Random AA Questions Flashcards
What are the key considerations for maintaining cardiac stability during aortic cross-clamping?
- Decreased cardiac output
- Hypotension after clamp release
- Hypoxemia
- Blood clots
- Increased afterload
- Arrhythmias
Each point includes causes and management strategies.
What is the cause of decreased cardiac output during aortic cross-clamping?
The sudden increase in afterload reduces the heart’s ability to pump blood effectively.
How can hypotension after clamp release be managed?
Preload optimization with fluid administration and careful use of vasopressors like norepinephrine.
What are the early signs of Local Anesthetic Systemic Toxicity (LAST)?
- Tinnitus
- Metallic taste
- Perioral numbness
- Dizziness
- Confusion
- Twitching
- Seizures
- Hypertension
- Bradycardia
- Arrhythmias
- Cardiac arrest
Symptoms can be neurological or cardiovascular.
What immediate actions should be taken if a patient shows symptoms of LAST during a regional block?
- Stop administering the local anesthetic
- Call for help
- Secure the airway and provide 100% oxygen
- Administer benzodiazepines if seizing.
What is the bolus dose for Intralipid therapy in managing LAST?
1.5 mL/kg IV over 1 minute.
What is the typical dose of Propofol for deepening anesthesia in a 20 kg pediatric patient?
40-60 mg IV.
What adjustments should be made for airway management in a 3-year-old undergoing tonsillectomy?
Intubate using an appropriately sized endotracheal tube, typically uncuffed, size 4.5-5.0 mm.
What is the recommended maintenance fluid rate for a 20 kg pediatric patient?
60 ml/hr using the 4-2-1 rule.
How should you manage postoperative pain for a patient after major abdominal surgery?
Consider using regional anesthesia, Acetaminophen, or Ibuprofen.
What alternative techniques can be considered if direct laryngoscopy fails during difficult intubation?
- Video laryngoscopy
- Supraglottic airway devices
- Fiberoptic intubation.
What are the key anatomical considerations when positioning a patient for spine surgery?
- Spinal alignment
- Pressure points
- Avoiding nerve compression.
What challenges arise in administering anesthesia for endoscopic procedures?
Ensuring equipment and medications are available in remote locations.
What laboratory values are essential during aortic cross-clamping procedures?
- Hemoglobin
- Electrolytes
- Coagulation profile.
What steps should be taken during the emergence phase in patients with a difficult airway?
- Gradually reduce sevoflurane
- Monitor for laryngospasm
- Have emergency equipment available.
When ventilating a patient in volume-controlled mode during a laparoscopic procedure, what adjustments would you make?
Increase tidal volume or respiratory rate to accommodate increased intra-abdominal pressure.
Fill in the blank: The classic early signs of LAST include ______.
tinnitus, metallic taste, perioral numbness.
True or False: Increased afterload during aortic cross-clamping can lead to arrhythmias.
True.
What is the typical dose of Fentanyl for analgesia in a 20 kg pediatric patient?
20-40 mcg IV.
What is the main risk of prolonged cross-clamping during aortic surgery?
Increased risk of blood clot formation.
What is the maintenance dose of sevoflurane for pediatric patients after intubation?
1.2 MAC (~2-2.5%).
What is a key consideration when managing a patient with LAST after stabilization?
Transfer to a higher level of care for monitoring.
What is the recommended dose of epinephrine for cardiovascular support?
0.01 mg/kg
Avoid large doses of vasopressors or antiarrhythmics as they could worsen the situation.
What should be done if cardiac arrest occurs during a procedure?
Initiate CPR and continue lipid therapy
This is part of the Advanced Cardiovascular Life Support (ACLS) protocol.
How long should a patient be monitored in the ICU after a crisis?
At least 12-24 hours
What is a key differentiator for hypoglycemia compared to LAST?
Blood glucose measurement shows low blood sugar (< 60 mg/dL)
Patients with diabetes or those on insulin/oral hypoglycemics are at risk for hypoglycemia.
What rapid intervention can resolve symptoms of hypoglycemia?
Administering glucose (IV dextrose)
What symptoms are similar between hypoglycemia and LAST?
Confusion, seizures, dizziness, tachycardia, altered mental status
True or False: A history of epilepsy is a strong clue for diagnosing a seizure disorder.
