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100 Secrets Flashcards

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1
Q

What are the side effects of opioids?

A

Opioid side effects include respiratory depression, nausea and vomiting, pruritus, cough suppression, urinary retention, and biliary tract spasm. Some opioids may induce histamine release and cause hives, bronchospasm, and hypotension.

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2
Q

How can one-lung ventilation (OLV) be achieved?

A

OLV can be achieved with double-lumen endotracheal tubes (DLTs), bronchial blockers, and standard single-lumen endotracheal tubes (ETTs), each of which has advantages and disadvantages.

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3
Q

When is anesthesia awareness most likely to occur?

A

Anesthesia awareness is most likely to occur in situations where minimal anesthetic is administered, often because of hemodynamical instability, such as during cardiopulmonary bypass, trauma, and in obstetrics.

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4
Q

What is the most common induction agent for electroconvulsive therapy?

A

Methohexital is the most common induction agent for electroconvulsive therapy because it has minimal anticonvulsant properties, has a rapid onset with a short duration of action, and has low cardiac toxicity.

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5
Q

What are common indications for permanent pacemaker placement?

A

Common indications for permanent pacemaker placement are symptomatic bradycardia that is not reversible, second-degree type II heart block, and third-degree heart block.

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6
Q

What do pacemaker code positions I, II, and III define?

A

Pacemaker code positions I, II, and III define the chamber in which pacing occurs, the chamber in which sensing occurs, and the mode of response to the sensed or triggered event, respectively.

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7
Q

How does chronic alcohol use affect gastric emptying?

A

Chronic alcohol use leads to delayed gastric emptying and relaxation of the lower esophageal sphincter, increasing the risk of aspiration.

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8
Q

What is the fetal circulation characterized by?

A

The fetal circulation is a parallel circulation containing three shunts (ductus venosus, foramen ovale, and ductus arteriosus) that function to deliver the most highly oxygenated fetal blood from the placenta to the developing heart and brain.

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9
Q

What is the function of the ductus venosus?

A

The ductus venosus shunts oxygenated blood from the placenta in the umbilical vein through the liver to the right atrium. This blood is then shunted through the foramen ovale to the left side of the heart and into the ascending aorta.

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10
Q

What happens in the presence of high pulmonary vascular resistance?

A

In the presence of high pulmonary vascular resistance, blood returning to the right atrium and ventricle is shunted from the main pulmonary artery through the ductus arteriosus to the descending aorta, preferentially flowing back to the placenta for reoxygenation via the umbilical artery.

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11
Q

How does the newborn heart compare to mature hearts?

A

The newborn heart is less compliant, develops less contractile force, and is less responsive to inotropic support than mature hearts. Myocardial maturation is generally complete by 6 to 12 months of age.

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12
Q

What is essential for efficient oxygen transport?

A

Efficient oxygen transport relies on the ability of hemoglobin to reversibly load oxygen in the lungs and unload it peripherally, represented by the sigmoid shape of the oxyhemoglobin dissociation curve.

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13
Q

What does the oxyhemoglobin dissociation curve describe?

A

The oxyhemoglobin dissociation curve describes the relationship between oxygen tension (PaO₂) and binding (percent oxygen saturation of hemoglobin).

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14
Q

What occurs in the lungs regarding hemoglobin saturation?

A

In the lungs, where oxygen tension is high, hemoglobin will nearly fully saturate under normal circumstances. As oxygenated blood moves through peripheral tissues and oxygen tension lowers, oxygen will be released at an accelerating rate.

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15
Q

What are the American College of Cardiology/American Heart Association guidelines?

A

The American College of Cardiology/American Heart Association guidelines are the gold standard for directing appropriate cardiac testing before noncardiac procedures.

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16
Q

When is additional cardiac evaluation necessary?

A

Additional cardiac evaluation and testing are necessary for patients with moderate or excellent functional capacity (METs >4), patients undergoing emergent surgical operations, or patients undergoing low-risk surgical operations.

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17
Q

What indicates adequate functional capacity?

A

The ability to climb two or three flights of stairs (METs >4) without significant symptoms is considered evidence of adequate functional capacity.

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18
Q

What is the best induction agent for hypovolemic trauma patients?

A

Ketamine is the best induction agent for hypovolemic trauma patients and is also good for patients with active bronchospastic disease. Recent studies suggest it may be safe in patients with elevated intracranial pressure.

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19
Q

Is propofol safe for patients with egg allergies?

A

Propofol is generally regarded as safe for use in adult patients with documented egg allergies, but it should be avoided in children with known anaphylaxis to eggs.

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20
Q

How are local anesthetic agents classified?

A

Local anesthetic agents are classified as either esters or amides, differing primarily in allergic potential and method of biotransformation.

