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SRNA3CoExisting > Exam 1 REVIEW > Flashcards

Exam 1 REVIEW Flashcards

1
Q

Adverse effects of Doxorubicin (CM)

A

Cardiac toxicity, myelosuppresion

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2
Q

Adverse effects of Asparaginase (CHHT)

A

Coagulopathy
Hemorrhagic pancreatitis
Hepatic dysfunction
Thromboembolism

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3
Q

**Adverse effects of Bleomycin (PPP-IB)

A

Pneumonitis, Pulmonary HTN, Toxicity
Interstitial pulmonary fibrosis
Bronchiolitis obliterans

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4
Q

If they use Bleomycin in the past.

A

Avoid high O2 concentration if they have use bleomycin in the past.

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5
Q

***Bleomycin short adverse effects

A

Pulmonary HTN

Pulmonary toxicity

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6
Q

Adverse effects of Carmustine and Mitomycin (MP)

A

Myelosuppression, pulmonary toxicity

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7
Q

Adverse effects of Chlorambucil (MPS)

A

Myelosuppression, pulmonary toxicity, SIADH

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8
Q

Adverse effects of Busulfan and ETOPOSIDE (CMP)

A

Cardiac toxicity
Myelosuppression
Pulmonary toxicity

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9
Q

**Adverse effects of Cisplastin (DMMO, PSRT) RHL

A 
Dysrhythmias
Magnesium wasting
Mucositis, 
Ototoxicity
Peripheral neuropathy
SIADH
Renal tubular necrosis
Thromboembolism

Renal insufficiency
Hypomagnesemia
Large fiber neuropathy

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10
Q

Adverse effects of Cyclophosphamide (EHM, 3xPPPS)

A

Encephalopathy/delirium, hemorrhagic cystitis, myelosuppression, pericarditis, pericardial
effusion, SIADH, pulmonary fibrosis

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11
Q

Adverse effects of Etoposide (CMP)

A

Cardiac toxicity, myelosuppression, pulmonary toxicit

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12
Q

Adverse effects of Fluorouracil (GAM-C)

A

Gastritis
Acute cerebellar ataxia
Myelosuppression
Cardiac toxicity

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13
Q

Adverse effects of Ifosfamide (CHRS)

A

Cardiac toxicity
Hemorrhagic cystitis
Renal insufficiency
SIADH

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14
Q

**Adverse effects of Methotrexate MEM-HPPMR

A 
Mucositis
Encephalopathy,
Myelosuppression 
Hepatic dysfunction
Pulmonary toxicity
Platelet ,dysfunction
Renal failure
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15
Q

Mitomycin SE (MP)

A

Myelosuppression, pulmonary toxicity

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16
Q

Mitoxantrone SE

A

Cardiac toxicity, myelosuppression

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17
Q

Paclitaxel SE (AAA, PB)

A

Ataxia, Autonomic dysfunction, Arthralgias, Myelosuppression,
Peripheral neuropathy,
Bradycardia

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18
Q

Vinblastine (CH PMS)

A 
Cardiac toxicity
Hypertension, 
Pulmonary toxicity 
Myelosuppression
SIADH
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19
Q

*****3 side effects of Cisplastin RHL

A

Renal insufficiency
Hypomagnesemia
Large fiber neuropathy

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20
Q

Prolonged methotrexate use can cause

A

irreversible dementia

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21
Q

CV:Doxorubicin exposure anesthesia consideration

A

Left ventricular dysfunction
Dysrhythmias
Engorgement of great vessels

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22
Q

Pulmonary: Bleomycin, busulfan, chlorambucil exposure

anesthesia considerations OHA

A
  • Obstructive/restrictive disease
  • Avoid high concentrations of oxygen with
  • history of bleomycin exposure
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23
Q

NEURO: Cisplatin, vincristine, fluorouracil exposure

EPS PONE

A

Elevated intracranial pressure
Papilledema
Spinal cord compression due to metastases
Phrenic nerve palsy in presence of metastases
or superior vena cava syndrome
Exercise caution with peripheral nerve blocks,
Neuraxial anesthesia

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24
Q

Most endocrine abnromalities with paraneoplastic syndrome

A

Most occur after the diagnosis

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25
Q

Paraneoplastic syndromes NEURO

A

Myasthenia Gravis

Eaton-Lambert syndrome

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26
Q

Paraneoplastic syndromes

ENDOCRINE

A

SIADH

Hypercalcemia

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27
Q

Paraneoplastic syndromes is a

A

Pathophysiologic disturbances in pts with cancer

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28
Q

Paraneoplastic syndromes is most common in

A

▪ Most common in individuals with lung, ovarian,

lymphatic, or breast cancer

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29
Q

Paraneoplastic syndromes May involve

A

endocrine, neuromuscular or musculoskeletal, cardiovascular, cutaneous, hematologic, gastrointestinal and renal systems

