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Anesthesia Oral Boards > UBP condescened > Flashcards

UBP condescened Flashcards

1
Q

Extubation criteria

A

-Adequate oxygenation: SpO2 > 92%, PaO2 > 60 on FiO2 40%
-Adequate ventilation: TV > 5 cc/kg, RR > 7, EtCO2, < 50, PaCO2 < 60
-hemodynamically stable
-reversal of NMB
-neurologically intact
-normal acid/base/lytes/normothermia
-negative inspiratory pressure > 20
-Rapid shallow breathing index < 105

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2
Q

Rapid Shallow Breathing Index

A

RR/TV in L

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3
Q

Cricoid pressure

A

-pushes esophagus to side, does not effectively compress the esophagus
-interferes w/ mask ventilation and intubation
-has not been proven to prevent aspiration -> lowers LES tone and may promote aspiration
-proper application of force (30N) is difficult to apply
-if pt begins to vomit -> release cricoid pressure to prevent esophageal rupture

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4
Q

Airway fire protection

A

-laser tube
-FiO2 30% or less
-avoid nitrous oxide
-inflate cuff with saline
-minimize laser time

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5
Q

Treatment airway fire

A

-disconnect/turn off O2
-remove ETT
-flood field w/ saline
-mask ventilate with 100% O2
-use rigid bronchoscopy to inspect for airway debris and damage, possible bronchial lavage
-re-intubate
-leave intubated for 24 hours
- steroids
-pulmonary consult
-serial CXR

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6
Q

Contraindications to jet ventilation

A

severe COPD/respiratory disease that does not allow for proper exhalation

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7
Q

Complications to jet ventilation

A

PTX
pneumomediastinum
airway fire
gastric distention
aspiration

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8
Q

Airway innervation

A

posterior oropharynx to epiglottis: glossopharyngeal n
epiglottis to VC: superior laryngeal nerve (internal branch)
VC and below: Recurrent laryngeal n

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9
Q

Airway motor innervation

A

recurrent laryngeal n: abduction
external branch of superior laryngeal n: cricothyroid m (adduction)

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10
Q

CEA indications:

A

TIA w/ angiographic evidence of stenosis
reversible ischemic deficits w/ > 70% stenosis
unstable neuro status despite anticoagulation

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11
Q

CEA regional v general

A

regional: awake for serial neuro exams, requires cooperation, dec CV depression, may not get adequate coverage if extends into territory of CN
general: controlled airway, ventilation, cooperative patient

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12
Q

COPD and CEA pretesting

A

CXR and room air ABG -> assess pt’s baseline PaCO2 -> if baseline hypercarbic don’t want to fix rapidly in the OR -> cerebral vasoconstriction and ischemia

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13
Q

How to do regional for CEA

A

-awake pt is best neuro monitor esp if concern of possible plaque rupture
-superficial and deep cervical plexus block.
-superficial cervical plexus block: 10cc along posterior border of SCM
-deep cervical plexus block (C2-C4): draw line from mastoid to anterior transverse process of C6 => at level of cricoid cartilage is C2 -> inject 10cc of local anesthetic at transverse processes of C2, C3, C4

**usually can be done under superficial cervical plexus block alone

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14
Q

How to do a deep cervical plexus block

A

(C2-C4): draw line from mastoid to anterior transverse process of C6 => at level of cricoid cartilage is C2 -> inject 10cc of local anesthetic at transverse processes of C2, C3, C4
-risks: phrenic n block, epidural, subarachnoid, vertebral artery injection, Horner’s, RLN injury

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15
Q

General plan for CEA

A

-TIVA (w/ SSEPs)
-if you use volatiles: reverse steel phenomenon (improved cerebral protection and myocardial priming)

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16
Q

Neuromonitoring EEG

A

-correlates w/ cerebral ischemia, but cannot detect subcortical ischemia
-processed EEG: can detect severe cerebral ischemia, but not focal

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17
Q

Neuromonitoring SSEP

A

-detects deep brain structure injury, sensitive to anesthetics, hypothermia, hypoTN

