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Anesthesia Flashcards

1
Q

Laryngospasm is the reflex closure of the … and … vocal cords

A

False and True

It occurs along the descent of the epiglottis over the laryngeal orifice

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2
Q

Appropriate steps to manage a laryngospasm

A

1 - 100 % O2 via face mask, CPAP w/ jaw thrust
2 - Finger pressure laryngospasm notch
3 - Deepen anesthesia

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3
Q

Succinylcholine dosing for laryngospasm

A

.25-.5 mg/Kg IV

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4
Q

Gold standard for diagnosis of OSA

A

Polysomnogram is the gold standard for diagnosing OSA

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5
Q

Quick questionnaire to assess for OSA?

A

Snoring
Tiredness
Observed apneas
Pressure treatment (blood pressure treatments)

BMI >35
Age >50
Neck circumference >40cm
Gender (male)

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6
Q

STOP BANG Scoring criteria

A

0-2 - Low risk
3-4 - Moderate risk
5-8 - High Risk

15% at 3 points
65% at 7-8 points

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7
Q

Systemic inflammatory response syndrome (SIRS) criteria

A

Temperature <36 or >38
Heart rate >90
Respiratory Rate >20/min or PaCO2 <32
WBC >12k or <4K

Must be two criteria to have SIRS

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8
Q

Treatment of hypotension with bradycardia

A

Atropine 0.5mg every 3-5 minutes up to 3.0mg

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9
Q

Treatment of hypotension with tachycardia

A

Phenylephrine 1% 100ug per dose every 5 minutes (alpha agonist with reflex bradycardia)

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10
Q

Main disadvantage of using a laryngeal mask airway

A

Aspiration of gastric contents is not prevented

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11
Q

Preoperative fasting guidelines for nonhuman milk

A

6 hours (nonhuman milk)

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12
Q

Preoperative fasting guidelines for breast milk

A

4 hours (breast milk)

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13
Q

Preoperative fasting guidelines for clear liquids

A

2 hours (clear liquids)

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14
Q

Preoperative fasting guidelines for infant formula

A

6 hours (infant formula)

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15
Q

ASA VII

A

Declared brain dead; planned for organ harvest

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16
Q

ASA V

A

Moribund patient, not expected to survive without surgery

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17
Q

ASA IV

A

Severe systemic disease that is constant threat to life

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18
Q

ASA III

A

Severe systemic disease (controlled and not constant threat to life). Severe systemic disease with constant threat to life is ASA IV

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19
Q

ASA II

A

Mild-moderate systemic disease

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20
Q

Which leads of an ECG are more sensitive to ischemia and are thus the most commonly used

A

Leads II and V5 are more sensitive to ischemia

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21
Q

Noninvasive blood pressure monitoring is more reflective of … as opposed to directly correlating blood pressure

A

Noninvasive blood pressure monitoring is more reflective of blood FLOW

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22
Q

Bispectral index objectively measures the depth of anesthesia.
What instrument is used to measure this and what is the scale

A

Electroencephalogram will read numbers between 0 and 100.

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23
Q

Sources of error occur while utilizing the BSI. Name two medications that will cause paradoxic changes

A

Ketamine and nitrous oxide causes paradoxical changes to EEG readings

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24
Q

At what level of sedation (minimal, moderate, deep, or general) does spontaneous ventilation become inadequate with the potential for airway intervention?

A

Deep sedation - Airway intervention may be required and spontaneous ventilation is inadequate

