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AP 1 > Test 1 part III (CM) > Flashcards

Test 1 part III (CM) Flashcards

1
Q

What is the oxygen saturation of blood at the proximal pulmonary artery (measured by PAC)? Reflects average O2 saturation of blood returning to heart

A

SvO2

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2
Q

What is a normal SvO2?

A

65-80%

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3
Q

What conditions cause an increase in SvO2?

A
  1. left to right shunts
  2. hypothermia
  3. sepsis
  4. cyanide toxicity
  5. wedged PAC
  6. increase in CO
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4
Q

What conditions cause a decrease in SvO2?

A
  1. hyperthermia
  2. shivering
  3. seizures
  4. reduced pulmonary transport of oxygen
  5. hemorrhage
  6. decreased CO
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5
Q

Transcutaneous monitoring of the adequacy of oxygenation specific to the brain → O2 supply vs demand within a region of the brain

A

Cerebral Oximetry

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6
Q

You have to monitor a core temperature with what kinds of anesthesia?

A

GA > 30 min and RA with anticipated temperature changes

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7
Q

What is normothermia?

A

37 C

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8
Q

What is hypothermia?

A

< 36 C

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9
Q

What is hyperthermia?

A

> 38 C

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10
Q

How does hypothermia occur?

A

A redistribution of lower-temp blood from vasodilated periphery

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11
Q

How does hyperthermia occur?

A
  1. Genetic predisposition to MH
  2. Infection
  3. drugs inhibit sweating
  4. recreational drugs
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12
Q

What are the core temperature monitoring sites?

A

Tympanic membrane, PA, distal esophagus, nasopharynx

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13
Q

Core temperature is estimated using which sites?

A

oral, axillary, rectal, bladder

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14
Q

Do rectal and skin temperatures increase with malignant hyperthermia?

A

No

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15
Q

The transfer of body heat to a cooler environment, all surfaces absorb heat from surroundings

A

Radiation

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16
Q

Heat transfer via Sweating (rare), surgical wounds/cleansing, respiratory (expire warm, moist air), transcutaneous evaporation (peds!)

A

evaporation

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17
Q

Heat loss from direct contact with surfaces (OR table), negligible

A

Conduction

18
Q

Heat loss to cool air, “wind chill” factor

A

Convection

19
Q

What are the top two ways a patient can become hypothermic in the OR?

A
  1. Radiation (majority of heat loss)
  2. Convection (2nd most important contributor)
20
Q

What adverse outcomes are associated with hypothermia?

A
  1. Increased M&M, prolonged PACU stay, increased perioperative costs
  2. Increased O2 consumption
  3. Inc Risk CV events
  4. Sickling w sickle cell dz
  5. Impaired coagulation
  6. Decreased drug metabolism
  7. Reduced MAC volatile anesthetic agents (by 5% per 1C)
  8. Wound infection
  9. Delayed healing d/t impaired immune function
21
Q

What are risk factors for hypothermia?

A

High physical status, lengthy procedure (>3hr), geriatrics, lean body mass, failure to monitor, combined anesthetic technique (GA + RA)

22
Q

What are ways to prevent hypothermia in the OR?

A

Warming before induction can reduce redistribution hypothermia.
1. Preoperative cutaneous warming (warming blanket)
2. airway heating/humidification (HME esp in peds)
3. warm IV fluids
4. warm ambient OR temp (>23C)
5. cutaneous heating

23
Q

Which is better: Prevention of hypothermia or active rewarming?

A

Prevention of hypothermia

24
Q

What is the benchmark for adequate recovery from NMB?

A

Adductor pollicis TOF ratio >0.9

25
Q

What is the most common site for monitoring NMB (TOF)?

A

Ulnar Nerve (gold standard)
Can also use other peripheral, superficial nerves: median, posterior tibial, common peroneal, facial

26
Q

Occurs when each of the successive twitch responses from T1 through T4 become smaller

A

Fade

27
Q

Fade exists with what kinds of blocks?

A
  1. Non-depolarizing block
  2. Phase 2 Depolarizing Block
28
Q

Comparing the size of T4 twitch to T1 switch provides what?

A

Train of Four Ratio (TOFR)

29
Q

Which is the first “organ” to have onset of NMB?

A
  1. Eye muscles
  2. Extremities
  3. Trunk
  4. Abdominal Muscles
  5. Diaphragm

Recovery from NMB is the same order in reverse

30
Q

Which organ is the most resistant to NMB, but recovers the quickest?

A

Diaphragm

31
Q

A method that administers one single supramaximal stimuli (0.1 to 1 hertz (Hz) for 0.1 to 0.2 milliseconds (ms)), most useful at onset of NMB (induction of anesthesia), must have comparison twitch response prior, indicates 100% NMB if no movement detected.

A

Single Twitch

32
Q

4 supramaximal stimuli (2 Hz for 2 sec) are given every 0.5 sec, # of twitches correlates with degree of NMB

A

Train of Four

33
Q

If you have 3/4 twitches, what % block do you have?

A

75-80%

34
Q

If you have 2/4 twitches, what % block do you have?

A

80-85%

35
Q

If you have 1/4 twitches, what % block do you have?

A

90-95%

36
Q

If you have 0/4 twitches, what % block do you have?

A

100% block

37
Q

Intraoperatively, what degree of NMB do you want (how many twitches)?

A

85% to 95% or 1 to 2 twitches

38
Q

Assesses the degree of NMB when there is no response to a single supramaximal twitch or TOF (deep NMB is present). This method involves administering 5s of tetanic stimulation, followed by a single supramaximal twitch or TOF. If no response, an intense blockade remains. If response is seen with the single twitch or TOF, then there is some recovery from NMB.

A

Post tetanic Stimulation

39
Q

Method that consists of two short bursts of a 50-Hz tetanus separated by 0.75 seconds.
-improves the ability to detect residual paralysis during recovery.
-Normal response is 2 contractions of equal intensity
-Partial NMB is present if 2nd response is weaker than the 1st (fade) - comparable to TOFR <0.6

A

Double Burst Stimulation

40
Q

The high frequency delivery of a supramaximal stimulus. Normal response is contraction.
-Non-depolarizing and Phase 2 Depolarizing blocks yield a non-sustained response (Fade). If fade is present, a clinically significant block remains.
-Painful and may cause muscle fatigue
-TOF 4/4 with sustained tetany > 5 sec indicates adequate NMB reversal

A

Tetanic Stimulation

AP 1 (32 decks)

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