Anesthesia

Question 1

How do you reverse non-depolarizing muscle relaxants (like rocuronium)?

Answer 1

Neostigmine and glycopyrrolate/atropine

Neostigmine is an anticholinesterase inhibitor which increases acetylcholine concentration to outcompete rocuronium and glycopyrollate or atropine to prevent systemic acetylcholine overdose

Question 2

What physiology occurs with carbon dioxide insufflation?

Answer 2

Decrease venous return, SV, CO, EF
Increase systemic vascular resistance
Increase respiratory acidosis due to increased dead space
Increase hypercarbia

Question 3

What are the signs of malignant hyperthermia?

Answer 3

Early signs: 
Masseter rigidity
Tachycardia
Muscle rigidity
Hypercarbia

Late signs:
Hyperthermia, hyperkalemia, arrhythmia, myoglobinuria

Question 4

What is the cause of malignant hyperthermia?

Answer 4

Succinylcholine and halothanes

Question 5

What is the treatment of malignant hyperthermia?

Answer 5

Discontinue volatile anesthetic agents
Administer dantrolene
Treat hyperkalemia
Monitor for DIC

Question 6

Are ASA and NSAIDs a contraindication to epidural analgesia?

Answer 6

No

Question 7

Does opioid analgesia cause numbness, muscle weakness, or hemodynamic effects?

Answer 7

No

Question 8

What do you worry about 24-48hrs after epidural analgesia with fever, stiff neck, and headache?

Answer 8

Meningitis or epidural abscess

MCC organisms are Staph aureus, Coliform species, and pseudomonas

Question 9

How many milligrams of lidocaine are in 1% lido?

Answer 9

1000mg/100ml or 10mg/ml

Question 10

What is the maximum dose of lidocaine and lidocaine with epi?

Answer 10

5 mg/kg for lidocaine plain
7 mg/kg for lidocaine with epi
So for a 70kg person, 35 ml plain or 49ml with epi

Question 11

What are the mallampati classes?

Answer 11

Class 1 - Full visibility hard palate, soft palate, uvula, tonsils
Class2- Full visibility of hard and soft palate, partial visibility of uvula and tonsils
Class 3- Full visibility of hard and soft palate, but only base of uvula
Class 4- Only hard palate visible

Question 12

What agent should be used in conscious sedation and why?

Answer 12

Midazolam (versed) - allows patient to retain protective reflexes of airway and allows them to follow commands. It can alleviate anxiety, muscle relaxant, anticonvulsant, hypnotic, and amnesic.
Reversal with flumazenil.

Question 13

What test can you do on a vented patient who received nondepolarizing muscle relaxant?

Answer 13

Lift their head for 5 seconds

The diaphragm is most resistant to neuromuscular blockade while the neck and pharyngeal muscles are most sensitive

Question 14

What does succinylcholine due?

Answer 14

It depolarizes the neuromuscular junction causing fine muscle fasciculations

Question 15

What symptoms do narcotics cause?

Answer 15

Analgesia, respiratory depression, hypotension (from histamine release and blunting of sympathetic vascular tone)

Question 16

When would you place a pulmonary artery catheter?

Answer 16

In critically ill patients with severe left heart dysfunction

Question 17

How much does oxygens partial pressure have to decrease to before there is significant change on pulse ox oxygen saturation?

Question 18

Which non-depolarizing muscle relaxant is good for patients with hepatic or renal dysfunction?

Answer 18

Atracurium - because it degrades by itself at physiologic pH (Hoffman reaction)

Question 19

Which non-depolarizing muscle relaxant is good for patients with reactive airway disease?

Answer 19

Vecuronium - does not cause histamine release like the others.

Question 20

What is a supraventricular tachycardia HR that you should treat?

Answer 20

130 bpm

Question 21

What medications can you use to treat supraventricular tachycardia?

Answer 21

Adenosine
Digoxin
Verapamil
Atenolol
Procainamide

Question 22

What antiarrhythmic should you not give to a patient with liver disease and why?

Answer 22

Procainamide is metabolized by the liver. It is usually used for ventricular arrhythmias and can cause torsades.

Question 23

How do non-depolarizing muscle relaxants (like rocuronium) work?

Answer 23

They are competitive inhibitors of acetylcholine.