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Exit Exam Notes Flashcards

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1
Q

What are 10 anesthetic considerations for renal failure/dialysis patients?

A
  • Gastroparesis and risk of aspiration
  • Dysregulation of volume status
  • Dysregulation of acid-base (metabolic acidosis)
  • Dysregulation of electrolytes (increased K+, Decreased Na+/Ca+)
  • Coexisting diseases and end-organ complications
  • Autonomic dysfunction with hemodynamic instability
  • Pulmonary edema from low albumin/atelectasis
  • HTN, CAD, LV dysfunction, arrhythmias
  • Anemia/Thrombocytopenia
  • Altered pharmacokinetics due to decreased elimination, acidosis and hypalbuminemia

Avoiding renally excreting drugs (e.g., Morphine, Rocuronium)

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2
Q

What factors can cause an increase in temperature during anesthesia?

A
  • Malignant Hyperthermia
  • Sepsis/Fever
  • Pheochromocytoma (hypermetabolic state)
  • Medication
  • Warming patient too much
  • Blood Transfusion reaction
  • Thyroid Storm
  • Hypothalamic Lesion secondary to trauma, tumor, etc

These factors can lead to hyperthermia during surgical procedures.

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3
Q

Define hyperthermia and its associations.

A
  • Increased O2 consumption
  • Increased CO2 production
  • Increased HR, RR, and Sweating

In anesthetized patients, signs and symptoms include:
* Tachycardia
* Hypertension
* Increasing ETCO2
* Rhabdomyolysis

Hyperthermia is a hypermetabolic state characterized by elevated body temperature.

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4
Q

What is the goal of a massive transfusion protocol?

A

Volume replacement: +/- rapid infusion for adequate tissue perfusion.

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5
Q

List ways to assist during a massive transfusion protocol.

A
  • Communicate with surgeon to confirm severity of bleeding
  • Contact Blood Bank and start giving products (1:1:1 ratio of PRBC:FFP:Platelets with group specific blood or O negative)
  • Establish large/central IV access if possible (+ Arterial line)
  • Keep patient warm > 36 C
  • Checking labs Q30 min (ABG, CBC, Electrolytes, Lactate)
  • Checking Coags (PTT, INR, Platelets, Fibrinogen)
  • Permissive Hypotension (MAP 55-60) if allowable
  • Start Vasopressors
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6
Q

What specific medications can be started during a massive infusion protocol?

A
  • Vasopressors: Norepinephrine/Vasopressin
  • Sodium Bicarb (for acidosis)
  • CA2+ (Cardioprotective + part of Coag cascade)
  • TXA (to prevent breakdown of blood clots)
  • Plasma, platelets, fibrinogen if indicated
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7
Q

What are 10 anesthetic considerations for a massive infusion protocol?

A
  • Dilutional Coagulopathy
  • Hypothermia
  • Hyperkalemia
  • Acid/Base Abnormality
  • Transfusion Associated Lung Injury (TRALI)
  • Transfusion Acquired Circulatory Overload (TACO)
  • Citrate infusion inducing hypocalcemia
  • Citrate infusion resulting in metabolic acidosis/alkalosis
  • Anaphylaxis
  • Septic/Febrile reactions
  • Non-ABO compatible (non-checked blood)
  • DIC (hyper-coagulopathic state)
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8
Q

Define the mechanism of action (MOA) of Succinylcholine.

A

Depolarizing NMBA: competitive agonist at the NMJ and binds to the alpha-subunit of the NMJ. Once it binds, it cannot open the ion-channel to depolarize. It is broken down by plasma-cholinesterase in the blood.

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9
Q

What are the contraindications for administering Succinylcholine?

A
  • Known or suspicion of MH
  • Plasma Cholinesterase Deficiency
  • Known or suspected Hyperkalemic State (i.e. presence of burns within 72 hrs, ESRD)
  • Increased ICP or IOP
  • Muscular Dystrophy
  • Allergic Reaction
  • Not adequately sedated
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10
Q

What are the current CAS fasting guidelines for adults?

A
  • 6 hrs since solids, infant formula or non-human milk
  • 4 hrs after breast milk
  • 2 hrs clear fluids for adults
  • 1 hr for clear fluids for infants/kids
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11
Q

What are the anesthetic considerations for a patient with Down’s Syndrome?