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25
At what level of sedation is there a purposeful response to repeated noxious stimuli
Deep sedation
26
Describe the first-pass hepatic effect on PO drugs
Oral drugs are absorbed by the GI tract and pass through the liver via the portal circulation prior to entering the systemic circulation. Drugs may be variably metabolized
27
What is the minimum alveolar concentration?
The MAC is the partial pressure (concentration) of a volatile anesthetic that prevents movement in 50% of patients during a surgical stimulus. The higher the MAC, the less potency
28
MAC of sevoflurane
MAC of Sevoflurane - 2.05
29
Potential renal concerns (production of compound A) are taken into account with which volatile anesthetic?
Sevoflurane
30
Does isoflurane have a faster or slower onset of action then sevoflurane
Isoflurane has a slower onset of action than sevoflurane
31
MAC of isoflurane
MAC of isoflurane - 1.15
32
MAC of Desflurane
MAC of desflurane - 6.0
33
Which volatile anesthetic has coronary steal effect?
Isoflurane Coronary steal affect is a phenomenon where an alteration of circulation patterns leads to a reduction in the blood flow directed to the coronary circulation
34
MAC of nitrous oxide
MAC of nitrous oxide - 105
35
Anatomic differences of pediatric airway
- Tongue is relatively larger - Epiglottis is higher and more floppy - Larynx is funnel shaped - Narrowest point of the airway is in the subglottic region
36
What is the formula for selecting the size of an ET tube in a child greater than 2 years old?
(Age/4) +4 = mm diameter of ET tube
37
In the pediatric population, the cardiac output is driven mostly by what?
In the pediatric population, the cardiac output is driven mostly by the heart rate
38
The physiologic difference in a child's upper airway as compared to that of an adult...
The child's upper airway is more compliant and thus more prone to compression from negative inspiratory forces. The child's upper airway is more likely to collapse
39
Why are pediatric patient's more prone to abrupt drops in body temperature
Decreased fat insulation and having a large surface area to volume ratio make pediatric patients more likely to have a drop in body temperature
40
In a morbidly obese patient, the singlebiggest predictor for a problematic intubation is what pre-operative assessment?
The neck circumference is the single biggest predictor for a problematic intubation in the morbidly obese patient 40 cm neck circumference = 5% chance of problematic intubation 60 cm neck circumference = 35% chance of problematic intubation
41
BMI of morbidly obese patient
BMI >40
42
Pickwickian syndrome
Obesity hypoventilation syndrome
43
Symptoms of hyperglycemia
- Tachycardia, tachypneic, abdominal pain, ketone breathe of DMI
44
Symptoms of hypoglycemia
- AMS, diaphoresis, tachycardia, possible seizure disorder
45
Treatment of hypoglycemia with no AMS
Oral glucose containing solution
46
Treatment of hypoglycemia with AMS
IF IV access: 10-25gm glucose (20-50ml of 50% solution or 40-100ml of 25% solution) If no IV access: 1-2mg of IM glucagon
47
For asthmatic patients, which two agents inhibit bronchoconstriction
Propofol and ketamine both inhibit bronchoconstriction and are thus beneficial for the asthmatic patient
48
Which volatile agents are potent bronchodilators?
Enflurane and isoflurane are both bronchodilators
49
Sterile water with added electrolytes describes what solution?
A crystalloid
50
LR and normal saline are what type of solution?
LR and normal saline are crystalloids
51
A solution that contains large molecular weight substances with less membrane permeability to allow for increased intravascular osmotic pressure, is what type of a solution?
A colloid (albumin)
52
Each unit of pRBCs increased hematocrit by what percentage and increases hemaglobin by what percentage?
3% increase of hematocrit per 1 unit pRBCs | 1% increase of hemaglobin per 1 unit of pRBCs
53
1 unit of platelets will increase the platelet count by...
1 unit of platelets will increase the platelet count by 5,000 -10,000 /mm3
54
This may be used for reversal of warfarin and will replace deficient coagulation factors
Fresh frozen plasma, contains all coagulation factors and can be used to reverse warfarin
55
Cryoprecipitate is an enriched solution containing
fibrinogen, vWF, Factor XII and factor VIII-C
56
What is the maximum score of the Aldrete discharge criteria?
``` 10 Respiration - normal depth and rate Oxygen saturation - >92% Consciousness - A&Ox3 Circulation - BP +/- 20mm HG of anesthetic level Activity - FC x 4 ```
57
What 5 clinical assessments does the Aldrete discharge criteria take into account?
``` Respiration - normal depth and rate Oxygen saturation - >92% Consciousness - A&Ox3 Circulation - BP +/- 20mm HG of anesthetic level Activity - FC x 4 ```
58
If the Aldrete discharge score is <8, can the patient be discharged
