Flashcards in Anesthesia Deck (35):
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)
What drug is important for intubation pretreatment in children?
Atropine to prevent bradycardia
Pressure on cricothyroid cartilage to compress esophagus, minimizing risk of aspiration
What drugs are used for sedation/induction of general anesthesia?
Thiopental, etomidate, midazolam, ketamine, methohexital, fentanyl, propofol
Can cause hypotension, good for inc ICP. Cannot use in asthma.
think tHIOpental = HIO = hypotension and good for inc ICP
Minimal hepatic/renal effects, good for pts with decreased CO. Can precipitate adrenal insufficiency
Can cause hypotension. Decrease dose if patient taking a drug that inhibits P450 (e.g. erythromycin).
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)
What drugs are used to paralyze the patient for intubation?
Can cause hyperkalemia. Duration 5-10 min
What things can cause falsely lowered POX reading?
Methylene blue, indigo carmine blue, certain nail polishes
What can cause falsely raised POX reading?
What can cause a false POX reading of 85%?
Spinal cord ends at
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
Complications of spinal anesthesia
Hypotension/nausea (from unopposed parasympathetic activity) more common. Less commonly, post-spinal headache from CSF leak. Urinary retention, backache common.
Complications of epidural anesthesia
Hypotension/nausea less common than with spinal. Urinary retention, backache common. Rare but serious: epidural abscess or hematoma.
Succinylcholine is CI in what patients?
Burns, rhabdo, NM disease, GBS, narrow-angle glaucoma, malignant hyperthermia
Comes as lipid emulsion, can cause hyperTG over time. Careful aseptic technique to prevent sepsis since emulsion is great growth medium.
Do not use in seizures, hypotension, asthma
How to reverse effect of neuromuscular blockade?
Anticholinesterases, which prevent breakdown of Ach.
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.
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!
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.
MOA: blockade of Na channels. Less effective in acidic environment (e.g. infection). Adding epi prolongs duration by inducing vasoconstriction.
Toxicity of local anesthetics
Tinnitus, vertigo, seizures, hypotension, PR prolonging, QRS widening, arrhythmias
Do not use epi with local anesthesia in what areas?
SPF-10: scrotum, penis, fingers, toes, ears, nose
Two classes of local anesthetics
Amides and esters. Recall that amides have "i" before "caine" e.g. lidocaine, bupivacaine, prilocaine.
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
Treatment of malignant hyperthermia
Benzos (fast). Dantrolene (definitive but takes 30 min)
What is tylenol #2, 3, 4?
Acetaminophen with varying doses of codeine
Acetaminophen with hydrocodone
Toradol = NSAID
Compazine, antiemetic, antidopaminergic