Week 13 Handout - 4th Flipped Classroom Flashcards
What does the left main artery supply?
LAD: supplies septum and anterior LV; Circumflex: supplies lateral LV and part of LA
(Barash et al., 2022, pp. 1051-1052)
What does the right coronary artery supply?
Supplies RA, RV, and inferior LV; typically gives rise to PDA supplying posterior septum and inferior LV
(Barash et al., 2022, pp. 1051-1052)
Define Coronary Artery Disease (CAD).
Atherosclerotic narrowing of coronary arteries leading to decreased myocardial O₂ supply and increased relative O₂ demand
(Barash et al., 2022, pp. 1051-1052)
What are the leading causes of perioperative morbidity and mortality?
Coronary Artery Disease (CAD)
List three risk factors for Coronary Artery Disease.
- Hypertension (HTN)
- Diabetes Mellitus (DM)
- Smoking
What is Coronary Perfusion Pressure (CPP)?
CPP = DBP − LVEDP
(Nagelhout et al., 2023. pp. 349, 480-481, 487-488, 546-547)
What is a classic sign of CAD?
Angina pectoris: stable, unstable, or variant (Prinzmetal’s)
What are common clinical manifestations of myocardial infarction?
- Chest pain
- Diaphoresis
- Nausea
- Dyspnea
- Hypotension
True or False: Over 50% of perioperative myocardial infarctions are silent.
True
Especially in elderly and diabetic patients (Barash et al., 2022, pp. 1050-1052)
Who needs revascularization?
- Left main disease
- Triple-vessel disease + decreased LV function
- Unstable angina
What are the indications for Coronary Artery Bypass Grafting (CABG)?
- Multivessel ± proximal LAD
- Two-vessel + proximal LAD
- Severe ischemia without LAD
- Failed PCI / not suitable for PCI
(Nagelhout et al., 2023. p. 547)
What should be assessed in a preoperative assessment for CAD?
- Symptoms
- Medications
- ECG
- Echocardiogram
- Cardiac history
What is the Revised Cardiac Risk Index (RCRI) used for?
To estimate perioperative cardiac risk
Fill in the blank: Continue _______ and statins if prescribed perioperatively.
beta-blockers
What should be done if a patient is less than 30 days post-myocardial infarction?
Delay elective surgery
What is the risk of reinfarction within 30 days post-MI?
33%
What should be monitored postoperatively in high-risk CAD patients?
- Dysrhythmias
- Ischemia
- Bleeding
- Hypotension
What are some anesthetic agents used for CAD patients?
- Phenylephrine
- Norepinephrine
- Esmolol
- Opioids
- Beta-blockers
- Sevoflurane
- Nitroglycerin
What is the goal of anesthesia management for CAD patients?
Maintain CPP and balance myocardial oxygen supply and demand
What are the ECG leads recommended for ischemia detection?
Leads II, V4, and V5
What should be avoided to minimize myocardial ischemia risk?
Increased heart rate and decreased blood pressure
What is the significance of maintaining oxygen saturation above 95%?
To prevent myocardial ischemia
Fill in the blank: The risk of post-MI mortality if reinfarction occurs is _______.
50%
What is Obstructive Sleep Apnea (OSA)?
A sleep disorder characterized by repeated interruptions in breathing during sleep.
What does the STOP-BANG assessment evaluate?
It assesses the risk of obstructive sleep apnea.
What are intraoperative concerns for patients with OSA?
- Difficult mask ventilation
- Difficult laryngoscopy
- Sensitivity to opioids and benzodiazepines
What postoperative concerns exist for patients with OSA?
- Longer PACU stay for prolonged SPO2 monitoring
- Possible admission to a monitored bed
- Potential disqualification for same-day discharge
- May need to bring home CPAP
What is Chronic Obstructive Pulmonary Disease (COPD)?
A progressive lung disease that causes breathing difficulties.
What should be assessed preoperatively for patients with COPD?
- Recent exacerbations
- Respiratory function using GOLD classification or BODE score
What do lower BODE scores indicate?
Better postoperative survival rates.
What is a significant intraoperative concern regarding induction agents for COPD patients?
