8 - Anesthesia

Question 1

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

Answer 1

MAC (minimum alveolar concentration)

Question 2

MAC is inversely related to

Answer 2

potency (small MAC = more lipid soluble = more potent)

Question 3

Anesthetic agent - Fast, minimal myocardial depression, tremors at induction

Answer 3

Nitrous Oxide (NO2)

Question 4

Anesthetic agent - Least pungent, slow onset/offset; MOST cardiac depression and arrhythmias; good for CHILDREN

Answer 4

Halothane

Question 5

Anesthetic agent - Fast onset/offset, less laryngospasms, GOOD for MASK induction

Answer 5

sevoflurane

Question 6

Anesthetic agent - Lowers brain O2 consumption, no ICP increase; Good for NEUROSURGERY

Answer 6

Isoflurane

Question 7

Anesthetic agent - Can cause seizures

Answer 7

Enflurane

Question 8

Anesthetic agent - very rapid onset/offset; sedative; anesthesia and amnesia, NO anagelsia; SEs: HoTN, Metabolic Acidosis

Answer 8

Propofol

Question 9

Anesthetic agent - dissociation of thalamic/limbic system; no resp depression; SEs: hallucinations, tachycardia, increase airway secretions

Answer 9

Ketamine

Question 10

Anesthetic agent - Contraindicated in pt with head injury b/c increase cerebral blood flow, increase ICP

Answer 10

Ketamine

Question 11

Anesthetic agent - fast acting, fewest cardiac effects; good for CHF or angina pts; can leads to adrenocortical suppression

Answer 11

Etomidate

Question 12

Last muscle to go down and 1st to recover from paralytics

Answer 12

Diaphragm

Question 13

1st muscle to go down and last to recover from paralytics

Answer 13

Neck and face muscles

Question 14

Anesthetic agent - fast acting, depolarizing agent; causes fasciculations; can NOT be reversed; causes hyperkalemia from depolarization release of K

Answer 14

Succinylcholine

Question 15

1st signs of malignant hyperthermia

Answer 15

Increase end-tidal CO2

Question 16

Side effect of succinylcholine caused from calcium release from sarcoplasmic reticulum; Ca metabolism defect

Answer 16

Malignant hyperthermia

Question 17

What does Dantrolene treat and how

Answer 17

Malignant hyperthermia - inhibits Ca release and decouples excitation complex

Question 18

MOA of non-depolarizing agents

Answer 18

Inhibits neuromuscular junction by competing with acetylcholine

Question 19

Non-depolarizing agent - that can be used in liver and renal failure; causes Histamine release (HoTN)

Answer 19

Atracurium

Question 20

Non-depolarizing agent - fast, intermediate duration, HEPATIC metabolism

Answer 20

Rocuronium

Question 21

Non-depolarizing agent - slow acting, long duration; RENAL metabolism

Answer 21

Pancuronium

Question 22

Non-depolarizing reversal agent (2) - blocks acetylcholinesterase (increase ACh)

Answer 22

Neostigmine

Edrophonium

Question 23

Works by increasing action potential threshold (prevents Na influx)

Answer 23

Local anesthetics

Question 24

Max lidocaine dosing single and w/epi

Answer 24

4mg/kg; 7mg/kg w/epi

Question 25

Max bupivacaine dosing single and w/ epi

Answer 25

2mg/kg; 3mg/kg w/epi

Question 26

Opioids are metabolized by

Answer 26

Liver, excreted via kidneys

Question 27

Narcotic that can cause seizures, tremors, fasciculations; can NOT be given in pts on MAOIs (serotonin release syndrome); avoid in renal failure pts

Answer 27

Demerol (normeperidine analogue)

Question 28

Most potent narcotic

Answer 28

Sufentanil

Question 29

Agonist to GABA receptors in CNS; anticonvulsant; resp depression

Answer 29

Benzodiazepine

Question 30

Short acting benzo, crosses placenta, contraindicated in PREGNANCY

Answer 30

Midazolam (versed)

Question 31

Tx for benzo overdose; may cause seizures and arrhythmias

Answer 31

Flumazenil

Question 32

Epidural anesthesia allows anesthesia by

Answer 32

Sympathetic dennervation

Question 33

Drug given in epidural causes respiratory depression

Answer 33

Morphine

Question 34

Drug given in epidural causes decreased heart rate and blood pressure

Answer 34

Lidocaine

Question 35

Epidural insertion level for thoracotomy

Answer 35

T6-9

Question 36

Epidural insertion for laparotomy

Answer 36

T8-10

Question 37

Spinal anesthesia is injection into subarachnoid space below what spinal level to avoid spinal cord

Answer 37

L2

Question 38

Perioperative conditions associated with most postop hospital mortality (1st and 2nd)

Answer 38

1st - pre-op renal failure | 2nd - CHF

Question 39

Most effective agent to prevent intra-op and post-op CV events

Answer 39

Beta-blocker

Question 40

How long to wait after MI before elective surgery

Answer 40

6-8 wks

Question 41

Intra-op sudden transient rise in end-tidal CO2 followed by massive drop

Answer 41

CO2 embolus

Question 42

Most common cause of post-op hypoxemia

Answer 42

Atelectasis (alveolar hypoventilation)

Question 43

Most common cause of post-op hypercarbia`

Answer 43

Poor minute ventilation (need to increase TV, bigger breaths)