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18
Q

Neuromonitoring transcranial doppler

A

-can detect cross clamp hypoperfusion and shunt malfunction and emboli
-placed at ipsilateral MCA -> detects BF and embolic events
**hard to place

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19
Q

Neuromonitoring cerebral oximetry

A

simple, but low sensitivty and specificity
-detects regional ischemia, but includes all tissue beds (approximates venous saturation, since mostly venous blood)
-decrease > 20% suggests cerebral ischemia

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20
Q

Neuromonitoring carotid stump pressure

A

-helps guide need of shunting, no guideline of pressure that shunt should be placed
- < 50 indicates hypoperfusion
*goes in ICA above clamp and measures pressure from collateral flow

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21
Q

CEA reperfusion injury

A

cerebral hemorrhage or edema after cross clamp removed
-vessels distal to obstruction are maximally dilated -> lost ability to autoregulate -> renewed BF and perfusion is too high
**important to maintain strict BP control

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22
Q

Bradycardia in CEA

A

surgical manipulation of baroreceptors in carotid sinus
-infiltrate w/ local to prevent recurrence

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23
Q

CEA neuromonitoring change

A

FiO2 100%
ensure adequate MAP
ask surgeon to release clamp, consider shunt placement
ensure normocarbia
pharmacologic brain protection -> dec CMRO2

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24
Q

CEA Postop delayed awakening

A

-Residual anesthesia (opioids, volatiles, benzos)
-cardiac failure: hypoperfusion
-metabolic/hypo/hyperglycemia
-hypothermia
-neuro deficits (stroke) -> hematoma compressing artery, stenosis postop (doppler)

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25
Q

CEA postop HTN

A

-control due to risk of bleeding, MI, arrhythmia, intracerebral hemorrhage, cerebral edema

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26
Q

Causes of postop HTN CEA

A

hypoxemia
hypercarbia
pain
full bladder
carotid baroreceptor blunting (carotid sinus dysfxn after surgery)

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27
Q

postop HTN CEA tx

A

correct hypercarbia/hypoxia, tx pain, give hydralazine, NG, beta blocker to lower SBP < 160 or w/i 20% baseline

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28
Q

CEA chemoreceptor dysfunction

A

Up to 10 months to recover
-loss of response to hypoxia and hypercarbia
-give supp O2, cautious w/ opioids
**esp concerned if b/l CEA in past

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29
Q

CEA cerebral hyperperfusion syndrome

A

-previously hypoperfused lost ability to autoregulate -> inc systolic pressure and CBF -> focal neuro deficits, edema, HA, sz

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30
Q

CEA neck hematoma, what to do?

A

apply pressure, call surgeon, transport to OR, have difficult airway equipment ready

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31
Q

Sitting position for posterior fossa surgery: risks

A

-brain stem ischemia: quadraplegia due to obstruction of carotid or vertebral arteries
-macroglossia/facial edema
-venous air embolism

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32
Q

Oliguria

A

prerenal: hypovolemia, hypotension, hypoperfusion, renal v or artery thrombosis
intra: ATN (ischemia, toxin, abx, myoglobin, hemoglobin), intrinsic dx (vascular, glomerula, thromboembolism, interstitial nephritis)
post: obstructed catheter, urethral or ureteral obstruction

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33
Q

When should sitting position be avoided for crani surgery?

A

known intracardiac shut: PFO, ASD/VSD -> inc risk of stroke w/ air embolism

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34
Q

Venous air embolism causes

A

-inc in pulm a pressure, dec cardiac output, inc deadspace -> mediators released cause inc in PVR

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35
Q

Ways to detect venous air embolism

A

TEE: most sensitive, but difficult to manipulate under drapes
-precordial doppler: R sternal border b/w 2-4 intercostal
-DECREASED EtCO2, inc in CVP