Avoid neuraxial anesthesia as it decreases ERV and restricts accessory muscle use.
What is the risk of using Nitrous Oxide in COPD patients?
It can cause bullae to expand and rupture.
What ventilator management strategies should be employed for COPD patients?
- Prevent barotrauma from high inspiratory pressures
- Avoid full correction of chronic hypercapnia
- Reduce air trapping
What are common postoperative concerns for COPD patients?
They may require continued intubation and mechanical ventilation.
What should be assessed preoperatively for asthma patients?
How well controlled their asthma is.
What are red flags indicating increased risk for pulmonary complications in asthma patients?
- Frequent use of inhaler
- ER visit in last 30 days
- Frequent nocturnal awakenings with difficulty breathing
- Recent increases in medication
- Signs of viral infection
What is a primary intraoperative concern for asthma patients?
Prevent exacerbation and bronchospasm.
What are preferred induction agents for asthma patients?
- Propofol
- Ketamine
- Sevoflurane
What should be avoided in asthma patients during induction?
- Desflurane
- Isoflurane
- Atricurium
- Mivacurium
- Morphine
- Beta Blockers
What is the preferred reversal agent for neuromuscular blockade in asthma patients?
Sugammadex.
What are signs of pulmonary hypertension?
- Hypoxemia
- Hypercarbia
- Acidosis
What should be done preoperatively for patients with pulmonary hypertension?
- Do not discontinue any PAH medications
- Perform ECG, echocardiogram, chest x-ray, and ABG assessments
What are early signs of pulmonary embolism?
- Tachycardia
- Decreasing/variable ETCO2 waveform
- Moderate hypoxemia without CO2 retention
- Hypotension
What is the treatment for bronchospasm?
- Deepen anesthesia with volatile agent (Sevo)
- Propofol
- Ketamine
- Lidocaine
- 100% FiO2
What is a key characteristic of restrictive lung disease?
Difficulty fully expanding the lungs during inhalation.
What defines restrictive lung disease (RLD)?
Total lung capacity (TLC) less than the 5th percentile.
What are the types of restrictive lung disease?
- Intrinsic
- Extrinsic
- Neuromuscular
What is pneumoconiosis?
Any lung disease caused by the inhalation of organic or nonorganic airborne dust and fibers.
What is the hallmark of sarcoidosis?
Epithelioid-cell granulomata.
What causes pneumonitis?
Inflammation of lung tissue often due to irritants or allergens.
What is a definition of ARDS?
Severe inflammation and damage to the alveolar-capillary membrane.
What is flail chest?
Paradoxical chest wall movement due to multiple rib fractures.
What is Flail Chest?
Results from chest trauma with multiple rib fractures; occurs in ~5% of thoracic injuries.
What is the primary characteristic of Flail Chest?
Paradoxical chest wall movement — inward during inspiration, outward during expiration — due to segmental instability.
What causes Pneumothorax?
Air enters the pleural space, causing partial or complete lung collapse.
What are the classifications of Pneumothorax severity?
- Small: ≤15% lung collapse
- Moderate: 15–60% collapse
- Large: >60% collapse
What is the preoperative anesthetic consideration for patients with respiratory issues?
Thorough pulmonary assessment (PFTs, ABGs, imaging).
What should be optimized in preoperative anesthetic considerations?
Comorbid conditions (e.g., pulmonary hypertension).
When should bronchodilators/steroids be continued?
If prescribed.
What preoperative procedure may be considered for respiratory patients?
Pre-op pulmonary rehab or incentive spirometry.
What is preferred during intraoperative anesthesia when feasible?
Regional anesthesia.
What should be minimized during intraoperative anesthesia?
Sedation to prevent hypoventilation.
What strategies should be used during intraoperative anesthesia?
Lung-protective strategies (low tidal volume, higher RR).
What should be avoided to prevent complications during intraoperative anesthesia?
High peak airway pressures.
What should be monitored closely during anesthesia?
Hypoxia and CO₂ retention.
How should PEEP be used during anesthesia?
Cautiously to avoid barotrauma.
What is a key postoperative anesthetic consideration?
Aggressive pulmonary hygiene.
What is recommended for postoperative recovery?
Early mobilization.