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30
Q

Paraneoplatic syndrome May reflect

A

tumor necrosis, inflammation,
release of toxic products by cancer cells
or production of endogenous pyrogens

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31
Q

Paraneoplastic syndrome Cachexia

A

Psychologic effects of cancer on appetite, cancer cells compete with normal tissues for nutrients and may eventually cause nutritive death of normal cells

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32
Q

Paraneoplastic syndrome Nervous System: symptoms generally develop over

A

days to weeks usually prior to the tumor being

discovered

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33
Q

Nervous system symptoms of Paraneoplastic

Neuro : Memory, speech, vision, sleep, limbs, muscle tone

A

Symptoms include difficulty in walking or swallowing, Loss of muscle tone, loss of fine motor coordination, Slurred speech, memory loss, vision problems, sleep
disturbances,
Dementia, seizures, sensory loss in the limbs, and vertigo or dizziness

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34
Q

Paraneoplastic syndrome: Mostly seen in

A

small cell lung, lymphoma, myeloma

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35
Q

Paraneoplastic syndrome Can affect both

A

central and peripheral nervous systems

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36
Q

Neuro abdnormalities with Paraneoplastic syndrome occurs

A

Majority manifest BEFORE the diagnosis of cancer

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37
Q

ENDOCRINE abdnormalities with Paraneoplastic syndrome occurs

A

Most occur AFTER the diagnosis of cancer

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38
Q

ENDOCRINE abdnormalities with Paraneoplastic syndrome arise from

A

Arise from hormone or peptide production within

tumor cells

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39
Q

ENDOCRINE abdnormalities with Paraneoplastic syndrome Preferred management

A

Treatment of underlying tumor = preferred

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40
Q

ENDOCRINE abdnormalities with Paraneoplastic Syndrome

Most common cause of hospitalized patients

A

▪ Hypercalcemia- cancer is the most common cause in

hospitalized patients

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41
Q

ENDOCRINE abdnormalities with Paraneoplastic Syndrome: SIADH

A

▪ SIADH- mostly from small cell lung cancer

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42
Q

ENDOCRINE abdnormalities with Paraneoplastic Syndrome: CUSHING

A

Cushing’s Syndrome small cell lung ca & carcinoid

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43
Q

ENDOCRINE abdnormalities with Paraneoplastic Syndrome: Hypoglycemia

A

Hypoglycemia - islet cell

tumors of the pancreas

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44
Q

Paraneoplastic syndrome
Hormone : ACTH
Associated cancer _________
Manifestation_______

A

Carcinoid, lung (small cell), thymoma, thyroid (medullary)

Manifestations: Cushing’s syndrome

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45
Q

Paraneoplastic syndrome
Hormone : ADH
Associated cancer _________
Manifestation_______

A

Duodenal, lung (small cell), lymphoma, pancreatic, prostate

Manifestations : Water intoxication

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46
Q

Paraneoplastic syndrome
Hormone : Erythropoietin
Associated cancer _________
Manifestation_______

A

Hemangioblastoma, hepatic, renal cell uterine myofibroma

Manifestations: Polycythemia

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47
Q

Paraneoplastic syndrome
Hormone : HCG
Associated cancer _________
Manifestation_______

A

Human chorionic gonadotropin Adrenal, breast, lung (large cell), ovarian, testicular
Manifestations: Gynecomastia, galactorrhea, precocious
puberty

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48
Q

Paraneoplastic syndrome
Hormone : Insulin-like substances
Associated cancer _________
Manifestation_______

A

Retroperitoneal tumors

Manifestations: Hypoglycemia

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49
Q

Paraneoplastic syndrome
Hormone : Parathyroid hormone
Associated cancer _________
Manifestation_______

A

Lung (small cell, squamous cell), ovary,
pancreas, renal
Manifestations: Hyperparathyroidism, hypercalcemia,
hypertension, renal dysfunction, left ventricular dysfunction

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50
Q

Paraneoplastic syndrome
Hormone : Thyrotropin
Associated cancer _________
Manifestation_______

A

Choriocarcinoma, testicular (embryonal)

Manifestations: Hyperthyroidism, thrombocytopenia

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51
Q

Paraneoplastic syndrome
Hormone : Thyrocalcitonin
Associated cancer _________
Manifestation_______

A

Thyroid (medullary)

Manifestations: Hypocalcemia, hypotension, muscle weakness

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52
Q

Paraneoplastic syndrome Renal abnormalities

A

Glomerulonephritis
Membranous glomerulonephritis
Nephrotic syndrome
Amyloidosis

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53
Q

Paraneoplastic syndrome Renal abnormalities

Glomerulonephritis common in

A

Glomerulonephritis common in lymphoma & leukemia

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54
Q

Paraneoplastic syndrome Dermatologic & Rheumatologic Abnormalities ▪

A

Appearance should initiate cancer screening

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55
Q

Paraneoplastic syndrome Hematologic Abnormalities ▪

▪ Eosinophilia most often seen in ____and what can it cause?

