TL block 5 Flashcards
1
Q
RF for children undergoing T&A OSA in PACU
A
hx of prematurity
age < 3
neuromuscular d/o
URI w/i 4 weeks of surgery
nasal or craniofacial d/o
2
Q
Anesthetic goals for HOCM
A
-maintain sinus rhythm
-reduce sympathetic stimulation
-maintain LV filling (preload)
-maintain SVR
3
Q
Factors that promote LVOT obstruction in hypertrophic cardiomyopathy
A
tachycardia
hypovolemia
vasodilation
high chronotropic/inotropic state
4
Q
Complications of using glycine for TURP
A
AMS (ammonia)
transient blindness
hyperoxaluria
5
Q
Complications of mannitol for TURP
A
hyperglycemia
lactic acidosis
osmotic diuresis
6
Q
Complications of sorbitol for TURP
A
osmotic diuresis
7
Q
Use of labetalol in pheochromocytoma surgery
A
AVOID
-if not adequately alpha blocked, the circulating calecholamines will have unopposed alpha stimulation -> makes HTN worse
-b/c long-acting will get hypoTN once pheo removed
8
Q
What anti-HTN should be used during pheo?
A
Direct acting vasodilators: nicardipine, nitroprusside, NG
phentolamine (alpha blockers)
9
Q
Esmolol for pheo
A
can only be used conservatively if preop alpha-antagonism has been completed
10
Q
alpha-methyl-para-tyrosine
A
inhibits tyrosine hydroxylase (rate limiting step in catecholamine synthesis)
-adjunct in malignant or inoperable tumors
11
Q
MOA botulinum toxin
A
-cleaves SNARE protein -> stops fusion and release of ACh into nerve terminal -> flaccid paralysis
12
Q
MOA tetanus toxin
A
travels retrograde up motor neron -> prevents release of GABA from interneurons
**inhibitory mechanism inhibited -> spastic paralysis
13
Q
What color glasses to protect from neodymium:yttrium aluminumm garnet laser?
A
green
Nd:YAG =green
14
Q
What color glasses to protect from CO2 laser
A
clear
15
Q
What color glasses to protect from argon?
A
orange
arangatang = orange
16
Q
What color glasses to protect from potassium-titanyl-phosphate-Nd:YAG
A
orange-red
lots of names require 2 colors
17
Q
Aortic cross clamp hemodynamic changes
A
-inc BP above the clamp
-dec BP below clamp
-segmental wall motion abnormalities
-inc LV wall tension
-dec EF
-dec cardiac output
-dec renal blood flow
-inc pulm occlusion pressure
-inc CVP
-inc coronary blood flow
18
Q
Aortic cross-clamp metabolic changes
A
-dec total body O2 consumption
-dec total body CO2 production
-inc mixed venous
-dec total body O2 extreaction
-inc epi and norepi
-resp alkalosis
-metabolic acidosis
19
Q
coronary blood flow aortic cross clamp
A
increased BF b/c inc aortic diastolic pressure
20
Q
hypoxia w/ one-lung ventilation for bronchopulm lavage steps
A
-ensure DLT in correct position
-fiO2 1
-PEEP to ventilated lung
-suctioning and bronchodilators
21
Q
RF for uterine rupture
A
polyhydramnios
uterine scar (prior surgery)
adv maternal age
22
Q
Which part of maternal risk is decreased w/ elective c/s versus vaginal delivery
A
uterine rupture (less b/c no contractions)
23
Q
higher risk for hysterectomy: vaginal or c/s?