True
What are common symptoms of a stroke?
Confusion, dizziness, altered mental status, focal neurological deficits, seizures
Focal deficits might include unilateral weakness or facial droop.
What imaging technique is used to diagnose a stroke?
CT scan or MRI
What differentiates a panic attack from LAST?
No seizures or cardiovascular collapse
Panic attacks typically resolve quickly with reassurance.
What is a key sign of hypercarbia?
Elevated end-tidal CO₂ (above normal 35-45 mmHg)
What condition is characterized by muscle rigidity and rapid increase in body temperature?
Malignant Hyperthermia (MH)
What is the treatment for Malignant Hyperthermia?
Dantrolene and cooling measures
What should be done if direct laryngoscopy fails during intubation?
Consider alternative techniques
When should you switch techniques during intubation?
If visualization is poor, multiple attempts have failed, or oxygen saturation is declining
What is a video laryngoscopy used for?
Improved view of vocal cords when direct laryngoscopy fails
What is a supraglottic airway device?
Examples include Laryngeal Mask Airway (LMA) or i-gel
These are used when mask ventilation is difficult.
What is the advantage of fiberoptic intubation?
Allows for intubation under direct visualization of the airway anatomy
What should be avoided to prevent nerve damage during spine surgery?
Prolonged pressure on bony prominences and nerves
What is a key anatomical consideration during prone positioning for spine surgery?
Protecting the airway and ensuring neutral alignment of the cervical spine
What can happen due to improper chest and abdominal support during surgery?
Decreased venous return and increased intra-abdominal pressure
What is a critical risk of ocular compression during surgery?
Ischemic optic neuropathy (ION)
What is the purpose of proper chest and abdominal support in the prone position?
To prevent abdominal compression, which can restrict diaphragmatic movement, reduce venous return, and increase intra-abdominal pressure
Using a Jackson table or chest rolls is recommended for this support.
What complications can arise from abdominal compression during surgery?
- Decreased venous return
- Compromised cardiac output
- Elevated intrathoracic pressure
These factors can impede ventilation and are particularly critical in patients with pre-existing conditions.
What is ischemic optic neuropathy (ION) and its potential cause during surgery?
A condition that can cause permanent blindness due to ocular compression during prolonged prone procedures
Special headrests can be used to prevent pressure on the eyes.
What vascular considerations should be taken into account in prolonged prone positioning?
- Risk of venous pooling in lower extremities
- Potential for deep vein thrombosis (DVT) formation
- Compression of the inferior vena cava (IVC) or aorta affecting venous return
Intermittent pneumatic compression devices can help mitigate these risks.
Why is spine positioning critical during surgery?
To ensure proper thoracic, lumbar, and cervical spine alignment and avoid injury
This is especially important in procedures involving lumbar fusion or decompression.
What is a common peripheral nerve injury associated with improper positioning?
- Brachial plexus injury
- Ulnar nerve injury
- Common peroneal nerve injury
- Femoral nerve injury
Each injury results from specific positioning issues, such as arm abduction or pressure on the elbows.
What are potential ocular complications from prone positioning?
- Ischemic optic neuropathy (ION)
- Corneal abrasions
These complications can arise from prolonged pressure on the eyes.
What are the risks of skin breakdown during prone positioning?
Pressure ulcers can form on areas like the chest, iliac crests, elbows, and knees
Adequate padding and regular monitoring are essential to prevent skin injury.
How does abdominal compression affect ventilation and cardiac output?
It can impede diaphragmatic movement, limiting tidal volume and increasing peak airway pressures
This is critical in patients with pre-existing lung disease or obesity.
What are key steps to ensure proper positioning for spine surgery?
- Perform a detailed preoperative assessment
- Use appropriate padding and support devices
- Monitor during the procedure
- Document the positioning process
These steps are vital to prevent complications.
What challenges arise in administering anesthesia for endoscopic procedures?
- Limited airway access
- Shared airway management
- Risk of aspiration
- Patient positioning complications
- Non-operating room environment
Each challenge requires careful planning and coordination.
What essential equipment is needed for anesthesia in remote settings?
- Standard monitoring equipment
- Airway equipment (e.g., Ambu bag, laryngoscope)
- Suction equipment
- Essential medications (e.g., propofol, midazolam)
Availability of these tools is crucial for patient safety.