What may be required postoperatively as needed?
Supplemental oxygen or ventilatory support.
What complications should be monitored for postoperatively?
Respiratory failure or atelectasis.
Why does altered airway anatomy matter in anesthesia?
It impacts airway management and is crucial for CRNAs.
What percentage of patients were impossible to intubate in the study?
28%.
What was the difficult intubation rate in the study?
4 out of 181 patients could not be intubated at all.
What are the two categories of altered airway anatomy?
- Congenital
- Acquired
Name three congenital anomalies related to altered airway anatomy.
- Pierre Robin syndrome
- Treacher Collins syndrome
- Down syndrome
List some acquired anomalies that can affect airway anatomy.
- Tumors
- Burns
- Neck trauma
- Obesity
- OSA
- Previous radiation
What is a key impact of facial anomalies on airway management?
Poor mask seal.
What anatomical distortions can complicate laryngoscopy?
- Neck masses
- Tumors
- Airway trauma
- Edema
What can restrict cervical spine mobility and complicate airway management?
Trauma or degenerative diseases.
What is the first step in managing difficult airways?
Anticipate difficulty by reviewing previous intubation challenges.
What should be included in a preoperative assessment for difficult airways?
- Mallampati score
- Thyromental distance
- Neck mobility
What are the components of Plan A in difficult airway management?
Video or direct laryngoscopy with optimal positioning.
What is the purpose of awake intubation in high-risk cases?
To maintain spontaneous breathing until the airway is secured.
What should be activated when managing a difficult airway?
Difficult airway protocol with clear role assignments.
What does the ASA Difficult Airway Algorithm suggest if you can ventilate but can’t intubate?
Try alternative approaches.
How many attempts are recommended for each Plan in difficult airway management?
Maximum 3 attempts.
What are some medications used for sedation in anesthesia?
- Midazolam
- Dexmedetomidine
- Fentanyl
- Remifentanil
What is the role of antisialogogue in anesthesia management?
To reduce saliva for better local anesthetic penetration.
What is a key complication during awake intubation?
Laryngospasm.
What should be prepared in advance when planning an awake intubation?
Emergency surgical airway capability.
What is a potential risk of administering succinylcholine during intubation?
Worsening obstruction due to muscle relaxation.
What is essential for patient safety when managing a difficult airway?
A systematic approach to airway assessment and preparation.
What was the outcome of the case study involving a 58-year-old male with a history of laryngeal cancer?
Procedure completed without complications.
Fill in the blank: Diabetes is the most common ______ disorder among surgical patients.
endocrinological
Approximately what percentage of the US population is affected by diabetes?
Over 10.5%.
What disruption does diabetes manifest as?
Disruption in the metabolism of glucose.
What percentage of diabetic patients will require surgery at some point in their lifespan?
Approximately 25-50%.
What percentage of the US population is affected by diabetes?
Approximately 25-50% of diabetic patients will require surgery at some point in their lifespan
The source mentions 25-50% of patients may require surgical intervention.
What are the subtypes of diabetes?
- Type I
- Type 2
- Gestational
What characterizes Type 1 Diabetes?
Autoimmune destruction of the pancreatic beta cells, leading to absolute insulin deficiency
Diagnosis often occurs early in life, associated with increased end-organ complications.
What is the primary treatment for Type 1 Diabetes?
Reliant upon exogenous insulin to control hyperglycemia.
What happens in the absence of insulin in Type 1 Diabetes?
Glucagon rises causing serum glucose to elevate, leading to osmotic diuresis and hypovolemia.
What is the predominant form of diabetes?
Type 2 Diabetes, with close to 90% of patients exhibiting this form.
What characterizes Type 2 Diabetes?
Insulin resistance, progressive loss or decrease in insulin secretion, and eventual elevated hepatic glucose production.
What lifestyle factors contribute to Type 2 Diabetes?
Rising levels of obesity are contributing to an increased and earlier diagnosis.
What are the treatment options for Type 2 Diabetes?
- Lifestyle changes
- Oral glucose-lowering agents
- Exogenous insulin supplementation
What are the risks associated with Gestational Diabetes?