A
c/s
-b/c if bleeding uncontrolled during c/s hysterectomy
24
Q
Increase in maternal blood volume w/ pregnancy
A
45% inc
(mediated by Na retention from renin-angiotensin system)
25
Normal P50 for Hg
27
-PaO2 at which 50% of molecules bound by O2
26
P50 for maternal Hg
30
-PaO2 at which 50% of molecules bound by O2
(R shift of curve)
27
P50 for fetal Hg
19-21
--PaO2 at which 50% of molecules bound by O2
(left shift of curve)
28
How does maternal blood volume inc in pregnancy
sodium retention via renin-angiotensin system -> dilutional anemia
29
Normal Hg in pregancy
> 11
-dilutional anemia (why Hg curve shifts to the R)
30
How is pregnancy hypercoagulable
inc in fibrinogen and factor VII
31
Tx no pulse
defibrillation
torsades! give IM Mg as well
32
dec in fetal HR after peak of uterine contraction prob?
late decel
utereoplacental insuff -> fetal lhypoxia
33
abrupt dec in fetal heart rate not assoc w/ uterine contractions
variable decelerations
-cord compression
34
gradual dec in fetal heart rate correlate w/ uterine contractions
early decel
fetal head compression
35
Types of decel in fetal HR and causes
VEAL CHOP
Variable: cord compression
Early: head compression
Accelerations: OK
Late: placental insuff
36
Treatment of hyperammonia by glycine in TURP
Arginine
-promotes urea formation from ammonia and excretion
37
What solution causes dispersion in TURP?
normal saline and other balanced salt solutions b/c of ionic composition
38
best method of pain control for thoracotomy
thoracic epidurals and paravertebral blocks
39
Difference between coma and persistent vegetative state
persistent vegetative state = cerebral death
-both unable to follow commands, communicate or have purposeful movements
-PVS can get spontaneous eye opening, possible sleep wake cycles, possible vocalizations not purposeful
-PVS home care can be possible, coma requires hospital
40
RF for pulm artery rupture w/ pulm artery catheters
hypothermia (stiff catheter)
anticoagulation
old age
pulm HTN
41
MC complication of PAC insertion
RBBB
-can still get LBBB and CHB, R most common
42
endocarditis and pulm artery catheter
2x increase if non-heparin coated catheters used
43
What 2 metals are MRI safe?
aluminum and brass
44
axillary n block
45
axillary n block surrounding musculature
46
planes for u/s brachial plexus blocks
47
What innervates the medial forearm?
antebrachial cutaneous nerve
-blocked w/ axillary n block w/i axillary fossa
48
genetic dx w/ subglottic stenosis
Trisomy 21 (Down Syndrome)
49
Down Syndrome airway concerns
subglottic stenosis
atlantoaxial joint instability
macroglossia
floppy soft palate
enlarged tonsils and adenoids
50
DM and airway
type 1 chronic hyperglycemia -> glycosylation of joints and affects atlanto occipital joint and compromises neck extension
51
pathologic cervical spine fusion assoc?
ankylosing spondylitis
52
why swelling w/ hypothyroidism
inappropriate ADH secretion
53
Alveolar gas equation
PAO2 = FiO2* (Patm-PH2O) - (PaCO2/resp quotient)
54
Arterial O2 content equation
CaO2 = (SaO2*Hg*1.36) + (PaO2*0.003)
55
Body resp to hypoxia at higher altitude
-inc minute ventilation
-cardiac output inc
-inc in EPO from kidneys to inc RBCs -> inc viscosity inc risk of thrombosis
-inc pulm hypoxic vasoconstriction -> inc strain on R heart
56
ICU pt inc pulm insp pressures and hypoxia causes:
-ventilator assoc lung injury
-vent induced lung injury
-Auto PEEP
-alveolar rupture -> PTX (barotrauma)
57
ppx for peds to prevent apneic episodes prior to surgery
caffeine
aminophylline
58
If infant has no hx of bradycardia or apnea, how long to proceed w/ elective outpt procedure
44-60 weeks post conceptual age
59
If pt is less than 44-60 postconceptual age, and req general anesthesia postop plan?
postop in hospital monitoring 12-24 hours
60
RF for postop apnea in peds
general anesthesia
IV sedation
anemia
-proportional to gestational age and postconceptual age
61
if infant has hx of apnea and bradycardia, when should they get elective surgery?
six months after free from any apnea or bradycardia episodes
62
Difference b/w CRPS I and II
CPRS I: occurs in absence of prior n injury
CRPS II: occurs after n injury
63
hyperalgesia, allodynia, abnormal sweating, color change sin extremity, dx?
