Via Aerea, RSI, anestesia

Question 1

Hipnoticos, dosis

Answer 1

Etomidato: 0,3 mg/kg
Ketamina: 1-2 mg/kg
Midazolam: 0,2 mg/kg
Propofol: 1,5-2,5 mg/kg
Tiopental: 3-5 mg/kg

Question 2

Sugamadex, dosis

Answer 2

Rocuronio o vecuronio
4 mg/kg
2 mg/kg si recuperacion espontanea hasta reaparicion T2
Reversion imediata/ 16 mg/kg

Esperar 24 h para volver a administrar rocuronio/vecuronio

Question 3

Etomidate, característica

Answer 3

no analgesic effect
Relative hemodynamic stability
Concerns: adrenal suppression, myoclonus, regional cerebral excitation
Safe to use with seizures/status epilépticus
NOT USED as an infusion for maintenance of sedation
Patients with sepsis should receive Gcc? (Hydrocortisone 100mg)

Question 4

Midazolam

Answer 4

Induction dose: 0.1-0.3 mg/kg
Patients con hypovolemia - 0.1 mg/kg
Long-term sedation: 0.05-0.4 mg/kg/hour

Question 5

Ketamine

Answer 5

1-2 mg/kg
Preserve respiratory drive
Sympathetic stimulation
Broncodilatation?
Reasonable alternative in pacients with ICP elevation and normal o low BP
Should be avoided with hypertension and suspected ICP elevation

Question 6

Propofol

Answer 6

Induction 1.5-3 mg/kg
Good for broncospasm, intracranial pathology

Question 7

TCE, RSI

Answer 7

With potentially elevated ICP: etomidate/ketamine
Is signs of cerebral herniation - avoide ketamine (use etomodate)
If significant hypertension (MAP > 120) etomidate, no ketamine

Question 8

RSI, status epilepticus

Answer 8

Propofol 1-2,5 mg/kg
etomidate si TCE
midazolam 0.2-0.3 mg/kg

Question 9

RSI, broncospasm

Answer 9

Ketamine/propofol
Etomidate, misazolam
Hypotension + broncospasm: ketamine/etomidate

Question 10

RSI, cardiovascular desease

Answer 10

Etomidate
Patients with coronary desease/suspected aortic dissection: fentanyl 3 mcg/kg as a pretreatment

Question 11

RSI, shock

Answer 11

Etomidate 0.15 mg/kg (with sepsis and hypotension refractory - hydrocortisone 100 mg)
Ketamine 1 mg/kg

Question 12

Ketofol

Answer 12

1 : 1 mix (100 mg + 100 mg)
Initial dose 0.375 - 0.5 mg/kg

Question 13

Escala Ramsay

Answer 13

1. Despierto, ansioso i agitado
2. Despierto, cooperado, orientado i tranquilo
3. Dormido con respuesta a órdenes
4. Somnoliento con breves respuestas a la luz y al sonido
5. Dormido con respuesta solo a dolor
6. Profundamente dormido, sin respuesta a estímulos

Question 14

Escala RASS

Answer 14

+4 combativo
+3 muy agitado
+2 agitado
+1 ansioso
0 alerta i tranquilo
-1 adormilado
-2 sedación ligera
-3 sedación moderada
-4 sedación profunda
-5 sedación muy profunda

Question 15

Succinylcholine, myasthenia gravis

Answer 15

Can be used safely. Patients are relatively resistant, should receive 2 mg/kg

Question 16

Use of nondepolarising NBA and not succinylcholine, when performing RSI:

Answer 16

1. Malignant hyperthermia history (personal o family)
2. Neuromuscular disease involving denervation (SC is safe in myasthenia gravis)
3. Muscular dystrophy
4. Stroke > 72 hours old
5. Rhabdomyolysis
6. Burn > 72 hours old
7. Significant hyperkalemis

Question 17

Rocuronium

Answer 17

RSI (1,5 mg/kg)
1-1,2 mg/kg: time to intubation 45-60 sec
Endotracheal intubation 0,6-1mg/kg
PC: 3-8 mcg/kg/minute

Question 18

Naloxone, dosis

Answer 18

Off-label: Clonidine toxicity 0,4-2 mg, up to 14 mg
Opioid reversal: 0.04-2 mg, repeat with escalating doses every 2-3 min