- Macrosomia
- Intrauterine fetal demise
- Neonatal hypoglycemia
- Predisposition to Type 2 diabetes post-pregnancy
What is the critical glycemic control level to decrease risks in Gestational Diabetes?
Maintain glucose levels within 60-120 mg/dL.
What is the predominant method for diagnosing diabetes?
Hemoglobin A1c (HbA1c) for diagnosis with levels > 6.5%.
What are the preoperative goals for diabetic patients?
- Determine if necessary for preoperative intervention
- Schedule case early in the day
- Maintain glucose within 140-180 mg/dL
What is the recommended management for insulin prior to surgery?
- Decrease long-acting by 20% the night prior
- Discontinue short-acting insulin the morning of surgery
- Discontinue oral antihyperglycemic agent the night prior
What are common end-organ complications of diabetes?
- Cardiovascular complications
- Autonomic neuropathy
- Diabetic nephropathy
- GI neuropathies
What is a notable impact of diabetes on cardiovascular health?
Increased risk of intraoperative hypotension, hypothermia, and sympathetic response to intubation.
What is the preferred method of glucose management perioperatively?
Continuous IV infusion.
What should be monitored postoperatively in diabetic patients?
- Blood glucose checks
- Insulin administration
- Awareness of potential cardiovascular changes
What does precise glucose monitoring prevent during the surgical process?
Prevents adverse events from occurring.
What should be considered for the anesthetic plan in diabetic patients?
It should be highly individualized for the present condition and extent of the procedure.
What percentage of adults in the U.S. are classified as obese?
75%
This classification refers to individuals with a BMI greater than or equal to 30 kg/m².
By what percentage has obesity in individuals 20 years and older increased since 1994?
19%
This statistic highlights the rising trend of obesity over the years.
What is the increased risk of death for individuals with obesity in the U.S.?
10-50% higher risk of death from all causes
This includes risks associated with surgery.
What does BMI stand for and how is it calculated?
Body Mass Index; calculated as weight (in kg)/height (in meters squared)
BMI is a measure used to categorize individuals based on body fat.
What is the BMI range for overweight individuals?
25-29 kg/m²
This classification is part of the BMI categorization.
What is the BMI threshold for severe obesity?
> 40 kg/m²
This indicates a significantly higher risk for health complications.
What is the purpose of calculating Ideal Body Weight (IBW)?
To correlate with the lowest morbidity/mortality for a given population
Useful for certain drug calculations to prevent toxicity.
List four cardiac history considerations for physical assessment.
- Exercise intolerance
- Prior myocardial infarction (MI)
- Hypertension (HTN)
- Angina
These factors can affect anesthesia management.
What respiratory history considerations should be assessed?
- Orthopnea
- Wheezing
- Sputum production
- Obstructive sleep apnea
Important for understanding the patient’s respiratory status.
What gastrointestinal conditions should be assessed in obese patients?
- GERD
- Hiatal hernia
- Gallstones
- Pancreatitis
- Dyspepsia
- NAFLD
These conditions can impact surgical procedures.
What endocrine symptoms may indicate dysfunction in obese patients?
- Oligomenorrhea
- Menorrhagia
- Hirsutism
These symptoms can suggest issues with thyroid, adrenal cortex, or pituitary gland.
Fill in the blank: Obesity creates a higher risk for ________ and gastric reflux.
hiatal hernia
This can subsequently increase the risk for aspiration.
What is the recommended awake intubation criteria for patients?
BMI >50 or other risk factors such as OSA
Awake intubation is advised to mitigate aspiration risks.
What equipment should be ensured for preoperative considerations?
- Correct size equipment
- Difficult airway equipment
- Monitoring equipment
These considerations are crucial for managing obese patients effectively.
What should be avoided in airway placement for obese patients?
Sniffing positioning
Ramp shoulders and head instead to promote adequate ventilation.
What are the recommended intraoperative ventilator settings for obese patients?
- FiO2 <0.8
- PEEP 10-12 cmH2O
- Tidal volume 6-10 mL/kg ideal body weight
These settings help prevent complications such as atelectasis.
What pharmacokinetic changes are associated with obesity?
- Increased adipose
- Cardiac output
- Blood volume
- Lean body weight
- Renal clearance
These changes affect medication dosing and efficacy.