CRPS
64
allodynia
pain caused by stimulus that does not normally elicit pain
65
Def of URI w/ severe symtpoms and case should be delayed
fever
purulent d/c
lethargy
changes in behavior
abnormal lung exam
66
breathing alterations in bronchpulm dysplasia
inc airway resistance
inc physiologic dead space
inc work of breathing
-> wheezing, intercostal restractions, nasal flaring, hypoxia, hypercarbia
67
Def of bronchopulm dysplasi
requirement for supplemental O2 at 28 days in infants born before 32 weeks
**chronic
68
RF for bronchopulm dysplasia
-prematurity
-PDA
-prenatal and postnatal infxn
-O2 toxicity
-mechanical venilation
-excessive IV fuilds
69
Pathology of bronchopulm dysplasia
-interstitial fibrosis, alveolar hypoplasia, dec septation
70
treatment of bronchopulm dysplasia
-CPAP or mechanical vent (low TV and O2)
-adequate nutrition
-fluid restriction 120-150 cc/kg/day
-steroids (improve lung fxn and dec inflammation)
-diuretics
-bronchodilators
71
Triad of congenital diaphragmatic hernias
dyspnea
cyanosis
dextrocardia
72
assoc dx w/ congenital diaphragmatic hernia
congenital heart dx
intestinal malrotations
-more likely in females
73
Anesthetic goals in congenital diaphragmatic hernias
-permissive hypercapnia (avoid large TV or peak pressures in lungs)
-maintain temperature
-limit PVR
-avoid nitrous oxide
-NO venous access in lower extremities -> when abd contents returned may compress IVC
74
Why is inhalational induction faster in infants
-larger proportion of blood going to vessel rich group
-dec solubility of sevo in blood (more water, less proteins)
75
Neonatal resuscitation
if poor tone: dry, stimulate, clear oral secretions
-if still apneic/gasping, HR < 100 -> position clear airway, PPV -> HR still < 100 -> ETT
-if HR < 60: intubate, chest compressions -> still no improvement give epi in umbilical vein catheter
76
Pierre Robin Sequence symp
airway obstruction
glossoptosis (tongue further back than it should be)
micrognathia
**assoc w/ dec esophageal motility-> get swallow study first! high risk of aspiration
-50% cleft lip/palate
77
treatment for neonates w/ euvolemic hypoTN
Atropine!!
-immature symp nervous system, predominate parasymp NS
-dec catecholamine stores and insensitive to exogenous catecholamines
-b/c of dec lithotripsy (can't relax, why cardiac output is dept on HR! fluids don't make a difference if euvolemic
78
Why do infants have a faster inhalational induction w/ sevo compared to adults?
-increased MV relative to FRC
-dec blood and tissue solubility of sevo
-inc proportion of cardiac output goingn to vessel-rich group
79
if pt having a tracheoesophageal fistula repaired, what should be evaluated?
echo! cardiac structural abnormalities
-not usually cardiac conduction dx, structural!
VACTERL
Verebral, Anal imperforate, TE fistula, Renal, Limb abnormalities
80
if pt had tracheoesophageal repair, and looking to do caudal anesthesia for imperforate anus repair, what should be done first?
lumbosacral spine imaging to r/o neural tube defect (CI to caudal anesthesia)
VACTERL
Verebral, Anal imperforate, TE fistula, Renal, Limb abnormalities
81
Goal SpO2 in congenital diaphragmatic surgery
90-95%
82
Anesthestic goals for congenital diaphragmatic hernia
-permissive hypercapnia (PaCO2 up to 65)
-maintain normothermia
-SpO2 90-95%
-prevent worsening pulm HTN
83
if congenital diaphragmatic hernia surgery and pt gets hypoTN and hypoxia whats going on?
