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Flashcards in Clinical Anesthesiology Questions Deck (20)
1

What are the Pre-Anesthesia Medications?

Anti-Anxiety / Amensia = Benzodiazepines like midazolam and Diazepam 

 

Anacaids - Bicitra or H2 Blockers 

 

Anti-emetics - Scopolomine patch - EVERY patient gets one to diminish post-op emesis which can lead to aspiration pneumonitis, ARDS and even death!!! 

2

Why to trauma-surery patients tend to have high levels of recall from surgery?

bc they are limited in the general anesthesia that they can receive bc their BP is unstable 

3

What are the IV induction agents?

Propofol, Ketamine, Etomidate, [Barbituates - thiopental]

4

Pros and Cons of Propofol

Pros - Rapid onset and short acting, flexibility of use, Anti-Emetic, Bronchodilation, Neuroprotection

 

Cons - Pain on injection, No analgesia, Hypotension from vasodilation, Egg/Soy allergy from Lecithin and requires sterile technique, respiratory depression 

 

PIS - lactic acidosis due to cytopathic hypoxia with long term propofol sedation!!! 

5

Pros and Cons of Etomidate

Pros - CV stability so used for cardiac patients/shockpts/hypovolemia, less respiratory depression/apnea and metabolized by ester hydrolysis

 

Cons - ADRENAL suppressoin which is bad for chronically ill pts who cant mount a stress response; Pain on injection; Myoclonus!!! 

6

Pros and cons of Ketamine

Pros - Dissociative state, vasoconstrictor, Bronchodilator, less respiratory depression, analgesia 

 

Cons - Psychotropic effects, HTN +/- Tachycardia  (Caution with CAD/CVA pts), Direct cardiac depression in critically ill pts who can't increase sympathetic, Increased ICP and seizures (do NOT use in brian pts), Salivation, Emergence reaction 

7

What is the most important element in analgesia for preventing long term pain?

Onset - Pre-emptive analgesia is key to preventing sensitization and long term pain

8

What are the IV analgesics used?

Fentanyl and Sufentanil 

Remifentanil/Alfentanyl = fastest onset but last less time

Morphine/Dilodid = used on the floors a lot bc last 3 hours 

Methadone = good baseline drug for people with chronic pain/IVDA but onset is longer and effects last longer 

9

Pros and cons of opioids?

Pros - analgesia**, Minimal cardiac depression, reduces inhalational agents, versatile

 

Cons - respiratory depression (can get apneic fast and code), Bradycardia, skeletal muscle rigidity, N/V/Constipation

10

What is the depolarizing muscle relaxant? how does it work? What are the cautions in using it?

Succinylcholine = depolarizing NMBA

Mechanism: agonist at the NMJ on Nicotinic receptors and activates them and maintains depolarization 

Will see fasciculations when giving it but good for Emergency surgery and rapid sequence induction

 

CAUTIONS:

- Hyperkalemia!!!! 

-AchE deficiency problem bc metabolized by plasma pseudocholinesterase and so dont wake up for 24 hours after giving it 

- Bradycardia and Asystole (kids) so give with ATropine 

- Malignant hyperthermia trigger

- Increased Intraocular pressure and ICP

11

What are the Non-depolarizing NMBA? Which one's good to use in Trauma? Which one causes tachycardia?

Rocuronium, Vecuronium, Cisatracurium, Pancuronium

 

Ciastracurium good in Trauma bc Hoffman Elimination of itself 

 

Pancuronium causes tachycardia

12

What do you used for induction in pediatric pts?

Inhalational Induction - no IV

can give an anti-anxiolytic - oral/rectal/IM dart of benzo/ketamine

 

Induction with non-irritating volaties: Sevoflurane and N2O

13

What is MAC? What does it mean?

MAC = minimum alveolar concentration - concentration of inhaled anesthetic required to prevent movement in response to skin incision in 50% patients

 

Higher MAC = Less potent 

ex. Iso Mac 1.1 which is more potent than Des Mac 6.6

14

What do all volatile anesthetics cause?

Bronchodilation

15

Pros and cons of Iso

Pros - cheap, and hemodynamic stability

 

Cons - Long-acting

16

Pros and Cons of Desflurane

Pros- rapid onset and elimination

 

Cons - pungent, expensive, tachycardia!! 

17

Pros and Cons of SEvoflurane?

Pros - rapid and pleasant

cons - Emergence Delerium

18

Pros and Cons of Nitrous?

Pros - Second Gas Effect!!!! Non-pungent

 

Cons- NOT to be used in surgerys with air poclets or laparoscopics 

19

What should you do for patients at increased risk for gastroparesis (ex. Diabetes)? 

Give the premedication with Metoclopromide (Reglan) 

20