Volatiles And Other Anesthetics Flashcards
1
Q
Isoflurane is what type of volatile ?
A
Halogenated Methyl Ethyl Ether.
2
Q
5 Characteristics of ISO
A
1) Pungent Odor
2) Intermediate Blood solubility
3) Immediate Onset and Recovery
4) Highly Potent
5) Isomer of Enflurane
6) No preservative needed
3
Q
All CNS effects of ISO (5)
A
No Seizure = Suppress convulsant properties
Increases CBF ( Hello> Everyone> I =Do increase CBF ) at MAC 1.1
Decrease CRMO2 - dose dependent ( ISO=DES=SEVO>Halothane)
Cerebral protection
Increase in ICP ∞ to increase CBF
4
Q
CV effects of ISO (9) HR, left SV, CO, SVR, PVR, Arrythmia, Coronary, BP, IPC
A
Transiently Increase HR ( Des>ISO) * all the pungents increase HR !!
Decrease Left SV
No change in CO
Most profound Decrease in SVR ( I» don’t > See an SVR )
Little to no effect on PVR
Min to nonexistent Epinephrine induced arrhythmia effect
Most potent coronary dilator : coronary steal, dilates smaller >larger coronaries, ischemis in CAD pts
All volatiles decrease BP
Good cardiac protection APC ( anesthetic pre conditioning )/ IPC (Ischemic pre conditioning)
5
Q
ISO pulomonary effects (8) RR, TV, Min Vent, CO2, Vent response to CO2, airway resistance, PVR, HPV
A
*Increase Frequency of breathing
Decrease TV
Decrease Minute ventilation = increase PaCO2–Resp acidosis
*Increase CO2
Decrease Ventilatory response to CO2
Decrease airway resistance after antigen bronchoconstriction
Decrease PVR ( ISO>SEVO)
Decrease HPV ( hypoxic pulm vasoconstriction)
6
Q
Hepatic effects of ISO (3)
A
1-Maintain hepatic artery but increase portal vein blood flow= good for hep oxygenation
2-No transient increase in ALT ( but DES and Enflurane increase ALT)
(All surgical stimulation does increase all LFTS)
3- metabolism to acetylated liver protein similar to halothane = severe antibody response possible in that manner : H>E>I>D
*HEID your liver from antibody attack
7
Q
Metabolism of ISO
A
Only 0.2% is metabolized
By P450 enzymes
Oxidative metabolism to TRIFLUOROCETIC ACID leads to acetylated hepatic protein AB complexes
Less inorganic fluoride production than Enflurane .
8
Q
ISO Molecular weight
A
184
9
Q
MAC of ISO
A
1.17
10
Q
ISO stability of SODA LIME
A
Yes
11
Q
Boiling Point
A
48.2
12
Q
Vapor Pressure of ISO
A
240
13
Q
Blood: Gas Coefficient
A
1.46
14
Q
MAC 50-70 % N2Oof ISO
A
0.50
15
Q
How many stages of anesthesia
A
4 Stages
16
Q
Stage 1 of anesthesia starts and ends when ?
A
Start at Induction
End at loss of consciousness ( no eyelid reflex)
Can still feel pain
17
Q
What is Stage 2 of anesthesia
A
Delirium Excitement
Uninhibited excitation
Pupils dilated, divergent gaze
Potentially dangerous response to noxious stimuli: Breath holding, Muscular rigidity, Vomiting Laryngospasm
18
Q
What is Stage 3 of anesthesia
A
Surgical Anesthesia
Centralized gaze with constriction of pupils
Regular respirations
Anesthesia depth is sufficient for noxious stimuli when the noxious stimuli dose not cause increase sympathetic response.
19
Q
Pupils dilated with divergent gaze is what stage of anesthesia ?
A
Stage 2
20
Q
What potential dangerous response to noxious stimuli occur in Stage 2 of anesthesia
A
Laryngospasm
Vomiting
Breath holding
Muscular rigidity
21
Q
What is Stage 4 anesthesia
A
Stay away from. Too deep
Apnea
Non reactive dilated pupils
Hypotension resulting in complete CV collapse if not monitored closely
22
Q
What stage is nonreactive dilated pupil ?
