolomine (less common)
Propofol dose?
Issues with propofol?
Does 1-2mg/kg
- capable of dropping SVR, MAP, CI, SV
- Use with caution or reserve for hemodynamically stable pts with good ventricular function
What is the common dose for Etomidate?
0.2 mg/kg
What are the side effects of Etomidate?
- Small decrease in SVR and MAP
- Increase in HR and CO
- Myoclonus
- Increase Epileptiform activity
- Induce adrenal suppression in some cases
What is the common dose of Thiopental?
2-4 mg/kg
What are the side effects of Thiopental?
- Rapid onset
- Rapid distribution
- Decrease preload,
- Myocardial depressent
- Increases heart rate via baroreceptor reflex
What is the dose ketamine?
2 mg/kg
What are the side effects of ketamine?
- Dissociative anesthesia
- Unconsciousness in 20-60 seconds
- Increase in HR, MAP, Plasma Epi Levels
- Advantages in Hypovolemia, Major hemorrhage, or cardiac tamponade
- Increase ICP and coronary demand from sympathetic stimulation
T/F: Ketamine can have the potential to cause vivid or life experiences relived?
TRUE
What are the inhalational agent used?
- Isofluaren
- Sevoflurane
- Desflurane
- Nitrous Oxide
- Halothane
T/F: Inhalational agent have a dose-dependent tachycardia.
TRUE
T/F: Pancuronium can increase the heart rate through the nicotinic receptor.
FALSE
Pancuronium increases heart rate through vagolytic effect.
What are long acting muscle relaxants?
-Pancuronium
What are intermediate acting muscle relaxants?
- cisatracurium,
- rocuronium
- vecuronium
What are short acting muscle relaxants?
-succinylcholine
Name a few modified induction sequences dependent on the patient and situation?
- Anticipated difficult airway
- Emergency situations
- Decompensated state
The patient is in a decompensated state and needs a safe induction. What medication would be used?
- Remifentanil 1 mcg/kg
- Etomidate 0.2 mg/kg
- Succinylcholine 1.5 mg/kg
What are some consideration of using new drug compared to an older drug that has similar effect on a patient?
- Careful Patient assessment
- Cautious Dosing
- Fiscal restraints
- Compatible with any type of fast tracking methods
What should happen during the post induction period?
- Confirm EtCO2, Bilateral breathe sounds, symmetric chest rise
- Reassess the hemodynamic stability
- Initiate maintenance
- Simple technique used daily with varied dosages based on the patient ‘s physical status provides the most consistent results
