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Anaesthesiology > Physiology in Anaesthesia: Part 4 > Flashcards

Physiology in Anaesthesia: Part 4 Flashcards

1
Q

Define

Closing volume

RESP

A

Lung volume at which small airways begin to close

In health, FRC MUST exceed this

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2
Q

Complications of acidosis

GENERAL

A
  1. CNS: depressed LOC, raised ICP
  2. CVS: depression, increased catecholamines, raised calcium, dysrhythmias, vasodilation, hypovolaemia
  3. Pulmonary hypertension
  4. Hyperkalaemia
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3
Q

Stages of systole

two

CVS

A
  1. isovolumetric ventricular contraction
  2. ventricular ejection
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4
Q

Name and describe

Peaks of the atrial pressure wave

three

CVS

A

A-wave: immediately preceding systole; represents atrial contraction
C-wave: beginning of systole; represents isovolumetric ventricular contraction
V-wave: systole through early diastole; represents atrial filling

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5
Q

Stages of diastole

A
  1. isovolumetric ventricular relaxation
  2. rapid ventricular filling
  3. slow ventricular filling (diastasis)
  4. atrial contraction
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6
Q

Functions of diastole

A
  1. reuptake of calcium by the sarcoplasmic reticulum
  2. ventricular filling
  3. coronary artery perfusionl
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7
Q

Function of the cardiac papillary muscles

A
  1. contract with the ventricles during systole
  2. pull base of the heart towards the apex
  3. shortens the longitudinal axis
  4. increases systolic efficiency
  5. prevents excessive bulging of valves into the atria
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8
Q

What is the ejection fraction equation

A

EF = (EDV - ESV) / EDV
OR
EF = SV / EDV

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9
Q

Techniques used to measure stroke volume

A
  1. ventriculography: gold standard, but cumbersome
  2. echocardiography: transthoracic, transoesophageal
  3. thoracic impedance: non-invasive, but very inaccurate
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10
Q

Techniques used to measure cardiac output

A
  1. indicator-dilution techniques: thermodilution, dye dilution
  2. Fick method
  3. Doppler techniques
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11
Q

Determinants of stroke volume

A

PRELOAD: equivalent to end-diastolic volume
AFTERLOAD: intraventricular pressure during systole
CONTRACTILITY: intrinsic ability of cardiac muscle to do work

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12
Q

Factors that increase cardiac contractility

A
  1. raised serum calcium
  2. sympathetic stimulation
  3. parasympathetic inhibition
  4. inotropic drugs
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13
Q

Factors that decrease cardiac contractility

A
  1. reduced serum calcium
  2. parasympathetic stimulation
  3. sympathetic inhibition
  4. myocardial ischaemia/infarction
  5. hypoxia
  6. acidosis
  7. mismatched ventriculo-atrial coupling
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14
Q

Define wind-up
(pain physiology)

A

Frequency dependent increase;
spinal cord neural excitability;
additive afferent C-fibre stimulation

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15
Q

Systems in the body that prevent pH changes

A
  1. buffering systems: immediate
  2. ventilatory response: minutes
  3. renal response: hours to days
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16
Q

Specific buffering systems of the body

A
  1. HCO3 (>50%)
  2. Hb (35%)
  3. phosphates
  4. plasma proteins
  5. bone
17
Q

What causes propofol infusion syndrome

A

Propofol infusion for greater than 48 hours;
dose greater than 5mg/kg/hr (83mcg/kg/minute).

Caused by failure of mitochondrial respiratory chain;
failure of free fatty acid transport into mitochondria

18
Q

What are signs of propofol infusion syndrome

A
  1. cardiomyopathy and acute cardiac failure
  2. metabolic acidosis
  3. skeletal muscle myopathy
  4. hepatomegaly
  5. hyperkalaemia
  6. lipidaemia
  7. bradycardia (LATE SIGN)
19
Q

Anion gap:
1. calculation
2. normal parameters

A
  1. Anion gap = Na - [HCO3 + Cl]
  2. 10-12
20
Q

Causes of a high anion gap metabolic acidosis

A
  1. lactic acidosis
  2. ketoacidosis
  3. acute/chronic renal failure
  4. toxins: salicylates, ethylene glycol, methanol
21
Q

Causes of a non-anion gap metabolic acidosis

A
  1. renal tubular acidosis
  2. rapid saline infusion
  3. gastrointestinal bicarbonate loss (vomiting, diarrhoea, nasogastric tube drainage)
  4. toxins: ammonium chloride
22
Q

Methods to decrease central line sepsis

A
  1. cleaning with chlorhexidine over povidone
  2. using minocycline/rifampin catheters
  3. using the subclavian rather than jugular vein
  4. using single lumen rather than multi-lumen catheters
  5. using ultrasound guidance
23
Q

Sarin nerve gas:
1. what is it
2. name signs of poisoning

A
  1. potent organophosphate
  2. DUMBELS:
    Diarrhoea
    Urination
    Miosis
    Bronchorrhoea, bronchoconstriction
    Emesis
    Lacrimation
    Salivation
    ALSO:
    cardiac
    CNS
24
Q

Cardiac signs of sarin nerve gas poisoning

A

bradycardia
prolonged QT segment
ventricular dysrhythmias

25
Q

Manoeuvres to maximise functional residual capacity

A
  1. early ambulation
  2. incentive spirometry
  3. deep breathing
  4. IPPV
26
Q

Calculation of pulmonary vascular resistance

A

PVR = [(PAPmean - PAcp) / CO] x 80

PAPmean: mean pulmonary arterial pressure
PAcp: pulmonary wedge pressure
CO: cardiac output

27
Q

What is the normal pulmonary vascular resistance

A

50-150 dynes/sec/cm^-5

28
Q

What happens when the aorta is cross-clamped

A
  1. raised mean arterial pressure
  2. raised central venous pressure
  3. raised pulmonary artery occlusion pressure
  4. reduced cardiac index
29
Q

What are the risks associated with aortic cross-clamping

A
  1. renal ischaemia
  2. colonic ischaemia
  3. reperfusion injury
30
Q

What is the cardiac index

A

it relates cardiac performance to body surface area

Anaesthesiology (12 decks)

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