A

Rarely symptomatic but usually present with
advanced cancer
leukemia and lymphoma
▪ Can cause wheezing or occasionally end -organ damage resulting from eosinophilic infiltration

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56
Q

Radiation therapy adverse effects:

Skin : Acute and Chronic

A

Acute: Erythema, rash, hair loss
Chronic: Fibrosis, sclerosis, telangiectasias

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57
Q

Radiation therapy adverse effects: Gastrointestinal

Acute and Chronic

A

Acute: Malnutrition, mucositis, nausea, vomiting Chronic: Chronic: Adhesions, fistulas, strictures

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58
Q

Radiation therapy adverse effects: Cardiac

A

Acute: NONE
Chronic: Conduction defects, pericardial effusion, pericardial fibrosis, pericarditis

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59
Q

Radiation therapy adverse effects: Respiratory

A

Acute: NONE
Chronic: Airway fibrosis, pulmonary fibrosis, pneumonitis,
tracheal stenosis

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60
Q

Radiation therapy adverse effects: Renal

A

Acute: Glomerulonephritis
Chronic: Glomerulosclerosis

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61
Q

Radiation therapy adverse effects: Hepatic

A

ACUTE: Sinusoidal obstruction syndrome
Chronic: NONE

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62
Q

Radiation therapy adverse effects: Endocrine

A

Acute: NONE

Chronic Endocrine Hypothyroidism, Panhypopituitarism

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63
Q

Radiation therapy adverse effects: Hematologic

A

Acute:Bone marrow suppression
Chronic: Coagulation necrosis

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64
Q

Colon cancer is one of

A

The most types of cancer, very treatable if caught early

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65
Q

Colon Cancer stage 0

A

Cancer has not grown beyond inner layer of colon wall

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66
Q

Colon Cancer stage 1

A

Grown to outer layer of wall

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67
Q

Colon Cancer stage 2

A

Tumor is through wall, not spread to lymph nodes

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68
Q

Colon Cancer stage 3

A

Spread to lymph nodes

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69
Q

Colon Cancer stage 4

A

Cancer spreads to distant sites in body, such as liver or lung

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70
Q

Colon cancer How does the tumor begins

A

Normal tissue forms a polyp projecting from colon wall

Over time polyp become a tumor

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71
Q

Risk factors for colon cancer are (PAF)

A

Patient with a hx of Ulcerative colitis or Crohn’s Disease
Age
Family Hx of colon cancer

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72
Q

Clavicle repair Position

A

Beach chair or supine, head turned away from

surgical field, bump placed behind affected shoulder

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73
Q

Clavicle repair Airway

Tube taping?

A

GETA or GLMAA

• Tape tube on one side opposite of surgical field

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74
Q

Clavicle repair Unique considerations

A
  • RSI if trauma
  • ISB will NOT help cover proximal clavicular pain
  • IV/cuff on nonoperative side
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75
Q

Clavicle repain pre-op

CMS

A

Perform a thorough distal neuro assessment on
the affected arm both pre/post
( Circulation, sensation, motor function)

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76
Q

Clavicle repair head.

A

• Carefully stabilize head in beach chair position

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77
Q

Clavice repair Tube , what to do severely and why ?

A
  • Tape the ETT or LMA SEVERELY

* Head will be under drapes

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78
Q

Clavicle repair, important to have

A

Eye protection is important

Tape eyes closed, place pads over eyes, consider goggles (DON’T)

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79
Q

Clavicle repair: Surgeon may require

A

SBP < 100 mm Hg to prevent bleeding

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80
Q

Clavicle Repair Complications:

A

brachial plexus or subclavian artery injury

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81
Q

Dye injection:

Post op

A

Pt may be allergic to dye, tattooing of skin, discoloration of urine
urine emesis or stool may be blue for 24-48h

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82
Q

Isosulfran dye reaction:

Treat with

A

Pruritus, localized swelling, blue hives

Diphenhydramine 10-50mg IV, epi if BP ↓

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83
Q

Dyes and SPO2 (how much and when)

A

Drops SPO2 (2-5% 20-25 minutes after injection)

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84
Q

Regional for breast procedures

A

Regional (paravertebral, pec I & II blocks)
• Less PONV, less pain, earlier discharge,
less chronic pain

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85
Q

Breast Biopsy and Lumpectomy

A

Paravertebral block
• With MAC or GA
• Pectoral nerve block type II

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86
Q

Paravertebral block for mastectomy

Levels block ? how much and meds concentration

A

Multilevel paravertebral blocks
• T1-T6 block required
• 4-5 mL/level
• 0.5% bupivacaine or 0.5% ropivacaine (1:400,000 epi)

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87
Q

Contraindications to regional

A

Contraindications: patient refusal, local
anesthetic allergy, pathology or anatomical
distortion of paravertebral space, infection at site

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88
Q

When to sedate for breast block

A

Sedate when performing block, best in OR

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89
Q

Medication management for breast surgery patient:preop

A

Midazolam

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90
Q

Medication management for breast surgery patient: Intraop

A

Propofol 25-100 mcg/kg/min
Fentanyl/remi and midazolam titrate effect
Remi bolus 0.5-1mcg/kg 90 second prior to initial incision with LA

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91
Q

Breast biopsy /SNL Airway

A

GA may mask or LMA if appropriate

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92
Q

What is Normal hepatic blood flow in

adults?

