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Fiser absite > Chapter 8 - Anesthesia > Flashcards

Chapter 8 - Anesthesia Flashcards

2
Q

MAC (minimum alveolar concentration) equals what?

A

Smallest concentration of inhalation agent at which 50% of patients will not move with incision

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3
Q

Small MAC means what?

A

More lipid soluble = more potent = slow speed of induction

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4
Q

Effects of inhalational agents?

A

Unconsciousness, amnesia, some degree of analgesia

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5
Q

Side effects of inhalational agents?

A

Blunted hypoxic drive, myocardial depression, increased cerebral blood flow, decreased renal blood flow

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6
Q

Characteristics of NO2?

A

Fast, minimal myocardial depression

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7
Q

Characteristics of halothane?

A

Slow, highest degree of cardiac depression and arrhythmias, least pungent (good for kiddies)

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8
Q

What is halothane hepatitis?

A

Fever, eosinophilia, jaundice, increased LFTs

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9
Q

Side effect of enflurane?

A

Seizures

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10
Q

Characteristics of sevoflurane?

A

Less myocardial depression, fast on/off, less laryngospasm, higher cost

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11
Q

Side effects of sodium thiopental (barbiturate)?

A

Decreased cerebral blood flow and metabolic rate, decreased blood pressure

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12
Q

Characteristics of propofol?

A

Very rapid distribution and on/off, amnesia, sedative; NOT an analgesic

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13
Q

Side effects of propafol?

A

Hypotension, respiratory depression; do not sure in pts with egg allergy

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14
Q

Characteristics of ketamine?

A

Dissociation of thalamic/limbic systems, places pts in cataleptic state (amnesia, analgesia); no respiratory depression

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15
Q

Side effects of ketamine?

A

Hallucinations, catecholamine release (inc. CO and tachycardia), inc. airway secretions, inc. cerebral blood flow (contraindicated in head injuries)

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16
Q

Characteristics of etomidate?

A

Fewer hemodynamic changes, fast acting

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17
Q

Side effect of etomidate?

A

Continuous infusions can lead to adrenocortical suppression

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18
Q

What is the last muscle to go down and 1st to recover from paralytics?

A

Diaphragm

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19
Q

What is the 1st muscles to go down and last to recover from paralytics?

A

Neck and face muscles

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20
Q

What is the only depolarizing agent?

A

Succinylcholine

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21
Q

Characteristics of succinylcholine?

A

Fast, short acting; causes fasciculations

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22
Q

Side effects of succinylcholine?

A

Malignant hyperthermia, inc. ICP, incraed end-tidal CO2 then fever, tachycardia, rigidity, acidosis, hyperkalemia

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23
Q

Treatment of malignant hyperthermia?

A

Dantrolene: inhibits Ca release and decouples excitation complex; cooling blankets, HCO3, glucose, supportive care

24
Q

What patients do you NOT use succinycholine in?

A

Burn patients, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure

25
Q

Nondepolarizing agents MOA?

A

Inhibit neuromuscular junction by competing with ACh

26
Q

What can cause prolongation of nondepolarizing agents?

A

Hypothermia, hypercarbia, certain abx, electrolyte abnormalities, myasthenia gravis

27
Q

Which nondepolarizing agent can be used in liver and renal failure?

A

Cis-atracurium (because it undergoes Hoffman degradation)

28
Q

Where is rocuronium metabolised?

A

Liver

29
Q

How does neostigmine reverse nondepolarizing agents?

A

Blocks AChE, increasing ACh

30
Q

How does edrophonium reverse nondepolarizing agents?

A

Blocks AChe, increasing ACh

31
Q

What should be given with nondepolarizing reveral agents to counteract effects of generalized ACh overdose?

A

Atropine or glycopyrrolate

32
Q

How do local anesthetics work?

A

By increasing action potential threshold, preventing Na influx

33
Q

What is the max dose of 1% lidocaine?

A

0.5cc/kg

34
Q

Why are infected tissues hard to anesthetize?

A

Acidosis

35
Q

When should you not use epinephrine with local anesthetics?

A

Patients with arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals, uteroplacental insufficiency

36
Q

What type of local anesthetic has a higher rate of allergic reaction?

A

Esters (secondary to PABA analogue)

37
Q

Narcotic receptor?

A

Mu

38
Q

What happens when you mix narcotics in patients on MAOIs?

A

Can cause hyperpyrexic coma

39
Q

Effects of narcotics?

A

Profound analgesia, respiratory depression (dec. CO2 drive), no cardiac effects, blunted sympathetic response

40
Q

Unique side effects of morphine?

A

Decreased cough, constipation, histamine release

41
Q

Unique side effects of demerol?

A

Tremors, fasciculations, convulsions, NO histamine release

42
Q

In which patients should you avoid the use of demerol?

A

Renal failure - can get buildup of normeperidine analogue and result in seizures

43
Q

Morphine in epidural can cause what?

A

Respiratory depression

44
Q

Lidocaine in epidural can cause what?

A

Decreased heart rate and blood pressure

45
Q

Treatment for acute hypotension and bradycardia in patient with epidural?

A

Turn epidural down, fluids, phenylephrine, atropine

46
Q

Treatment for spinal headaches?

A

Rest, increased fluids, caffeine, analgesics; blood patch if persists >24h

47
Q

Contraindications for spinal anesthesia?

A

Hypertrophic cardiomyopathy, cyanotic heart disease

48
Q

What two conditions are associated with the most postoperative hospital mortality?

A

CHF and renal failure

49
Q

Presentation of post-op MI?

A

May have no pain or EKG changes; hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia

50
Q

Which patients need a cardiology workup?

A

Angina, previous MI, SOB, CHF, FEV1 5/min, age >70, patients undergoing major vascular surgery

51
Q

Biggest risk factors for postop MI?

A

Age >70, DM, previous MI, CHF, unstable angina

52
Q

What is the best determinant of esophageal vs. tracheal intubation?

A

End tidal CO2

53
Q

What causes an intubated patient to have sudden transient rise in ETCO2?

A

Alveolar hypoventilation; increase TV or RR

54
Q

What causes an intubated patient to have a sudden drop in ETCO2?

A

Disconnected from the vent; PE or significant hypotension

Fiser absite (58 decks)

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