A
Stage 4
too deep
23
Q
Molecular weight of Nitrous Oxide
A
44
24
Q
MAC of N2O ( Nitrous Oxide )
A
104
25
Therapeutic Index is described as
As the ratio between LD50 and ED50 LD50/ED50
26
What is LD50
Dose of the drug required to produce to death in 50 % of patients.
27
What is ED 50
Dose of a drug required to produce desired drug effects in 50 % of patients
28
Why is LD50/ED50 not clinically useful in anesthesia
Because we expect 100% of patients to fall asleep and nobody to die
29
Cricoid Pressure , also called Sellick Maneuver . How and what force what gets displaced where?
Downward Pressure with the thumb and Index finger on the cricoid cartilage
Approx 5 kg pressure or 30 Newton
Displaced posteriorly and the esophagus is thus compressed against the underlying cervical vertabrae
To prevent spillage of gastric content during induction .
30
Difficult Airway Algorithm . The 4 steps to consider
1. Assess basic management problems : diff consent, diff mask ventilation, Diff SGA placement, Diff Laryngoscopy , Diff intubation , Diff SUrgical airway access
2. Active seek O2 delivery throughout Diff airway
3. Consider Feasibility : awake vs post induction intubation , non-invasive vs Invasive , VL as an initial approach , Preservation vs ablation of Ventilation
4. Develop primary and alternative strategies
31
Difficult Airway Algorithm, what are the primary vs alternative strategies ? ( 2 main ones )
1) Awake Intubation :
A) noninvasive approach >>
A1 ) Succeed >> confirm Ventilation, Tracheal intubation or SGA place with exhaled CO2
A2) Fail >> 1) cancel case, 2) feasibility of other options like face mask or SGA 3) Invasive airway : surgical or percutaneous airway, jet ventilation, retrograde intubation .
B) Invasive Airway Acces
2) Intubation after Induction of Anesthesia
32
Difficult Airway Algorithm: 2nd alternative algorithm
2) Intubation after induction of anesthesia :
A1) Initial Intubation successful >> Confirm ventilation with exhaled CO2
B) Initial Intubation attempts unsuccessful >> consider 1) call for help 2) Returning to spontaneous ventilation 3) Awakening the patient Then :
B1) face mask ventilate adequate >> Nonemergency pathway >> Ventilation adequate >> alternative approach to intubation >> Successful intubation
B2) Face mask ventilation adequate >> Non emergency pathway >>Intubation unsuccessful >>alternative approach to intubation >> Fail after multiple attempts >> 1) Invasive airway 2) Feasible other options 3) Awaken patient.
A2) Face Mask Ventilation not adequate >> SGA >> SGA adequate >> Non emergency pathway >> Ventilate adequate >> Alternative Intubation approach >> Successful intubation
A2b) Face mask Ventilation not adequate >> SGA>> SGA not adequate >> EMERGENCY pathway >> Ventilation not adequate / Intubation unsuccessful >>call for help >> Emergency noninvasive airway (SGA) >> Successful ventilation = 1) invasive airway access 2) feasibility of other options 3 Awaken patient .