A

1,500mL/min

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93
Q

% distribution of blood flow in hepatic

A

• 25-30% delivered via hepatic artery,
• 70-75% supplied by portal vein (normal oxygen
saturation around 85%)

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94
Q

Portal vein normal oxygen saturation around

A

85%

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95
Q

% of blood delivered by hepatic artery

A

25-30%

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96
Q

% supplied by portal vein

A

70-75%

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97
Q

Liver receives how much of CO?

A

25-30% of the cardiac output

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98
Q

The Hepatic plexus is innervated by:

A
  1. Sympathetic nerve fibers from T6-T11

2. Parasympathetic fibers from right phrenic nerves and the right and left vagus

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99
Q

Laparoscopic cholecystectomy complications

A

• 5% of “lap choles” convert to open because inflammation obscures the anatomy

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100
Q

Laparoscopic procedures Anesthesia considerations:
➔
• Treated c/ glucagon, naloxone, or nitroglycerin

A

• Insufflation ➔ ↑ intra-abdominal pressure ➔interferes c/ ventilation and venous return, can result in bradycardia (glycopyrrolate vs atropine)
Immediate ↓ in venous return and cardiac output →
↑ MAP and systemic vascular resistance

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101
Q

Can help after insufflation

A

Reverse Trendelenburg can help c/ BP and SVR

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102
Q

During Lap Chole procedures, Opioid induced

A

Sphincter of Oddi spasm occurs in less than 3% of patients

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103
Q

With lap chole procedures if sphincter of oddi spasms occur what do you treat it with?

A

glucagon, naloxone, or nitroglycerin

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104
Q

Assessing liver damage, enzymes: ALT

A

cytoplasmic enzyme high specific to the liver

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105
Q

Assessing liver damage, enzymes: AST

A

Enzyme that exist in hepatic and extra hepatic tissues

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106
Q

When both liver enzymes are elevated

A

Ratio is considered
ALT/AST ratio < 1 nonalcoholic steato-hepatitis NASH
2 to 4 = alcoholic liver disease.

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107
Q

Assessment of liver function:

A

ALBUMIN and INR

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108
Q

Synthesized exclusively by hepatocytes

A

Albumin

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109
Q

Albumin is responsible for

A

15% of all protein synthesis in the liver

There can be severe impairment of the synthesis capacity in the liver

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110
Q

INR is correlated with

A

liver dysfunction

111
Q

Considered the reliable predictive value for survival in patients with liver disease

A

INR

112
Q

INR is associated with the impairment of the

A

Hepatic synthetic function of coagulation factors.

113
Q

Bilirubin is the

A

degradation product of hemoglobin and myoglobin.

114
Q

•Total bilirubin concentration is normally

A

< 1 mg/dL

115
Q

•Total bilirubin concentration• > 3 mg/dL =

A

scleral icterus

116
Q

•Total bilirubin concentration• > 4 mg/dL =

A

overt jaundice

117
Q

Sensitive marker for hepatocellular damage

A

• α glutathione-S-transferase ; ↑ transiently after
administration of isoflurane, desflurane, and
sevoflurane

118
Q

MOST indicative of liver damage

A

ALT

119
Q

Distinguishing Cholethiasis from ureterolithiasis and acute intermittent porphyria)

A

Serum bilirubin and alkaline phosphatase

are sharply ↑

120
Q

Hep C is the most

A

virulent ➔ chronic hepatitis (40%) and cirrhosis ➔ end-stage liver disease requiring liver transplantation

121
Q

Hep B co exist with

A

D

122
Q

Hep C co exist with

A

E

123
Q

What is Immune-Mediated Hepatotoxicity?

A

Administration of volatile anesthetics (especially halothane) leads to immune-mediated hepatotoxicity (IgG)

124
Q

In immune mediated hepatotoxicity

A

Microsomal proteins on the surface of hepatocytes are covalently modified by reactive oxidative trifluoroacetyl halide (TFAH) metabolites to form neoantigens (“self” is turned into“nonself”)
➔ Rare life-threatening hepatic dysfunction

125
Q

➔ Rare life-threatening hepatic dysfunction

A

immune mediated hepatotoxicity

126
Q

Fluorinated volatile anesthetics (DIE)

A

(enflurane, isoflurane, and desflurane) form trifluoroacetylated metabolites, which have a cross sensitivity c/ halothane

127
Q

Fluorinated Volatile anesthetics: does NOT have this property

A

sevoflurane

128
Q

Coagulopathy

A

Hepatocytes produce fibrinogen .,factor 5,7,9,10,12 and protein C and S and antithrombin