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36
Q

Treatment for venous air embolism

A

have surgeon flood the field, apply bone wax, control open blood vessels
-FiO2 100%, d/c nitrous oxide
-Use CVP in RA to aspirate air, manual occlusion of jugular veins
-left lateral decubitus position (keeps air in RA, prevents entry into RV and obstruction of RVOT)
-head below heart
-hemodynamic support: inotropes, fluids

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37
Q

Normal ICP

A

15

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38
Q

What’s inc ICP

A

20-25 should be treated

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39
Q

Symptoms of inc ICP

A

papillema, nausea/vomiting, confusion, Cushings triad (bradycardia, HTN, irregular breathing)

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40
Q

Normal cerebral perfusion pressure

A

80-100

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41
Q

What cerebral perfusion pressure is considered to be ischemia

A

< 50

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42
Q

Ideal cerebral perfusion pressure for head injury

A

60-70

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43
Q

Increased ICP, needs central line, where to place?

A

subclavian or femoral to avoid head down positioning -> inc ICP

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44
Q

succ and ICP

A

fasciculations can cause transient inc in ICP -> but hypoxia and hypercarbia w/ difficult airway cause higher inc in ICP

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45
Q

Treatment of inc ICP

A

-ventriculostomy
-HOB position 30 degrees
-analgesia: blunt pain/symp resp
-avoid hypoxemia
-avoid hypothermia: shivering inc ICP
-osmotic therapy: mannitol, furosemide, hypertonic saline

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46
Q

Hypothermia effects

A

-inc O2 demand w/ shivering
-inc ICP w/ shivering
-poor wound healing
-coagulopathy
-arrhythmia

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47
Q

glucose and neurosurg

A

avoid hyperglycemia -> inc brain swelling
-no dextrose containing fliuds -> causes edema w/ injured blood brain barrier

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48
Q

Neurogenic pulm edema

A

s/p head injury or intracranial bleed
-symp response -> systemic vasoconstriction -> dec LV compliance and inc LA pressure -> pulm edema
-w/ catecholamine surg, inc pulm capillary permeability
-tx: supportive, lung protective

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49
Q

Pseudotumor cerebri

A

elevated ICP (> 20) w/ normal CSF, normal mentation, no mass lesion

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50
Q

Pseudotumor cerebri treatment

A

Acetazolamide (dec CSF production)
Furosemide
steroids
lumbar puncture/CSF drain
VP shunt
**no LP before CT head, r/o space occupying lesion

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51
Q

nitrous oxide and ICP

A

inc CBF, inc CMRO2

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52
Q

Benzos ICP

A

no change CBF, dec CMRO2

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53
Q

Why ischemia w/ dec PaCO2

A

cerebral vasoconstriction, left shift of O2-Hgb curve

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54
Q

PaO2 and CBF

A

Dec PaO2 (<60) -> inc in CBF

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55
Q

Cerebral autoregulation

A

b/w CPP of 50-150, shifted to the right in HTN
**when MAP above this, or tumor abolishes cerebral autoregulation -> CBF is dpt on MAP

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56
Q

Inc ICP treatment

A

-HOB up 30 degrees
-avoid hypoxemia
-inc SBP to maintain CPP
-analgesia: blunt pain/symp resp
-avoid hypothermia (shivering inc ICP)
-mannitol, furosemide, hypertonic saline
-avoid hyperglycemia

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57
Q

Etomidate CBF, CMRO2

A

dec both

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58
Q

N2O and CBF, CMRO2

A

inc CBF, in CMRO2

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59
Q

Benzos CBF, CMRO2

A

no change CBF, dec CMRO2

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60
Q

Electrolyte disturbances from SAH

A

SIADH
CSW
hypoK/hypoCa/HypoMg from diuretics

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61
Q

Preop eval SAH

A

-neuro deficits/coma
-cardiac dysrhythmias 2/2 catecholamine release
-electrolyte disturbances: SIADH, CWS, hypoK/hypoCa/hypoMg from diuretics
-labs: CBC, T&C