A2c) Face mask Ventilation not adequate >> SGA>> SGA not adequate >> EMERGENCY pathway >> Ventilation not adequate / Intubation unsuccessful >>call for help >> Emergency noninvasive airway (SGA) >> Fail = Emergency invasive airway
33
Trachea extends from the ___overlies what vertebra__how long ___how many cartilages ___sensory innervation
```
Larynx to the carina
The 5th thoracic vertebra
10 - 15 cm long
16-20 horseshoe shaped cartilages
Sensory innvervation by the RLN a branch of CN X vagus
```
34
```
Mallampati 1 ( there 4 classes )
Purpose
```
I : Soft Palate , Fauces, Uvula , Tonsillar pillars
| Evaluate oropharyngeal space to predict ease of DL and Endotracheal Intubation
35
Mallampati II
Soft palate , Fauces, Uvula , * you lost the pillars
36
Mallampati III
Predicts diff DL and intubation
| Soft palate and base of Uvula . * you lost Pillars and Fauces
37
Mallampati IV
Soft palate not visible
38
Four grade Views
1: Most glottis visible
2: Only Posterior Glottis is visible
3: Epiglottis but no part of Glottis can be seen
4: No airway structures
39
Grade View I
Most of glottis is seen
40
Grade View II
Only posterior Glottis seen
41
Grade View III
Epiglottitis but no part of glottis seen
42
Grade IV view
No airway structures seen
43
Patient with Hx or anticipated difficult Airway consider
1) Awake Intubation vs Intubation post induction
2) Initial Intubation via noninvasive vs invasive technique
3) VL as an initial approach
4) Maintaining vs ablating spontaneous breathing
* what is the pt corporation and * always have a diff to intubate cart ready
44
Where is the narrowest region in the Infant airway ?
Cricoid ring
45
Macintosh style vs Miller style
Macintosh : curved blade : less trauma to teeth , more room for ETT , larger flange= increase ability to sweep the tongue , less bruising of epiglottis bc the tip blade doesn’t touch the epiglottis directly . It’s placed in the valleculla : between the base of the tongue and pharyngeal structure of the epiglottis
Miller : Straight blade : better exposure of glottic opening , smaller profile = good for patients with small mouth opening . The tip passed beneath the LARYNGEAL structure of the epiglottis , directly elevates the epiglottis to expose the glottic opening
46
Where is the Valleculla ?
Between the base of the tongue and the pharyngeal structure of the epiglottis
47
What are the standard intubating blade sizes.
Sized by their length
MAC 3 and Miller 2
For larger patients
MAC 4 and Miller 3
48
Obesity , define ... Extreme Obesity may have what accompanying issues (8) what special equipments might you need ?
```
Obesity is a BMI ≥
Extreme Obesity is a BMI ≥40 :
1)OSA,
2)HF ,
3)DM,
4)HTN,
5)Pulm HTN,
6)Difficult Airway,
7)Decreased arterial Oxygenation ,
8)Increased gastric volume
Special equipments : Oversized BP cuffs, Airway management devices, large procedure tables and gurneys.
```
49
Diabetes HG A1C is
≥ 7 %
50
Incisor Distance
Incisor gap less than 3 to 4.5 cm = difficult achieving line view for DL
Overbite = reduces interincisor gap when pt head and neck optimally positioned for DL
51
Upper Lip Bite Test ( ULBT) ( 3 classes )
I : Lower incisors can bite above the vermillion border and upper lip
II: Lower incisors cannot reach vermillion
III: Lower incisors cannot bit lip
52
Lower incisors cannot bite lip
ULBT III
53
Lower Incisors can bite Upper lip and Vermillon border
UBLT II
54
Lower incisors cannot reach Vermillion
UBLT II
55
Thyromental/Sternomental Distance
Mentum To thyroid cartilage
< 6 to 7 cm or < approximately 3 Fingerbreaths = poor laryngoscopic view
Normal TMD is 3 FB or more *
Normal Sternomental distance > 12.5 to 13.5 cm
56
The ___ is the predominant cause of airway restance in the oropharynx. It obstruction happens because of the relaxation of the _____muscle during anesthesia
Tongue
| genioglossus muscle
57
What structure demarcates the border between the oropharynx and the hypopharynx
the epiglottis
58
What nerve innervated the Post 1/3 of tongue, Soft palate, and the oropharynx
Glossopharyngeal Nerve CN IX
59
Soft Palate separates ____from the ______