A
  • Airway
  • Atlanto-occipital instability (C-spine precautions)
  • Small mouth opening + Large Tongue + excess Tissue = Difficult intubation
  • Duodenal Atresia = Increased risk of aspiration
  • Congenital Cardiac Conditions
  • VSD, ASD, AVSD, TOF, Pulm HTN
  • Obesity/OSA
  • Increased Risk of Nerve Damage = Joint Laxity
  • Increased Risk of Leukemia
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12
Q

Define Local Anesthetic MOA.

A

Local anesthetics (LAs) work by blocking the transmission of nerve impulses, primarily through inhibition of sodium (Na⁺) channels in the neuronal cell membrane.

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13
Q

What is Local Anesthetic Systemic Toxicity (LAST)?

A

Toxic amount of blood plasma levels by injection of LA into the bloodstream, caused by accidental intravascular injection or injection above the recommended maximum dose.

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14
Q

What are the hallmark symptoms of LAST?

A
  • CNS: Tinnitus, Metallic taste, Peri-oral numbness, progression to respiratory arrest and unconsciousness
  • CVS: Seizures, Hypotension, Compensated tachycardia progressing to Bradycardia, Ventricular arrhythmias, and Cardiac Arrest.
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15
Q

What is the treatment for LAST?

A
  • Airway management: Increase FiO2 to 100%
  • Seizure suppression with Benzodiazepine
  • Infuse 20% lipid emulsion (1.5ml/kg)
  • Resuscitation ACLS/BLS
  • Keep epinephrine bolus doses < 1mg/kg
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16
Q

Define Total/High Spinal and its presentation.

A
  • Local Anesthetic spread to the cervical roots and brainstem causing toxic effects
  • Hypotension/Bradycardia
  • Weakness hands/arms, SOB with weakness in accessory muscles
  • Shoulder Weakness, Hypoventilation and/or desaturation leading to respiratory arrest
  • Slurred Speech, Sedation, altered LOC
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17
Q

What is the treatment for Total/High Spinal?

A
  • Increase FiO2 to 100%
  • Supportive Management of Respiratory/Hemodynamics
  • Stop Epidural if present
  • Reverse Trendelenburg
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18
Q

What are the concentrations, duration of action, and toxic doses for Lidocaine?

A
  • Concentration Available: 0.5%, 1%, 1.5%, and 2% solutions.
  • Duration of Action: Without epinephrine: 30–60 minutes; With epinephrine: 2–6 hours.
  • Toxic Dose: Without epinephrine: 5 mg/kg (maximum of 300 mg); With epinephrine: 7 mg/kg (maximum of 500 mg).
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19
Q

What are the concentrations, duration of action, and toxic doses for Bupivacaine?

A
  • Concentration Available: 0.25%, 0.5%, and 0.75% solutions.
  • Duration of Action: Without epinephrine: 2–4 hours; With epinephrine: 3–7 hours.
  • Toxic Dose: Without epinephrine: 2.5 mg/kg (maximum of 175 mg); With epinephrine: 3 mg/kg (maximum of 225 mg).
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20
Q

What are the concentrations, duration of action, and toxic doses for Ropivacaine?

A
  • Concentration Available: 0.2%, 0.5%, and 0.75% solutions.
  • Duration of Action: Without epinephrine: 2–6 hours; With epinephrine: 4–8 hours.
  • Toxic Dose: Without epinephrine: 3 mg/kg (maximum of 200 mg); With epinephrine: 3.5 mg/kg (maximum of 250 mg).
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21
Q

How does the pediatric airway differ from the adult airway?

A
  • Peds are obligate nose breathers = easily obstructed via secretions
  • Larger occiput results in no need for sniffing position
  • Larger tongue creates more obstruction
  • Anteriorly slanted vocal cords = difficulty inserting ETT
  • Narrowest part of trachea is subglottic at cricoid
  • Larynx more anterior and superior in child
  • Floppier Epiglottis in children
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22
Q

Why do we ask about adverse history or family history related to anesthetics/surgery?

