Fiser Absite. Ch 08-09. Anesthesia. Fluid And Electrolytes Flashcards
(146 cards)
1
Q
What is MAC?
A
minimum alveolar concentration = smallest concentration of inhalation agent at which 50% of patients will not move with incision
2
Q
What does a small MAC mean?
A
more lipid soluble = more potent
3
Q
Speed of induction is inversely proportional to ____
A
solubility
4
Q
Which inhalation agent is fastest but has high MAC (low potency), also minimal myocardial depression?
A
Nitrous oxide
5
Q
Which inhalation agent is slow, higest degree of cardiac depression and arrhythmias; least pungent; which is good for children?
A
Halothane
6
Q
What are the sx of Halothane hepatitis?
A
fever, eosinophilia, jaundice, increased LFTs
7
Q
Which inhalation agent can cause seizures?
A
Enflurane
8
Q
Which inhalation agent is good for neurosurgery but has higher cost?
A
Isoflurane
9
Q
Which inhalation agent has less myocardial depression, fast onset/offset, less laryngospasm; higher cost?
A
sevoflurane
10
Q
Which induction agent is a fast acting barbituate with side effects of decreased cerebral blood flow and metabolic rate, decreased blood pressure.
A
sodium thiopental
11
Q
Which induction agent has very rapid distribution and on/off; amnesia; sedative. Not an analgesic. Metabolized in liver by plasma cholinesterases. Do not use in patients with egg allergy.
A
Propofol
12
Q
What are the side effects of propofol.
A
hypotension and respiratory depression
13
Q
Which induction agent has dissociation of thalamic/limbic systems; places pt in a cataleptic state (amnesia, analgesia). No respiratory depression.
A
Ketamine
14
Q
What are the side effects of Ketamine?
A
hallucinations, catecholamine release (increased carbon monoxide, tachycardia), increased airway secretions, and increased cerebral blood flow
15
Q
When is ketamine contraindicated?
A
pts with a head injury
16
Q
Which induction agent has fewer hemodynamic changes; fast acting. Continuous infusions can lead to adrenocortical suppression.
A
Etomidate
17
Q
What is the last muscle to go down and 1st muscle to recover from paralytics?
A
diaphragm
18
Q
What is the first muscle to go down and the last to recover from paralytics?
A
neck muscles and face
19
Q
What is the only depolarizing agent?
A
succinylcholine
20
Q
What is the 1st sign of malignant hyperthermia?
A
increased end-tidal CO2
21
Q
Tx for malignant hyperthermia?
A
Dantrolene inhibits Ca release. cooling blankets, bicarb, glucose
22
Q
Do not use succinylchoine in pts with what?
A
burn pts, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure
23
Q
What can happen if pt with open-angle glaucoma gets succinylcholine?
A
it can become close angle glaucoma
24
Q
Atypical pseudocholinesterases
A
cause prolonged paralysis with succinylcholine (Asians)
25
How do nondepolarizing paralytic agents work?
inhibit neuromuscular junction by competing with acetylcholine
26
Which paralytic undergoes Hoffman degredation. Can be used in liver and renal failure. Histamine release.
Cis-atracurium
27
Which paralytic is fast, short acting; degradation by plasma cholinesterases. Histamine release.
Mivacurium
28
Which paralytic is fast, intermediate duration; hepatic metabolism.
Rocuronium
29
Which paralytic is slow acting, long-lasting; renal metabolism. Most common side effect is tachycardia.
Pancuronium
30
What two drugs can be given for reversing nondepolarizing agents and what is their MOA?
Neostigmine and Edrophonium, they block acetylcholinesterase, increasing acetylcholine
31
___ or ___ should be given with neostigmine or edrophonium to counteract the effects of generalized acetylcholine overdose
atropine or glycopyrrolate
32
Local Anesthetics work by increasing action potential, preventing ____
Na influx
33
How much lidocaine can you use?
