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Introduction to Anesthesia > Systems Review 1: Cardiac, Respiratory, Renal and Hepatic > Flashcards

Systems Review 1: Cardiac, Respiratory, Renal and Hepatic Flashcards

1
Q

The heart pumps ___ quarts of blood every minute. The coronary arteries pump ____ gallons out every day.

A

The heart pumps 5 quarts of blood every minute. The coronary arteries pump 130 gallons out every day.

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2
Q

Main percentage of deaths from CVD?

A
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3
Q

No signs of CAD, but still have it

A

This is referred to as silent ischemia. Blood to your heart may be restricted due to CAD, but you don’t feel any effects.

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4
Q

Minor clinical predictors of heart failure

A

Advanced age

Abnormal ECG

Rhythm other than sinus

History of CVA

Uncontrolled HTN

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5
Q

Intermediate clinical predictors of heart failure

A

Remote MI ( >1 month)

Stable angina

Compensated CHF

Creatinine ³2.0

Diabetes

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6
Q

High clinical predictors of heart failure

A

Acute or recent MI (< one month)

Unstable or severe angina

Large ischemic burden

Positive stress test

Decompensated CHF

Significant arrhythmias

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7
Q

What is STEMI

A

STElevation Myocardial Ischemia

Abrupt occlusion/decrease in coronary perfusion

Inflammatory process

Mortality rate 15-20%

Reperfusion therapy decreases mortality to 6.5%

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8
Q

B Blocker side effects

A

Side effects – hypotension, bradycardia, bronchial spasm, masks hypoglycemia

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9
Q

Ca Channel Blockers

A

Dilate arteries – decreases SVR which decreases workload and O2consumption

Decrease heart rate and myocardial contractility – decreases O2consumption

Avoid in patients with severe heart failure

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10
Q

Antidote for heparin

A

Antidote – Protamine Sulfate

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11
Q

What do statins do?

A

Decrease the amount of “bad” (LDL) cholesterol

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12
Q

What do ACE inhibitors do?

A

Treat hypertension and may lower the risk of recurrent myocardial infarction

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13
Q

Normal pressures

A
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14
Q

Normal cardiac output

A

3-9 liters/min

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15
Q

What is cardiac index?

A

Vasodynamic parameter
Heart performance to the size of the individual

CI=CO/BSA

2.1-4.9 L/min/m2

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16
Q

What’s central venous pressure?

A

The pressure of blood in the thoracic vena cava, near the right atrium

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17
Q

Name some factors that increase CVP

A

Hypervolemia

Forced exhalation

Tension pneumothorax

Heart failure

Pleural effusion

Decreased cardiac output

Cardiac tamponade

Mechanical ventilation and the application of positive end-expiratory pressure (PEEP)

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18
Q

Factors that decrease CVP?

A

Hypovolemia

Deep inhalation

Distributive shock – Fluid remains in feet

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19
Q

How to control valvular stenosis?

A

Maintain BP

NSR 70-80 bpm, maintain atrial kick

Avoid arrhythmias, tachycardia

Maintain contractility (Do not use Propofol)

No chest compression

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20
Q

How to control valvular insuffeciency?

A

Keep blood pressure lower normal
Keep heart rate elevated (ideally 80-100 bpm)

Contractility – maintain or increase

Avoid:
Cardiac depression
Hypoxemia, hypercarbia and acidosis they increase SVR
Over-sedation preop

21
Q

1 and million Americans live with this most common disorder, affects 8 out of every 1,000 newborns

A

Congenital heart defect

22
Q

What can a ventricular heart defect lead too?

A

Leads to congestive heart failure, pulmonary hypertension, arrhythmia or stroke.

23
Q

Dyspnea, what is it? What are common symptoms?

A

Shortness of breath (SOB)

Associated symptoms– night sweats, pain, chest pressure, discomfort, ankle edema, diaphoresis, cyanosis

24
Q

What is a capacity compared to lung volumes?

A

It is useful to know that the “capacities” consist of the sums of two or more “volumes”. For example, FRC=ERV+ RV

25
Q

Chart that plots the volume and flow of air coming in and out of the lungs from one inhalation and one exhalation.

A

Pneumotachographs generated by a spirometer

26
Q

Maximum breathing capacity is also known as?

