What is the antidote for Benzodiazepine overdose?
[It is a competitive inhibitor that may cause seizures or arrhythmias and is contraindicated in patients with elevated intracranial pressure or status epilepticus.]
Epidural is contraindicated in which patients?
Patients with hypertophic cardiomyopathy or cyanotic heart disease
[Spinal anesthesia is also contraindicated in these patients. Sympathetic denervation causes decreased afterload, which worsens these conditions.]
An example of a nondepolarizing agent is?
What is the most common PACU complication?
Nausea and vomiting
Why are infected tissues difficult to anesthetize with local anesthetic?
[Inflammation causes metabolic acidosis which lowers the pH of affected tissues. Such inflammatory conditions alter the pharmacokinetics and pharmacodynamics of local anesthetics by reducing their interactivities with lipid bilayers and/or membrane lipids.]
In which patients is Ketamine contraindicated as an induction agent?
Patients with head injuries
[Ketamine causes increased cerebral blood flow]
Which inhalation induction agent can cause seizures?
Which inhalation induction agent is characterized by slow onset and offset, highest degree of cardiac depression and arrhythmias, and is the least pungent (good for children)?
[Halothane hepatitis = fever, eosinophilia, jaundice, increased LFTs]
What are contraindications to administering epinephrine with a local anesthetic?
- Unstable angina
- Uncontrolled hypertension
- Tissues with poor collaterals (I.E. Penis or ears)
- Uteroplacental insufficiency
What dose of Lidocaine can be used as a local anesthetic?
0.5 cc/kg of 1% lidocaine
Which 2 drugs can be used to reverse nondepolarizing agents?
Neostigmine or Edrophonium
[They block acetylcholinesterase, thus increasing acetylcholine. Atropine or glycopyrrolate should be given with Neostigmine or Edrophonium to counteract effects of generalized acetylcholine overdose]
What is the most potent narcotic?
[Sufentanil and remifentanil are very fast acting narcotics with short half lives.]
What are the contraindications to using Succinylcholine as a paralytic?
- Severe burns
- Neurologic injury
- Neuromuscular disorders
- Spinal cord injury
- Massive trauma
- Acute renal failure
[These are contraindications because of the hyperkalemia caused by Succinylcholine depolarization]
Which intravenous induction agent is fast acting but causes decreases in cerebral blood flow, metabolic rate, and blood pressure?
Sodium thiopental (Barbiturate)
Where are opioids metabolized and excreted?
- Metabolized in the liver
- Excreted in the urine via the kidneys
Which inhalation induction agent lowers brain O2 consumption with no increase in intracranial pressure, thus making it good for use in neurosurgery?
What are the relative lengths of action of lidocaine, procaine, and bupivacaine?
Bupivacaine > Lidocaine > Procaine
Which inhalation induction agent is characterized by fast onset, less laryngospasm, and is less pungent (good for mask induction)?
What are 3 potential side effects of Succinylcholine?
- Malignant hyperthermia
- Open-angle glaucoma
How might a postop myocardial infarction present?
- No pain or ECG changes
- Increased filling pressures
Where is spinal anesthesia injected?
Into the subarachnoid space
By what mechanism of action do local anesthetics work?
They increase action potential threshold, preventing Na influx
[Side effects include tremors, seizures, tinnitus, and arrhythmias. CNS symptoms occur before cardiac symptoms.]
Malignant hyperthermia is caused by a defect in what?
[Calcium released from the sarcoplasmic reticulum causes muscle excitation-contraction syndrome.]
What can be added to epidural anesthesia to cause decreased heart rate and blood pressure?
Which surgical procedures are considered low risk (Less than 1% cardiac risk)?
- Endoscopic procedures
- Superficial procedures
- Cataract surgery
What is the most likely cause of a sudden transient drop in end-tidal CO2 in an intubated patient undergoing surgery?
Likely became disconnected from the vent
[Could also be due to pulmonary embolism, but the patient would have hypotension.]
Which surgical procedures are considered high risk (greater than 5% cardiac risk)?
- Any emergent operation (especially in the elderly)
- Most aortic, major vascular, and peripheral vascular surgeries
[Carotid endarterectomy is considered moderate risk surgery]
Which inhalation induction agent is characterized by fast onset, minimal myocardial depression, and tremors at induction?
Nitrous oxide (NO2)
Higher volume hospitals are associated with lower mortality for which 2 procedures?
- Abdominal aortic aneurysm repair
- Pancreatic resection
Where should the endotracheal tube be placed with respect to the carina?
2 cm above the carina