129
Q

Sinusoidal endothelial cells produce

A

factor VII and vWF

130
Q

Cirrhosis on pro and anticoagulants

A 
↓ serum albumin
prolonged prothrombin time, 
↑ serum AST/ALT, 
Thrombocytopenia
 ↑ INR
131
Q

Hepatic failure correct coagulation with

A

FFP (has all the clotting factors)

132
Q

Hepatic Failure if PT/INR prolonged

A

Administer Vitamin K (treat thrombocytopenia)

133
Q

The liver role with coagulation

A

The liver clears activated coagulation factors from circulation

134
Q

Drug doses for Liver disease: blood

A

Administer blood slowly because clearance of citrate is decreased with cirrhotic liver

135
Q

Drug doses for Liver disease: Plasma cholinesterase and SUCC

A

Severe liver disease may alter plasma cholinesterase activity and prolong SUCCINYLCHOLINE

136
Q

With liver disease , Volume of distribution is

A

INCREASED

137
Q

Because with liver disease Vd is increase, the initial dose of ____________however, subsequent doses should be

A

NDNMB needs to be larger than normal; decreased due to decrease hepatic clearance

138
Q

Liver disease and Vecuronium doses

A

Elimination half life of Vecuronium is NOT INCREASED until the dose EXCEED 0.1mg/kg

139
Q

Hepatic Failure: Critically ill patients should receive

A

low doses of volatiles or N2O c/ TIVA

140
Q

Hepatic failure and protein binding

A

Decrease protein binding due to low albumin

↑ active forms of IV drugs

141
Q

Acute alcohol; Chronic alcohol ingestion

A

Less anesthetics (additive effects) ; more

142
Q

Risk stratification For liver disease

Parameter: Bilirubin (mg/dL) Low, mod, High

A

<2
2-3
>3

143
Q

Risk stratification For liver disease

Parameter: Albumin Low, mod, High

A

> 3.5
3-5
<3

144
Q

Risk stratification For liver disease

Parameter: Prothrombin time (sec) Low, mod, High

A

1-4
4-6
>6

145
Q

Risk stratification For liver disease

Parameter: Encephalopathy Low, mod, High

A

None
Moderate
Severe

146
Q

Risk stratification For liver disease

Parameter: NutritionLow, mod, High

A

Excellent
Good
POOR

147
Q

Risk stratification For liver disease

Parameter: Ascites Low, mod, High

A

None
Moderate
Marked

148
Q

Risk Stratification parameters for liver disease are (BAPENA)

A 
Bilirubin
Albumin
Prothrombin time
Encephalopathy
Nutrition
Ascites
149
Q 
High risk for Liver disease 
Bilirubin
Albumin
Prothrombin
Encephalopathy
Nutrition
Ascities
A 
>3
<3
>6
Severe
Poor
Marked
150
Q

What is porphyria

A

Genetic errors of metabolism characterized by OVERPRODUCTION of porphyrins and their precursors

151
Q

What is the most important porphyrin?

A

Heme (bound to proteins to form hemoproteins including hemoglobin and cytochrome P-450)

152
Q

Porphyria and anesthesia

A

ONLY ACUTE PORPHYRIAS are relevant to anesthesia because they produce life-threatening reactions to certain drugs.

153
Q

Acute intermittent porphyria is the

A

common acute form of porphyria, producing the most serious symptoms

154
Q

Acute intermittent porphyria Signs and symptoms

A

Hypertension, Renal dysfunction and CNS symptoms and can be precipitated by the administration of certain drugs.

155
Q 
Acute intermittent Porphyria DRUGS TO AVOID
KEPT MAN (most important KEMT)
A 
Ketorolac
Etomidate
Pentazocine
Thiopental and Thiamylal
Methohexital
Nifedipine
156
Q

Porphyria anesthesia considerations

A

Carbohydrate administration can suppress porphyrin synthesis (10% glucose in saline recommended )
Minimize NPO time
Document existing muscle weakness

157
Q

Porphyria anesthesia intra op

A

Avoid all barbiturates

Keep patient warm

158
Q

Treatment of acute Porphyria

A

• Remove triggering agents
• Adequate hydration and carbohydrate administration
• Treat symptoms as needed
• Benzodiazepines and propofol can help alleviate symptoms
Hematin

159
Q

Is the only specific therapy for acute porphyric crisis

A

Hematin (3-4mg/kg IV over 20min)

