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Flashcards in Chapter 8 - Anesthesia Deck (53):
2

MAC (minimum alveolar concentration) equals what?

Smallest concentration of inhalation agent at which 50% of patients will not move with incision

3

Small MAC means what?

More lipid soluble = more potent = slow speed of induction

4

Effects of inhalational agents?

Unconsciousness, amnesia, some degree of analgesia

5

Side effects of inhalational agents?

Blunted hypoxic drive, myocardial depression, increased cerebral blood flow, decreased renal blood flow

6

Characteristics of NO2?

Fast, minimal myocardial depression

7

Characteristics of halothane?

Slow, highest degree of cardiac depression and arrhythmias, least pungent (good for kiddies)

8

What is halothane hepatitis?

Fever, eosinophilia, jaundice, increased LFTs

9

Side effect of enflurane?

Seizures

10

Characteristics of sevoflurane?

Less myocardial depression, fast on/off, less laryngospasm, higher cost

11

Side effects of sodium thiopental (barbiturate)?

Decreased cerebral blood flow and metabolic rate, decreased blood pressure

12

Characteristics of propofol?

Very rapid distribution and on/off, amnesia, sedative; NOT an analgesic

13

Side effects of propafol?

Hypotension, respiratory depression; do not sure in pts with egg allergy

14

Characteristics of ketamine?

Dissociation of thalamic/limbic systems, places pts in cataleptic state (amnesia, analgesia); no respiratory depression

15

Side effects of ketamine?

Hallucinations, catecholamine release (inc. CO and tachycardia), inc. airway secretions, inc. cerebral blood flow (contraindicated in head injuries)

16

Characteristics of etomidate?

Fewer hemodynamic changes, fast acting

17

Side effect of etomidate?

Continuous infusions can lead to adrenocortical suppression

18

What is the last muscle to go down and 1st to recover from paralytics?

Diaphragm

19

What is the 1st muscles to go down and last to recover from paralytics?

Neck and face muscles

20

What is the only depolarizing agent?

Succinylcholine

21

Characteristics of succinylcholine?

Fast, short acting; causes fasciculations

22

Side effects of succinylcholine?

Malignant hyperthermia, inc. ICP, incraed end-tidal CO2 then fever, tachycardia, rigidity, acidosis, hyperkalemia

23

Treatment of malignant hyperthermia?

Dantrolene: inhibits Ca release and decouples excitation complex; cooling blankets, HCO3, glucose, supportive care

24

What patients do you NOT use succinycholine in?

Burn patients, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure

25

Nondepolarizing agents MOA?

Inhibit neuromuscular junction by competing with ACh

26

What can cause prolongation of nondepolarizing agents?

Hypothermia, hypercarbia, certain abx, electrolyte abnormalities, myasthenia gravis

27

Which nondepolarizing agent can be used in liver and renal failure?

Cis-atracurium (because it undergoes Hoffman degradation)

28

Where is rocuronium metabolised?

Liver

29

How does neostigmine reverse nondepolarizing agents?

Blocks AChE, increasing ACh

30

How does edrophonium reverse nondepolarizing agents?

Blocks AChe, increasing ACh

31

What should be given with nondepolarizing reveral agents to counteract effects of generalized ACh overdose?

Atropine or glycopyrrolate

32

How do local anesthetics work?

By increasing action potential threshold, preventing Na influx

33

What is the max dose of 1% lidocaine?

0.5cc/kg

34

Why are infected tissues hard to anesthetize?

Acidosis

35

When should you not use epinephrine with local anesthetics?

Patients with arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals, uteroplacental insufficiency

36

What type of local anesthetic has a higher rate of allergic reaction?

Esters (secondary to PABA analogue)

37

Narcotic receptor?

Mu

38

What happens when you mix narcotics in patients on MAOIs?

Can cause hyperpyrexic coma

39

Effects of narcotics?

Profound analgesia, respiratory depression (dec. CO2 drive), no cardiac effects, blunted sympathetic response

40

Unique side effects of morphine?

Decreased cough, constipation, histamine release

41

Unique side effects of demerol?

Tremors, fasciculations, convulsions, NO histamine release

42

In which patients should you avoid the use of demerol?

Renal failure - can get buildup of normeperidine analogue and result in seizures

43

Morphine in epidural can cause what?

Respiratory depression

44

Lidocaine in epidural can cause what?

Decreased heart rate and blood pressure

45

Treatment for acute hypotension and bradycardia in patient with epidural?

Turn epidural down, fluids, phenylephrine, atropine

46

Treatment for spinal headaches?

Rest, increased fluids, caffeine, analgesics; blood patch if persists >24h

47

Contraindications for spinal anesthesia?

Hypertrophic cardiomyopathy, cyanotic heart disease

48

What two conditions are associated with the most postoperative hospital mortality?

CHF and renal failure

49

Presentation of post-op MI?

May have no pain or EKG changes; hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia

50

Which patients need a cardiology workup?

Angina, previous MI, SOB, CHF, FEV1 5/min, age >70, patients undergoing major vascular surgery

51

Biggest risk factors for postop MI?

Age >70, DM, previous MI, CHF, unstable angina

52

What is the best determinant of esophageal vs. tracheal intubation?

End tidal CO2

53

What causes an intubated patient to have sudden transient rise in ETCO2?

Alveolar hypoventilation; increase TV or RR

54

What causes an intubated patient to have a sudden drop in ETCO2?

Disconnected from the vent; PE or significant hypotension