Nasopharynx from the Oropharynx
60
Internal Branch of SLN provides sensory to
1) Hypopharynx
2) Base of Tongue
3) Posterior surface of epiglottis
4) Aryepiglottic folds
5) Arytenoids
6) Epiglottis
7) Mucosa above the glottis
8) Cricothyroid Joint
9) Thyroepiglottic Joint
* * no motor anywhere
61
Superior Laryngeal External Branch Sensory and Motor innervation
Sensory: Anterior Mucosa below the glottis
| Motor : Cricothyroid Membrane
62
Recurrent Layngeal Sensory and Motor
```
Sensory : Mucosa below the glottis
Motor :
1)Thyroarethnoid membrane,
2)Lateral crycoarythenoids membrane,
3)Interarytenoid membrane,
4) Posterior Cricoarythenoid membrane
```
63
Larynx is located at the level of
The 3rd to the 6th cervical vertabrae
64
What are the cartilages of the larynx
3 paired : Cuneiform , arytenoids, corniculate
| 3 Unpaired : epiglottis , thyroid and cricoid
65
The 3 paired cartilages of the larynx
Arytenoids
Corniculate
Cuneiform
66
The 3 unpaired cartilages of larynx
Epiglottis
Thyroid
Cricoid
67
Narrowest portion of the adult airway
Vocal cords Which are formed by the thryroarytenoid ligaments
68
Only cartilage of the larynx that is a full ring
Cricoid
| Shaped like a signet
69
Anterior 2/3 of the tongue innvervated by
Sensory : Lingual nerve (trigemminal branch ) and chorda tympani
Motor :
70
ETT size calculation for infants Uncuffed and cut length
(Age+16)/4 (per M&P)= mm or 4 + Age/4 (per PP )= mm
Cut length in cm
14+ Age/2 = cm
71
ETT size calculation cuffed
Subtract 1/2 a size from the regular formula result
| (Age + 16)/4 Then always have .5 size smaller and .5 size bigger available
72
Superior Thyroid Artery is found
1) along the lateral edge of the cricothyroid membrane.
| 2) Crossing the upper cricothyroid membrane
73
14 + Age/2
Cut length
74
(16+ Age)/4
ETT size in mm
75
The thyroid cartilage shields the
Conus elasticus
76
Parasympathetic Nerves
1973
| X IX VII III
77
Which nerve provides sensory Below the cords
RLN
78
Which nerve provides Sensory above the cords ?
SLN — Internal Branch
79
After Subtotal Thyroidectomy what damages ?
Unilateral Recurrent Nerve Damage
| Superior Laryngeal Nerve damage
80
Why does SAT drop quickly after induction
Because of decreased FRC and Increased O2 consumption.
81
Pre- Oxygenation : how many breaths ?
8 Vital Capacity breaths of 100% O2 for 1 minutes = 3 minutes of normal TV of 100% O2 for 3 minutes
82
LMA contraindications
Relative contraindications include:
patients with pharyngeal pathology (ex, abscess)
pharyngeal obstruction
full stomachs (ex, pregnancy, hiatal hernia)
low pulmonary compliance (ex, restrictive airways disease) requiring peak inspiratory pressures greater than 30 cm H2O.
83
What nerve damage after LMA
Lingual
Hypoglossal
RLN
84
Murphy eye of TT is to
Prevent occlusion
85
Explain sniffing position
Moderate head elevation (5-10 cm above the surgical table) and extension of the atlantooccipital joint place the patient in the desired sniffing position.
The lower portion of the cervical spine is flexed by resting the head on a pillow or other soft support
86
Best confirmation/definitive test of Tracheal placement of a TT
Earliest evidence of brachial intubation is
The persistent detection of CO2 by a capnograph is the best confirmation/definitive test of tracheal placement of a TT, it cannot exclude bronchial intubation.
The earliest evidence of bronchial intubation often is an increase in peak inspiratory pressure.
87
Proper tube location can be reconfirmed by
Proper tube location can be reconfirmed by palpating the cuff in the sternal notch while compressing the pilot balloon with the other hand. The cuff should NOT be felt above the level of the cricoid cartilage, because a prolonged intralaryngeal location may result in postoperative hoarseness and increases the risk of accidental extubation.
88
FOI is ideal for:
A small mouth opening
Minimizing cervical spine movement in trauma or rheumatoid arthritis
Upper airway obstruction, such as angioedema or tumor mass
Facial deformities, facial trauma
FOI can be performed awake or asleep via oral or nasal routes.