A
  • Confirm/Rule out MH
  • Plasma cholinesterase Deficiency
  • Prior potential difficult airway
  • Allergic reactions to any prior anesthetics
  • Prior adverse effects (PONV, Delayed emergence)
  • Individuals Response to Surgical Stress
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23
Q

What are the 5 T’s in the differential diagnosis for Post-Partum Hemorrhage (PPH)?

A
  • Tone: Uterine Atony (most common)
  • Tissue: Retained Product
  • Trauma: Vascular Injury
  • Thrombin: Coagulopathy
  • Turn Out: Uterine Inversion
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24
Q

What are the overall goals in managing PPH?

A
  • Determine severity of hemorrhagic shock and resuscitate
  • Consider early intubation/Massive Transfusion Protocol
  • Avoid lethal triad: Hypotension, Acidosis, Coagulopathy
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25
What is the treatment and management of PPH?
* Transfuse and volume resuscitation * Treat Triad (hypotension, acidosis, coagulopathy) * Gather resources (Rapid infuser, Blood products, Cell Saver) * Send blood work (CBC, ABG, Electrolytes, Coags) * Assist with intubation (RSI/Glide) * Assist with large-bore IV access/Arterial Line insertion * Prepare induction medications * Prepare uterotonics with PPH kit
26
Describe the uterotonics used for PPH.
* Carbetocin: analogue of oxytocin with longer duration causing uterine contraction. * Ergometrine: Direct uterine and smooth muscle constriction; not given if patient had a prior stroke or HTN. * Hemabate: form of prostaglandin causing uterine stimulation; not to be given to asthmatics. * Misoprostol: Form of prostaglandin causing uterine stimulation.
27
What types of patients are known to have difficult airways?
* History of difficult airway * Small mouth opening * Mallampati 3 or 4 * Micrognathia, retrognathia, or macroglossia * Limited Neck Mobility * Obesity * Pregnant * Beard * OSA * Short thyromental distance * Trauma/Past surgeries to upper airway * High arched or narrow palate * Tumors or masses in airway or neck * Infections causing swelling * Burns or scarring * Congenital syndromes
28
What are 6 history factors that can classify a patient as having a difficult airway?
* Documented Hx of difficult airway * Obese/High BMI * Pregnant * Hx of rheumatoid Arthritis * Hx of C-Spine Surgery/injury * Hx of radiation to head/neck
29
What is the drug calculation for 1:100000 epinephrine?
1g epi in 100000 solution, which is equivalent to 10 mcg/ml.
30
What is the equivalent dose to 10 mg Morphine for IV hydromorphone?
2 mg Hydromorphone (5X stronger than morphine).
31
What is the equivalent dose to 10 mg Morphine for IV Fentanyl/Remifentanil?
100 mcg Fentanyl & Remifentanil (100X stronger than morphine).
32
What is the equivalent dose to 10 mg Morphine for Oral Morphine?
30 mg Oral Morphine = 10 mg IV Morphine.
33
What is the equivalent dose to 10 mg Morphine for a Fentanyl Patch?
10 mcg/hr (24 hrs) Fentanyl patch = approx. 10 mg IV Morphine.
34
What is the strength comparison of 2mg Hydromorphone to morphine?
5X stronger than morphine ## Footnote Hydromorphone is significantly more potent than morphine, requiring careful dosing.
35
What is the strength of 100 mcg Fentanyl compared to morphine?
100X stronger than morphine ## Footnote Fentanyl is a highly potent opioid used in various medical settings.
36
How does 30 mg Oral Morphine compare to IV Morphine?
30 mg Oral Morphine = 10 mg IV Morphine ## Footnote This conversion is crucial for pain management strategies.
37
What is the approximate equivalence of a 10 mcg/hr Fentanyl patch in IV Morphine?
Approx. 10 mg IV Morphine ## Footnote This conversion aids in transitioning patients from IV to transdermal opioid therapy.
38
What is the conversion factor for IV morphine to oral morphine?
3:1 ## Footnote This means 10 mg of IV morphine is roughly equivalent to 30 mg of oral morphine.
39
What does a 25 mcg/hr fentanyl patch correspond to in terms of oral morphine?
Approximately 60 mg of oral morphine daily ## Footnote This is essential for determining appropriate pain management regimens.
40
What is the acronym for Differential Diagnosis in Anesthesia?
D.I.M.S. ## Footnote This helps anesthesiologists consider potential issues during patient emergence.