What is the goal of sedation for endoscopy?
To provide moderate to deep sedation while maintaining spontaneous respiration and preventing airway compromise
It is important to balance patient comfort with the risk of hypoventilation.
What are common sedation medications used during endoscopy?
- Propofol
- Midazolam
- Fentanyl
- Dexmedetomidine
Each medication has specific dosing, advantages, and potential complications.
What is the emergency management protocol for hypoventilation in remote anesthesia settings?
- Early recognition through capnography and oxygen desaturation monitoring
- Management with jaw thrust or chin lift maneuvers
Quick intervention is essential to ensure patient safety.
Fill in the blank: The use of a _______ can help reduce the risk of venous stasis during surgery.
[intermittent pneumatic compression device]
These devices promote venous return and reduce the likelihood of DVT.
True or False: Ischemic optic neuropathy is a common complication of prone positioning.
False
It is rare but can have devastating consequences if it occurs.
What is the most reliable method for detecting early hypoventilation during sedation?
Continuous end-tidal CO2 (EtCO2) monitoring
A rising EtCO2 or sudden loss of the waveform indicates airway obstruction or apnea.
What happens to SpO2 if the patient is not adequately ventilating or if airway patency is lost?
SpO2 will fall
What simple maneuvers can be used for mild airway obstruction?
- Jaw thrust
- Chin lift
What should be done if manual maneuvers fail to open the airway?
Consider inserting an oral or nasal airway
What is the purpose of bag-valve-mask (BVM) ventilation?
To provide positive pressure ventilation and oxygenation if the patient is apneic
What should be considered if manual ventilation is ineffective?
Place a laryngeal mask airway (LMA)
What is the next step if a patient cannot be ventilated with a mask or LMA?
Proceed to endotracheal intubation
What is a common risk during procedures like upper GI endoscopy?
Laryngospasm
What are the early signs of laryngospasm?
- Sudden stridor
- Complete airway obstruction
What management technique may help overcome a laryngospasm?
Apply continuous positive airway pressure (CPAP)
What medication can be administered to deepen sedation during laryngospasm?
Propofol (0.5-1 mg/kg)
What should be done if laryngospasm persists and ventilation is compromised?
Administer succinylcholine (0.1-0.2 mg/kg IV)
What is aspiration and why is it a risk during upper GI endoscopy?
Aspiration is the entry of gastric contents into the airway, a risk due to proximity to the stomach and sedation
What are the symptoms of aspiration?
- Sudden desaturation
- Coughing
- Appearance of gastric contents in the airway
What immediate action should be taken if aspiration occurs?
Suction the airway
If a patient cannot protect their airway after aspiration, what should be done?
Intubate and provide positive pressure ventilation
What is essential for emergency preparedness in remote anesthesia settings?
- Crash cart with emergency medications
- Emergency airway devices
- Staff training
What should the anesthesia team ensure during shared airway procedures?
Clear communication with the endoscopist
What laboratory values are essential to monitor during aortic cross-clamping procedures?
- Hemoglobin and Hematocrit
- Arterial Blood Gases (ABGs)
- Electrolytes (Potassium, Calcium, Magnesium)
- Coagulation Profile (PT, PTT, INR, Platelet Count)
- Lactate
- Renal Function (Creatinine, BUN, Urine Output)
What is the target hemoglobin level during aortic surgery?
Above 7-8 g/dL
What should be done if hemoglobin levels fall due to blood loss?
Transfusion of packed red blood cells (PRBCs)
What key values should be monitored in arterial blood gases during aortic surgery?
- pH
- PaCO₂
- PaO₂
What is the importance of monitoring electrolytes during aortic surgery?
Electrolyte imbalances can cause significant changes in cardiac conduction and muscle function
What should be administered if hyperkalemia develops after the release of the cross-clamp?
- Calcium gluconate
- Insulin glucose
- Sodium bicarbonate
What is the significance of monitoring the coagulation profile during aortic surgeries?
To balance the risk of bleeding and clot formation
What is a critical marker of tissue hypoperfusion during aortic cross-clamping?
Elevated lactate
What should be done if urine output drops during aortic cross-clamping?
Consider volume expansion with crystalloids or colloids
What are the key steps in the emergence phase of anesthesia?