Awake FOI: predicted inability to ventilate by mask, upper airway obstruction
Asleep FOI: Failed intubation, desire for minimal C spine movement in patients who refuse awake intubation
Oral FOI: Facial, skull injuries
Nasal FOI: A poor mouth opening
89
Surgical Airway Jet ventilation
A 16- or 14-gauge intravenous cannula is attached to a syringe and passed through the CTM toward the carina. Air is aspirated. If a jet ventilation system is available, it can be attached. The catheter MUST be secured, otherwise the jet pressure will push the catheter out of the airway, leading to potentially disastrous subcutaneous emphysema.
Short (1 s) bursts of oxygen ventilate the patient. Sufficient outflow of expired air must be assured to avoid barotrauma. Patients ventilated in this manner may develop subcutaneous or mediastinal emphysema and may become hypercapnic despite adequate oxygenation.
Transtracheal jet ventilation will usually require conversion to a surgical airway or tracheal intubation.
90
If jet ventilation is not available
Should a jet ventilation system not be available, a 3-mL syringe can be attached to the catheter and the syringe plunger removed. A 7.0-mm internal diameter TT connector can be inserted into the syringe and attached to a breathing circuit or an ambu bag. As with the jet ventilation system, adequate exhalation must occur to avoid barotraumas.
91
Extubating Awake Patients
* Extubating an awake patient is usually associated with coughing (bucking) on the TT. This reaction increases the heart rate, central venous pressure, arterial blood pressure, intracranial pressure, intraabdominal pressure, and intraocular pressure.
* It may also cause wound dehiscence and increased bleeding. The presence of a TT in an awake asthmatic patient may trigger bronchospasm.
* Some practitioners attempt to decrease the likelihood of these effects by administering 1.5 mg/kg of intravenous lidocaine 1-2 min before suctioning and extubation; however, extubation during deep anesthesia may be preferable in patients who cannot tolerate these effects (provided such patients are not at risk of aspiration and/or do not have airways that may be difficult to control after removal of the TT).
92
2 types of patients you do not deep extubate
Difficult airway
| At risk for aspiration
93
Extubation criteria
RR< 30
NIF> 20 mmHg
Vital Capacity >15 ml/kg
Tidal Volume > 6ml/kg
Hemodynamically stable with no significant inotrope
Adequate NMB reversal (5 sec head lift )
Adequate gas exchange : no acidosis and o2 >93%
94
Ventricular Bigeminy during intubation means
Light anesthesia
95
What is Laryngospasm
Laryngospasm is a forceful involuntary spasm of the laryngeal musculature caused by sensory stimulation of the superior laryngeal nerve
96
Treatment of laryngospasm
Treatment of laryngospasm includes providing gentle positive-pressure ventilation with an anesthesia bag and mask using 100% oxygen.
Administering intravenous lidocaine (1-1.5 mg/kg). If laryngospasm persists and hypoxia develops, small doses of succinylcholine (0.25-0.5 mg/kg) may be required (perhaps in combination with small doses of propofol or another anesthetic) to relax the laryngeal muscles and to allow controlled ventilation
97
Proper TT placement capnography
Waveform decreases to 0 during inspiration and a Peak Plateau > 20 mmHg during exhalation
98
Sevo induction technique
* A technique for induction of anesthesia with sevoflurane includes priming the circuit (emptying the reservoir bag and opening the adjustable pressure-limiting [“pop-off”] valve), dialing the vaporizer setting to 8% while using a fresh gas flow of 8 L/min, and maintaining this flow for 60 seconds before applying the face mask to the patient.
* At this point a single breath from end-expiratory volume to maximum inspiration followed by deep breathing typically produces loss of consciousness in 1 minute.
99
What is MS MAID for ?
