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Flashcards in Anesthetic emergencies Deck (20):
1

What determines the Tx of anesthetic emergencies?

the cause of the emergency

2

Tx for Perivascular injection w/ Thiopental or Phenylbutazone

• Dilution w/ saline
- enough to dilute thiopental to < 1% to prevent tissue necrosis)

• Lidocaine SQ
- instead of saline to neutralize pH & ↓ vasospasm

3

Tx of Bradycardia due to ↑ vagal tone

• atropine
• glycopyrrolate

4

Tx for Hypotension during anesthesia

• ligher anesthetic depth
• fluid
• Positive inotropes
- dopamine
- dobutamine
- ephedrine

5

Tx of premature ventricular contractions due acidemia or drugs like:
- thiopental
- ketamine
- halothane

• Correct metabolic imbalance
• Lidocaine IV for acute therapy
- or Procaineamide

6

Cardiopulmonary failure is characterized by...?

apnea & absence of pulse / heart beat

7

Tx of Cardiopulmonary failure

ABCDE
• Airway establishment
• Breathing
• Cardiac compression - circulation
• Drugs
• ECG

8

Drugs used to Tx Cardiopulmonary Failure
- Asystole?
- Ventricular fibrillation?
- Electromechanical dissociation?

Asystole
• Epi
Ventricular fibrillation
• Lidocaine
• Na Bicarb
Electromechanical dissociation
• Dopamine
• Dexamethasone

***Following resuscitation:
• Ionotropic support to help maintain BP
- dopamine

9

4 levels of Apnea as an assoc'd side effects w/ Thiopental overdose.
• what is the action taken with each?

• Pink MM, normal CRT, strong pulse
--> observe until respiration starts OR vitals change

• Cyanotic MM
+ strong pulse
& arterial pressure ( > 80mmHg)
--> intubate & ventilate (10bpm)
--> continue until anesthetic lightens
--> ↓ ventilation rate to 4bpm
(see if Resp restarts)

• Cyanotic MM
+ weak pulse ( replacement fluid + ionotropic drug

• No Pulse
--> start full CPR

10

Atropine

Muscarinic antagonists
• Tx bradycardia

11

Glycopyrrolate

Muscarinic antagonist
(low CNS effects)
• good Vagal blocking action

12

Epinephrine

Alpha-adrenergic action
• good peripheral & intrathoracic vessel resistance
• ↑ diastolic pressure
• useful for Tx of Asystolic arrest

13

Ephedrine

Inotropic effect
• direct/indirect peripheral sympathomimetic
• related to NEpi

14

Dopamine

Direct-actin sympathomimetic
• ionotropic effects
- less desirable effects too

15

Dobutamine

preferred due to selective effect on cardiac contractility

16

Lidocaine

Na+ channel blocker
• Anti-arrhythmic action on ventricles

17

CNS stimulants
• define
• example of drug targeting emetic center
• Use in anesthesia-induced collapse?

Drugs that ↑ electrical & NT activity in CNS
• Apomorphine
--> specific for emetic center

• limited clinical use in Tx acute ventilatory failure
- temporary
- ↑ risk of convulsion
** Best therapy = ventilation

18

Doxapram

• Stimulates respiratory center in medulla
- could not be used as substitute for aggressive artificial respiratory support & mechanical disorder of ventilation

19

Reasons to ↓ dose of tranquilizers & anesthetics in older patients?

• ↓ in brain weight
• ↓ in liver blood flow
• ↓ renal functions
• ↓ in blood volume

20

What should you do if you have to anesthetize a patient w/ cardiac dysfunction?

• Tx to improve cardiac function & reduce pulmonary edema

• Keep HR w/in 10% of its value in the resting animal

• Avoid sedating & anesthetic drugs that cause vasoconstriction

• Limit admin of IV fluid