GA: Emergence - Exam 2 Flashcards
(99 cards)
Ways to emerge more smoothly(time wise):
-SA agents for short cases
-avoid excessive premed
-prepare to switch techniques/ agents at end of long case
-time meds and doses
GA components that affect emergence timeframe
-FGF (high=fast, low=slow) ***
-Ventilation (hyper=fast, hypo=slow)
-Concentration gradient (BG and OG coefficients)
-Eliminating rebreathing (high FGF)
-pts BMI (high, may last longer)
-duration of GA (IA can take days to wear off -lipid soluble, maybe sent to ICU on vent)
-type of surg (neck and airway surg, do NOT want pt coughing on emergence, maybe emerge DEEP)
Until FiAA reaches _ on gas analyzer you are still giving IA to pt
0
You have washed your pt’s IA out with high MV and high FGF of O2, why aren’t they breathing?
Could have also washed out CO2 to a point where hypercarbic reflexes are diminished
-back off on higher flows, slow their RR maybe, shorter exp time may help
How will I know when my TIVA pt should be waking up?
know your beta half lives!
TOF adductor pollicis or orbicularis oculi
-twitches to receptor block %
-time to recovery
1= 90% blocked - 30min
2= 80% blocked - 3-15min
3= 75% blocked - 3-15min (still 30 min for pancuronium)
4= 0-70% blocked -<5min
Onset of paralysis happens in this order:
-eye muscles, extremities, trunk, diaphragm
-will recover in opposite order so monitor facial n on induction and ulnar n for recovery
T/F You should give anticholinergics to reverse NMBD if you don’t have any twitches.
no, try PTC if 0/4 on TOF
-1 twitch = reversal in 30 min
-2-3 twitches = recovery in 4-15 min
-4/4 twitches = total recovery in 5 min
If pt is 75% blocked per TOF they can have:
-5 sec head lift
-15-20mL/kg VC
–25cmH2O NIF
-effective cough
TOF outputs should be _mA
30
For monitoring recovery from NMBD which is better, quant or qual?
quantitative data
When can I reverse my NMBD?
Must have 1 TOF twitch
-also consider timing+conc of last dose + if spont resp effort is seen
If I don’t have any TOF twitches but use PTC and have 7-8 twitches will I have 1 TOF twitch soon?
Yes, like <10 min
-more twitches, sooner until TOF will give a twitch
Which NMBD wears off the slowest according to PTC?
PANCuronium
-by 6-10 twitches most other NMBD have given 1 TOF twitch but PANCuronium will usually give 1TOF by 11 twitches
How do anti(acetyl?)cholinesterase drugs work for reversal?
increase amount of ACh at receptors by preventing their breakdown EVERYWHERE
-hence following MUSCARINIC effect of bradycardia which it treated with antimuscarinics :)
T/F Neostigmine is an anticholinergic
HELL NAW, its an AChE inhibitor!!! -increases ACh
AChE Inhibitors
-Edrophonium dose, onset, DOA
0.5-1mg/kg
onset: 30-60 sec, peak:1-5 min
DOA: 5-20 min
AChE Inhibitors
-Edrophonium tips
-only administer if pt has 4 visible twitches
-goes better w/ Atropine bc similar onset
AChE Inhibitors
-Neostigmine dose, max, onset/peak, DOA
0.04-0.08 mg/kg, MAX 5mg total
onset: 1-5 min peak: 7-14 min
DOA: 30-60 min
AChE Inhibitors
-Neostigmine tips
-give with Glyco, similar onset
-give 0.2:1 glyco and neo
AChE Inhibitors
-Pyridostigmine dose
0.1-0.25mg/kg
-not used often
AChE Inhibitors increase ACh everywhere but we only want to stimulate the _ receptors and avoid _ action so we give anticholinergics with them
nicotinic (desired)
muscarinic (undesired effects)
Anticholinergic/ Antimuscarinics
Atropine dose + tip
7-15mcg/kg
-lipophilic, can cross BBB, placenta, and cause CNS s/e like hallucinations/sedation
Anticholinergic/Antimuscarinics
Glycopyrolate dose + tip
0.01-0.02mg/kg
Glyco gecko is tiny!
-better antisialagogue (antisaliva drug); ionized and won’t cross BBB