41
What are some anesthetic considerations for obese patients?
* Difficult BVM * Decreased FRC * OSA sensitivity * Difficult IV access * Increased aspiration risk * Altered pharmacology * Increased postoperative morbidity * Co-morbid diseases ## Footnote These factors significantly impact anesthesia management in obese individuals.
42
What are absolute contraindications for neuraxial anesthesia?
* Patient refusal * Coagulopathy * Infection at injection site * Allergy to medication * Increased ICP ## Footnote Recognizing these contraindications is critical for patient safety.
43
What is the Post-Anesthesia Discharge Scoring System (PADSS)?
5 categories with max 2 points each ## Footnote Categories include vitals, activity level, pain, nausea/vomiting, and surgical site bleeding.
44
What are complications of a Femoral Nerve Block?
* Prolonged motor block * LAST * Infection * Nerve damage * Hematoma * Allergic reaction ## Footnote Awareness of these complications is necessary for risk management.
45
Define Rheumatoid Arthritis.
Chronic inflammatory disease affecting joints and major organ systems ## Footnote This condition has significant implications for anesthesia management.
46
What is the equation for Coronary Perfusion Pressure (CPP)?
CPP = Aortic DBP - LVEDP ## Footnote Understanding this equation is vital for cardiac anesthetic management.
47
What is the difference between concentric and eccentric hypertrophy?
* Concentric: Pressure overload, thickened muscle, smaller chamber * Eccentric: Volume overload, stretched chamber, decreased compliance ## Footnote These conditions affect cardiac function and anesthetic management.
48
What are early complications of significant blood transfusions?
* Hyperkalemia * Hypocalcemia * Hypothermia ## Footnote Monitoring for these complications is essential during and after transfusions.
49
What are the indications for lung isolation?
* Surgery of lungs, bronchus, pleura * Heart/great vessels surgery * Esophageal surgery * Non-thoracic surgery * Nonsurgical procedures ## Footnote Lung isolation techniques are critical in specific surgical contexts.
50
What should be the normal ACT time before going onto CPB Pump?
Normal ACT = 80-120 seconds, prior to pump suction = 400 seconds ## Footnote This is crucial for ensuring adequate anticoagulation during cardiac procedures.
51
What is the dose of Heparin given for cardiac surgery?
400 units/kg ## Footnote Proper dosing is vital for preventing thromboembolic events.
52
What are the considerations for administering Ketorolac?
* Allergic reactions * Renal impairment * Recent GI bleeding * Impact on fetal circulation * Hepatic function considerations ## Footnote These factors must be assessed before administration.
53
What drugs are used to shift K+ for treating Hyperkalemia?
* Insulin * Bicarb * Calcium chloride * Salbutamol * Lasix * Hyperventilation * Consider dialysis ## Footnote Prompt treatment is necessary to prevent life-threatening complications.
54
What are indications for using LMA?
* Spontaneously breathing patients * Difficult airway algorithm * Post tonsillectomy bleed ## Footnote LMA can be a less invasive alternative for airway management.
55
What medication should be continued on the morning of surgery?
* Cardiac and hypertensives (except ACE inhibitors and ARBs) * Chronic disease medications * Steroids ## Footnote Continuation of these medications is crucial for patient stability.
56
What should be discontinued prior to surgery?
* ACE inhibitors * Anticoagulants * Antidepressants * Oral hypoglycemic medications * NSAIDs ## Footnote Stopping these medications can reduce surgical risks.
57
What is the normal ACT range prior to going onto CPB Pump?
80-120 seconds ## Footnote Normal ACT is critical for ensuring adequate anticoagulation during CPB.
58
What is the required ACT before going onto the CPB Pump?
480 seconds ## Footnote This is necessary to ensure sufficient anticoagulation.
59
What is the dose of Heparin given for Cardiac/CPB Surgery?
400 units/kg ## Footnote This dose is standard for achieving therapeutic anticoagulation.
60
What is the reversal agent for Heparin in Cardiac Surgery?
Protamine 0.7 – 1 mg/100 units of Heparin given ## Footnote Protamine neutralizes the effects of Heparin.
61