Preparation for Anesthesia
Machine
Suction
Monitor
Airway
IV
Drugs
100
Patients not good candidate for MAC
```
Children
Confused
Uncooperative
Retarded
Patients with tremors
Patients unable to lie down flat
Unmanageable Anxiety –previous poor anesthesia outcome
PTSD
```
101
Never do MAC with deep sedation on
```
Never do this on:
Patients with gastroesophageal reflux
Sleep apnea
Sick sinus syndrome
Mediastinal masses or tumors
```
102
Urinary Output
0.5- 1 ml/kg/hr
103
Is HCT a good indicator of Blood Volume ?
Hemoconcentration (hct is a poor indicator of blood volume). High Hct means the patient is dry
104
Physical signs and symptoms of Hypovolemia:
Supine Hypotension
(implies blood volume deficit greater than 30%)
Orthostasis or Positive tilt test
( increases in HR greater than 20 beats/min and decreases in systolic BP greater than 20 mmHg when the patient assumes the standing position)
Oliguria
105
Lab evidence of hypovolemia
Hemoconcentration (hct is a poor indicator of blood volume). High Hct means the patient is dry
Azotemia (nitrogenous products in blood)
Low urine sodium concentration (less than 20 meq for every 1000 ml of urine)
Metabolic alkalosis
Metabolic acidosis (reflects hypoperfusion). Due to Na++ reabsorption
106
Crystalloids last for
20 - 30 minutes
107
Be careful using LR in
Lactated Ringers-
use caution in renal patients d/t K+ accumulation
Has electrolyte composition most resembling ECF
pH is around 6.6 (kind of acidic)
Lactate is converted to bicarbonate= can cause metabolic alkalosis !!
108
1/2 life of colloids
3 - 6 hours
109
The predicted daily maintenance fluid requirements for healthy adults may exceed
2500ml/day.
110
Maintenance Fluid
Maintained with isotonic solution
4cc/kg for the 1st 10kg of body weight (Up to 10 kg)
2cc/kg for the next 10kg of body weight second 10 kg
1cc/kg for the rest of the body weight (21 kg and above)
This formula works for children and adults
In an adult weighing over 20kg, just add 40 to the weight to find the maintenance rate
111
Shortcut math for Maintenance
In an adult weighing over 20kg, just add 40 to the weight to find the maintenance rate
112
Another option for hourly maintenance (approximation) in the adult patient is to use
1.5 cc/Kg/hr
113
NPO Deficit =
Hr. maint. X Hrs. NPO
114
NPO replacement and Maintenance
Hr 1 = ½ NPO def + hr maint.
Hr 2 = ¼ NPO def + hr maint.
Hr 3 = ¼ NPO def + hr maint.
115
Adjusted Body weight
Actual Body weight + Ideal Body weight
—————————————————
2
116
Ideal Body Weight
First 5 feet = 100 pounds then
For females add 5 pounds for every inch above 5 feet
For males add 7 pounds for every inch above 5 feet
117
What is Obesity
Obesity is 20 % above the ideal body weight
Morbid obesity is twice the IDEAL BODY WEIGHT
For obese patients calculate fluid and drugs required according to the adjusted body weight
118
Add it all together
```
NPO Deficit +
Hourly maintenance +
Third space losses =
Rate of fluid administration 1st/2nd/3rd/4th hour+
Blood loss
```
119
Normal Blood volume in male, female, adult, Infant, Full term, Premature
Adult male: 75 ml X Wt in Kg
Adult female: 65 ml X Wt in Kg
Obese: 70 X Wt in Kg
Infant: 80 ml X Wt in Kg
Full term: 85 ml X Wt in Kg
Premature: 95 ml X Wt in Kg
120
Allowable Blood Loss
Allowable
Blood = EBV X (Starting hct-Target hct)
—————————————
Loss starting hct
121
Sponges and Lap sponges soaked
Fully soaked sponge (4 x 4) 10 ml of blood
Fully soaked lap sponge 100 – 150 ml of blood
To be more accurate weigh sponges/laps. Most commonly done in pediatrics
122
You can or replace blood loss with crystalloid when ?