1. PTX -> chest tube, needle decompression
2. worsening pulm HTN -> start inh NO
84
What to avoid in pt's w/ methylenetetrahydrofolate reductase def
Nitrous oxide -> inhibits methionine synthetase -> elevation in homocysteine, inc risk of thrombosis and acute coronary events
85
What pt population is propofol typically avoided?
Mitochondrial d/o
-direct mitochondrial resp chain inhibition -> cause of propfol-related infusion syndrome
86
What enzyme does etomidate inhibit? pt population shouldn't be used?
11 beta hydroxylase
-avoid in sepsis
87
acid base for pyloric stenosis
hypoK hypoCl metabolic alkalosis
88
blood volume premature infant
90-105 cc/kg
89
blood volume full term nerborn
80-90 cc/kg
90
blood volume infant 3-12 months
70-80 cc/kg
91
blood volume child 1-12 years
70-75 cc/kg
92
blood volume adult male
65-70 cc/kg
93
blood volume adult female
60-65 cc/kg
94
1 year old ex-28 wker, tracheal balloon dilation, kid req suppl O2, preop test?
ECHO!
see if pt has pulm HTN
-high risk of assoc w/ bronchopulm dysplasia and pulm HTN -> needs to be dx to be taken care of correctly in OR
95
Type 1 diaphragm fibers
slow-twich, high-oxidative, fatigue-resistant fibers that allow for sustained contractions
-lower in neonates
-50% in adults, kids same at 2
96
Type 2 diaphgram fibers
fast-twitch, low-oxidative fibers with quick contractions that fatigue
-higher in neonates, why they fatigue quickly
97
At what age does neonatal diaphgram become adult diaphgram?
2 years!
-Prior to 2 years, more fast-twitch type 2 fibers compared to type 1 higher endurance fibers -> why neonates tire quickly
98
Goldenhar syndrome anesthetic concerns
-micrognathia, hypoplastic zygomatic arch, facial asymmetry, facial hypoplasia
-congenital cardiac defects
-respiratory problems
-subluxation of C1-2
-normal intelligence usually, disabled 5-15%
99
Intra v extrathoracic airway obstruction flow volume loops
The configuration of the flow-volume loop can help distinguish the site of airway narrowing. The airways are divided into intrathoracic and extrathoracic components by the thoracic inlet.
(A) Normal flow-volume loop: the expiratory portion of the flow-volume curve is characterized by a rapid rise to the peak flow rate, followed by a nearly linear fall in flow. The inspiratory curve is a relatively symmetrical, saddle-shaped curve.
(B) Dynamic (or variable, nonfixed) extrathoracic obstruction: flow limitation and flattening are noted on the inspiratory limb of the loop.
(C) Dynamic (or variable, nonfixed) intrathoracic obstruction: flow limitation and flattening are noted on the expiratory limb of the loop.
(D) Fixed upper airway obstruction (can be intrathoracic or extrathoracic): flow limitation and flattening are noted in both the inspiratory and expiratory limbs of the flow-volume loop.
(E) Peripheral or lower airways obstruction: expiratory limb demonstrates concave upward, also called "scooped-out" or "coved" pattern.
100
Dural sac and spinal cord termination in infants
L3, S3
101
Why less bradycardia w/ spinal in infants?
b/c immature symp NS -> so infants don't rely on cardiac accelerating fibers (T1-4) for their resting heart rate
102
Why do infants need a larger dose of local anesthesia per kg compared to adults for spinals?
Infants have a higher CSF volume on a cc/kg basis
**also why dec PDPH
103
Infant CSF volume
4 cc/kg
104
children CSF volume
3 cc/kg
105
Adults CSF volume
1.5-2 cc/kg
106
continuous machine like murmur at L upper sternal border
PDA
107
holosystolic murmur at left sternal border
large VSD
108
When do PDA's usually close in normal infants?