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62
Q

Intraop goals for SAH

A

-avoid aneurysm rupture: maintain transmural pressure (MAP - ICP)
-maintain CPP
-brain relaxation: hyperventilation (PaCO2 30-25), mannitol, furosemide, CSF drain, avoid hypercarbia, hypoxemia, and nitrous
-blunt symp resp, no succ, no hypoTN
-No dextrose (BG < 180)

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63
Q

cerebral protection during aneurysm clipping

A

-prop, etomidate, thiopental (dec CBG and CMRO2)
-mild hypothermia (32-34)
-inc MAP (collateral flow)
-minimze occlusion time
-monitor brain function (EEG, SSEP)
-brain relaxation (CSF drainage, mannitol, hyperventilation)

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64
Q

SAH intraop rupture

A

-control bleeding but maintain CPP
-bleeding control: temp clip or compression ipsilateral carotid artery
-cerebral protection: avoid hyperthermia, hypoxemia, hyperglycemia

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65
Q

Hypothermia complications

A

-delayed emergence
-HTN if hypothermic w/ emergence
-MI
-wound infxn
-coagulopathy
-dysrhtyhmias
-prolonged anesthetics and muscle relaxants

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66
Q

Post SAH rebleeding timeframe

A

Usually w/i first 24 hours

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67
Q

Vasospasm post SAH

A

Starts days 3-12, peak 1 week after
-dx: cerebral angio (gold), transcranial doppler (>200 cm/s)
-cerebral auto regulation impaired
-tx: Nimodipine, angio w/ intra-arterial verapamil

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68
Q

tx for neurogenic pulm edema

A

Treat CNS cause, lung protective ventilation, diuretics, Hgb > 10, PEEP

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69
Q

SIADH tx

A

Tx underlying cause, water restriction, hypertonic saline, diuretics
DEMECLOCYLINE (kidneys not sensitive to ADH)

70
Q

Treatment for SIADH

A

Treat underlying cause, water restriction, hypertonic saline, diuretics
DEMECLOCYCLINE

71
Q

Pathophys SIADH

A

Excessive ADH -> water retention -> hypoNa, normal total body Na, euvolemia, U Na < 100

72
Q

Cerebral salt wasting

A

Excessive renal sodium excretion centrally mediated process -> hypoNa
-dehydrated and hypovolemic

73
Q

Treatment for cerebral salt wasting syndrome

A

Fluids, salt tabs, mineralocorticoids (fludrocortisone)

74
Q

Diabetes Insipidus

A

Inability to concentrate urine due to renal resistance or decreased secretion of ADH
-large volume of dilute urine -> hyperNa

75
Q

Diabetes Insipidus treatment

A

Central: desmopressin/DDAVP and hydration
Nephrotoxic: diuretic, hydration, indomethacin

76
Q

What causes central pontine myelinolysis

A

Rapid correction of hyponatremia
-locked in syndrome: quadraparesis, dysphagia, dysarthria, diplopia, LOC
-don’t correct faster than 12 mmol/L/day

77
Q

What are SSEPs measuring?

A

Ascending sensory pathway (dorsal column pathway)

78
Q

SSEPs and epidural

A

-if epidural in place, only give narcotics -> local anesthesia will interfere

79
Q

MEPs measure what?

A

Descending motor pathway (lateral corticospinal tract)
**more sensitive to volatiles than SSEP

80
Q

Contraindications for MEP

A

Seizure history
Skull fracture
Implanted metal devices
Clips in brain

81
Q

MEPs and epidural

A

Only give narcotics through epidural, local anesthesia will interfere

82
Q

Brain death: how to confirm

A

-Objective findings of severe insult: documentation, neuro imaging (SAH, infarct, herniation)
-irreversible damage
-no confounding factors: sedation, hypothermia, acid/base, endocrine disturbance
-no cortical response (sternal rub)
-no brainstem function (corneal or gag reflex)
-apnea test

83
Q

ECT contraindications

A

-intracranial mass/vascular malformation
-recent SAH, evolving stroke ( <1 month)
-severe cardiac dx: MI < 1 mo, diminished ventricular function
-severe pulm dx
-ASA 4-5
-pheochromocytoma

84
Q

ECT hemodynamic changes

A

Parasympathetic then sympathetic!