A

Maximum Voluntary Ventilation (MVV)

27
Q

Normal FEV1 values?

A

Values of between 80% and 120% of the average value are considered normal

28
Q

____________________is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration. What are normal values?

A

Forced Expiratory Flow (FEF)

The usual intervals are 25%, 50% and 75% (FEF25, FEF50 and FEF75), or 25% and 50% of FVC

Values ranging from 50-60% and up to 130% of the average are considered normal

29
Q

Typical values for a patient with COPD?

A
30
Q

What does the Gold Grade predict?

A

Measures the severity of COPD and grades it accordingly

31
Q

The kidney can autoregulate at MAPs between ____ and ____mmHg

A

50 and 150mmHg

Hypotension shifts left, hypertension shifts right

32
Q

The human response to stress does what to conserve water?

A

Shift of renal flood flow away from the cortical regions and towards the juxtamedullary nephrons, which conserves water

33
Q

Normal urine output?

A

0.5cc/kg/hour

34
Q

What is the mortality rate with ARF happens in the surgical setting?

A

~10%

35
Q

What are the claims of Dopamine in renal failure, and does it help?

A

Dopamine, which increases renal blood flow, has been traditionally thought to decrease the incidence of renal failure

It’s vasodilating properties have been shown to partially reverse norepinephrine-induced renal vasoconstriction

Similarly, a randomized controlled trial of saline versus “low-dose” dopamine in 47 liver transplant patients showed no differences in urine output or creatinine clearance at one month after surgery. Thus, _Dopamine has no practical use in renally impaired patients_

36
Q

How is Fenoldopam a renal protective drug?

A

Antihypertensive, arterial/arteriolar vasodilation

D1-selective agonist which has been shown to increase urine output as well as glomerular flow, without the hypertension associated with dopamine

Considered superior to Dopamine at 0.1 mcg/kg/min for 24 hours following surgery in high risk patients

37
Q

What microbials are nephrotoxic?

A

Aminoglycosides (amikacin, gentamicin, tobramycin, neomycin) and amphotericin B are the most problematic antimicrobials, because they are nephrotoxic and their spectrum of activity cannot be replicated by other, less-toxic medications

If aminoglycosides or amphotericin B are used, potentially confounding factors such as hypovolemia, fever, renal vasoconstriction, and electrolyte disorders should be minimized.

38
Q

Name three nephrotoxic drugs

A

NSAIDs
Antimicrobials of the Aminoglycosides class
Radiographic contrast

39
Q

What affect do NSAIDs have on the kidney?

A

Hypertension, peripheral edema, sodium retention, hyperkalemia, and renal failure

40
Q

Increased intra-abdominal pressure during laparoscopy can mimic what disorder?

A

Abdominal Compartment Syndrome, compressing the kidneys (retroperitoneal) and resulting in oliguria

41
Q

Renal blood flow can fall by as much as ___% during preparation of the aorta for clamping, possibly due to spasm

A

50%

42
Q

Cardiopulmonary bypass is associated with acute renal failure, with quoted incidences generally ranging from ___%

A

2-7%

43
Q

SCh will increase K+ by ____ mEq/L regardless of renal status and can be safely given even when serum [K+] > ___mEq/L

A

SCh will increase K+ by ~ 0.6 mEq/L regardless of renal status and can be safely given even when serum [K+] > 5 mEq/L

44
Q

Hepatic blood flow

A

70% Portal Vein

30% Hepatic artery

25% of cardiac output

Does NOT maintain autoregulation of blood flow with cirrhosis and exposure to volatile anesthetics

45
Q

Decrease of hepatic blood flow _____% from volatiles and regional w/o stimulation

A

25-30%

46
Q

Coagulopathies can be caused by?

A

Loss of vitamin K-dependent factors II, VII, IX, X

47
Q

Alcohol withdrawal syndrome

A

48-72 hours dry

Delirium Tremors’s, seizures

Increased sympathetic tone

Versed until sedated

Esmolol for tachycardia

Mortality as high as 10%

48
Q

Narcotics can sometimes cause spasm of the sphincter of oddi, what would be the appropriate treatment?

A

Relieved by naloxone or glucagon (1-3mg)

49
Q

Effect of agents on Lower Esophogeal Tone

A

Introduction to Anesthesia (15 decks)

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