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My Advanced anesthesia 2 > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

3 layers of sphere

A
  • Sclera
  • Uveal tract (middle layer)
  • Retina
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2
Q

look at slide 3

A

.

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3
Q

Middle Layer (called what?) of eye has 3 structures?

A
  • Choroid : Layer of blood vessels, located posteriorly
  • Ciliary Body: behind iris, produces aqueous humor
  • Iris: pigmented, controls light entry
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4
Q

Traction of ______ on ______ causes detachment

A

vitreous

retina

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5
Q

Scarring, bleeding or opacification of vitreous is treated with ________

A

vitrectomy

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6
Q

look at slide 8

A

.

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7
Q

All ocular muscles originate in the ____ apex around the _________, except for the __________.

A

orbital

annulus of Zinn

inferior oblique

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8
Q

Ocular Cardiac Reflex (OCR) manifests as:

Seen especially with ___________________.

A
  • Bradycardia
  • AV block
  • Ventricular ectopy
  • Asystole (rarely)

medial rectus traction

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9
Q

look at slide 11

A

.

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10
Q

look at slide 13

A

.

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11
Q

Blood supply to eye dependent on intraocular perfusion pressure: equation?

A

MAP - IOP

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12
Q

The quantity of aqueous and blood volume regulates ____

A

IOP

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13
Q

Normal IOP ______ mmHg

A

10-22

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14
Q

production of aqueous humor is by?

A

carbonic anhydrase

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15
Q

Venous pressure: Increase in CVP increase IOP, even more than increase in BP.
Coughing, straining, breathholding, and vomiting increases IOP by obstruction of drainage. IOP may increase up to 40x with coughing….

A

.

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16
Q

Decreased PaCo2 results in a fast drop in IOP from choroidial vasoconstriction
Increased PaCO2 results in a slow increase in IOP
A fast respiratory rate may increase IOP from insufficient venous drainage…..

A

.

17
Q

Metabolic acidosis _______ the choroid vessel volume and therefore IOP
Metabolic alkalosis ________ the choroid volume and the IOP

A

decreases

increases

18
Q

look at slide 23

A

.

19
Q

Inhalation agents drop IOP by:

A
  • lowering BP and thereby decreasing choroidal volume
  • relax extraocular muscles and lower wall tension
  • Pupil constriction enables aqueous outflow
20
Q

Med consideration for eyes:

A
  • Ketamine may increase as it usually raises BP and doesn’t relax extraocular muscles
  • Etomidate is associated with myoclonus (10-60%) and may not be appropriate with an open globe
  • Succinylcholine (Sch) increases IOP
21
Q

Succinylcholine: Prolonged contracture alters forced duction test (test for extraocular muscle balance) for 20 minutes and may influence the type of strabismus surgery done….

A

.

22
Q

Carbonic anhydrase inhibitor: Acetazolamide (diamox) decreases aqueous production by inhibiting Na pump responsible for secretion of aqueous humor, decreasing IOP. IV dose 500mg, acts w/n minutes Chronic use depletes Na, K, and bicarb, leading to metabolic acidosis. Check lytes preop for chronic use patients….

A

.

23
Q

Osmotic diuretic: Mannitol used IV introp to drop IOP. Increases circulating blood volume (CHF) and pt may require urinary catheter. Max effect 30-45 minutes, returns to baseline 5-6 hours…

A

.

24
Q

topical anticholinesterase drug maintain miosis to Rx glaucoma.

A

Echothiophate

Risk: prolonged muscle paralysis after succs BC depletes plasma cholinesterases

25
Q

2 cholinergic drugs used to constrict pupil. Bradycardia and acute bronchospasm have been reported

A

Pilocarpine

Acetylcholine

26
Q

Flomax (Tamsulosin hydrochloride) has selective alpha antagonistic properties. It binds the iris dilator muscles, affecting iris dilation and complicates cataract surgery. Iris remains floppy even after 7-28d off therapy…

A

.

27
Q

3 types facial nerve block

A

1) Van Lint
2) Atkinson
3) O’Brien

28
Q

Blocks entire trunk of facial nerve. Expect lower facial droop postop for several hours. Injection is close to vagus and glossopharyngeal nerve. Associated w/ vocal cord paralysis, laryngospasm, dysphasia and resp distress

A

Nadbath Rehman block

29
Q

Retrobulbar Block: Superior rectus muscle runs outside the muscle cone and may not be blocked as noted by intorsion on downward gaze….

A

.

30
Q

look at slide 47-50

A

.

31
Q

RBB contraindications

A
  • Bleeding disorders (risk RB hemorrhage)
  • Extreme myopia (longer globe more at risk of perforation)
  • Open eye injury (pressure of fluid behind eye may force intraocular contents out through wound)
32
Q

look at slide 52-53

A

.

33
Q

N2O should be d/c’d 15 minutes before placement of sulfur hexaflouride and avoided for 7 to 10 days after….

A

.

34
Q

Another vitreal air agent, perfluoropropane (C3F6) persists for weeks. Avoid N2O for one month after instillation of this agent….

A

.

35
Q

which surgeries are air gas bubbles placed?

A
  • Vitrectomy
  • retinal detachment
  • vitreoretinal surgeries
36
Q

scleral buckle surgery issues:

A

Painful and high risk n/v as well as nucleation surgeries, top 2

My Advanced anesthesia 2 (12 decks)

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