What is the treatment protocol for rhabdomyolysis in bariatric surgeries?
- Fluids
- Bicarb
- Mannitol
Early recognition and treatment are essential to prevent renal failure.
What are the four main risk factors for thromboembolism after bariatric surgery?
- BMI of 60
- Truncal obesity
- Obesity hypoventilation syndrome/sleep apnea
These factors significantly increase the likelihood of postoperative complications.
What is the STOP-BANG questionnaire used for?
To assess the risk of obstructive sleep apnea (OSA)
It includes questions about snoring, tiredness, observed apnea, and other risk factors.
What chronic conditions are linked to obstructive sleep apnea?
- Atherosclerosis
- Hypertension
- Stroke
- Diabetes
- Heart failure
These associations underline the importance of diagnosing and treating OSA.
What chronic conditions can result from chronic hypoxemia and hypercapnia associated with OSA?
Obstructive Sleep Apnea has been linked to:
* Atherosclerosis
* Hypertension/Pulmonary HTN
* Stroke
* Diabetes
* Insulin resistance
* Dyslipidemia
* Heart failure
* Ischemic heart disease
Chronic conditions associated with OSA can significantly impact overall health.
How is obstructive sleep apnea diagnosed?
Diagnosed by polysomnography
Polysomnography is an extensive sleep study that monitors various body functions during sleep.
What is the gold standard treatment for obstructive sleep apnea?
CPAP
Continuous Positive Airway Pressure (CPAP) is the most common and effective treatment for OSA.
What are the classifications of the number of abnormal respiratory events per hour of sleep?
Mild = 5-15
Moderate = 15-30
Severe = >30
These classifications help determine the severity of obstructive sleep apnea.
What are some alternative treatments for obstructive sleep apnea?
Alternatives include:
* Hypoglossal nerve stimulator
* Surgery to remove excess tissue
* Adjunctive analeptic drugs
These alternatives may be considered based on individual patient needs and circumstances.
What is a critical pre-anesthesia consideration for patients with OSA?
Go in with a plan
Planning is essential to manage the unique challenges posed by OSA during anesthesia.
What can small doses of anesthetic agents cause?
May cause severe reactions
Patients with OSA may be more sensitive to anesthetic agents, necessitating careful dosing.
What strategies are recommended for difficult airway management in patients with OSA?
Strategies include:
* Fiberoptic awake intubation
* Video laryngoscope and other adjuncts
These strategies are critical for ensuring safe intubation in patients at risk of airway complications.
What are some anesthesia complications associated with OSA?
Complications include:
* Difficult Airway
* Difficult intubation
* Difficult ventilation
* Increased airway complications from opioids
* Risk of hypoxia from Propofol
* Increased risk of postoperative failure from neuromuscular blockade
Awareness of these complications is crucial for anesthesiologists treating patients with OSA.
What should be ensured during extubation in patients with sedative agents still effective?
Extubation with sedative agents still in effect can lead to airway obstruction
Proper timing for extubation is essential to prevent complications.
What monitoring is crucial post-anesthesia for patients with OSA?
Ensure:
* Close monitoring
* EtCO2
* Pulse oximetry
* Patient brings home CPAP
* Prolonged PACU time if severe
Close monitoring can help prevent serious complications post-surgery.
True or False: Life-threatening complications from obstructive sleep apnea can arise during procedures requiring anesthesia.
True
Identifying and managing the risk of sleep apnea is vital for patient safety during anesthesia.
Fill in the blank: It is important to ________ the patient’s respiratory status post-surgery.
Closely monitor
Continuous assessment is key to ensuring patient safety.
What should be avoided as much as possible when formulating a plan for anesthesia induction in patients with OSA?
CNS depressing agents
Avoiding these agents can help reduce the risk of complications.
What is the relevance of CHF to anesthesia?
CHF affects cardiac output, fluid balance, and oxygenation, making anesthesia challenging.
This reduces the heart’s ability to handle perioperative stress.
What are the mortality estimates for patients with CHF undergoing surgery?
10% for elective surgery to as high as 30% for abdominal surgery.
