Anesthesie

Question 1

How are amides and esters metabolized

Answer 1

Amides = liver by cytochrome p450, excreted in the kidneys

Esthers = plasma through pseudocholinesterase

Question 2

What is the toxic dose of lidocaine during liposuction (tumescence)?

Answer 2

35-55mg/kg

Question 3

What is the volume of xylocaine that can be administered to a 50kg woman?

Answer 3

4.5mg/kg without epi
7mg/kg with epi

Question 4

Name 3 mechanism to reduce DVT in these patients?

Answer 4

Compression stockings
Early mobilization
Pharmacological prophylaxis
Prioritize sedation over GA

Question 5

Name 1 medication for thromboprophylaxis

Answer 5

Enoxaparin

Question 6

What is the mechanism of action of Dextran?

Answer 6

Inhibition of Von Willibran factor

Question 7

Name 2 causes of malignant hyperthermia?

Answer 7

Inhalation gases (-fluranes)
Paralytic (succinylcholine)

Question 8

List 4 treatments for malignant hyperthermia?

Answer 8

Stop gases
Supportive O2 + hyperventilation
Cooling fluids
Dantrolene
Address metabolic anomalies

Question 9

Name 2 objectives of conscious sedation?

Answer 9

Anxiolytic
Amnesia

Question 10

Name 2 important aspects of conscious sedation?

Answer 10

• Use small incremental doses
• Maintain ability to receive feedback from patient

Question 11

Name 2 agents used for conscious sedation and one side effect of each

Answer 11

Midazolam: respiratory depression
Propofol: pain on injection
Ketamine: hallucinations

Question 12

Name 2 advantages of conscious sedation vs general anesthesia

Answer 12

• Decreased postop N/V
• Early discharge
• Reduce risk of DVT
• Reduce airway pain
• Reduces risks of hypothermia

Question 13

Name 3 consequences of malignant hyperthermia

Answer 13

• Rhabdomyolysis
• Metabolic acidosis
• Acute kidney injury
• Seizures
• Cardiac arrest

Question 14

What is the pharmacological treatment for malignant hyperthermia

Answer 14

Dantrolene

Question 15

Name 4 signs of malignant hyperthermia

Answer 15

• Hyperthermia
• Muscular rigidity
• ECG changes (tachycardia)
• Increased end tidal CO2

Question 16

What is the safe way to proceed for a patient with malignant hyperthermia

Answer 16

Total intraveneous anesthisia
Roccuronium

Question 17

What are 3 indications for pre-operative antibiotics for prophylaxis of endocarditis?

Answer 17

• Prosthetic cardiac valve
• Congenital cardiopathy
• Cardiac transplant
• Prior hx of infectious endocarditis

Question 18

At which point should prophylaxis be administered

Answer 18

30 minutes prior to surgical incision

Question 19

What is the best imaging of choice to r/o DVT?

Answer 19

Dopper echo

Question 20

What is the imaging of choice for pulmonary embolism

Answer 20

Pulmonary CT Angio

Question 21

What hereditary factor deficiency most commonly causes hyper-coagulability?

Answer 21

Factor V Liden

Question 22

Name 3 late complications of filler injection

Answer 22

• Nodules
• Asymetry
• Telangiectasia
• Delayed allergic reaction

Question 23

What is the maximal dose of marcaine

Answer 23

2.5mg/kg

Question 24

What is the treatment option for marcaine toxicity

Answer 24

20% lipid emulsion (1.5cc/kg bolus + infusion of 0.25cc/kg/minute)

Question 25

What is the test to confirm the diagnosis malignant hyperthermia

Answer 25

Caffeine halothane contracture test

Question 26

When do you stop apixaban pre-op

Answer 26

3 days for major surgery, 2 days if its minor