What are the treatment steps for suspicion of Air/Gas Embolism?
* Head down/left lateral position * Stop source of air/gas entry * Stop Nitrous/pneumoperitoneum (if in use) * Aspirate Central Line (if in use) * Chest compressions (break up volumes of air) ## Footnote These steps help manage the embolism effectively.
62
What are the Hs and Ts in ACLS reversible causes of cardiac arrest?
* Hypoxia * Hypovolemia * Hydrogen Ions (Acidosis) * Hypothermia ## Footnote Identifying these causes is crucial for effective ACLS intervention.
63
What is the rate of chest compressions recommended during ACLS?
100-120/min ## Footnote This rate is essential for optimal perfusion during CPR.
64
What is the depth of chest compressions recommended during ACLS?
5 cm = 2 inches ## Footnote Adequate depth ensures effective blood circulation.
65
What is the compression to ventilation ratio in ACLS for an un-intubated patient?
30:2 ## Footnote This ratio is used to maximize the effectiveness of CPR.
66
What are the first steps in managing V-fib/V-tach in ACLS?
* Start Compressions * Shock immediately 200J * Epinephrine 1 mg after 2nd shock (then Q3-5 min) * Amiodarone 300 mg after 3rd shock (150 mg 2nd dose) * Consider Reversible causes ## Footnote These steps are vital for restoring normal rhythm.
67
What is the immediate action for PEA/Asystole in ACLS?
* Start compressions * Epinephrine 1 mg immediately * IV/Airway Access * Consider Reversible causes ## Footnote Prompt action improves chances of survival.
68
What should be done for tachycardia in ACLS?
* Airway/IV Access/monitors (12 leads) * Is tachycardia causing signs of decreased LOC/Hypotension/Chest Pain? * Synchronized Cardioversion OR Adenosine (6mg then 12 mg) ## Footnote Evaluating the patient's condition is critical before treatment.
69
What is the recommended action for NRP HR < 100?
PPV via BVM with room air and increase as needed ## Footnote Proper ventilation is crucial for newborns with low heart rates.
70
What is the Gold Standard for confirming Malignant Hyperthermia diagnosis?
Muscle Biopsy (then Genetic Testing) ## Footnote This is the most definitive method for diagnosis.
71
What is the average blood volume for a term infant?
80 ml/kg ## Footnote Understanding blood volume is essential in pediatric care.
72
What is the formula for allowable blood loss (ABL) once allowable Hb is determined?
[(Initial Hb – Allowable HB) x EBV] / Initial HB ## Footnote This formula helps in managing blood loss during surgery.
73
What is the suggested anesthetic management before cord clamping during an emergency C-section?
* High gas flow and 2 MAC * Avoid Benzo and Narcotics ## Footnote Proper management ensures maternal and fetal safety.
74
Termination of effect of IV anesthetics occurs through ________.
[redistribution] ## Footnote This process is crucial for the recovery from anesthesia.
75
List factors that increase MAC.
* Childhood (highest at 6 months) * Hyperthyroidism * Hyperthermia * Hypernatremia * Chronic Alcohol Use * Drugs: Amphetamines, Cocaine (Acute) ## Footnote These factors influence the potency of anesthetics.
76
List factors that decrease MAC.
* Elderly/Pregnancy * Hypercarbia/Hypoxia/Hypothermia * Hyponatremia * Anesthetics/Opioids * Chronic Amphetamines * Acute Alcohol use ## Footnote Understanding these factors is important for anesthetic management.
77
What are the diagnostic criteria for Pre-Eclampsia?
* BP > 140/90 x 2 * > 20 weeks gestation * Proteinuria * +/- Organ Dysfunction ## Footnote Early recognition is key for maternal and fetal health.
78
What is the definitive treatment for Preeclampsia?
Immediate delivery ## Footnote This is essential to prevent complications.
79
Which drug class is most commonly responsible for intraoperative anaphylactic reactions?
Muscle Relaxants (most common) ## Footnote Awareness of this risk is important for surgical teams.
80
Name the receptors targeted for PONV.
* Histamine * Serotonin * Dopamine ## Footnote Targeting these receptors helps in managing postoperative nausea and vomiting.
81
What are the negative effects of hypothermia?
* Increasing rates of wound infection * Decreased Drug Metabolism * Cardiac Arrhythmias and Ischemia * Delayed wound healing * Increasing blood loss ## Footnote Maintaining normothermia is crucial during surgery.