10-15 hours after delivery
-inc in O2 and dec PVR, combined w/ dec in prostaglandin -> ductal constriction
109
Ebstein's anomaly
-enlarge RA
-RV hypoplastic/dysfunctional
-abnormal tricuspid valve
-ASD
-R to L shunting
-tricuspid regurge
110
Muscular v Perimembranous VSD
Perimembranous: upper ventricular septum close to aortic and mitral valve 70-80% **2nd MC cardiac valve anomaly
Muscular VSD: lower in the ventricular septum in more muscular portion, closer to the apex 20-30% of VSDs
111
Pulmonary atresia
-underdeveloped RVOT => resistance of BF towards pulm
-must keep PDA open
-usually assoc w/ other congenital heart dx
112
Bicuspid aortic valve
-2 of the valve leaflets fuse during fetal development
-males 4x as likely
-can get AR and AS
-high rate of aortic valve endocarditis
113
what volatile has the highest incidence of emergence delirium?
sevo
114
with an increase in MV which will the induction speed increase more for: sevo or iso?
iso! b/c more soluble so it makes a bigger difference
115
IV dose of midaz
0.05-.1 mg/kg
116
Peds elective surgery healthy, periop fluid guidelines
20-40 cc/kg of isotonic solution over 2-4 hours
-**reduces ADH -> limits hypoNa
117
Peds maintenance fluids in 12 hours immediately postop
2-1-.5 cc/kg/hr
118
Which peds populations should get dextrose containing solutions?
neonates
infants < 6 months
malnourished children
cardiac surgery
glucose 1-2.5%
119
NPO time cereal w/ milk
6 hours
120
tx of mild postintubation croup
cool, humdified mist
121
tx of moderate-severe postintubation croup
nebulized racemic epi -> must be monitored for 4-5 hours to see if rebound effects
122
what can cause postintubation croup
sublottic injury and edema w/ traumatic intubation, oversized ETT tube, or overinflated ETT cuff
123
high risk of postop croup uncuffed or cuffed ETTs?
uncuffed
124
which pt population is considered high risk for postop croup?
down syndrome b/c of subglottic stenosis
125
Maximal allowable blood loss
MABL = Est Blood volume * [(starting Hct - minimal acceptable Hct) / starting Hct ]
126
At what age to start u sing cuffed ETT?
2 years
127
size of ETT <1500g peds
uncuffed 2.5
128
size of ETT 1500g to full term
3 uncuffed
129
size of ETT 0-6 months
3.5 uncuffed
130
size of ETT 6 months - 1.5 years
4 uncuffed
131
ideal leak pressure of an uncuffed ETT in peds
20-30
-if > 40 -> replace with smaller ETT
132
equation for ETT in peds
age/4 + 4
133
where is the umbilical cord w/ omphalocele
at apex of herniated sac (covered by amniotic membrane/sac NOT SKIN)
134
where is the umilical cord w/ gastroschisis
not covered by membrane, so to the side of the gastroschisis (not covered by anything)
**occurs later in development, so associated abnormalities are rare
135
Assoc w/ ompahlocele
-trisomies: 13, 18, 21
-Beckwith-Wiedemann syndrome
-cardiac valve issues
-intestinal/anal atresia
-cleft palate
-neural tube defects
-urogenital prob
136
infant lung/chest compliance
less lung compliance than adults (fewer alevoli and less elastin)
higher chest wall compliance than adults (ribs more cartilage)
-at 2 normalizes
137
Airway differences in infants
Larger occiput
obligate nose breathers
relatively larger tongues
longer epiglottis
shorter trachea
more cephalad larynx (C3-4)
138
Where is larynx in infants?
C3-4 (more cephalad than adults)
139
Where is layrnx in adults?
