Exam 1 Part 3

Question 1

Emergence characterized by

Answer 1

• Airway obstruction
• Agitation
• Delirium
• Hypothermia
• Shivering
• Autonomic lability

Question 2

Emergence planning

Answer 2

• Should start as soon as you put the patient to sleep
• vapors decreased or off
• Excess muscle relaxation is reversed
• pt is breathing spontaneously

Question 3

Emergence is synonymous with removal of ETT or other airway device. Coughing is an indication that the patient is awake. T or F?

Answer 3

False

Question 4

Factors influencing emergence

Answer 4

• agent solubility
• agent concentration
• duration of anesthesia

Question 5

Emergence of inhalational anesthesia depends chiefly on ______________

Answer 5

pulmonary elimination

Combination of building CO2 and breathing gas off

Question 6

_____ and/or _____ ______ blunt the ventilatory responses to both hypercarbia and hypoxemia.

Answer 6

• IV
• inhalational anesthetics

Question 7

What drives a pt to take a breath?

Answer 7

• central/chemical chemoreceptors
• hypercapnic ventilatory drive–the more narcotic we give, the higher the capnic threshold
• hypoxic ventilatory drive

Question 8

PaCO2 where spontaneous ventilation is initiated is ______ ______.

Answer 8

apneic threshold

Question 9

To increase PaCO2, need to:

Answer 9

• Adjust minute ventilation (RR x TV)
• Maintain FiO2 > 0.85 during hypoventilation

Question 10

Maintain FiO2 > 0.85 during hypoventilation except in _________ ______ patients.

Answer 10

severe COPD because their drive to breath will go away

Question 11

The following are effects of __________:

Stimulation of sympathoadrenal system

Vasodilator (except pulmonary arteries CONSTRICT)

hypercarbic narcosis

dysrhythmias

Answer 11

hypercarbia

Question 12

Intermediate NMB is between ____ and ____ minutes

Answer 12

15-45 minutes

Question 13

NMB depolarizes the end-plate _______ receptor.

Answer 13

nicotinic

Question 14

Succx has short duration due to _______________ metabolism . It quickly diffuses away and is metabolized.

Answer 14

pseudocholinesterase

Question 15

Side effects of succx:

Answer 15

• myocyte rupture
• hyperkalemia
• myalgia
• sinus bradycardia – muscarinic receptor
• malignant hyperthermia

Question 16

Non depolarizing NMB __________ inhibit end plate nicotinic cholinergic receptor.

Answer 16

competitively

Question 17

Non depolarizing NMBs (do/do not) bind to the Ach receptors.

Answer 17

do not bind

Question 17

What NMBs block the Ach receptor sites, thn as the Ach continues to be released it pushes the drug off the site so it can bind once again?

Answer 17

non-depolarizing

Question 18

Monitoring locations

Answer 18

• ulnar nerve
• facial nerve
• posterior tibial nerve (medial malleolus, flexes big toe)
• external peroneal nerve (dorsiflexion)

Question 19

__________________ is a better monitoring location during intubation. ______ is better for emergence.

Answer 19

orbicularis oculi

adductor pollicis

Question 20

4 out of 4 twitches, I can still have ____ % block.

3 out of 4, ____ % block.

2 out of 4, ____ % block

1 out of 4, _____ % block

0 out of 4, ______ % block

Answer 20

75 %

85%

90

95

99

Question 21

Conditions prior to NMB reversal:

Answer 21

• 1 twitch or
• post-tetanic count > 10

Question 22

If profound NMB with no response to single twitch, then (5):

Answer 22

• apply 50 Hx tetany for 5 seconds
• wait 3-5 seconds
• single twitch response (1/sec)
• count total twitches
• >10 twitches indicates sufficient receptors for reversal

Question 23

NDMB reversal by ___________.

Answer 23

anticholinesterases … which inhibits acetylcholinesterase. Neostigmine

Question 24

Neostigmine side effects causes stimulation of ______ nervous system.

Answer 24

parasympathetic

Question 25

Neostigmine peak onset: Dose?

Answer 25

5-10 minutes Max 0.07 mg/kg NOT 5mg!!

Question 26

How much glycopyrollate with Neo?

Answer 26

0.2 mg per 1 mg of neo

Question 27

Assessing adequacy of ventilation

Answer 27

Arterial blood gas: * PaO2 \> 65 on FiO2 \< 0.4 * PaCO2 \< 50 torr * EtCO2 * SpO2 \> 90% * Tidal volume

Question 28

In obstructive sleep apnea, what is the major factor in arousal?

Answer 28

SaO2 = 85% Hypercapnia = increased PAP Increased afterload = right ventricular hypertrophy

Question 29

Factors that incr ease incidence of PONV:

Answer 29

* Type of surgery: eye, ENT, abdominal, GI/GU * use of volatile anesthetics * nitrous oxide * large does of neostigmine * opioids

Question 30

Surgical sites that have increased risk of PONV:

Answer 30

* intra-abdominal * laparoscopic * orthopedic * gynecological * ENT * Breast * Plastic * Neuro

Question 31

If 80 kg patient, how much reversal do you need to give?

Answer 31

8 cc: 4cc of Neo, 4cc of glycopyrrolate

Question 32

Anti emetics work on the chemotaxic trigger zone:

Answer 32

* seratonin antagonist (Zofran) * dopamine antagonist (Droperidol) * antihistimine * others (Decadron)

Question 33

Post op pain magement: (3)

Answer 33

* epidural * narcotics * NSAIDS--Toradol 30mg)

Question 34

NSAID Toradol 30 mg equivalent to ___ mg morphine. Contraindications?

Answer 34

10 Contra: GI ulcers/bleeding, coagulopathy, renal impairment, bone grafts

Question 35

Narcotics titrate to ____ to ____ breaths per minute.

Answer 35

10-16

Question 36

No droperidol to what patients?

Answer 36

Parkinsons

Question 37

Epidural placement is for post-op pain management.

Answer 37

* Bolus 6-8 cc of numbing agent in divided doses prior to extubation * VERIFY NORMOVOLEMIA PRIOR TO BOLUS! * be prepared for hypotension