0.5 cc/kg
34
Relative length of action of bupivacaine, lidocaine, procaine
bupivacaine > lidocaine > procaine
35
Name conditions where you cannot use epinephrine with local anesthetics.
arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals (fingers, toes, penis, nose, and ear), uteroplacental insufficiency
36
How to tell the difference between the amides and the esters?
Amides all i in the first part of the name: lidocaine, bupivacaine, mepivacaine; Esters: tetracaine, procaine, cocaine
37
What is the biggest difference between the amides and the esters?
Amides rarely have allergic reactions. Esters have increased allergic reactions secondary to PABA analogue
38
Name 4 opioids?
Morphine, fentanyl, Demerol, codeine
39
Where are the opioids metabolized and excreted?
metabolized in liver and excreted by kidneys
40
Avoid use of narcotics in patients on MAOIs can cause ____
hyperpyrexic coma
41
Morphine, Demerol and Fentanyl which one causes histamine release?
morphine
42
Fentanyl is ___x the strength of morphine
80
43
sufentanil, alfentanil, remifentanil
very fast-acting narcotics with short half-lives
44
Versed, Ativan, Valium what are their generic names and short or long acting
Versed (midazolam) short acting; Ativan (lorazepam) long acting; Valium (diazepam) long acting
45
Morphine in epidural can cause ___
respiratory depression
46
Lidocaine in epidural can cause ___
decreased HR and BP
47
Tx for acute hypotension and bradycardia with epidural?
turn epidural down; fluids; phenylephrine; atropine
48
T-___ epidural can affect cardiac accelerator nerves
5
49
Epidural contraindicated with ___, ____ -> can get inadvertent spinal anesthesia.
hypertrophic cardiomyopath, cyanotic heart disease
50
Good for pediatric hernias, and perianal surgery.
Caudal block
51
Epidural and spinal complications
hypotension, headache, urinary retention, abscess/hematoma formation, neurologic impairment
52
High spinal can cause ____
respiratory depression
53
Spinal headache tx and what makes worse?
rest, increased fluids, caffeine, analgesics; blood patch to site persists >24 hrs. Headache worse sitting up.
54
What two conditions are associated with them most postoperative hospital mortality?
CHF and renal failure
55
May have no pain or EKG changes; can have hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia
Postop MI
56
Patients who need cardiology workup.
Angina, previous MI, shortness of breath, CHF, walks 5/min, age > 70, patients undergoing major vascular surgery
57
List the ASA classes with description
I - healthy; II - mild disease without limitation (controlled HTN, obesity, DM, older age); III - severe disease (angina, previous MI, poorly controlled HTN, DM with complictions, moderate COPD); IV - severe constant threat to life ( unstable angina, CHF, renal failure, liver failure, severe COPD); V - moribound (ruptured AAA, saddle pulmonary embolus, ascending aortic dissection with HF); VI - donor; E - emergency
58
Biggest risk factors for postop MI
age > 70, DM, previous MI, CHF and unstable angina
59
Best determinant of esophageal vs. trachael intubation?
end-tidal CO2
60
Intubated patient undergoing surgery with sudden transient rise in ETCO2. Most likely Dx? Tx?
alveolar hypoventilation; increase tidal volume (most likely due to atelectasis) or increase respiratory rate
61
Intubated patient with sudden drop in ETCO2. List 3 likely reasons
disconnected from vent, PE or significant hypotension
62
ET tube should be placed ___ cm above carina
2
63
Most common PACU complication
N/V
64
Roughly ___ of the total body weight is water (men); ___ have a little more body water, ____ have a little less
2/3, infants, women
65
2/3 of water weight is located where? and the other 1/3?
intracellular (mostly muscle), extracellular
66
2/3 of extracellular water is located where? and the other 1/3?
interstitial, plasma
67
What determines plasma/interstitial compartment osmotic pressures? what about intracellular/extracellular?
proteins, Na
68
Most common cause of volume overload? what is the first sign?
iatrogenic, weight gain
69
What is the meqs in 0.9% NS?
