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Flashcards in Basics Review Deck (16)
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1
Q

How do volatile agents (and nitrous oxide) change the pattern of spontaneous ventilation?

A

Increase RR, decrease Vt, decrease Minute ventilation

2
Q

How does nitrous oxide affect MAP, HR, and CO?

A

No change or slight increase

3
Q

How do volatiles affect MAP, HR, and CO?

A

Decrease MAP (des=iso>sev), increase HR(iso>des>sevo), decrease CO (sevo>des>iso)

4
Q

What is the redistribution half life of propofol?

A

3-5 minutes

5
Q

What are the clinical effects of hypercarbia?

A
  • Stimulation of sympatho-adrenal system (increase HR, CO, pulm pressure, BP, SV)
  • peripheral vasodilation, pulmonary vasoconstriction
  • hypercarbic narcosis (becomes anesthetic)
  • dysrhythmias
6
Q

How much does a dose of succinylcholine raise the plasma K+ concentration?

A

Approx. 0.5-1.0 mEq/dL

7
Q

Which NMB monitoring site is best during intubation?

A

Orbicularis oculi

8
Q

Which NMB monitoring site is best during emergence?

A

Adductor pollicis

9
Q

Which muscles are most resistant to NMB? Most sensitive?

A
  • vocal cord (most resistant)
  • diaphragm
  • Orbicularis oculi
  • abdominal rectus
  • adductor pollicis
  • masseter
  • pharyngeal
  • extraocular (most sensitive)
10
Q

Which type of NMB drug exhibits post-tetanic potentiation?

A

Non depolarizing

11
Q

Why doesn’t sustained ventilation = sufficient reversal?

A

Upper airway structures are weak, posing risk of upper airway obstruction

12
Q

What percentage of receptors are blocked with TOF 0-4?

A
4/4 = 75%
3/4 = 85%
2/4 = 90%
1/4 = 95%
0/4 = 99%
13
Q

How can you use a post-tetanic count to determine ability to reverse NMB?

A

If no response to single twitch,

  • 50 hz tetany for 5 sec
  • wait 3-5 sec
  • one twitch/sec
  • if >10 twitches present, there are sufficient receptors for reversal
14
Q

What are some common extubation criteria?

A
  • sustained head lift >5 seconds
  • RR 5-30
  • tidal volume >5cc/kg
  • PaO2 >65 on FiO2 <10L/min
  • level of consciousness
  • NMB reversed
15
Q

Contraindications of deep extubation

A
  • difficult mask ventilation
  • difficult intubation
  • aspiration risk
  • airway edema
16
Q

Criteria for deep extubation

A
  • MAC 1.3
  • NMB completely reversed
  • SV at reg rate and rhythm
  • no airway reflexes (check with cuff deflation AFTER suctioning)
  • 100% O2
  • lidocaine 0.5mg/kg
  • consider fentanyl