Acute blood losses in the range of 1500 to 2000ml (or approximately 30% of EBV) exceed the ability of crystalloids to replace without jeopardizing O2 carrying capacity of the blood
Compensatory mechanisms maintain homeostasis up until that point
123
When to consider blood replacement
15 % loss should be consideration for replacement. The Hct should be used as a guide for determining blood replacement
124
How many % blood loss is well tolerated ?
10 %
125
Once anemia risk is greater than risk of transfusion, blood loss is replaced with blood to maintain:
Hgb 7 – 8 grams/dl
| Hct 21 – 24 %
126
Blood, Colloid, Crystalloid ratio
Blood is replaced unit per unit loss with PRBCs 1:1
Crystalloids 3:1
3 ccs of crystalloids (LR or NS) per each 1 cc blood loss
Colloids 1:1
1 cc of colloid per each cc of blood loss, until transfusion point is reached
They do not have O2 carrying capacity. Colloids stay intravascularly.
127
Whole Blood
Whole blood
Not readily available because it is better utilized by components
450ml blood with 63ml anticoagulant
Generally WB will increase HCT 3-4% per unit in a 70kg non-bleeding adult
Indicated in acute blood loss >30% of EBV
If over 24hrs old, no viable platelets, and factors V and VIII are markedly reduced
128
PRBC
Packed RBCs
Remember PRBCs restore O2 carrying capacity but do not contain any plasma proteins important for coagulation
Removal of plasma removes fibrinogen (factor I)
High viscosity, so many providers dilute with 100-200ml of appropriate crystalloid
HCT of PRBCs 60-70%
129
1 unit PRBC will raise the HgB and the HCT by ?
| 10ml.kf PRBC will raise the HgB and the HCT by ?
1 unit of PRBCs will raise the Hgb 1 Gm/dl
1 unit of PRBCs will raise the Hct approx. 3%
10 ml/kg transfusion PRBCs will increase hgb by 3 g/dl
10 ml/kg transfusion of PRBCs will raise hct by 10%
130
1 unit platelet will raise PLT by
One unit increases PLT count 5-10k
131
FFP Dose , all coag present except ..., what lab indicates need to replace ? Risk ?
Fresh Frozen Plasma
Dose 10-15 ml/kg
All coagulation factors except platelets are present
Most providers judge need based on PT and PTT being 1.5 times greater than preoperative level
Risk of viral illnesses (Hepatitis) and transfusion reaction
132
5 rights
```
PATIENT
DRUG
DOSE
ROUTE
TIME
STILL MUST CHECK BLOOD WITH A LICENSED PERSON. MUST CHECK BY BLOOD BAND…..EVERY TIME
```
133
MH
INCREASE AND CONTINUOUS LEAKING OF CALCIUM FROM FROM RYANODINE RECEPTORS OF THE SARCOPLASMIC RETICULUM.
SUSTAINED CONTRACTION
INCREASE IN METABOLISM
* mostly young male
134
Late sign of MH
PROLONGED MUSCLE RIGIDITY CAUSES INCREASE IN TEMPERATURE (LATE SIGN). CORE TEMP CAN RISE AS MUCH AS 1o C every 5 minutes.
135
Earliest sign of MH
EARLIEST SIGN: SUCCINYLCHOLINE INDUCED MASSETER MUSCLE RIGIDITY (MMR) AND/OR OTHER MUSCLE RIGIDITY
136
Most sensitive sign
UNANTICIPATED DOUBLING OR TRIPLING OF ETCO2 IN ABSENCE OF VENT CHANGES IS ONE OF THE EARLIEST AND MOST SENSITIVE INDICATORS OF MH
137
Most MH deaths are due to
DEATHS ARE DUE TO DIC AND ORGAN FAILURE D/T DELAYED OR NO TREATMENT WITH DANTROLENE
138
Muscolosketal diseases that increase risk of MH
MUSCULOSKELETAL DISEASES:
Central-Core Disease
Multi-Minicore Myopathy
King-Denborough Syndrome
139
ANY PATIENT WHO DEVELOPS MMR DURING INDUCTION SHOULD BE CONSIDERED POTENTIALLY SUSCEPTIBLE TO MH
True