Na 154 and Cl 154
70
Lactated Ringer's has the ionic composition of plasma, what is it?
Na 130, K 4, Ca 2.7, Cl 109, bicarb 28
71
How to calculate plasma osmolarity and what is the range of normal?
(2 x Na) + (glucose/18) + (BUN/2.8); 280-295
72
How to estimate volume replacement in cc/kg/hr
4 cc/kg/hr for first 10 kg, 2 cc/kg/hr for second 10 kg, 1 cc/kg/hr each kg after that; (110 cc/hr for 70 kg man)
73
What is the best indicator for adequate volume replacement?
urine output
74
During open abdominal operations, fluid loss is ___ L/hr unless there are measurable blood losses
0.5-1.0 L/hr
75
Usually do not have to replace blood lost unless it is >____ cc
500
76
Insensible fluid losses is ___ cc/kg/day, 75% skin, 25% respiratory (pure water)
10
77
IV replacement after major adult GI surgery: During operation and 1st 24 hours use ____.
LR
78
After 24 hrs switch to ___
D5 1/2 NS with 20 mEq K
79
5% dextrose will stimulate ___, resulting in amino acid uptake and protein synthesis (also prevents protein catabolism)
insulin
80
D5 1/2 NS @ 125 /hr provides 150 g glucose per day (____ kcal/day)
525
81
Stomach secretes ___ L/day
1 to 2
82
Biliary system secretes ___ mL/day
500-1000
83
Pancreas secretes ___ mL/day
500-1000
84
Duodenum secretes ____ mL/day
500-1000
85
Normal K+ requirement is ___ mEq/kg/day
0.5-1.0
86
Normal Na+ requirement is ___ mEq/kg/day
1 to 2
87
Which bodily fluid has the highest concentration of K+
saliva
88
Primary electrolyte(s) lost in the: Stomach?
H+, Cl-
89
Primary electrolyte(s) lost in the: Pancreas?
HCO3-
90
Primary electrolyte(s) lost in the: Bile?
HCO3-
91
Primary electrolyte(s) lost in the: Small Intestine?
HCO3-, K+
92
Primary electrolyte(s) lost in the: Large Intestine?
K+
93
Gastric losses should be replaced with which fluid?
D5 1/2 NS with 20 mEq K+
94
Pancreatic/biliary/small intestine losses should be replaced with which fluid?
LR with HCO3-
95
Large intestine (diarrhea) losses should be replaced with which fluid?
LR with K+
96
GI losses should generally be replaced ___ ?
cc/cc
97
UO should be kept at least ___ cc/kg/hr; should not be replaced usually a sign of normal postoperative diuresis?
0.5
98
Normal range of K+
3.5-5.0
99
Initial finding of hyperkalemia on EKG?
peaked T waves
100
Tx for hyperkalemia: ____ membrane stabilizer for heart
Calcium gluconate
101
Tx for hyperkalemia: ____ causes alkalosis, K enters cell in exchange for H
Bicarb
102
Tx for hyperkalemia: ____ K driven into cells along with glucose
10 U insulin and 1 ampule of 50% dextrose
103
Tx for hyperkalemia: ___ binder
Kayexalete
104
Tx for hyperkalemia: ___ if refractory
Dialysis
105
EKG with hypokalemia?
t waves disappear
106
Hypokalemia tx: may need to replace ___ before you can correct K+
Mg+
107
Normal range of sodium?
135-145
108
What are the sx of hypernatremia?
restlessness, irritibility, ataxia, seizures
109
Correct hypernatremia with ___ slowly to avoid ___
D5W, brain swelling
110
Formula for total body water?