No - Each assessment is worth 2 points with the below criteria Respiration - normal depth and rate Oxygen saturation - >92% Consciousness - A&Ox3 Circulation - BP +/- 20mm HG of anesthetic level Activity - FC x 4
59
Scopalamine acts on what receptor?
Muscarinic receptors
60
What is the equation for determining the size of the ETT in pediatric populations?
(Age/4) + 4
61
What is the maintenance fluid requirement equation for the pediatric population?
4-2-1 rule 4ml/kg/hour per kg up to 10kg 2ml/kg/hour for each additional kg up to 20kg 1ml/kg/hour for each additional kg above 20kh
62
Estimated blood volume of a child greater than one year old
70ml/kg - estimated blood volume of a child greater than one year old
63
Estimated blood volume of an infant 3months to one year old
70-80ml/kg is estimated blood volume of an infant 3 months to 1 year old
64
Estimated blood volume of a term neonate
80-90 ml/kg is estimated blood volume of a term neonate
65
Pediatric dosing of albuterol
Nebulized albuterol 2.5mg in 3ml every 20 minutes
66
Pediatric dosing of dexamethasone for ponv
Pediatric dosing for dexamethasone for ponv 0.1mg/kg IV
67
Pediatric dosing for diphenhydramine
Pediatric dosing for diphenhydramine is 0.5-1mg/kg IV q4-6 hours max 50mg dose
68
Pediatric dosing for epinephrine given for arrest
10mcg/kg IV
69
Pediatric dosing of fentanyl for analgesia
Pediatric dosing for fentanyl for analgesia is 0.5-1.0 mcg/kg IV or 1-2 mcg/kg intranasal
70
Pediatric dosing for an antisialogogue effect when utilizing glycopyrrolate
Pediatric dosing for an antisialogogue effect when utilizing glycopyrrolate is 0.05-0.2mg IV/IM
71
Pediatric induction dosing of IV ketamine
2-3mg/kg
72
Pediatric IM induction dosing of ketamine
5-8mg/kg
73
Pediatric dosing of IV ketorolac
0.5-1mg/kg IV/IM
74
Pediatric dosing of labetalol
0.1 mg/kg IV increments q5-10 minutes per BP
75
Pediatric dosing of ondansetron
0.15mg/kg with max dose of 4mg
76
Pediatric dosing for propofol induction
2-3mg/kg
77
Pediatric dosing of remifentanil
IV bolus 0.5-1 mcg/kg IV
78
Pediatric dosing of rocuronium
0.6-1.2 mg/kg IV paralysis | 20-40 minutes until reversible (80% hepatic)
79
Pediatric dosing of verses
PO: 0.25-0.5 mg/kg max 20mg Intranasal: 0.2-0.3 mg/kg IM: 0.25mg/kg IV: 0.05-0.1mg/kg with max of 0.25 mg/kg
80
Reversal agent for benzodiazepines and dosages
Flumazenil 0.2mg q1min with max dose of 1mg
81
Reversal agent of opioids
Narcan 0.4mg q2-3 minutes to max dosage of 10mg
82
Patient is bradycardic and hypertensive. You only want to decrease blood pressure. Which medication should be given? a. Esmolol b. Labetolol c. Hydralazine
C. Hydralazine
83
Treatment for hypotension and tachycardia?
Phenylephrine - alpha agonist with reflex bradycardia
84
Treatment for hypotension with normal heart rate?
Ephedrine (alpha and beta agonist)
85
Treatment for hypotension and bradycardia?
Atropine 0.5mg
86
Modified Aldrete Score categories
Respiration, Oxygen saturation, consciousness, Circulation, Activity with maximum of 10. Patient should not be discharged if score is less than 8
87
Which of the following are targets for antiemetic therapy? a. Serotonin antagonism b. Histamine c. Dopamine d. Muscarinic e. Corticosteroids
All of these are targets for antiemetic therapy a. Serotonin antagonism b. Histamine c. Dopamine d. Muscarinic e. Corticosteroids
88
``` Pulmonary capillary wedge pressure indirectly estimates what? right atrial pressure left atrial pressure right ventricular pressure left ventricular pressure ```
Right atrial pressure
89
Which antiemetic is okay in a patient with parkinson's disease? - Zofran - Metocopramide - Droperidol - compazine
- Zofran | the other's are anti-dopaminergics
90
What lab marker is present for someone who is a carrier of hepatitis B? - HbsAg - anti-HbC - HBeAG
- HbsAg
91
A patient has a cocaine positive uranalysis. How long should you wait before operating? a. 2 hours b. 4 hours c. 6 hours d. 8 hours
8 hours
92
Which is an absolute contraindication in MAO-I use? a. epinephrine b. norepinephrine c. Levonordephrine d. Ephedrine
D. Ephedrine
93
What is one major effect of propofol? a. Bronchoconstriction b. Bronchodilation
B. Bronchodilation
94
SVT refractory to vagal maneuvers is treated with which medication? a. adenosine b. propofol c. ativan d. amiodarone
A. Adenosine
95
What lab value must you check for pre-operatively in ESRD patients? a. Hyperkalemia b. Hypercalcemia c. Hyperphophatemia
A. Hyperkalemia
96
What is the safest paralytic agent to use in myotonic muscular dystrophy? A. succ b. Rocuronium c. Pancuronium
B Roc - short acting depolarizing agents (Vec, Roc, Cis)
97
What is the alpha-2/alpha-1 ratio of precedex? a. 800:1 b. 400:1 c. 1600:1 d: 2000:1
C. 1600:1
98
Which inhalation anesthetic should not be used in a patient with renal disease? A. Iso B. Sevo C. Des
B. Sevo | Use iso, which is also preferred for chronic liver disease patients
99
What level is the larynx at in children? a. C2-C3 b. C3-C4 c. C4-C5
B. C3-C4

OMFS (14 decks)

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