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Flashcards in Anesthesia Deck (35):
1

8 P's of rapid sequence intubation

Prepare, Pretreat (drugs), Position (sniffing position), preoxygenated (POX 100%), Pressure (Sellick), Paralyze (drugs), Placement (tube), Position (of tube, confirm two ways)

2

What drug is important for intubation pretreatment in children?

Atropine to prevent bradycardia

3

Sellick maneuveur

Pressure on cricothyroid cartilage to compress esophagus, minimizing risk of aspiration

4

What drugs are used for sedation/induction of general anesthesia?

Thiopental, etomidate, midazolam, ketamine, methohexital, fentanyl, propofol

5

Thiopental

Can cause hypotension, good for inc ICP. Cannot use in asthma.

think tHIOpental = HIO = hypotension and good for inc ICP

6

Etomidate

Minimal hepatic/renal effects, good for pts with decreased CO. Can precipitate adrenal insufficiency

7

Midazolam

Can cause hypotension. Decrease dose if patient taking a drug that inhibits P450 (e.g. erythromycin).

8

Ketamine

Can cause tachycardia and increased ICP, good for patients with broncospasm. Cannot use in head trauma due to inc ICP effect. Not a lot of hypotensive effect (unless it is someone who is catecholamine deplete)

9

What drugs are used to paralyze the patient for intubation?

Succinylcholine, vecuronium

10

Succinycholine

Can cause hyperkalemia. Duration 5-10 min

11

What things can cause falsely lowered POX reading?

Methylene blue, indigo carmine blue, certain nail polishes

12

What can cause falsely raised POX reading?

Carboxyhemoglobin

13

What can cause a false POX reading of 85%?

Methemoglobin

14

Spinal cord ends at

L1-L2

15

Spinal vs. epidural anesthesia

Spinal anesthesia: stick needle into CSF, lasts for 2-3 hrs. Epidural anesthesia: catheter goes into epidural space and can continuously infuse. Both are indicated for surgeries involving LE's, lower abdomen, GU and anal region

16

Complications of spinal anesthesia

Hypotension/nausea (from unopposed parasympathetic activity) more common. Less commonly, post-spinal headache from CSF leak. Urinary retention, backache common.

17

Complications of epidural anesthesia

Hypotension/nausea less common than with spinal. Urinary retention, backache common. Rare but serious: epidural abscess or hematoma.

18

Succinylcholine is CI in what patients?

Burns, rhabdo, NM disease, GBS, narrow-angle glaucoma, malignant hyperthermia

19

Propofol

Comes as lipid emulsion, can cause hyperTG over time. Careful aseptic technique to prevent sepsis since emulsion is great growth medium.

20

Methohexital

Do not use in seizures, hypotension, asthma

21

How to reverse effect of neuromuscular blockade?

Anticholinesterases, which prevent breakdown of Ach.

22

Hepatic insufficiency considerations for sedation

Chronic alcohol use increases anesthetic requirements, while acute alcohol intoxication decreases them. Hypoalbuminemia means more unbound drug available. P450 activity may be decreased, so prolonged elimination of many drugs.

23

Pediatric considerations for sedation

Neonates: high metabolic requirements, increased O2 consumption; left shift of O2 curve due to fetal Hg; impaired temp regulation. Functional residual capacity is lower. Succinylcholine assoc with risk of bradycardia and rarely malign hyperthermia in peds. Airway narrowest point is beyond where you can see while intubating!

24

OB patients sedation consideration

Functional residual capacity decreased so more susceptible to hypoxemia. Demerol (meperidine) is better than morphine b/c newborn less sensitive to it. Tx hypotension with ephedrine because it preserves uterine blood flow.

25

Local anesthesia

MOA: blockade of Na channels. Less effective in acidic environment (e.g. infection). Adding epi prolongs duration by inducing vasoconstriction.

26

Toxicity of local anesthetics

Tinnitus, vertigo, seizures, hypotension, PR prolonging, QRS widening, arrhythmias

27

Do not use epi with local anesthesia in what areas?

SPF-10: scrotum, penis, fingers, toes, ears, nose

28

Two classes of local anesthetics

Amides and esters. Recall that amides have "i" before "caine" e.g. lidocaine, bupivacaine, prilocaine.

29

Malignant hyperthermia

Autosomal dominant hypermetabolic syndrome occurring after exposure to anesthetic agent. Cause: impaired reuptake of Ca by sarcoplasmic reticulum in muscle due to ryanodine receptor dysfunciton. Signs: tachy, hypertherm, hypercarb, hypoxic, acidosis, muscle rigidity, ventricular dysrhythmias

30

Treatment of malignant hyperthermia

Benzos (fast). Dantrolene (definitive but takes 30 min)

31

What is tylenol #2, 3, 4?

Acetaminophen with varying doses of codeine

32

Vicodin

Acetaminophen with hydrocodone

33

Ketorolac

Toradol = NSAID

34

Prochlorperazine

Compazine, antiemetic, antidopaminergic

35

Droperidol

antiemetic, antidopaminergic