Anesthetic emergencies

Question 1

What determines the Tx of anesthetic emergencies?

Answer 1

the cause of the emergency

Question 2

Tx for Perivascular injection w/ Thiopental or Phenylbutazone

Answer 2

• Dilution w/ saline
- enough to dilute thiopental to < 1% to prevent tissue necrosis)

• Lidocaine SQ
- instead of saline to neutralize pH & ↓ vasospasm

Question 3

Tx of Bradycardia due to ↑ vagal tone

Answer 3

• atropine

* glycopyrrolate

Question 4

Tx for Hypotension during anesthesia

Answer 4

• ligher anesthetic depth
• fluid
• Positive inotropes
   - dopamine
   - dobutamine
   - ephedrine

Question 5

Tx of premature ventricular contractions due acidemia or drugs like:

• thiopental
• ketamine
• halothane

Answer 5

• Correct metabolic imbalance
• Lidocaine IV for acute therapy
- or Procaineamide

Question 6

Cardiopulmonary failure is characterized by…?

Answer 6

apnea & absence of pulse / heart beat

Question 7

Tx of Cardiopulmonary failure

Answer 7

ABCDE
• Airway establishment
• Breathing 
• Cardiac compression - circulation
• Drugs
• ECG

Question 8

Drugs used to Tx Cardiopulmonary Failure

• Asystole?
• Ventricular fibrillation?
• Electromechanical dissociation?

Answer 8

Asystole
     • Epi
Ventricular fibrillation
     • Lidocaine
     • Na Bicarb
Electromechanical dissociation
     • Dopamine
     • Dexamethasone

***Following resuscitation:
• Ionotropic support to help maintain BP
- dopamine

Question 9

4 levels of Apnea as an assoc’d side effects w/ Thiopental overdose.
• what is the action taken with each?

Answer 9

• Pink MM, normal CRT, strong pulse
–> observe until respiration starts OR vitals change

• Cyanotic MM 
\+ strong pulse 
& arterial pressure ( > 80mmHg) 
--> intubate & ventilate (10bpm)
--> continue until anesthetic lightens
--> ↓ ventilation rate to 4bpm 
(see if Resp restarts)

• Cyanotic MM
+ weak pulse ( replacement fluid + ionotropic drug

• No Pulse
–> start full CPR

Question 10

Atropine

Answer 10

Muscarinic antagonists

• Tx bradycardia

Question 11

Glycopyrrolate

Answer 11

Muscarinic antagonist
(low CNS effects)
• good Vagal blocking action

Question 12

Epinephrine

Answer 12

Alpha-adrenergic action
• good peripheral & intrathoracic vessel resistance
• ↑ diastolic pressure
• useful for Tx of Asystolic arrest

Question 13

Ephedrine

Answer 13

Inotropic effect
• direct/indirect peripheral sympathomimetic
• related to NEpi

Question 14

Dopamine

Answer 14

Direct-actin sympathomimetic
• ionotropic effects
- less desirable effects too

Question 15

Dobutamine

Answer 15

preferred due to selective effect on cardiac contractility

Question 16

Lidocaine

Answer 16

Na+ channel blocker

• Anti-arrhythmic action on ventricles

Question 17

CNS stimulants
• define
• example of drug targeting emetic center
• Use in anesthesia-induced collapse?

Answer 17

Drugs that ↑ electrical & NT activity in CNS
• Apomorphine
–> specific for emetic center

• limited clinical use in Tx acute ventilatory failure

      - temporary
      - ↑ risk of convulsion * * Best therapy = ventilation

Question 18

Doxapram

Answer 18

• Stimulates respiratory center in medulla

- could not be used as substitute for aggressive artificial respiratory support & mechanical disorder of ventilation

Question 19

Reasons to ↓ dose of tranquilizers & anesthetics in older patients?

Answer 19

• ↓ in brain weight
• ↓ in liver blood flow
• ↓ renal functions
• ↓ in blood volume

Question 20

What should you do if you have to anesthetize a patient w/ cardiac dysfunction?

Answer 20

• Tx to improve cardiac function & reduce pulmonary edema
• Keep HR w/in 10% of its value in the resting animal
• Avoid sedating & anesthetic drugs that cause vasoconstriction
• Limit admin of IV fluid