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21
Q

What are the manifestations of local anesthetic–induced CNS toxicity?

A

CNS toxicity manifests with excitation, followed by seizures, and then loss of consciousness. Cardiac toxicity includes hypotension, bradycardia, dysrhythmias, and cardiac arrest.

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22
Q

What is the treatment for local anesthetic toxicity?

A

Treatment for local anesthetic toxicity includes lipid emulsion therapy (Intralipid 20%).

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23
Q

What are the requirements for postanesthesia care unit discharge?

A

Adequate oxygenation, controlled postoperative pain, and resolved postoperative nausea and vomiting (PONV) are requirements for discharge.

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24
Q

Is general or regional anesthesia contraindicated in patients with degenerative neurological diseases?

A

With the exception of spinal anesthesia in multiple sclerosis, neither general nor regional anesthesia is contraindicated in patients with degenerative neurological diseases and neuropathies.

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25
What is important for glucose control before, during, and after surgery?
Careful attention to glucose control is important to reduce the risk of wound infection, promote rapid wound healing, avoid metabolic complications, and shorten hospital stay.
26
What is the incidence of coronary artery disease in patients with diabetes?
Patients with diabetes have a high incidence of coronary artery disease, often with atypical or silent presentation.
27
What should be avoided when discontinuing chronic glucocorticoid therapy?
Chronic exogenous glucocorticoid therapy should not be discontinued abruptly, as it may precipitate acute adrenal insufficiency.
28
What nerves supply the shoulder?
The shoulder is primarily supplied by the axillary nerve inferiorly and the suprascapular nerve superiorly, both of which can be anesthetized by an interscalene block.
29
What are complications of the interscalene block?
Complications include ipsilateral phrenic nerve block, recurrent laryngeal nerve paralysis, pneumothorax, Horner’s syndrome, and unintentional intravascular injection.
30
When is regional anesthesia beneficial?
Regional anesthesia is beneficial for patients in whom general anesthesia should be avoided or in whom pain management is difficult to control.
31
What are age-related physiological changes?
Age-related physiological changes include left ventricular hypertrophy, increased reliance on preload for cardiac output, decreased venous compliance, and increased risk for postoperative delirium.
32
What is malignant hyperthermia?
Malignant hyperthermia (MH) is a hypermetabolic disorder that presents in the perioperative period after exposure to triggering agents, characterized by an unexplained rise in end-tidal carbon dioxide and rigidity.
33
What challenges do neonates and infants face during intubation?
Neonates, infants, and small children may be difficult to intubate due to a more anterior larynx, relatively large tongues, and a long, floppy epiglottis.
34
What is the fundamental reason to give intravenous fluids?
The fundamental reason to give intravenous fluids is to increase stroke volume.
35
What do dynamic indices predict?
Dynamic indices use the Frank-Starling law to predict volume responsiveness (hypovolemia) and are more accurate than static indices.
36
What roles does point-of-care ultrasound serve in the perioperative setting?
Point-of-care ultrasound assesses left and right ventricular function, evaluates volume status/responsiveness, and identifies pulmonary issues.
37
When should transesophageal or transthoracic echocardiography be considered?
It should be considered in cases where the procedure or patient’s underlying cardiovascular pathology might result in instability.
38
What preoperative preparation is needed for patients with reactive airway disease?
Patients require thorough preoperative preparation, including inhaled β-agonist therapy and possibly steroids.
39
What should be considered when diagnosing wheezing?
Consider mechanical airway obstruction, congestive heart failure, allergic reaction, pulmonary embolus, pneumothorax, aspiration, and endobronchial intubation.
40
What are lung protection ventilation strategies?
Lung protection ventilation strategies should be viewed as harm reduction strategies and applied to all mechanically ventilated patients.
41
What is the initial management focus for trauma patients?
Initial management focuses on the ABCs: Airway, Breathing, Circulation.
42
What is trauma-induced coagulopathy?
Trauma-induced coagulopathy is an independent predictor of transfusion, multiorgan failure, and mortality.
43
What is the recommended transfusion ratio for trauma management?
Early ratio-driven transfusion of 1:1:1 (red blood cells, plasma, platelets) should be used until viscoelastic hemostatic assays are available.
44
What are the types of neuromuscular blocking agents?
Depolarizing agents include succinylcholine, while nondepolarizing agents include steroidal agents (e.g., rocuronium) and benzylisoquinolinium agents (e.g., atracurium).
45
What is a phase I block?
