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Cardiology - Dr Constable > Quiz 3 - Induction of Anesthesia in Cardiovascular pt > Flashcards

Quiz 3 - Induction of Anesthesia in Cardiovascular pt Flashcards

1
Q

When preparing for a cardiovascular case, what drugs should you hang?

A

One inotrope
One vasopressor
One vasodilator
all preprogrammed and ready to use

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2
Q

When preparing for a cardiovascular case, what kinds of bolus meds should you have drawn and ready?

A

One Inotrope
One Vasopressor
One Vasodilator
Plus adrenergic blocker

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3
Q

When preparing for a cardiovascular case, what other meds should you have ready for bolus?

A

Antiarrythmic drugs
Anticoagulants and reversal agents
(heparin and protamine)

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4
Q

Should you have a pt stop their chronic cardiac meds before surgery?

A

no, except in rare incidences

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5
Q

In the preinduction setting, what last minute checks should you make?

A 
SOAP
S - Suction
O - Oxygen
A - Airway equipment
P - Pharmacy
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6
Q

What monitors should you have set-up for the cardiovascular pt?

A 
Basic monitors (BP, ECG, pulse ox)
Invasive monitors (Art line)
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7
Q

What meds should you use for induction on the cardiovascular pt?

A

Standard induction drugs

  • Hypnotic
  • Opioids
  • Muscle relaxants
  • Maintenance meds
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8
Q

How are induction drugs selected for the cardiovascular pt?

A

Depend on pts condition and the preference of the attending anesthesiologist.
Have routine drugs available for induction including rescue drugs

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9
Q

Why are high dose opioids not generally used for surgical cases?

A

Due to long postoperative intubation times otherwise they provide good stress response suppression and hemodynamic stability during surgery.

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10
Q

What’s the common dose for Fentanyl?

A

3-10 mcg/kg

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11
Q

What is a common dose for Sufentanil?

A

0.1-1 mcg/kg

Provides faster recovery time than fentanyl

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12
Q

Common dose of Remifentanil?

A

0.5-1mcg/kg

Requires careful provision of postop pain

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13
Q

What are some common hypnotics?

A 
Propofol
Etomidate
Thiopental
Ketamine
Scopolomine (less common)
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14
Q

Propofol dose?

Issues with propofol?

A

Does 1-2mg/kg

  • capable of dropping SVR, MAP, CI, SV
  • Use with caution or reserve for hemodynamically stable pts with good ventricular function
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15
Q

What is the common dose for Etomidate?

A

0.2 mg/kg

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16
Q

What are the side effects of Etomidate?

A
  • Small decrease in SVR and MAP
  • Increase in HR and CO
  • Myoclonus
  • Increase Epileptiform activity
  • Induce adrenal suppression in some cases
17
Q

What is the common dose of Thiopental?

A

2-4 mg/kg

18
Q

What are the side effects of Thiopental?

A
  • Rapid onset
  • Rapid distribution
  • Decrease preload,
  • Myocardial depressent
  • Increases heart rate via baroreceptor reflex
19
Q

What is the dose ketamine?

A

2 mg/kg

20
Q

What are the side effects of ketamine?

A
  • 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
21
Q

T/F: Ketamine can have the potential to cause vivid or life experiences relived?

A

TRUE

22
Q

What are the inhalational agent used?

A
  • Isofluaren
  • Sevoflurane
  • Desflurane
  • Nitrous Oxide
  • Halothane
23
Q

T/F: Inhalational agent have a dose-dependent tachycardia.

A

TRUE

24
Q

T/F: Pancuronium can increase the heart rate through the nicotinic receptor.

A

FALSE

Pancuronium increases heart rate through vagolytic effect.

25
Q

What are long acting muscle relaxants?

A

-Pancuronium

26
Q

What are intermediate acting muscle relaxants?

A
  • cisatracurium,
  • rocuronium
  • vecuronium
27
Q

What are short acting muscle relaxants?

A

-succinylcholine

28
Q

Name a few modified induction sequences dependent on the patient and situation?

A
  • Anticipated difficult airway
  • Emergency situations
  • Decompensated state
29
Q

The patient is in a decompensated state and needs a safe induction. What medication would be used?

A
  • Remifentanil 1 mcg/kg
  • Etomidate 0.2 mg/kg
  • Succinylcholine 1.5 mg/kg
30
Q

What are some consideration of using new drug compared to an older drug that has similar effect on a patient?

A
  • Careful Patient assessment
  • Cautious Dosing
  • Fiscal restraints
  • Compatible with any type of fast tracking methods
31
Q

What should happen during the post induction period?

A
  • 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

Cardiology - Dr Constable (9 decks)

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