- Assess readiness for extubation
- Suction the airway
- Plan for extubation
- Maintain adequate oxygenation
- Monitoring
What should be done during the emergence phase for patients with a difficult airway?
Prepare for airway rescue
What is the preferred method of extubation for patients at risk of aspiration?
Awake extubation
What is laryngospasm and when is it most likely to occur?
A reflexive closure of the vocal cords, most likely during extubation or shortly afterward
What are the early signs of laryngospasm?
- Stridor
- No air movement on auscultation
- Sudden hypoxia
What is laryngospasm?
A reflexive closure of the vocal cords in response to stimulation
Common cause of airway obstruction during emergence, particularly during extubation.
What are the signs of laryngospasm?
- Stridor or high-pitched sounds post-extubation
- No air movement on auscultation
- Sudden hypoxia (falling SpO₂)
- Desaturation despite respiratory effort
These signs indicate airway obstruction and require immediate attention.
What is the first step in managing laryngospasm?
Remove irritants by suctioning the airway to clear secretions or blood
This can help prevent further irritation that triggers the spasm.
What is the role of positive pressure ventilation (PPV) in laryngospasm management?
Apply continuous positive airway pressure (CPAP) or positive pressure ventilation with a face mask using 100% oxygen
This helps to reopen the vocal cords.
What medication can be used to deepen anesthesia in laryngospasm cases?
Propofol (0.5-1 mg/kg IV)
Deepening sedation can help break the spasm in mild cases.
When should succinylcholine be administered in laryngospasm management?
If the spasm persists and the patient cannot be ventilated
A small dose of succinylcholine (0.1-0.2 mg/kg IV) can induce muscle relaxation.
What is a common cause of airway obstruction in patients with a difficult airway?
Swelling or loss of tone post-extubation
This can lead to significant airway management challenges.
What should be done if airway obstruction occurs post-extubation?
- Insert an oral or nasal airway
- Reintubation if noninvasive methods fail
Video laryngoscope or fiberoptic scope can assist in difficult cases.
What can cause post-extubation hypoventilation?
- Residual muscle relaxant effects
- Opioid-induced respiratory depression
Both can significantly impair respiratory function after extubation.
How can neuromuscular blockade be reversed?
Administer neostigmine and glycopyrrolate, or sugammadex for non-depolarizing muscle relaxants
This ensures full recovery of muscle function.
What is the normal CO₂ insufflation pressure during laparoscopic surgery?
12-15 mmHg
This range provides adequate visualization while minimizing adverse effects.
What physiological effects occur at insufflation pressures above 15 mmHg?
- Reduced venous return
- Decreased cardiac output
- Increased intra-thoracic pressure
These effects can lead to hemodynamic instability.
What are the critical effects of insufflation pressures above 20 mmHg?
- Marked hypotension
- Severe respiratory compromise
- Organ ischemia
Immediate intervention is required to lower insufflation pressure.
What adjustments should be made to ventilator settings during increased intra-abdominal pressure?
- Lower tidal volumes (6-8 mL/kg IBW)
- Increase PEEP (5-10 cm H₂O)
- Monitor peak inspiratory pressure (keep < 30 cm H₂O)
- Increase respiratory rate (12-16 breaths/min)
These adjustments help maintain ventilation and prevent complications.
What is the target tidal volume to avoid barotrauma during laparoscopic procedures?
6-8 mL/kg of ideal body weight (IBW)
Reducing tidal volume minimizes excessive airway pressures.
What is the purpose of increasing PEEP during laparoscopic procedures?
To counteract the reduction in functional residual capacity (FRC)
It helps maintain adequate lung volumes despite increased abdominal pressure.
What is a common cause of hypercarbia during laparoscopic procedures?
Absorption of CO₂ from pneumoperitoneum
This can lead to elevated CO₂ production and respiratory complications.
What is a multimodal approach to postoperative pain management?
Using a combination of systemic analgesics, regional anesthesia techniques, and adjunct medications
It minimizes opioid consumption and related side effects.
What are the advantages of using opioids for postoperative pain management?
- Effective for moderate to severe pain
- Can be used in patient-controlled analgesia (PCA)
However, they are associated with significant side effects.
What is the role of non-opioid analgesics in postoperative pain management?