A phase I block is seen with depolarizing agents, while a phase II block is seen with nondepolarizing neuromuscular blocking agents.
46
What is the best practice for neuromuscular blocking agents?
The best practice is to dose them sparingly and allow enough time for normal metabolism to occur.
47
When should reversal agents be administered?
Reversal agents should be administered to all patients receiving nondepolarizing neuromuscular blocking agents unless the T4:T1 ratio is greater than 0.9.
48
How should hyperkalemia-induced cardiotoxicity be treated?
Cardiotoxicity due to hyperkalemia should be immediately treated with intravenous calcium chloride or calcium gluconate.
49
What is a common complication of high fluid volumes?
Patients who receive high volumes of fluid, especially normal saline, often develop hyperchloremia and a non-anion gap metabolic acidosis.
50
What is minimum alveolar concentration (MAC)?
MAC is defined as the minimum alveolar concentration of inhaled anesthetic required to prevent movement in 50% of patients in response to surgical incision.
51
What factors decrease MAC?
The MAC of inhaled anesthetics is decreased by old age, hyponatremia, hypothermia, opioids, barbiturates, and pregnancy.
52
What should nitrous oxide not be used in?
Nitrous oxide should not be used in the presence of bowel obstruction, pneumothorax, or during middle ear or ophthalmological surgery.
53
What characterizes the lung's ventilation/perfusion (V/Q) mismatch?
The lung is heterogeneous, characterized by regional V/Q mismatch, resulting in dead space and shunt.
54
What are causes of hypoxemia?
Causes of hypoxemia include low inspired oxygen, alveolar hypoventilation, V/Q mismatch, right-to-left shunt, and impaired oxygen diffusion.
55
What factors determine surgical suitability?
No single pulmonary function test measurement absolutely contraindicates surgery; physical examination and coexisting medical problems must be considered.
56
How does the output of traditional vaporizers depend on fresh gas flow?
The output depends on the proportion of fresh gas that bypasses the vaporizing chamber compared to the proportion that passes through it.
57
What are the mainstay treatments for severe anaphylaxis?
Epinephrine, volume resuscitation, and cardiopulmonary resuscitation are the mainstay treatments.
58
What monitoring is required with neuraxial anesthesia?
Patients require close monitoring with the potential for aggressive fluid resuscitation and vasopressor support due to dense sympathetic blockade.
59
What is the nature of epidural anesthesia?
Epidural anesthesia is segmental, with the block most intense near the site of catheter or needle insertion.
60
When is bicarbonate supplementation indicated?
Bicarbonate supplementation is only indicated in the presence of severe metabolic acidosis with a pH under 7.20.
61
What entails medical decision-making capacity?
It entails understanding the proposed treatment, appreciating the severity of the situation, using reason in the decision-making process, and communicating the decision.
62
What happens to do-not-resuscitate (DNR) orders in the perioperative period?
DNR orders are generally suspended in the perioperative period due to the temporary and reversible nature of anesthesia.
63
What is the difference between phenylephrine and ephedrine?
Phenylephrine is a direct α1-adrenergic agonist, whereas ephedrine is an indirect α1, β1 adrenergic agonist.
64
What is the half-life of intravenous epinephrine and norepinephrine?
They have a short half-life (~90 seconds) and are generally administered by continuous infusion or frequent rebolusing.
65
What is the relationship between blood pressure, cardiac output, and systemic vascular resistance?
Blood pressure is the product of cardiac output and systemic vascular resistance; excessive use of vasopressors does not ensure normal cardiac output.
66
What is nicardipine?
Nicardipine is a selective arterial vasodilator and one of the few calcium channel blockers that does not have negative inotropic effects.
67
Why is glycopyrrolate preferred over atropine?
Glycopyrrolate is preferred because it does not cross the blood-brain barrier and is associated with little to no central nervous system effects.
68
What is blood pressure a product of?
Blood pressure is the product of cardiac output and systemic vascular resistance.
69
What is Nicardipine?
Nicardipine is a selective arterial vasodilator and does not have negative inotropic effects.
70
Why is Glycopyrrolate preferred over Atropine in the perioperative setting?
Glycopyrrolate does not cross the blood-brain barrier and is associated with little to no sedation compared with atropine.
71
How does Nitroglycerin differ from Nitroprusside in terms of vasodilation?
Nitroglycerin vasodilates veins more than arteries, while Nitroprusside primarily dilates arteries.
72
What effects does laparoscopic surgery have on pulmonary compliance and cardiac output?
Laparoscopic surgery decreases pulmonary compliance, venous return, cardiac output, and pH due to elevated PaCO₂.
73
Where do sympathetic nerves originate?
Sympathetic nerves originate from the spinal cord at T1–L2.
74
What condition are patients with high spinal cord injuries at risk for?
Patients with high spinal cord injuries (T6 and above) are at risk for autonomic dysreflexia.
75
What are the primary determinants of myocardial oxygen demand?