0.6 x patient's weight
111
Formula for total free water deficit
TBW x (([Na+]/140) -1)
112
Formula for water requirement in hypernatremia
Water requirement = (desired change in Na over 24 hrs x TBW) / desired Na after giving the water requirement; For a 70 kg man with Na 165 = (16 x 42)/149 = 4.5 L
113
In hypernatremia change Na at ____ mEq/h
0.7
114
Sx of hyponatremia
headaches, delirium, seizures, nausea, vomiting
115
Formula for Na deficit in hyponatremia
Na deficit = 0.6 x weight in kg x (140 - Na)
116
What is the first tx for hyponatremia? second? third?
water restriction, diuresis, NaCl replacement
117
Why is Na corrected slowly In hyponatremia and what is the rate?
avoid central pontine myelinosis, 1 mEq/h
118
What is the formula for correcting Na in pseudohyponatremia caused by hyperglycemia?
for each 100 increment of glucose over normal add 2 points to the Na value
119
What is the normal Ca range?
8.5-10.0
120
Most common malignant cause of hypercalcemia?
breast CA
121
What drug causes retention of Ca2+ and should not be given to patient with hypercalcemia?
thiazides (also LR contains Ca2+)
122
What is the tx for hypercalcemia?
NS at 200-300 cc/hr, Lasix
123
Tx for malignant hypercalcemia?
mithramycin, calcitonin, alendronic acid, dialysis
124
Main sx of hypercalcemia?
lethargic state
125
Sx of hypocalcemia?
hyperreflexia, Chvotstek's sign (tapping on face produces twitching), perioral tingling and numbness, Trousseau's sign (carpopedal spasm), prolonged QT
126
In hypocalcemia, may need to correct ___ before being able to correct Ca
Mg
127
Protein adjustment for Ca
(4.0 - serum albumin) * 0.8
128
Normal range of Mg
2.0-2.7
129
Sx of hypermagnesemia? What type of pts?
lethargic state; burn, trauma and dialysis pts
130
Tx for hypermagnesmia
Ca
131
Signs and sx of hypomagnesmia are similar to what?
hypocalcemia
132
Formula for anion gap and normal range
Na - (HCO3 + Cl)
133
Mnemonic for anion gap acidosis
MUDPILES; methanol, uremia, diabetic ketoacidosis, paraldehydes, isoniazid, lactic acidosis, ethylene glycol, salicylates
134
Normal gap acidosis usually due to loss of ____/____
Na/HCO3
135
Normal gap acidosis seen with?
ileostomies, small bowel fistulas
136
Tx for metabolic acidosis is underlying cause; keep pH > ___ with bacarbonate; severely decreased pH can affect ____
7.20, myocardial contractility
137
Metabolic alkalosis is usually the result of ____
contraction alkalosis
138
Nasogastric suction results in what electrolyte abnormality and what is the urine?
hypocholoremic, hypokalemic, metabolic alkalosis, paradoxical aciduria
139
Why is there hypokalemia in nasogastric suction?
because loss of water causes kidney to resorb Na iand dump K (Na/K ATPase)
140
What causes paradoxical aciduria?
Na+/H- exchange activated in an effort to absorb water along with K+/H- exchanger in an effort to resorb K+
141
Henderson-Hesselbach equation
pH = pK + log [HCO3−]/[CO2]
142
What is the best test for azotemia?
FeNa: (urine Na/Cr)/(plasma Na/Cr)
143
In Pre renal failure. What is the FeNa? urine Na? BUN/Cr ratio? urine osmolality?
FeNa 20; urine osmolality >500 mOsm
144
In contrast dye induced ARF: What best prevents renal damage? What are 2 others?
volume expansion, HCO3-, N-acetylcysteine gtt
145
Myoglobin is converted to ____ in acidic environment which is toxic to renal cells. Tx?
ferrihemate, alkalinize urine
146
In tumor lysis syndrome there is increased ___ and ___ and decreased Ca. This can result in increased BUN and Cr, EKG changes. Tx?
phosphate and uric acid; hydration, allopurinol (decreased uric acid production), diuretics, alkalinization of urine