C5-6 (More caudad than infants)
140
Most commonn congenital heart diseases
1. MC: bicuspid aortic valves
2. VSD: perimembranous
3. VSD: muscular
4. ASD: secundum
5. ASD: primum
141
RF for postop apnea
hx of prematurity
post conceptual age < 60 weeks
-hx of apnea
-**anemia (Hct < 25-30%)
142
Multiple Organ Dysfunction Syndrome
When functinoal abnormalities persist in 2 or more organs
-prevention: early detection and treatment of sepsis
143
Therapy for phantom limb pain
Mirror therapy
-TCA, anticonvulsants, gabapentin, ketamine, memantine, opioids
-PT, massage, TENS, acupuncture
144
permanent pacemaker indications:
2nd degree Type II AV block
3rd degree AV block
symp bradyarrhythmia
refractory SVT
-high risk pts w/ congenital long QT syndrome
-cardiomyopathy benefiting from resynchronization therapy -> HOCM and dilated cardiomyopathy
145
severe hypocalcemia
146
reasons for oligura intraop
-PPV -> inc IVC pressure -> dec perfusion to kidneys
-dec venous return b/c PPV -> dec preload -> inc ADH, dec ANP, dec cardiac output -> RAAS -> fluid retention
-PPV -> release of inflammatory mediators -> AKI
147
dhow much higher of an affinity does CO have for Hg compared to O2?
200-300
148
Platypnea
hypoxia imrpved when pt lies flat
hepatopulm syndrome
149
orthodeoxia
hypoxia worsens when pt stands up
hepatopulm syndrome
150
Pathophys behind hepatopulm syndrome
-so the ESLD build up of nitric oxide -> vasodilation in pulm vasculature -> worsened V/Q mismatch (inc perfusion) -> pt standing worsening hypoxia b/c blood shifts, but better oxygenation when laying flat b/c of gravity and where blood is distrubted
151
Fundoscopic exam shows narrowed retinal arteries and cherry red macula, blindness in one eye after spine surgery? dx?
retinal artery occlusion 2/2 rasied IOP due to external eye compression -> ischemic to the retinal artery
152
Ischemic optic neuropathy v central retinal artery occlusion
ION is b/l, central retinal artery occlusion is unilateral
-you can have central retinal artery occlusion from ischemic compression
-fundoscopic exam in central retinal artery occlusion shows a cherry red macula
153
Dx of hepatopulm syndrome
sitting position abnormal A-a gradient > 20 with PaO2 < 60
-contrast-enchanced echo confirms intrapulm vasodilation
154
decrescendo diastolic murmur with inc pulse pressure
aortic regurge
155
Aortic regurgitation hemodynamic goals
decreasing afterload
maintaing a high normal HR
maintaing contracility
156
What ETTs should be used and avoided we/ CO2 lasers
Used: meta wrapped or flexible metal
avoid: polyvinyl chloride
157
What ETT should be used for Nd:YAG lasers?
silicone-based and rubber shafts w/ silver foil and sponge coatings
158
What causes an increase in peak inspiratory pressure but no change to plateau pressure?
-airway secretions
-bronchospasm
-kinked ETT
-mucus plug
159
What causes an increase in peak inspiratory pressure and plateau pressure?
-abd insufflation
-ascites
-pulm dx
-tension PTX
-trendelenburg positioning
160
What affects peak inspiratory pressure?
airway resistasnce!
-including tubing, ETT, and terminal BRONCHI!!
-bronchospasm will lincrease
161
What affests plateau pressure
pulmonary compliance! lungs and alveoli
-if issue w/i the lungs it will increase
162
Where are sympathetic presynatic n cells located?
T1-L2
163
Horner Syndrome
-sympathetics blocked
-Miosis (constricted pupil)
Ptosis (droopy eyelid)
ANhidrosis (can't sweat)
164
What sympathetic block to do for abd cancers?
celiac plexus (L1)
165
Sympathetic N Block indications
-arterial/venous occlusion (get vasodilation)
-raynaud's
-vasospasm
-venous insuff
-phantom limb pain
-CRPS
-abd cancer
-chronic pancreatitis
-refractory angina
**VISCERAL PAIN, neuropathy pain
166
Nitroprussive: arterial v venous vasodilation?
both
-why can get coronary steal -> blood shunts away from occlused vassesls -> MI
167
nitric oxide: arterial v venous vasodilation
venous!