- Reduce inflammation
- Provide pain relief without respiratory depression
NSAIDs can increase the risk of bleeding.
What are the advantages of regional anesthesia techniques like epidural analgesia?
- Superior pain control
- Opioid-sparing
- Improved postoperative outcomes
They can enhance recovery and reduce complications.
What are the potential complications of epidural analgesia?
- Hypotension
- Motor block
- Technical complications (e.g., hematoma)
Requires careful monitoring and management.
What is the typical dose of bupivacaine for epidural analgesia?
5-10 mL of 0.1-0.125% bupivacaine as a bolus, followed by an infusion at 5-10 mL/hour
Bupivacaine is commonly used in epidural analgesia due to its effective pain management capabilities.
What is the purpose of fentanyl in epidural infusion?
Fentanyl is combined with local anesthetic to enhance pain relief in epidural infusion at a dose of 2-5 mcg/mL
Fentanyl is a potent opioid analgesic that can improve overall analgesia when used with local anesthetics.
What is a Transversus Abdominis Plane (TAP) block?
A TAP block involves injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles
This technique targets the nerves supplying the anterior abdominal wall, providing effective somatic pain relief.
What are common indications for a TAP block?
- Lower abdominal surgeries (e.g., appendectomy)
- Hernia repair
- Multimodal approach for larger abdominal surgeries
TAP blocks are particularly useful for surgical procedures involving the anterior abdominal wall.
What is one advantage of using a TAP block?
Provides somatic pain relief for the anterior abdominal wall, reducing the need for systemic opioids
This can lead to better patient outcomes and fewer side effects associated with opioid use.
What is a disadvantage of a TAP block?
Analgesia is limited to the duration of the local anesthetic, which can be extended with a catheter-based continuous infusion
Patients may require additional pain management strategies for prolonged pain relief.
What is the risk associated with local anesthetic toxicity?
There is a risk of local anesthetic systemic toxicity (LAST) if excessive doses are used or if the anesthetic is inadvertently injected intravascularly
LAST is a rare but serious complication that can arise from regional anesthesia techniques.
What is the dosage for ondansetron for postoperative nausea and vomiting prophylaxis?
4 mg IV every 6-8 hours
Ondansetron is commonly used as a prophylactic treatment to prevent nausea and vomiting after surgery.
What factors should be considered for tailoring pain management to a patient?
- Type of Surgery
- Patient Comorbidities
- Patient Preferences and Comfort
These factors help determine the most appropriate pain management strategy for individual patients.
What is a multimodal analgesia approach?
Combining regional anesthesia with systemic non-opioid analgesics to provide comprehensive pain relief
This approach minimizes opioid use and its associated side effects.
What are the pros of epidural analgesia?
- Superior Pain Control
- Opioid-Sparing Effect
- Improved Respiratory Function
- Early Mobilization
Epidural analgesia can significantly enhance postoperative recovery for patients undergoing major surgeries.
What is a significant con of epidural analgesia?
Epidural anesthesia can cause significant hypotension due to sympathetic blockade
This may necessitate fluid resuscitation or vasopressors to manage blood pressure.
What is one advantage of a TAP block over epidural anesthesia?
TAP blocks do not cause significant hypotension or hemodynamic instability
This makes TAP blocks a safer option for patients with hemodynamic instability.
Fill in the blank: The analgesic effect of a TAP block is limited to the duration of the _______.
local anesthetic
Continuous catheter techniques can extend the duration of analgesia.
What is the postoperative pain management plan for a patient undergoing major abdominal surgery?
- Acetaminophen: 1,000 mg IV every 6 hours
- Ketorolac: 15 mg IV every 6 hours
- Gabapentin: 300 mg orally every 8 hours
- Fentanyl PCA for breakthrough pain
- Epidural Analgesia with bupivacaine and fentanyl
This plan aims to optimize pain control while minimizing opioid use.
True or False: TAP blocks are effective for visceral pain from deeper structures within the abdomen.
False
TAP blocks are primarily effective for somatic pain and may not provide relief for visceral pain.
What should be monitored in patients receiving epidural analgesia?
Monitor for hypotension, motor block, and potential complications like epidural hematoma
Continuous assessment is crucial to ensure patient safety and effective pain management.
