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Anesthesiology > General Anesthesia questions > Flashcards

General Anesthesia questions Flashcards

1
Q

What stage of anesthesia are patients most vulnerable in?

A

Stage II - because they are hyperexcitable to external stimuli and have lose both airway reflexes and autonomic stability

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2
Q

What is mallampati class I?

A

the uvula is entirely visible

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3
Q

What is mallampati class II?

A

The uvula is partially visible

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4
Q

What is mallampati class III?

A

The uvula is not visible - intubation likely to be difficult

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5
Q

What is ASA I?

A

No systemic disease. Normal Healthy

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6
Q

What is ASA II?

A

Mild systemic disease but no fxnal capacity deficits: smoking, controlled HTN

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7
Q

What is ASA III?

A

Systemic disease with fxnal capacity deficits: CAD, RAD, mild renal or hepatic impairment

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8
Q

What is ASA IV?

A

Unstable CAD, COPD, CF

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9
Q

What is ASA V

A

Imminent death - will die without intervention: ruptured aorta

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10
Q

What are the stages of anesthesia?

A

Induction, Maintenance, Emergence

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11
Q

What is Stage I?

A

Lasts from full consciousness until patient closes his eyes

Induction: analgesia, patient is awake and responsive

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12
Q

What is Stage II?

A

Last from eye closure to regaining autonomic stability
Induction: hyperexcitable, delirium, movement, autonomic instability, loss of airway protection, significant risk of complications, protective airway reflexes lost

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13
Q

What is Stage III?

A

Return of autonomic stability, preservation of vital functions. 4 planes: planes 2 and 3 are surgical anesthesia

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14
Q

What is Stage IV?

A

Maintenance: depression of vital functions, autonomic instability

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15
Q

What is Stage V?

A

Maintenance: cardiac arrest

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16
Q

What is emergence?

A

Stage III, II, I

17
Q

What are the indications for tracheal intubation?

A

Airway access/airway protection
Need for muscle relaxation during surgery
Length of procedure greater than 2 hours
Need for mechanical ventilation

18
Q

What happens to the cardiovascular system in aging?

A

Decreased responsiveness in beta receptors - lower HR max for compensation, arterial pressure is more labile

19
Q

What happens to the pulmonary system in aging

A

Decreased vital capacity/pulmonary reserve, increased air trapping, increased V/Q, increased residual volume, reduced resting PaO2, decreased ventilatory response to hypoxia and decreased ability to cough and clear secretions

20
Q

What classes of drugs are the elderly very sensitive to?

A

Sedative hypnotics

21
Q

What happens to renal and hepatic function with age?

A

It declines leading to a reduction in drug elimination from the body

22
Q

What should be assessed for in an obese patient?

A

Functional capacity because they could have CHF or pulmonary HTN
Social history - tobacco use! Encourage to quit smoking 6 weeks prior

23
Q

What could be helpful to draw in a patient with a BMI over 50?

A

ABG

24
Q

What are morbidly obese patients at higher risk for?

A

Intubation difficulty, mask ventilation difficulty, postoperative respiratory failure.

25
Q

What are patients with OSA at higher risk for?

A

HTN, arrythmias, ACS, CHF, and sudden death due to increased baseline SNS tone.

26
Q

What should be done prior to induction of an obese patient?

A

3-5 minutes of preoxygenation

27
Q

What does preoxygenation do?

A

Increase PaO2

Washes out N2 thereby attenuating hypoxemia

28
Q

Which inhaled anesthetics are preferred in obese patients?

A

Des or sevo because they have a lower tissue/blood ratio so they wear off quicker. This is important because obese patients need to be fully awake before extubation

29
Q

Why should NMBs be dosed according to lean body mass?

A

Because obese patients have an increase in pseudocholinesterase activity

30
Q

What happens to opioids in the blood when dosed based on TBW in an obese patient?

A

they have a higher blood level because the high amount of fat are not well perfused.

31
Q

How should pain be managed in an obese patient postoperatively?

A

Dose according to lean body mass and deliver via PCA

32
Q

What is the danger of opioid use in an obese patient?

A

risk of apnea/decreased respiratory drive

33
Q

What other non-opioid drugs can be used for postop pain control?

A

NSAIDs, ketamine, dexmedetomidine (alpha agonist), local

34
Q

Which drug should be dosed according to TBW in obese patients?

A

Succinylcholine

35
Q

What is the innervation of the lower extremity?

A

L2 to S3

36
Q

What are the risk of neuraxial anesthesia in an anticoagulated patient?

A

local bleeding, epidural hematoma

37
Q

Where does a spinal anesthetic go?

A

The subarachnoid space

Anesthesiology (19 decks)

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