85
Q

Multiple sclerosis epidural v spinal

A

epidural is okay, spinal more likely to cause exacerbation

86
Q

low back pain, saddle anesthesia, LE weakness, bowel/bladder dysfxn

A

cauda equina syndrome
-get MRI and emergent neurosug c/s

87
Q

what happens if ventricular drain dropped to floor whole open

A

inc drainage of CSF and dec in ICP -> ventricular collapse and tearing of cortical veins

88
Q

neuraxail w/ spina bifida

A

AVOID unless MRI shows no tethered cord

89
Q

which volatile is most cardiac stable?

A

sevo
-causes the least tachycardia, does cause dose dpt myocardial depression and dec vascular resistance

90
Q

Normal cardiac index

A

2.6-4.2

91
Q

Normal PCWP

A

2-15

92
Q

Normal pulm artery pressure

A

15-30/4-12

93
Q

normal mixed venous

A

75%

94
Q

Hs and Ts PEA

A

hypoxia, hypoTN/hypovolemia, hypoK/hyperK, hypoglycemia, hypothermia, H+ acidosis

tamponade, tension PTX, toxins, thrombosis (PE/MI), trauma

95
Q

sinus bradycardia ddx

A

hypoxia/hypercarbia
beta blocker
succ
anticholinesterase inhibitors
acute inferior MI
vagal stimulation
high sympathetic block
acidosis
inc ICP
reflex bradycardia

96
Q

atropine dose for sinus brady

A

0.5 mg

97
Q

SVT ddx

A

WPW
thyrotoxicosis
digoxin toxcitiy
PE
preganncy
drug effect
intravascular volume shifts
-heart disease

98
Q

SVT treatment

A

-vagal maneuvers
-adenosine (6mg then 12)
-verapamil
-amiodarone
-synchronized cardioversion if unstable

99
Q

a flutter tx

A

Diltiazem or esmolol

100
Q

with a fib, prior to cardioversion?

A

must r/o thrombi if > 48 hours

101
Q

Junctional rhythm

A

HR 40-60
-ectoptic activity inferior to AV node -> abnormal P waves -> normal QRS
-if hypotnesive: atropine/ephedrine/ amio: inc activity of SA node

102
Q

Causes of PVC/bigeminy

A

electrolyte imbalances
acidosis
hypoxia
drug intereactions

103
Q

treatment of PVC/bigeminy

A

Lidocaine 1.5 mg/kg bolus
-esmolol
-procainamide
-verapamil
-overdrive pacing

104
Q

treat PVCs

A

> 5 per min

105
Q

Vtach w/ a pulse treatment

A

amiodarone 150 mg over 10 minutes
OR lidocaine 1.5 mg/kg
>3 PVCs, wide QRS, no p waves

106
Q

Unstable V tach

A

unsychronized cardioversion 200J

107
Q

V fib causes

A

MI, hypoxia, hypothermia, electrolyte imbalance

108
Q

V fib tx

A

CPR, O2, unsynchronized debrillation, consider amiodarone 300mg IIV, lidocaine 1.5 mg/kg

109
Q

LBBB and stress tests

A

cannot do exercise stress test: assoc w/ low specificity, must do chemical MPI stress

110
Q

why a fib poorly tolerated w/ aoritc stenosis

A

inc myocardial O2 demand
-dec time in diastole/dec LV filling time
-dec CPP
-no atrial kick

111
Q

severe AS transvalvular gradient

A

> 40 mmhg

112
Q

mid systolic ejection murmur 2nd right IC space

A

aortic stenosis

113
Q

decrescendo diastolic murmur L sternal border

A

aortic insufficiency

114
Q

induction w/ Mitral stenosis

A

be careful w/ dec in afterload -> can’t compensate w/ inc in SV b/c of stenosis to maintain cardiac output -> minimize dec in SVR