160
Q

Adverse events with ETT : LMA

Clinical significant Problems

A

3.4: 0.9 Ratio

161
Q

Adverse events with ETT : LMA

Laryngeal Spasms

A

0.38: 0.12

162
Q

Adverse events with ETT : LMA

Aspiration

A

0.017 :0.02

163
Q

Adverse events with ETT : LMA

Sore throat

A

50:10

164
Q

Adverse events with ETT : LMA

Laryngeal Trauma

A

6.2; <1 Ratio > 6

165
Q

Adverse events with ETT : LMA

Coughing or emergence

A

60: 2 Ratio 30

166
Q

Not much difference in occurence ETT vs LMA

A

Aspiration

167
Q

Major difference in this event for ETT vs LMA

A

Coughing on emergence
60 ETT
2 LMA

168
Q

Narcotic Management Fentanyl
TIVA
 Controlled hypotension = SBP < 100 mm Hg, MAP 60-70 mm Hg

A

do NOT exceed 4 mcg/kg for total dose

169
Q

Extra cranial Narcotic Management TIVA

SANDWICH ANESTHETIC

A

c/propofol and remi and boluses of fentanyl = facilitation
of moderate-controlled hypotension, improves hemodynamic stability during most stimulating parts, and promotes smooth emergence
 “Sandwich anesthetic”

170
Q

Controlled Hypotension

A

Controlled hypotension = SBP < 100 mm Hg, MAP 60-70 mm Hg

171
Q

Extracranial IV narcotics : patients

A

Minimize IV narcotics

Warn patient about postoperative discomfort

172
Q

Pain score: UPPP vs UPF

Sinus surgery

A

8-10
6-10
2-3

173
Q

UPF is _____ painful than UPPP

A

less

174
Q

What is the Retrobulbar block?

A

Retrobulbar block involves depositing local anesthetic inside the muscle cone behind globe

175
Q

Akinesia Requires

A

retrobulbar block

176
Q

What does the retrobulbar block do?

A

Blocks Ciliary ganglion of CN III, IV and VI

177
Q

A retrobulbar block does not anesthetize____ which leaves the patient able to close the eye with the ________ but not open it with the ____

A

cranial nerve VII (facial nerve), Orbicularis oculi VII ; levator muscle (CN III).

178
Q

Exception of retrobulbar block

A

The exception of the orbicularis oculi of the eyelid

179
Q

Oculocardiac reflex Neural pathways (2 nerves ) five and dime

A

The relevant neural pathways are branches of the trigeminal nerve (afferent) and vagus nerve (efferent)

180
Q

Oculocardiac reflex Treatment of bradycardia includes

A

removal of stimulus
asking the surgeon to stop the stimulation
initiation of intravenous anticholinergics (eg atropine 5-10 ,20mcg/kg or glycopyrrolate 2.5-5 mcg/kg), and checking depth of anesthesia (where GA is used).

181
Q

What is Oculocardiac reflex?

A

a decrease of HR by 10%, HYPOTENSION and Bradycardia due to a range of stimuli in or around the orbit, such as traction on the extraocular muscles, pressure on the globe, retrobulbar block, ocular trauma

182
Q

Emergence after eye surgery (FEDO)

A

Fully revere NMB
Extubate awake, but smoothly
Decompress blood from stomach
Observe swallowing

183
Q

Emergence if concerned about extreme edema?

A

Consider extubating over tube exchanger (bougie)

184
Q

Emergence after eye surgery : Bailey maneuver

A

LMA substituted for the tracheal tube while patient is deeply anesthesized, inflated LMA inserted, then tracheal tube removed, LMA inflated, and patient allowed to emerge

185
Q

Emergence Nasal airway before emergency if

A

NO sinus /nasal surgery

186
Q

Emegence after eye surgery

A

Expect pain and HTN, treat with opioids before emergence (not too much, have a calculated number in mind!)

187
Q

Emergence HTN can lead to

A

bleeding

188
Q

Complications with emergence after eye surgery:

A

Airway/resp. most common

↑CO2, pulm edema, reintubation, broncho/laryngospasm

189
Q

Make sure surgeon removes

A

throat pack at end of surgery!

190
Q

When sedatives and/or narcotics are used in geriatric patients.

A

Careful, slow titration is necessary

191
Q

OSA have

A

 Exaggerated response to sedatives

192
Q

Parkinsons: Deep brain stimulator placement why?

A

Avoid GABA agonists with deep brain stimulator placement (alter characteristic microelectrode
recordings of specific nuclei in the basal ganglia)

193
Q

Parkison’s Disease levodopa therapy

A

Continue levodopa therapy because acute withdrawal can results in skeletal muscle rigidity which can lead to ventilation problems

194
Q

Anesthesia management of Parkison’s Disease

A

Use opioids and DEXMEDETOMIDINE instead, but avoid respiratory depression because head frame limits ability to intubate

195
Q

Avoid in Parkinson’s

A

Hypotension

196
Q

In parkinson’s, sudden

A

Alteration of consciousness could indicate intracranial hemorrhage.