168
hydralazine: arterial v venous vasodilation
arterial selective
169
sodium nitroprusside and the brain
profound cerebral vasodilator -> inc CBF
-however that combined w/ dec SVR -> can cause cerebral ischemia
170
Meds that commonly cause drug fever
-amphoterician
-cephalosporins
-PCN
-phenytoin
-procainamide
-quinidine
-hydralazine
171
Inhalational induction: pregnant versus non-pregnant
faster in pregnant b/c
-dec FRC
-inc minute ventilation
-Dec MAC requirements
172
inhalational induction & FRC
-inhalational induction is inversely related to FRC
-b/c FRC is air in lungs at end of passive exhalation -> considered to be the lung volute diluting volatile anesthetics
173
Inhalational induction w/ emphysema
-emphysema has inc FRC -> inc dilution -> slower FA/Fi -> shower inhalational induction
174
Aortic insufficiency aka
aortic regurgitation
175
Why MI w/ acute aortic regurge?
-dec aortic diastolic BP -> dec coronary perfusion
-b/c regurge inc volume and pressure on LV -> hypertrophied -> bigger O2 demand
176
Acute aortic insuff tx
Dobutamine and nitroprusside -> inotropic w/ vasodilator to inc LV contraction and dec afterload
177
Chronic aortic insuff tx
Nifedipine or hydralazine
178
Aortic insuff hemodynamic goals
fast, full, forward
-avoid bradycarida
-full preload
-avoid afterload inc
179
dec in sensation in distal upper extremities and dec pain sensation after MVA
syringomyelia
-loss of pain and temp sensation, but maintains proprioception, touch, and vibration
180
imaging of choice for retained epidural catheters
CT scan!
-metals in some catheters will screw w/ MRI and can cause burning / tissue damage
181
What to do after imagingn if pt has retained cather?
-if no symptoms -> leave in place
-if symptoms -> neurosurg consult
182
Factosr that inc likelihood of epidural catheter breakage
-faster speed of removal
-inserting more catheter than nneeded
-removing catheter in diff position than it was placed
183
What to do if epidural catheter is difficult to remove?
-extreme flexion of spine w/ rapid injection of small amount of saline
- wind epidural around tongue blade, tape to pt, and then every 15 minutes turn it a little lighter
184
Preop prep for pheo
-alpha blockade 10-14 days prior to surgery
-ensure normovolemia
-add beta blockers if already alpha blocked and persistent tachycardia, HTN or dysrhythmias
185
Which muscle is innervated by SLN?
cricothyroid
186
What type of heat loss higher in infants and why?
radiation and convective b/c infants have a higher surface area to body mass ratio
187
During non-shivering thermogenesis in infants what % of cardiac output is directed to the brown fat tissue?
up to 25%
188
inhalational anesthetics and nonshivering thrmogeneiss
-inhaled anesthetics inhibit it w/ 5 min of exposure, and after it's done takes 15 min to restart
189
Normal mixed venous
75%
190
mixed venous and cardiac output
inc in cardiac oputput -> inc in SvO2
-dec in cardiac output -> dec in SvO2
191
Asymptomatic SVT in pregnancy
-vagal maneuvers 1st
-Adenosine
-onlyl use digoxin, CCB or BB if adenosine failed
192
How does adenosinen work?
Transiently blocks the aV node
193
Hyperaldosteronism acid-base?
hypoK metabolic alkalosis
194
tx for hyperaldo
-spironolactone or triamterene and K repletion
-surgery -> avoid hypervent will make hypoK worse
195
Signs of successful stellate ganglion block
-flushing of conjunctiva and skin of the face and arm
-horner syndrome (miosis, ptosis, anhidrosis)
-nasal congestion
-temp inc in ipsilateral arm
196
Common SE of stellate ganglion block
-globus sensation (feeling of lump in throat)
-recurrent laryngeal n block
-horner syndrome
-rare: sz injxn into veretebral arery or complte spinal (spinal injxn)
197
how to do cervical in line stablization
goal: stabilize apical and basal cervical spine
-one operator: maintains head and neck in neutral position
-2nd operator: stabilizes shoulders against the OR table, bed or stretcher
-3rd person DLs
