anesthesia

Question 1

• general anesthesia via vaporizer and carrier gas
• when inhaled partial pressure of gas = blood and goes through body
• dose is percent end-tidal agent and MAC is end-tidal level of gas needed to prevent movment to noxious stimulate in 50% of patients

Answer 1

inhaled anesthesia

Question 2

3 cardiac effects of inhaled agents

Answer 2

decreases 3 things: contractility, SVR and MAP

Question 3

• ischemia in pt with fixed stenotic lesions
• valvular heart disease
• cardiomyopathy
• congenital defects

these are implications of cardiac effects of what type of anesthesia?

Answer 3

inhaled agents

Question 4

what MET level are you concerned about with a patient going into surgery?

Answer 4

less than 4 METs

Question 5

3 signs of CHF

Answer 5

JVD
L.E edema
crackles

Question 6

4 pulm effects of inhaled agents

Answer 6

• bronchodilation
• decreased respiratory drive
• increased respiratory rate with decreased tidal volume
• atelectasis
• increased CO2 threshold to breathe– issue for OSA

Question 7

decreased breath sounds suggests what 4 conditions might be at play?

Answer 7

atelectasis
infection– could also have crackles or rhonchi
COPD
pneumothorax

Question 8

2 CNS effects of inhaled agents

Answer 8

• increased cerebral blood flow & ICP
• decreased cerebral metabolic demand

Question 9

4 neuro labs/imaging to get

Answer 9

CT/MRI for mass effect
plasma levels of anticonvulsant meds
carotid US for detection of carotid dz
MRI for ischemic changes

Question 10

fam h.o prolonged medication reactions is indicative of …

Answer 10

pseudocholinesterase deficiency

Question 11

fam h.o high fevers, unexplained cardiac arrest is indicative of …

Answer 11

malignant hyperthermia

Question 12

what is this condition? what 3 things can happen as it progresses?

• autosomal dom defect in ryanodine receptor that releases calclium
• hypersensitive to releasing stimuli & hyposensitive to inactivating signals

Answer 12

malignant hyperthermia
- acidosis, hyperK, arrhythmia

Question 13

2 triggering agents of MH

Answer 13

• volatile anesthetic gasses– sevo-, iso-, des-flurane
• succinylcholine (nondepolarizing muscle relaxant)

Question 14

2 things you see with MH

Answer 14

• increased: RR, CO2, HR, temp
• myoglobinuria

Question 15

how is MH tx

Answer 15

• stop agent, give DANTROLENE 2.5mg/kg
• support: decrease temp, manage hyperK

Question 16

3 components of general anesthesia

Answer 16

analgesia
hypnosis
muscle relaxant

Question 17

2 muscle relaxants

Answer 17

succinylcholine
NDMR

Question 18

propofol is what type of GA

Answer 18

IV hypnotics

Question 19

phases of GA (9)

Answer 19

1. pretreatment
2. monitoring
3. time out
4. pre-oxygenation
5. induction
6. airway mangement
7. maintenance
8. emergence
9. recovery

Question 20

what phase of GA is this

• goal is to reduce complications
• meds commonly given prior to patient arriving in the OR

Answer 20

pretreatment

Question 21

• anxiolytics (midazolam)
• olanzapine, meclizine, scopolamine
• Na bicitrate, famotidine– aspiration risk reduction
• metoclopramide
• albuterol

Answer 21

pretx meds

Question 22

Every patient shall have arterial blood pressure and heart rate determined every __ minutes

Answer 22

5

Question 23

goal pre-ox

Answer 23

90%

Question 24

What is the gas agent used in mask inductions?

Answer 24

Sevoflurane

Question 25

most common supraglottic airway

Answer 25

Laryngeal mask airmway (LMA) - they are placed in posterior oropharynx above the glottis

Question 26

- less secure than ETT & doesn't protect from laryngospasm and aspiration - no need for muscle relaxant - doesn't irritate the trachea - less coughing and bucking

Answer 26

supraglottic airways

Question 27

- can cause HTN and tachy on placement/removal & can be hard to place - irritating to the trachea causing coughing, bronchospasm - can still move air if patient laryngospasms

Answer 27

ETT

Question 28

- spinal/subarachnoid block - epidural block - combined spinal-epidural (CSE)

Answer 28

neuraxial regional anesthesia

Question 29

which spinal anesthetic lasts longest? shortest?

Answer 29

longest: tetracaine shortest: chloroprocaine

Question 30

used in: - c section - knee & hip replacement surgery - foot & ankle surgery - urology surg - below umbilicus if not candidate for GA

Answer 30

spinal anesthesia

Question 31

- rapid onset w/ very low dose with no CNS effect - can cause rapid drop in BP - if high can cause bradycardia & profound hypotension (T1-4), paralyze the diaphragm (C3-5)

Answer 31

spinal anesthesia pros and cons

Question 32

- used in lumbar or thoracic space - higher concentration for surgical *anesthesia*; lower for *analgesia* - can be enhanced by adding narcotic or epi

Answer 32

epidural

Question 33

uses: - labor & post op analgesia - csection if in place for labor - L.E or urology w/ uncertain duration - thoracic and abdominal procedures intra and post op

Answer 33

epidural uses

Question 34

- can be used for indeterminate op. length - used intraop and postop - sympathectomy more controlled - slower onset & less dense block; more finicky - larger dose of LA needed ; potential for dural puncture or epidural hematoma d/t larger needle

Answer 34

epidual pros and cons

Question 35

- **avoid general anesthesia if used as primary anesthetic** - better post-op pain control - less narcotic need while blocking; faster discharger - increased blood flow to surgical site - **Cannot be used for breast surg or paravertebral blocks** - potential for permanane nerve injury and local anesthetic systemic toxicity (LAST), bleding, infection

Answer 35

peripheral regional

Question 36

- combo of IV agents for deep sedation used to make patient comfy for procedures - risks: awareness & unprotected airway - agents: BZD, narcotics, hypnotics, ketamine

Answer 36

MAC (monitored anesthesia care)