115
Q

what to be careful for after fixing mitral regurge

A

LV failure -> now has to work harder to pump entire volume against afterload -> was previously splitting b/w

116
Q

blowing systolic murmur

A

mitral regurge

117
Q

causes of Tricuspid regurge

A

pulm HTN
carcinoid syndrome
ebsteins anomaly
infective endocarditis

118
Q

HOCM goals

A

maintain SVR
preload adequate
low HR
avoid PPV if possible

119
Q

Things that worsen HOCM

A

tachycardia
hypovolemia
sympathectomy/dec SVR
dysrhythmias
excess PEEP/PPV
inc myocardial contractility
Valsalva

120
Q

OB and HOCM

A

-ensure adequate L uterine displacement to maintain preload
-avoid spinal, epidural ok (don’t want a massive dec in SVR)
-can get pulm edema after delivery due to autotransfusion

121
Q

oxytocin and HOCM

A

avoid! dec SVR and inc HR!!

122
Q

Determinants of myocardial O2 consumption

A

HR
contractility
wall tension

123
Q

Normal QRS

A

< 0.12 ms

124
Q

when to avoid pulm a catheters

A

when pt has a LBBB -> can cause a RBBB

125
Q

how to measure cardiac output

A

10cc room temp or cold saline (whatever programed to) through PAC x3 -> if w/i 10% of each other, accurate
-greater temp change: low CO, less temp change: higher CO

126
Q

when is pulm artery catheter put in?

A

poor LV fxn (CVP doesn’t correlate w/ PWCP), pulm HTN, coronary stenosis with valvular lesions, poor RV function, ascending aorta/aortic arch procedure

127
Q

PCWP v TEE intraop ischemia

A

TEE is better at assessing regionanl wall motion abnormalities

128
Q

complications of PAC placement

A

arrhythmias
PA rupture
VAE
PTX
hemothorax
RBBB
infection
PE
valve injury

129
Q

treatment for benzo OD

A

flumazenil

130
Q

treatment for beta blocker OD

A

glucagon

131
Q

HD indications

A

Acidosis
Electrolytes (hyperK)
Intoxication (ASA, methanol)
Overload of fluids and heart failure
Uremia (encephalopathy, pericarditiis, issues w/ clotting(

132
Q

Parkland formula

A

4 x % BSA burned x kg
-half in first 8 hours, 2nd half in 16 hours after

133
Q

Normal mixed venous

A

70-75%

134
Q

what causes high mixed venous

A

sepsis, high CO states (burns), dec O2 consumption, CO poisoning, cyanide toxicity, L to R shunts, inotropes

135
Q

what causes low mixed venous

A

low cardica output, anemia, hypoxemia, high O2 consumption

136
Q

CI to TEE

A

esophagectomy
active GI bleed or recent surgery
oropharyngeal trauma
esophageal pathology: stricture, TEF, mallory-weiss tear, scleroderma

137
Q

stress test indications

A

-active cardiac conditions
-3 or more RF w/ < 4 METs having high risk surgery and will change management
-pts w/ 1-2 RF w/ < 4 METs undergoing intermediate risk surgery
-1-2 RF > 4 METs w/ high risk surgery

138
Q

Normal digoxin level

A

0.5-2

139
Q

cardiac output and heart transplant

A

if dec in SVR -> can’t increase HR to compensate to inc CO -> need to inc stroke volume -> dpt on preload

140
Q

nasal intubation in heart transplant

A

AVOID: inc risk of infxn w/ nasal flora w/ immunocompromised

141
Q

NSAIDs and heart transplant

A

inc risk of toxicity w/ cyclosprine and inc risk of gastritis w/ steroids
AVOID

142
Q

MAP equation

A

MAP = SVR x CO

143
Q

CO equation

A

CO = SV x HR

144
Q

roller pumps how works CABG

A

2 rollers partially compress tubing to promote forward flow

145
Q

centrifugal pumps how work CAGB

A

rotational force creates forward flow

146
Q

heparin dose for bypass

A

100 U/kg

147
Q

ACT goal

A

> 480

148
Q

glucose goal in bypass

A

< 150: hyperglycemia causes worse neuro outcomes

149
Q

hypoTN w/ bypass initiation

A

hemodilution/dec SVR due to priming solution
-inadequate venous return to reservoir: hypovolemia, caval obstruction, table too low

