Flashcards in ACE 2013 10A Deck (113)
What does placing a magnet to an ICD-pacemaker do to it generally?
Disables the anti-tachycardia features (cardioversion and defibrillation) while not changing the pacemaker settings
How should you manage a patient who is going to undergo surgery who is on IM depot naltrexone?
Have them stop the medication 6-8 weeks before surgery
Which of the following is best dosed using total body weight in the morbidly obese population: rocuronium, succinylcholine, vecuronium, cisatracurium
Succinylcholine; morbidly obese patients have increased concentrations of plasma pseudo-cholinesterase and may require more depolarizing NMB
Which of the following viruses has the highest risk of transmission following a stick: HIV, Hep A, Hep B, Hep C
Hep B (19-37%); Hep C is about 1.9% and HIV is 0.3%. Hep A is transmitted fecal-orally
How much does a full cylinder of O2 contain and what pressure reading does it read?
What are the general goals for anesthesia in patients with pulmonary hypertension?
1. Maintenance of preload
2. Maintenance of afterload (avoid hypotension)
3. Maintenance of NSR and adequate HR (optimize CO)
4. Avoid hypoxia, hypercapnia, acidemia (increases PA pressures)
What is the diagnosis of a patient with ascending weakness after a URI?
What is the most common complication seen in Guillian-Barre syndrome patients?
Hypotension (changes in catecholamine levels and impaired baroreceptor function) - 75% of patients
SIADH - >40% of patients
Respiratory failure - <20% of patients
What factors increase the risk of PA catheter-induced endobronchial hemorrhage?
2. Mitral stenosis
3. Pulmonary HTN
4. Advanced age
6. Distal placement of PAC or hyperinflation
What is the most common nerve affected by the lithotomy position and how does it present?
Common peroneal nerve
Inability to dorsiflex the foot (foot drop)
What nerve is affected if you have paresthesias along the medial thigh? Lateral thigh? Inability to flex the hip?
1. Obturator nerve
2. Lateral femoral cutaneous nerve
3. Femoral nerve
What does the superior laryngeal nerve provide sensation to?
Inferior aspect of epiglottis to the vocal cords
What does the glossopharyngeal nerve provide sensation to?
Posterior 3rd of the tongue, superior surface of epiglottis, and the pharynx
What does the recurrent laryngeal nerve provide sensation to?
Sensation below the vocal cords
Which volatile anesthetic in use today leads to the highest increase in serum fluoride levels?
What is a common risk seen with first-generation devices during extracorporeal shock wave lithotripsy? How can you avoid this?
Cardiac dysrhythmias; try to time the shocks after the R wave (refractory period so a new AP does not fire)
What is the mechanism of action for methylene blue?
Selective inhibitor of guanylate cyclase (NO-mediated vasodilation)
What is methylene blue used for?
Reduction of methemoglobinemia, treatment for vasoplegic syndromes (including refractory hypotension after bypass), possible benefit in Alzheimer's disease
What is medication is contraindicated with concurrent use of methylene blue?
Serotonin reuptake inhibitors; methylene blue inhibits monoamine oxidase
In what surgeries do you worry about venous air embolisms?
1. Posterior fossa in sitting position
2. Tumors near posterior sagittal sinus
3. Craniosynostosis procedures
4. Uterine externalization during C-sections (rare)
What is the most sensitive test for diagnosing VAE?
Why do elderly patients have more intraoperative hemodynamic lability?
1. Reduced compliance of blood vessels
2. Reduction of beta-receptor responsiveness
Which local anesthetics are patients more likely to be allergic to and why?
Esters; metabolized by plasma cholinesterases and RBC esterases to para-aminobenzoic acid (PABA) which is a known allergen
Which local anesthetics have the quickest onset of action?
Chloroprocaine and Lidocaine
Which local anesthetic is the most potent?
What is the treatment for cocaine-induced chest pain?
How much (%) does each unit of FFP increase coagulation factors?
How quickly must FFP be used after being thawed if kept at 1-6 degrees C?
Within 5 days
What coagulation factors are generally diminished after thawing FFP?
Factor V and VIII