Wrongs Flashcards
PONV ppx to give for pt with ONE PONV risk factor
glucocorticoid AND 5HT3 antagonist combo
neonate with persistent cyanosis and HR < 100 requires…
After warming, drying, stimulation—> supplemental oxygen, suction, open airway–> if pt apneic or HR still < 100 bpm, POSITIVE PRESSURE VENTILATION / ETT if needed (target preductal oxygen saturation (pulse oximeter is placed on the right upper extremity) of 60-65% by 1 minute of life and 85-95% by 10 minutes of life–> if HR < 60 bpm, start chest compressions (3 compressions to every 1 breath). After positive pressure ventilation, intubation, and chest compressions, if the neonate fails to improve, can try epi
Retrograde cardioplegia
- Delivery of cardioplegia solution into the cardiac veins via the coronary sinus
- Offers superior myocardial protection in the setting of severe obstructive coronary artery disease (CAD), aortic insufficiency (AI), or surgeries involving significant manipulation of aortic valve or coronary ostia
blood:gas partition coefficient
-ratio of gas dissolved in the blood and the alveoli at equilibrium (how the gas will partition between the blood and the alveoli after equilibrium has been reached)
-A larger coefficient = higher solubility in blood= slower onset of action because more anesthetic must be dissolved before it equilibrates with tissue of final action, the central nervous system
What is responsible for phase 2 of the cardiac action potential?
Phase 2= plateau phase
Calcium influx into the cardiac myocyte via slow L-type calcium channels
main mechanism of beta-blockers in reducing mortality in patients with heart failure
interupts signaling at myocardial beta1-adrenergic receptors, which prevents metabolic catecholamine cardiotoxicity
Medical direction vs. medical supervision
For medical direction, the physician must:
- perform a preanesthetic examination and evaluation;
- prescribe the anesthetic plan;
- personally participate in the most demanding procedures in the anesthesia plan, including, if applicable, induction and emergence;
- ensure that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified individual;
- monitor the course of anesthesia administration at frequent intervals;
- remain physically present and available for immediate diagnosis and treatment of emergencies; and
- provide indicated post-anesthesia care
Jugular bulb venous oxygen saturation monitoring (SjVO2)
- assesses the degree of cerebral oxygen extraction by measuring the mixed venous oxygen saturation in the jugular venous bulb
- represents the balance between global cerebral oxygen supply and demand
- The supply is determined by cerebral blood flow (CBF), arterial oxygen content (CaO2), and hemoglobin concentration (Hgb). The demand is determined by the cerebral metabolic rate (CMRO2).
mortality in phosgene exposure is related to
degree of pulmonary damage
Compared to on-request intravenous opioid (given by nurses), IV opioid PCA has overall HIGHER…
- higher opioid consumption
- higher rates of pruritus
For healthy pediatric patients >6 months undergoing elective surgery, current perioperative fluid management guidelines recommend
a bolus of 20 to 40 mL/kg of isotonic solution administered over 2 to 4 hours
Glucose-containing solutions are indicated for which pediatric populations?
at risk of perioperative hypoglycemia: infants less than 6 months old, malnourished children, children undergoing cardiac surgery
How do diuretics improve symptoms of CHF?
by reducing cardiac filling pressures along the SAME ventricular function curve (decreased EDV w/ same CO). They do not directly improve inotropy or stroke volume.
methemoglobinemia rx
Methylene blue (1-2 mg/kg)
treatment for methemoglobinemia in setting of G6PD- deficiency
vitamin C
Common acquired causes of methemoglobinemia
prilocaine, benzocaine, metoclopramide, nitrites (nitric oxide and nitroglycerin), aniline dyes, benzene, chloroquine, dapsone, and sulfonamides