150
Q

Getting ready to come off bypass

A

-Labs normal: pH, pCO2, pO2, Hct 20-24, K 4-4.5, Ca 1.1-1.2, mVO2 > 70%
-anesthesia machine one, benzos to prevent awareness
-EKg stable rhythm/rate
-warmed
air removed from heart
-support drugs available

151
Q

post bypass coagulopathy

A

MCC abnormal plt function
-ACT, PT/INR/PTT, CBC, TEG

152
Q

low mixed venous after off bypass

A

inadequate tissue oxygenation, needs inc FiO2

153
Q

pacing post bypass

A

A pacing preferred -> improved cardiac output w/ preserved atrial kick
-V if complete heart block

154
Q

Failure to capture w/ pacemaker ddx

A

MI/conduction abnormalities
lead dislodged
electrolyte abnormalities
acid-base disturbances
-abnormal antiarrhythmic drug levels

155
Q

difficulty coming off bypass ddx

A

air in RCA or other coronaries
graft is down
long time on pump
MI
arrhythmias
hypothermia
acidosis
perivalvular leak

156
Q

type A aortic dissection by Standford

A

ascending aorta, emergent surgical repair

157
Q

type B aortic dissection by Stanford

A

descending aorta, managed medically

158
Q

AAA complicatiosn

A

aortic root dilation
ruputure
tamponade
hemothorax
hoarseness (RLN compression)
SOB (trachea/bronchial tree compression)
SVC syndrome

159
Q

spinal cord blood supply

A

anterior 2/3: anterior spinal artery, lower by radicular arteries and artery of adamkiewicz

posterior 1/3: posterior spinal arteries

160
Q

CSF pressure goal w/ drain

A

8-10

161
Q

AAA repair, bair hugger?

A

don’t put warming on clamped lower extremities -> inc acidosis

162
Q

EVAR complications

A

endoleak: failure toe separate aneurysm from arterail blood flow
AKI
paraplegia
post implantation syndrome

163
Q

Post implantation syndrome

A

EVAR -> endothelial activation due to graft ->< fever, elevate dinflammatory mediators, leukocytosis

**self limited, 2-10 days, give NSAIDs if no renal issues

164
Q

when to use R sided DLT

A

distorted anatomy of L main bronchus
compression of L main bronchus by TAA
L pneumonectomy
L lung transplant

165
Q

pneumonectomy poor outcomes predictors

A

-ABG: PaCO2 > 45, PaO2 < 50
-FEV1 < 2L
-FEV1/FVC < 50%
-PAP > 40
-FEV1 < 800 cc

166
Q

FOr a pneumonectomy, who is considered to be high risk

A

PaCO2 > 45
PaO2 < 60
ppFEV1 < 40%
DLCO < 40%
VO2 max < 15 cc/kg/min

167
Q

Meds for ECT

A

-methohexital ideal: rapid onset and recovery, minimal anticonvulsant effects
-prop: Dec sz duration
-Etomidate: may prolong sz

168
Q

for a pneumonectomy, predicted postop FEV1 < 40%, next steps?

A

V/Q scan to look for contribution of lung that will be resected and get a TTE (risk of RV failure)

169
Q

Mediastinoscopy CI

A

carotid artery dx
CVA due to compression of R brachiocephalic artery
tracheal deviation
c spine disease
TAA

170
Q

where to put a line in mediastinoscopy

A

R side to monitor for compression of brachiocephalic artery

171
Q

mediastinoscopy, what do you need prior to d/c?

A

CXR to r/o PTX

172
Q
A

Anesthesia Oral Boards (8 decks)

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