Anesthesia

Question 0

Small MAC equals…

Answer 0

More lipid soluble -> more potent, slower induction

Ex: Nitrous oxide-> low potency, fast induction

Question 1

What does MAC stand for and what does it mean?

Answer 1

Minimum alveolar concentration

Smallest concentration of inhaled agent at which 50% of pts will not move with the first incision

Question 2

No Nitrous oxide with…

Answer 2

Anywhere with confined spaces- pneumo, SBO

Question 3

Nitrous oxide

Answer 3

Fast onset
Low potency
LEAST myocardial depression

Question 4

Inhaled agent with highest degree of cardiac depression

Answer 4

Halothane- good for kids

Halothane hepatitis- fever, increased eos, jaundice, inc LFT’s

Question 5

Sevoflurane

Answer 5

Less myocardial depression
Fast
Less laryngospasm
$$$

Question 6

Induction agents

Answer 6

Barbiturate- sodium thiopental
Propofol
Ketamine
Etomidate

Question 7

Do not use propofol in pts with what allergy?

Answer 7

Egg

Question 8

What does ketamine cause?

Answer 8

Dissociation of thalmic/limbic system
Hallucinations
Catecholamine release- inc carbon monoxide, tachy

NO in pts with head injury

Good for kids

Question 9

Etomidate

Answer 9

Fast
Fewer hemodynamic changes

Cont infusions can cause adrenocortico suppression

Question 10

Paralytics

Answer 10

Succinylcholine- de polarizing
Cis-atracurium- Hoffman deg- ok in liver and renal failure
Mivacurium
Rocuronium
Pancuronium - tachy

Question 11

De polarizing agent

Answer 11

Succinylcholine
Fast, short acting
Causes fasciculations at first- flaccid paralysis

Question 12

Succinylcholine contraindicated with…

Answer 12

Hyperkalemia- depolarization causes release of K
No in burn pts, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, renal failure, head injury

Question 13

Complication of succinylcholine

Answer 13

Malignant hyperthermia
Ca released from SR causes muscle excitation/contraction syndrome

1st sign- inc end tidal CO2
Tachy, rigid, acidosis, inc K

Atypical psuedocholinesterases- prolonged paralysis- Asians

Question 14

Treatment of malignant hyperthermia

Answer 14

Dantrolene 10mg/kg
Inhibits Ca release
Cooling blanket, HCO3, glucose

Question 15

What nondepolarizing agent can be used in liver or renal failure?

Answer 15

Cis- atracurium

Hoffman degradation
Histamine release

Question 16

What is the side effect of pancuronium?

Answer 16

Tachycardia

Nondepolarizing mm relaxant/paralyzer

Question 17

Reversing drugs for nondepolarizing agents

Answer 17

Neostigmine - blocks acetylcholinesterase- more Ach

Edrophonium-blocks

Atropine & glycopyrrolate - have to be given with neo or Edro to counteract Ach overdose

Question 18

Max dose of 1%lido

Answer 18

5mg/kg

Question 19

Max dose of lido + epi

Answer 19

7mg/kg

Question 20

Max dose of bupivicaine

Answer 20

3mg/kg

Question 21

Amides…

Answer 21

All have i in first part of name

Rare allergic rxns

Question 22

Esters…..

Answer 22

Increased allergic rxns due to PABA analogue

Question 23

Demerol complications

Answer 23

Tremors
Fasciculations
Convulsions

In renal failure can cause seizures

Question 24

Overdose of benzodiazepine is treated with

Answer 24

Flumazenil ( contra in pts with inc ICP)

Question 25

Tx for acute hypotension and Brady in epidural anesthesia

Answer 25

Stop epidural, fluids, phenylephrine, atropine

Question 26

Spinal anesthesia injected into what space?

Answer 26

Subarachnoid space No with hypertrophic cardio, cyanotic heart dz

Question 27

Treatment spinal headache

Answer 27

Fluids caffeine >24hrs- blood patch- place 10-20ml blood into epidural space Due to CSF leaking - brain sags into cranial vault- traction on pain fibers

Question 28

Complication of neuroaxial anesthesia

Answer 28

Epidural hematoma

Question 29

ASA classifications

Answer 29

``` I- healthy II- mild dz without limitation III- severe dz IV- constant threat to life V-moribund- not expected to survive OR VI- donor ```

Question 30

Placement of endotracheal tube

Answer 30

2cm above carina