Test 4 Bringing it all together part 1 Flashcards
those with genetic predisposition to MH have a mutation in the ____________ receptor of skeletal muscle –> uncontrolled elevation of _______
ryanodine (RYR1); intracellular calcium
times (in lifespan) when you expect a decrease in enzymatic activity of pseudocholinesterase
pregnancy
newborn
infants
what drug therapies can cause pseudocholinesterase def?
echothiophase iodide
neostigmine
chlorpromazine
oral contraceptives
cyclophosphamide
pancuronium bromide
phenylzine
trimethaphan camsylate
disease states that can cause a pseudocholinesterase deficiency
hepatic failure
acute MI
acute infection
uremia
malnutrition
myxedema
collagen vascular dz
carcinoma
TB
what is the expected apnea time in minutes for someone with a dibucaine number of 20
480 minutes (8 hours)
(atypical homozygte for pseudocholinesterase def: A-A)
what is the expected apnea time in minutes for someone with a dibucaine number of 60
10-30 minutes
(heterozygote for pseudocholinesterase def : W-A)
what is the expected apnea time in minutes for someone with a dibucaine number of 80?
10 minutes (this is a typical homozygote for pseudocholinesterase def : W-W)
someone who is an atypical homozygote (A-A) for pseudocholinesterase deficiency will have a dibucaine number of ___________
20
someone who is a heterozygote (W-A) for pseudocholinesterase deficiency will have a dibucaine number of ______________
60
someone who is a typical homozygote (W-W) for pseudocholinesterase deficiency will have a dibucaine number of _____________
80
what is the dibucaine number
The Dibucaine Number is the PERCENT INHIBITION of pseudocholinesterase activity.
________________ is a local anesthetic that can detect individuals with abnormal pseudocholinesterase
dibucaine
T/F: all patients susceptible to MH will show signs of MH upon exposure to triggering agents
false
which med given for prophylactic tx of PONV in pts with increased risk is not an anti-emetic, but allows the anesthesia provider to give less opoids thus reducing chance of PONV
pregabalin
pt is at increased risk of PONV, you tell them to apply scopolamine patch _________ hours prior to surgery
4
who do you NOT give reglan to ? (like in the prophylactic tx of PONV)
parkinsons
bowel obstruction
what is the concern with using droperidol for PONV prevention in high risk patient?
has sedation effects lastin up to 12 horus
what are some of the different drugs used to preventatively tx PONV if at increased risk?
- zofran
- reglan
- droperidol
- decadron
- scopolamine transdermal
- pregabalin
if pt has 3-4 risk factors for PONV they are __________________ risk, and it should be attempted to be prevented with what interventions?
severe; avoid GA or use propofol based anesthetic, minimize opoids, prevention with 3 drugs from different classes
if pt has 1-2 risk factors for PONV they are __________________ risk and anesthetic plan should consist of prevention with ___________ drugs from different classes
moderate - to - severe; 2-3
what is the scoring mechanism use to stratify risk and preventative management of PONV
simplified apfel score
anesthesia related risk factors for PONV
- volatile anesthetics
- N2O
- intra/postoperative opoids
surgery related risk factors for PONV
- increased duration (>3 hrs)
- type of surgery: intrabdominal, breast, laparoscopy, gyno, ENT
- being NPO
pt related risk factors for postoperative N/V
- female gender
- non-smoker
- hx of PONV/motion sickness
- childhood/young adulthood (age)
diagnostic test results are deemed current if within ___________ of scheduled surgery
6 months
what is the initial tx for malignant hyperthermia
dantrolene 10 mg/kg
tx for malignant hyperthermia
- dantrolene 10 mg/kg
- hyperkalemia protocol
- refrigerated IV crystalloid infusion
- icepacks
what are triggering agents for malignant hyperthermia
volatile inhalation anesthetics
succinylcholine
exposure to heat/exercise (rare)
what are the symptoms/signs you will see with malignant hyperthermia
hypercarbia
tachycardia
elevated core temp
muscle rigidity
metabolic acidosis
rhabdomylosis
hyperkalemic arrhythmias
a patient with severe systemic dz or more than one systemic dz would recieve what physical status class?
ASA III
a brain dead pt who is only presenting for organ procurement would recieve what physical status class?
ASA VI
patient with severe systemic disease that is a constant threat to life would recieve what physical status class
ASA IV
a moribund pt who is not expected to survive without the operation would be given what physical status class ?
ASA V
what physical status class would you give a pt who is presenting with any of the following: current smoker, social etoh, pregnancy, obesity (BMI btwn 30 and 40), well controlled DM/HTN and or mild lung dz
ASA II (PS II)
what physical status class would you give to a patient that is young, no comorbidities, non smoker, and 0 - minimal etoh use?
ASA I (PS I)
what type of anesthesia should be done for the placement of an AV fistula/block?
local anesthesia and/or brachial plexus block
techniques for skilled interviewing
- active listening
- empathetic responses
- guided questioning
- nonverbal
- validation
- reassurance
- partnering
- summarization
- transitions
- empowering pt
- humor
what are the goals of the preoperative assessment and preparation of the pt?
- optimize patient care, satisfaction, comfort and conviencence
- minimize perioperative morbidity and mortality
- minimize surgical delays or preventable cancellations on dos
- determine appropriate postoperative disposition of the patient
- evaluate the patients health status, determining which if any preop investigation/specialty consults are required
- optimize preexisting medical conditions
- formulate a plan for most appropriate perianesthetic care and postop support
- communicate patient management issues effectively among care providers
- communicate and provide specific instructions to patients for preop prep
- educate pt on surgery, anesthetis, periop care
- ensure time/cost efficient patient eval