197
Q

Alzheimer’s Medication management Tx (TDRG)

A

Cholinesterase Inhibitors (Tacrine, donepezil, rivastigmine, galantamine) May PROLONG ACTIVITY of SUCCINYLCHOLINE and MAY BE RESISTANT to NDNMB

198
Q

Subarachnoid Hemorrhage d/t Aneurysm and spasms

A

Intracerebral vasospasms can occur 3-15 days

after subarachnoid hemorrhage

199
Q

Subarachnoid Hemorrhage d/t Aneurysm and spasms If vasospasm is identified via

A

via transcranial doppler

200
Q

Vasospasms triple H therapy is initiated

A

(Hypervolemia, Hypertension, Hemodilution)

Colloid, crystalloid, and pressors may be used

201
Q

Medication: helps reduce occurrence of vasospasm

A

Nimodipine

202
Q

EEG waves

A 
DELTA = deep • 
S/THETA = sleep • 
ALPHA = awake • 
BETA = concentrating
203
Q

A. EEG monitoring

A

monitor cerebral function during GETA
= Detect cerebral ischemia during CEA, cerebral
aneurysm surgery, and arteriovenous malformation
management and CABG

204
Q

SAH d/t aneuryms limit the

A

risk of rupture
Avoid significant increase in BP
ICP can be left higher than normal but not abnormal >20, to tamponade aneurysm

205
Q

CPP and vasospasms

A

prevent cerebral ischemia , CPP must be kept elevated during vasospasms

206
Q

When is rupture most likely to occur

A

During the late stages of surgical dissection

207
Q

EPs: Anesthesia drugs effect on EEG latency and amplitude DAIL

A

IV anesthetics and Volatiles
DECREASE AMPLITUDE,
INCREASE LATENCY

208
Q

•MNEMONICS:

A

VEP = very sensitive
• SSEP = somewhat sensitive
• BAEP = barely sensitive

209
Q

A-line/CVP/PAP transducer at

A

external auditory/acoustic meatus level (Circle of

Willis assessment of CPP).

210
Q

BIS 100 :

A

Awake

211
Q

▪ Monitors brain wave activity; main

application is with______

A

BIS: alertness

212
Q

BIS 70-90:

A

Light/Moderate Sedation

213
Q

BIS 60-70:

A

Deep Sedation (low probability of explicit recall)

214
Q

BIS level with low probability of explicit recall

A

BIS 60-70

215
Q

BIS level 40-60

A

*** GENERAL ANESTHESIA

216
Q

BIS level 10-40

A

Deep Hypnotic State

217
Q

BIS level 0-10 :

A

Flat line EEG

218
Q

Assess for symptoms of increased ICP •

AMDPMM

A 
Altered consciousness 
Nausea, vomiting 
Decreased reactivity of pupils to light 
Papilledema 
Mydriasis 
Midline shift > 0.5cm
219
Q

High ICP Cushing’s triad •

A
  • Bradycardia
  • Systemic hypertension
  • Breathing disturbances
220
Q

Laparoscopic colon surgery regional

A 
TAP Block
Transthoracic Epidural  (as opioids sparring techniques)
221
Q

Laparoscopic colon surgery regional: Thoracic Epidural Analgesia (TEA)

A

Beneficial effects of TEA require that catheter placement be targeted at the Thoracic segments innervating injured skin, muscle and bone from which nociceptive input originated.

222
Q

ERAS Preopearative

(COPS PRIP)

A 
Cardiopulmonary exercise testing
Optimized diets 
Preadmission education and counseling
Shortening fasting
Prophylactic ABT
Respiratory drug intervention
Intensive Pulmonary physioologic therapy
Physical exercise training
223
Q

ERAS Intraoperative PPFES

A 
Protective lung ventilation
Prevention of hypothermia
Fissureless surgical techniques
Epidural anesthesia/analgesia
Single chest tube placement
224
Q

ERAS POSToperative (EMSIEE)

A

Epidural analgesia/ nonsteroidal analgesic painkillers
Measures to promove bowel movements
Standardized chest tube management
IV fluid restriction
Early removal of epidural and urinary catheter
Early oral feeding and ambulation

225
Q

TMJ surgery

Complications due to

A

Patients swallowing blood from the procedure, results in increased chance of N/V.

226
Q

TMJ surgery complications: Airway

A

Airway obstruction d/t retained throat packs from the surgery. Surgeon and staff must always check for throat packs if patient is showing signs of airway obstruction.

227
Q

TMJ complications: One of the most common complications is

A

a permanent loss in range of motion of the joint.

228
Q

TMJ complications Injury to the

A

Facial Nerve, CN VII, can result in partial loss of facial muscle movement or loss in sensation

229
Q

TMJ can cause Injury to the Trigeminal Nerve,

A

CN V, which is responsible for facial sensation and facial motor movements like chewing/biting.

230
Q

TMJ and hearing

A

Partial hearing loss

231
Q

TMJ complications Frey Syndrome? what does it cause?

A

a rare complication due to injury of the parotid glands near the TMJ. This will cause excessive facial swelling.