Heart failure is a major independent predictor of adverse perioperative outcomes in noncardiac surgery.
What causes heart failure?
An insult that alters perfusion and leads to a state of neurohumoral imbalance.
The myocardium is unable to pump enough blood to satisfy the body’s metabolic demands.
What compensatory mechanisms are activated in heart failure?
Activation of the SNS, RAAS system, and ventricular remodeling (hypertrophy).
Neurohormonal activation worsens fluid retention and increases risks of tachycardia and arrhythmias.
What does the NYHA Functional Classification categorize?
Functional status and prognosis of heart failure patients.
It includes four classes: I (Mild), II (Slight), III (Moderate), IV (Severe).
What does Stage A of the ACC/AHA Staging represent?
High risk for heart failure with no structural disease.
Example: Patient with hypertension or diabetes mellitus.
What is the goal of preoperative evaluation in CHF patients?
Stabilize the patient before surgery to prevent cardiac decompensation.
This includes addressing underlying diseases and optimizing medications.
What is the normal range for ejection fraction (EF)?
> 50-60%.
Mild dysfunction is 41-49%, moderate dysfunction is 26-40%, and severe dysfunction is < 25%.
What are standard monitors used during anesthesia?
ECG, NIBP, SpO₂, ETCO₂.
Advanced hemodynamic monitoring may include arterial lines and TEE.
What does the Frank-Starling Law describe?
The relationship between myofibril stretching during diastole and the ejected stroke volume.
Increased preload can lead to a greater force of contraction, but this may not correlate well in CHF patients.
What is the main goal of drug therapy for arrhythmias during anesthesia?
Correct electrolyte imbalances, treat hemodynamic abnormalities, and prevent progression of the arrhythmia.
Common arrhythmia in CHF include Atrial Fibrillation (AFib).
What are the benefits of regional anesthesia in CHF patients?
Less anesthetic drug requirements, possibly less hypotension or cardiac depression.
Risks include potential bradycardia and hypotension.
What is a significant postoperative consideration for patients with an EF of less than 35%?
Higher incidence of postoperative heart failure and death.
Multimodal analgesia should be used with caution, especially with NSAIDs.
What should be done for fluid management in CHF patients?
Diuresis if needed due to fluid shifts and maintain adequate oxygenation.
Early mobilization is also important.
What is the impact of psychiatric disorders on anesthesia response?
Psychiatric disorders can potentiate the effects of anesthesia drugs and may cause crises perioperatively when medications are stopped abruptly.
List some psychiatric disorders that can affect anesthesia.
- Bipolar disorder
- Depression
- Schizophrenia
- PTSD
- Anxiety
- Substance abuse disorder
- Delirium
What are the common characteristics of depression?
- Imbalance of GABAergic and glutamatergic activity
- Deficiency of neurotransmitters like dopamine, norepinephrine, and serotonin
- High risk of suicidal ideation
What are some treatment options for depression?
- Tricyclic antidepressants
- SSRIs
- SNRIs
- MAO inhibitors
- ECT (Electroconvulsive Therapy)
True or False: Anxiety is linked to GABA dysfunction.
True
What is the relationship between PTSD and anesthesia?
PTSD can be linked to GABA dysfunction and may cause increased anxiety and cortisol levels, delaying recovery.
What are the symptoms of schizophrenia?
- Poor grooming
- Disorganized behavior
- Delusions
- Hallucinations
- Emotional detachment
What is the recommended treatment for substance abuse disorders?
- Monitor for withdrawal symptoms
- Administer opioids or benzodiazepines as needed
- Postpone elective surgeries if necessary
What characterizes bipolar disorder?
It is characterized by manic episodes alternating with depressive episodes.
What is the narrow therapeutic range for lithium therapy?
0.8–1.0 mEq/L
What are the early signs of lithium toxicity?
- Confusion
- Sedation
- Muscle weakness
- Tremor
- Slurred speech
What is the role of anesthesia providers in Electroconvulsive Therapy (ECT)?
Anesthesia providers administer general anesthesia to ensure amnesia and prevent injuries during the procedure.
Fill in the blank: Preoperative assessment of __________ is vital to obtain any psychiatric history.
mental status
What should be done for patients with chronic schizophrenia preoperatively?
