Induction for the CV Patient - Quiz 3

Question 1

What types of meds should be available and preprogrammed for CV cases?

Answer 1

Inotrope

Pressor

Vasodilator

Antiarrythmics

Anticoagulants & Reversals

Bolus Syringes

Question 2

How should CV patients be premedicated before surgery?

Answer 2

Continue B-Blockers

Hold ACE & ARBS 24hrs before surgery

Anxiolytics

Question 3

How does Sufentanil compare to Fentanyl?

Answer 3

7-10x more potent than Fentanyl

Shorter Half Life

Higher pKa

Lower Volume Distribution

Question 4

How does Remifentanil compare to Fentanyl?

Answer 4

Similar Potency

Eliminated via Liver & Esterases

More Post-Op Pain & Hyperalgesia

Question 5

What are high dose opioid techniques?

Answer 5

Morphine 1-2mg/kg

Fentanyl 50-100 mcg/kg

Sufentanil 10-25 mcg/kg

Question 6

What is the rationale for High Dose Opioid Techniques?

Answer 6

Supresses Stress Response

&

Hemodynamic Stability

Question 7

What is the Induction dose for Fentanyl?

Answer 7

3 - 10 mcg/kg

Large Volume Distribution

Question 8

What is the Induction dose for Sufentanil?

Answer 8

0.1 - 1 mcg/kg

Question 9

What is the Induction dose for Remifentanil?

Answer 9

0.5 - 1 mcg/kg

1 Minute Onset

9-20 min Recovery Time

Question 10

How is Remifentanil Hyperalgesia treated?

Answer 10

Ketamine & Magnesium Sulfate

Question 11

What Hypnotics are used for Induction?

Answer 11

Propofol

Etomidate

Ketamine

Question 12

What is the Induction dose for Propofol?

Answer 12

1 - 2 mg/kg

Comes off quick d/t big redistribution

Question 13

What are the CV effects of Propofol?

Answer 13

↓SVR

↓MAP

↓Cardiac Index

↓Stroke Volume

Question 14

What is the Induction dose for Etomidate?

Answer 14

0.2 mg/kg

Question 15

What are the CV effects of Etomidate?

Answer 15

Small MAP & SVR decrease

↑HR

↑CO

Question 16

When would you want to avoid using Etomidate?

Answer 16

Patients w/ Seizures - can initiate myoclonus

&

High Incidence of PONV

Question 17

How does Etomidate affect Cortisol / Adrenal Response?

Answer 17

Profound supression for 24 hrs & Hypotension

Question 18

What is the Ketamine Induction dose?

Answer 18

2 mg/kg

Question 19

What does Ketamine do?

Answer 19

Causes Cataleptic Trance & Dissociative Anesthesia

Unconscious in 20-60 sec

Question 20

What are the CV effects of Ketamine?

Answer 20

↑HR

↑MAP

↑Plasma Epi

↑Coronary Demand

Question 21

What are the Neuro effects of Ketamine?

Answer 21

↑ICP

Inhibits Tumor Necrosis Factors –> Anti Inflammatory & Antihyperanalgesic Effects

EEG Theta Waves

Question 22

Which receptor does Ketamine work on?

Answer 22

Noncompetitive NMDA Antagonist

Question 23

What are the CV effects of Inhalation Agents?

Answer 23

Myocardial Depression

Dose-Dependent Vasodilation

Dose-Dependent Tachycardia - especially Des

Question 24

Out of Des, Sevo, and Isoflurane, which gas has the least Dose-Response relationship in regards to MAP

Answer 24

Sevoflurane

Question 25

\_\_\_\_\_\_\_\_ is a short acting NMB

Answer 25

Succinylcholine

Question 26

Which NMBs are Intermediate Acting?

Answer 26

Cisatracurium Rocuronium Vecuronium (Longer Onset & Acting than Roc)

Question 27

Which NMB is Long Acting?

Answer 27

Pancuronium - Vagolytic effect to counter opioids

Question 28

How do pts w/ HTN react to Induction Agents & Larygoscopy?

Answer 28

More HTN to Laryngeal Stimulation & More Hypotensive to Induction Agents

Question 29

How does Propofol Distribute throughout the body?

Answer 29

Quickly to Brain & Highly Perfused Areas, then to less perfused areas. Metabolized by Liver & pt breathes it off

Question 30

What is the Induction dose for Precedex?

Answer 30

Loading: 1mcg/kg in 10 min (None in CABGs) Infusion: 0.2 - 1.5 mcg/kg/hr

Question 31

What are the Neuro effects of Precedex?

Answer 31

Natural Sleep Sedation No CMRO₂ Change ↓Cerebral Blood Flow

Question 32

What are the CV Effects of Precedex?

Answer 32

Hypotension & Bradycardia d/t vasodilation Loading Dose HTN No Contractility Change

Question 33

True/False: Fentanyl is metabolized by the liver into active metabolites?

Answer 33

**False** - broken down by liver into _inactive_ metabolites

Question 34

What is the difference b/t Ephedrine & Epinephrine?

Answer 34

Similar, but Ephedrine has longer duration & does NOT increase glucose levels Decreases in effectiveness over time

Question 35

Which receptors does Esmolol work on?

Answer 35

Beta 1 Fast Onset Short Half-life d/t Plasma Esterase Metabolism

Question 36

Which vasopressor increases coronary artery perfusion & preload?

Answer 36

Norepinephrine ⬆Coronary perfusion d/t ⬆DBP First line for CV cases

Question 37

How does Milrinone work?

Answer 37

PDE3 Inhibitor - prevents cAMP breakdown Inotrope & Vasodilation w/o Tachycardia ↓Preload & ↓Afterload