232
Q

Sub-tenon Regional

A

Provides profound analgesia, but motor movements may still be present, done between the rectus muscles of the globe

233
Q

Most effective regional for eye

A

Retrobulbar

234
Q

Retrobulbar block Procedures

A

Pt instructed to look up and nasally
23G needle inserted and local injected in the muscle cone
after injection, eyelid should be closed, and digital pressure applied over the grobe to the orbit. After a few moments the eyelids should be opened and the globe inspected for akinesia.

235
Q

Currently, cataract surgery most commonly performed using only

A

topical anesthetics (e.g., 2-4% lidocaine, 0.75% levobupivacaine, 1% ropivacaine, or 1% oxybuprocaine). Need very compliant.

236
Q

Blocks- Local anesthetics should be avoided in

A

patients with uncontrolled movement disorders, or inability to cooperate.

237
Q

EYE Surgery General anesthesia is very rare. Indications include

A

children, dementia, mental disability, severe anxiety, severe head tremor, or inability to lie flat (breathing issues)

238
Q

Coughing or bucking can

A

increase intraocular pressure by 40 to 60 mmHg which can lead to optic nerve ischemia

239
Q

Contraindications include

A

uncontrolled movement disorders, claustrophobia, chronic cough, symptomatic gastric reflux, inability to lie flat, inability to communicate or cooperate, or patient refusal.

240
Q

Epidural hematoma occurs when the

A

middle cerebral artery via a skull fracture

241
Q

Prognosis better in this condition than acute subdural hematoma-Looks like a lemon or eye,

A

Epidural

242
Q

Most common cause for emergency neurosurgery and has the highest mortality.

A

Subdural hematoma

243
Q

On CT it appears as a crescent or banana shape.

A

Subdural

244
Q

**Indicate anesthetic and surgical emergency

A

Sustained HTN
Increased ICP
swelling indicative of aneurysm rupture

245
Q

Anesthesia management to minimize ICP

A

Give mannitol 20% 0.25-0.5g/kg , lasix 0.3mg/kg and dexamethasone 16mg IV
Stop N2O , ensure ISO or SEVO in use

246
Q

Induction in anesthesia management to minimize ICP

A

Induction with propofol 1-2mg/kg or etomidate 0.3-0.6mg/kg

247
Q

Anesthetic drugs on CBF

A

IV drugs such as propofol, etomidate, benzodiazepine and thiopental decreases CBF by virtue of drug induced decrease in CMRO2, and subsequent flow metabolism coupling.

248
Q

Autoregulation and PaCO2

A

Responsiveness remain intact with these agents vasoconstriction is caused by these meds and is the resonse for the decrease in CBF and CMRO2

249
Q

OPIODS and CMRO2

A

Opiods have very little effect on CRMO2, CBF, autoregulation and PaCO2 responsiveness

250
Q

Ketamine and CBF

A

It increases CBF and CMRO2 with little effect on autoregulation or PACO2 responsiveness.

251
Q

Volatile anesthetics and CBF

A

Iso, sevo, and dest are direct cerebral vasodilators.

252
Q

Complication that can occur before during and after the aneurysm has been clipped.

A

Arterial vasospasm

253
Q

An aneurysm is a

A

focal protrusion from weakness of a vessel wall at a major bifurcation of arteries in the Circle of Willis.

254
Q

CSF secreted by

A

Choroid plexus in each ventricle

255
Q

CSF absorption is at the

A

Arachnoid villi into the dura venous sinus

256
Q

Hydrocephalus

A

Dilation of the ventricular system due to obstruction of CSF flow

257
Q

Aneurysm rupture in the

A

Subarachnoid space

258
Q

Most of aneurysm occur in bifurcation of

A

Anterior communicating artery 30%
Posterior communicating artery 25%
Middle Cerebral Artery 25%
Basilar artery 2%

259
Q

During lap surgery, if insufflation cause bradycardia

A

ask surgeon to deflate

260
Q

Chemotherapy drugs on CV

A

Dysrhythmias, get EKG possibly needs echo or cardiology clearance

261
Q

Chemotherapy drugs on Renal

A

nephrotocity prehydrate and avoid nephrotoxic agents

262
Q

Chemotherapy drugs on CISPLATIN can cause

A

Neuropathy

263
Q

Chemotherapy drugs on methotrexate can cause

A

Irreversible dementia

264
Q

Choriocarcinoma

A

Uterus

265
Q

Interscalene bLock and clavicle repair

A

wont work for clavicle repair

266
Q

Put BP cuff

A

Nonoperative side

267
Q

Breast surgery tips

A

know lidocaine toxicity level

serum level doesn’t always transfer

268
Q

Epidural hematoma

A

Under the bone, between dura and skull

Middle meningeal artery

269
Q

ICP increased induction agent

A

Use etomidate

270
Q

Etomidate and profopol

A

0.1-0.4 mcg/kg to decrease CMRO2, and CBF

271
Q

ICP keep

A

glucose down

272
Q

PVB block level

A

T1-T6

273
Q

Signs of Rupture

A

Severe HTN
Seizures
Swelling and increased ICP

SRNA3CoExisting (16 decks)

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