82
What are common opioid side effects other than analgesia?
* Respiratory Depression * Nausea and Vomiting * Bradycardia * Urinary Depression * Pruritus (itching) ## Footnote Awareness of side effects is important for patient safety.
83
Name active cardiac conditions that may lead to surgical cancellation.
* Unstable Coronary Syndrome * Decompensated Heart Failure * Severe Valvular Disease * Significant Cardiac arrhythmias ## Footnote Assessing cardiac risk is essential before surgery.
84
What are the effects of Vasopressin on HR/SVR/PVR?
* HR decreases * SVR Increases * PVR decreases ## Footnote Understanding these effects can guide treatment in specific clinical scenarios.
85
What are the effects of Dobutamine on HR/SVR/PVR?
* HR increases * SVR decreases * PVR decreases ## Footnote Dobutamine is often used in cases of cardiogenic shock.
86
What is the ABG profile for a Malignant Hyperthermia crisis?
* pH: Acidotic * PaCO2: Increased * PaO2: Decreased * Mixed Respiratory and Metabolic Acidosis ## Footnote Recognizing this profile is critical for timely intervention.
87
What should NOT be administered during a Malignant Hyperthermia crisis if giving Dantrolene?
* Ca Channel Blockers * Beta blockers ## Footnote Certain medications can exacerbate the condition.
88
What determines the rate of onset and offset for volatile anesthetics?
Solubility ## Footnote Understanding solubility helps predict anesthetic effects.
89
What are the contraindications for using N2O?
* Pneumothorax/Bowel Obstruction * High ICP * CAD * Emphysema ## Footnote Awareness of contraindications is vital for patient safety.
90
List physiological alterations during pregnancy.
* Increased CO/HR/MV/O2 consumption * Decreased SVR/FRC * Anemia * Hypercoagulable ## Footnote These changes impact anesthetic management.
91
What does the first letter in the pacemaker coding system represent?
Chamber Paced (A,V,O) ## Footnote Understanding the coding system is essential for interpreting pacemaker function.
92
What happens when a magnet is placed over a Pacemaker/ICD?
Prevents device sensing; in Pacemakers it leads to asynchronous pacing at a preprogrammed rate ## Footnote This can affect device function and patient safety.
93
What methods can improve oxygenation for OLV?
* Increasing FiO2 * Checking Bronchial Blocker/DLT Placement * PEEP to ventilated lung * CPAP to nonventilated lung * Restrict pulmonary blood flow to non-ventilated lung ## Footnote These methods enhance oxygenation during one-lung ventilation.
94
What primarily influences the PaCO2-EtCO2 gradient?
Physiological Deadspace (phase 3 of capnograph) ## Footnote This gradient provides insights into ventilation efficiency.
95
What are the anesthetic considerations with laparoscopic surgery?
* Increased MAP, SVR, and CVP * Decrease Cardiac Output and Stroke Volume * Cephalad displacement of Diaphragm = decreased FRC, decreased compliance, atelectasis, and V/Q mismatch * Endobronchial migration of ETT * Hypercarbia ## Footnote These considerations guide anesthetic management during laparoscopic procedures.
96
What is the correct order for performing a Bier Block (Upper Extremity)?
* Insert catheter as distal as possible and secure * Place double-pneumatic tourniquet * Elevate arm and wrap with Esmarch bandage to allow for exsanguination (from fingertips to distal cuff) * Inflate DISTAL first, then proximal * Inject LA then withdraw IV cannula with pressure ## Footnote Following the correct order ensures effective anesthesia.
97
What is the mechanism of action for Propofol?
GABA-a receptor agonist ## Footnote Propofol is commonly used for induction due to its rapid onset.
98
What is the mechanism of action for Etomidate?
Selective GABA-a receptor modulation ## Footnote Etomidate is known for its stable hemodynamic profile.
99
What is the mechanism of action for Ketamine?
NMDA receptor inhibitor ## Footnote Ketamine provides dissociative anesthesia and analgesia.
100
What is the mechanism of action for Dexmedetomidine?
Alpha 2 agonist ## Footnote Dexmedetomidine is used for sedation with minimal respiratory depression.
101
What is the mechanism of action for Opioids?
Mu-opioid receptor agonists ## Footnote Opioids are widely used for pain management.
102