The primary determinants are increases in afterload (wall tension) and heart rate.
76
What can happen if renin-angiotensin system antagonists are continued on the day of surgery?
They can cause profound refractory hypotension that usually responds best to vasopressin administration.
77
How does obesity affect pulmonary compliance and oxygen consumption?
Obesity decreases pulmonary compliance and functional residual capacity (FRC) and is associated with increased oxygen consumption.
78
What position should patients with obesity be placed in before anesthesia induction?
Patients with obesity should be placed in the ramp position.
79
What are the benefits of ramp positioning?
Ramp positioning can improve pulmonary mechanics and reduce the incidence of hypoxemia on induction.
80
What should be used to confirm proper ETT placement on intubation?
Sustained end-tidal CO₂ detection should be used.
81
How does end-tidal CO₂ compare to PaCO₂ in the absence of V/Q abnormalities?
End-tidal CO₂ is approximately 3 to 5 mm Hg less than PaCO₂.
82
What happens to end-tidal CO₂ with abrupt decreases in cardiac output?
There will be a 'drop' in end-tidal CO₂.
83
What is the normal body temperature?
Normal body temperature is 37°C.
84
Which nerves innervate the base of the tongue, arytenoids, and posterior glottis?
The recurrent laryngeal nerve and the superior laryngeal nerve, a branch of the vagus nerve.
85
What are risk factors for difficult intubation?
Risk factors include history of head and neck cancer, obesity, pregnancy, airway trauma, poor mouth opening, decreased thyroid mental distance, short neck, large neck circumference, and inability to bite the upper lip.
86
What does the sniffing position facilitate?
The sniffing position facilitates alignment of airway axes for direct visualization of the glottis.
87
How is the sniffing position achieved?
The sniffing position can be achieved with head extension and neck flexion.
88
What is the gold standard for intubation in high-risk aspiration patients?
Rapid sequence induction and intubation (RSI) with cricoid pressure and a fast-acting neuromuscular blocking agent.
89
How do the Macintosh and Miller blades differ in placement?
The Macintosh blade is placed anterior to the epiglottis, while the Miller blade is placed posteriorly.
90
Who are strong candidates for awake intubation?
Patients with risk factors for difficult intubation, especially those with head and neck cancer and/or radiation.
91
What can multiple attempts at instrumenting the airway cause?
They may cause significant airway trauma, leading to an iatrogenic 'can’t intubate, can’t ventilate' situation.
92
What are complications of central venous catheterization?
Complications include pneumothorax, arterial injury, bleeding, thoracic duct injury, venous thrombosis, and infection.
93
What does the Seldinger technique involve?
Placing a guidewire into a vein to facilitate the exchange of catheters.
94
What is encouraged for assessing neuromuscular blockade?
Quantitative nerve monitoring by measuring the T4:T1 ratio.
95
What are the two types of aspiration?
Aspiration pneumonitis (irritative and obstructive) and aspiration pneumonia (infectious).
96
What does the MELD score predict?
The MELD score predicts 90-day mortality and prioritizes organ transplant recipients.
97
What can increase pulmonary vascular resistance?
Hypoxia, hypercarbia, or acidosis.
98
What must patients be before cardiopulmonary bypass?
Patients must be completely anticoagulated.
99
What is safe and better for the environment regarding anesthetic techniques?
Low-flow (<1 L/min) anesthetic techniques with sevoflurane.
100
What are mechanical ventilation settings for ARDS patients?
Tidal volume at 6 mL/kg of ideal body weight and limiting plateau pressures to less than 30 cm H₂O.
101
What should pain assessment include?
Pain assessment should include functional impairment and treatment goals, not just numeric pain scores.
102
What is the Cushing reflex?
The classic triad of systemic hypertension, bradycardia, and irregular respiration indicating brainstem compression.
103
What are physiological alterations in pregnancy?
Increased cardiac output, heart rate, plasma volume, minute ventilation, decreased systemic vascular resistance, and functional residual capacity.
104
What are the benefits of spinal anesthesia for cesarean delivery?
It produces a reliable and dense sensory and motor block, is easy to perform, has rapid onset, and carries no risk of local anesthetic toxicity.
105
What is the risk of epidural hematoma with neuraxial techniques?
The risk is extremely low when the platelet count is greater than 70,000/mm³.
106
What is the most common cause of postpartum hemorrhage?
Uterine atony, often resulting in substantial blood loss.
107
What type of blood should be used for emergency transfusion?
Use O-negative blood initially and switch to type-specific blood as soon as available.
108
What causes TACO and TRALI?
TACO causes hydrostatic pulmonary edema (too much volume), while TRALI causes nonhydrostatic pulmonary edema (inflammatory response).
109
What causes TRALI?
TRALI occurs when donor leukocyte antigen antibodies against recipient neutrophils cause febrile, nonhemolytic transfusion reactions.

Emergency (15 decks)

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