Continue antipsychotics to prevent delirium and agitation postoperatively.
What are the risks associated with SSRIs and SNRIs during surgery?
They can increase bleeding risk due to inhibiting serotonin reuptake by platelets.
What are some signs of anxiety in children aged 2 to 10?
Exhibit separation anxiety.
True or False: Patients with dementia are candidates for regional anesthesia.
False
What are the side effects associated with lithium therapy?
- Mild leukocytosis
- T-wave changes (reversible)
- Hypothyroidism
- Diabetes insipidus-like syndrome
What is a common treatment for patients with anxiety disorders?
- SSRIs
- SNRIs
- Benzodiazepines
- Beta-blockers (e.g., propranolol)
What is a major concern when treating patients with substance abuse issues perioperatively?
Patients may go into withdrawal, causing seizures if not given the required substances.
What medications should be continued preoperatively in patients with depression, anxiety, PTSD, and alcohol dependence?
SSRIs, SNRIs, and benzodiazepines
These medications help prevent withdrawal symptoms.
What is a potential intraoperative risk associated with SSRIs and SNRIs?
Increased bleeding risk due to inhibition of serotonin reuptake by platelets
This is based on the findings of Elisha et al. (2023).
How do SSRIs and SNRIs metabolize?
They are metabolized by the CYP450 system in the liver
Many drugs used in the operative room also utilize the CYP450 system.
What syndrome can be caused by MAOIs, SSRIs, and TCAs?
Serotonin syndrome
Symptoms include anxiety, tachycardia, delirium, seizures, hypertension, and muscle rigidity.
What effect do TCAs have on the MAC of inhalation agents?
TCAs increase the MAC of inhalation agents
This finding is documented by Elisha et al. (2023).
What is the therapeutic range for Lithium?
0.8 to 1.0 mEq/L
Lithium can cause prolonged neuromuscular blockade and cardiac effects.
What is the effect of Lithium on MAC?
It decreases MAC due to blocking norepinephrine and epinephrine
This means a lower dose is needed to induce and maintain anesthesia.
What is a common postoperative complication in elderly patients?
Postoperative delirium
This is especially prevalent in patients with preoperative cognitive impairment.
What condition is emergence delirium commonly associated with?
Pediatrics
Elisha et al. (2023) note this as a frequent occurrence.
Which patient populations are more likely to experience complications from emergence delirium?
Elderly, schizophrenia, and bipolar patients
These populations face higher risks for cognitive dysfunction.
What do anticholinergic agents like atropine and scopolamine increase the risk of?
Postoperative sedation, confusion, and delirium
This risk is heightened in patients on psychiatric medication.
What is the effect of TCAs such as Amitriptyline on anticholinergic symptoms?
They potentiate anticholinergic symptoms
This effect is supported by Butterworth et al. (2022).
What can decrease the risk of emergence delirium?
Administration of dexmedetomidine
It should be given 15 to 20 minutes before the end of the procedure.
What is a consequence of preexisting psychiatric disorders in patients using sedative medication?
Delayed awakening
This effect is noted by Elisha et al. (2023).
What psychiatric conditions alter patients’ physiological and psychological responses to anesthesia?
Depression, anxiety, PTSD, bipolar disorder, and substance abuse
These conditions significantly impact anesthetic requirements.
What neurotransmitters are key in psychiatric conditions affecting anesthesia?
Dopamine, norepinephrine, serotonin, GABA, and glutamate
Imbalances in these neurotransmitters play a crucial role.
What should be done to prevent adverse drug interactions and complications?
Thorough psychiatric history and medication review
This is essential for safe anesthesia management.
When should elective surgery be postponed?
In actively intoxicated or withdrawing substance-abuse patients
This is to ensure patient safety.
What monitoring is required for patients on Lithium?
Monitoring due to its narrow therapeutic range
Lithium can prolong neuromuscular blockade and decrease MAC.
What must be individualized in anesthesia planning?
Intraoperative anesthesia plan
This is necessary due to medication interactions and hemodynamic instability.
What should postoperative care address?
Withdrawal, pain, and mental health stability
This is crucial for holistic patient recovery.