What is the mechanism of action for Benzodiazepines?
GABA-a receptor agonist ## Footnote Benzodiazepines provide anxiolysis and sedation.
103
What is the best induction agent for hypovolemic trauma patients?
Ketamine ## Footnote Ketamine is preferred due to its hemodynamic stability.
104
What causes Negative Pressure Pulmonary Edema (NPPE)?
* Obstruction of Airway during NEGATIVE pressure breath * Biting of Tube * Laryngospasm ## Footnote Recognizing these causes is important for prevention and management.
105
What are potential complications with magnets and Pacemakers/ICDs?
* Programming is patient-specific; fixed rate pacing is “generic” and may be too high or low. * Competition with native rate causing asynchronous pacing on “R on T” * Pacemakers may be programmed not to respond to magnets (rare) ## Footnote Understanding these complications is crucial for safe management of patients with devices.
106
What determines the speed of onset of local anesthetics?
pKa ## Footnote A lower pKa leads to faster onset due to greater proportion of unionized drug.
107
What determines the duration of action for local anesthetics?
* Protein Binding * Lipid Solubility * Vascularity of Injection Site * Addition of vasoconstrictor (epinephrine) ## Footnote These factors influence how long an anesthetic remains effective.
108
What determines the onset/speed of volatile anesthetics?
* Blood-Gas Coefficient * Alveolar Ventilation * Cardiac Output * Concentration of Inhaled Anesthetic * Oil-Gas Partition Coefficient * MAC * Tissue Uptake and Distribution * Elimination and Recovery ## Footnote These parameters are important for predicting anesthetic effects.
109
What determines the potency of volatile anesthetics?
Higher Lipid Solubility = More Potent = Lower MAC ## Footnote Understanding potency is essential for effective anesthetic management.
110
Describe the physiological response to ECT therapy (BP/HR).
Short-lasting parasympathetic discharge resulting in bradyarrhythmias followed by a sympathetic stimulus resulting in hypertension and tachycardia. ## Footnote This response is important for monitoring during ECT.
111
What medications are given for post-operative shivering?
* Meperidine (Opioid) * Clonidine (Alpha-2 agonist) ## Footnote These medications help manage shivering effectively.
112
Tramadol, Buprenorphine, and Nalbuphine are all classes of what?
Opioid Agonist-Antagonists ## Footnote These drugs provide analgesia while minimizing side effects.
113
What is Buprenorphine used for?
Pain management and opioid addiction treatment ## Footnote Buprenorphine is found in formulations such as Suboxone and Subutex, often combined with naloxone.
114
What is the mechanism of action of Buprenorphine?
Partial agonist at opioid receptors ## Footnote It relieves withdrawal symptoms without causing intense euphoria.
115
What is a key advantage of Buprenorphine?
Lower risk of overdose due to ceiling effect on respiratory depression ## Footnote This makes it safer compared to full opioid agonists.
116
What is a consideration when using Buprenorphine?
Long half-life complicates acute pain management ## Footnote Additional opioids may be needed during acute pain.
117
What is the mechanism of action of Nalbuphine?
Agonist at kappa-opioid receptor and partial antagonist at mu-opioid receptor ## Footnote This dual action provides pain relief while limiting side effects.
118
What are the uses of Nalbuphine?
Treatment of moderate to severe pain, labor pain, postoperative pain ## Footnote It can also reverse respiratory depression caused by full opioid agonists.
119
What is an advantage of Nalbuphine?
Effective analgesia with less risk of respiratory depression ## Footnote This is in comparison to full mu-opioid agonists.
120
What is a consideration when using Nalbuphine?
Can cause dysphoria or unpleasant mood changes ## Footnote It should be avoided in patients dependent on opioids.
121
True or False: Buprenorphine can cause intense euphoria.
False ## Footnote Its partial agonist nature prevents the intense euphoria associated with full agonists.
122
Fill in the blank: Nalbuphine is used to treat _______.
[moderate to severe pain] ## Footnote It is also used during labor and after surgery.

AAframework (6 decks)

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