Mid-block Flashcards
(37 cards)
1
Q
Propofol induction dose
A
1.5-2.5 mg/kg
2
Q
Thipentone induction dose
A
3-5mg/kg
3
Q
Etomidate induction dose
A
0.2-0.3 mg/kg
4
Q
Ketamin induction dose
A
1-2mg/kg
5
Q
Indications for an RSI
A
- pregnancy beyond first trimester
- emergency surgery/trauma patients
- unstarved patient
- difficult airway management
6
Q
Definition of a starved patient for an elective surgery
A
- solids: 6 hours
- non-human milk: 6 hours
- breastmilk 4 hours
- clear fluids: 2 hours
7
Q
Causes of hypoxia in the recovery room
A
- hypoventilation (pain, atelectasis, residual NM blockade, residual drug effects)
- airway obstruction (tongue, laryngosmasm)
- pulmonary oedema
- PE (V:Q mismatch)
- aspiration
8
Q
Atropine: size, concentration and adult dose
A
1ml
10mg/ml
20ug/kg
9
Q
Mac of iso, halothane, sevo
A
1.2
0.75
2
10
Q
5 factors that decrease MAC
A
- pregnancy
- neonates
- eldery
- hypothermia
- hypothyroidism
11
Q
Use of neostigmine
A
Reversal of non-depolarising muscle relaxants
12
Q
5 factors that decrease MAC
A
- pregnancy
- neonates
- elderly
- hypothermia
- hypothyroidism
- sedatives
- acute opioid/alcohol use
- chronic amphetamine use
13
Q
Contraindications for a spinal anaesthesia
A
- local sepsis/infection
- INR
- unable to convert to GA (unskilled/no equipment)
- obstructive cardiac lesion (MS/AS)
14
Q
Airway evaluations that help to assess the airway
A
- MP
- thyromental distance
- inter-incisor distance
15
Q
Contraindications for a spinal anaesthesia
A
- local sepsis/infection
- INR >1.5, platelets <75
- allergy to LA
- uncooperative patient
- unable to convert to GA (unskilled/no equipment)
- obstructive cardiac lesion (MS/AS)
16
Q
Signs of local anaesthetic toxicity
A
- circumoral paraestheia and metallic taste
- tinnitus
- visual disturbance
- confusion and slurring
- hypertension
- tachycardia
17
Q
Indications for ETT
A
- controlled ventilation
- protection of the airway (aspiration etc)
- maintainance of patent airway (prone, head/neck ops, ENT surgery)
- post-op ventilation in ICU
18
Q
Complications during intubation
A
- trauma to tissue
- intubation response
- increased resistance to breathing (narrow/kinked tube)
- obstruction of ETT (foreign body, secretions(
- oesophageal intubation
- failed intubation
19
Q
Complications after extubation
A
- laryngospasm
- aspiration
- hoarseness
- tracheal oedema
- vocal cord ulceration
- tracheal stenosis
20
Q
Indications of LMA
A
- fasted patients without GORD for short-moderate procedures
- rescue
- resus (to avoid interruptions in chest compressions
21
Q
Indications for surgical airways
A
- prolonged ventilation in ICU
- head and neck deformity/trauma
- impossible intubation
- difficult weaning from ventilation
- emergency rescue
22
Q
Indications for surgical airways
A
- prolonged ventilation in ICU
- head and neck deformity/trauma
- impossible intubation
- difficult weaning from ventilation
- emergency rescue
23
Q
Definition of MAC
A
the stead-state minimum concentration at sea level that prevents the movement to a standard surgical stimulus in 50% of non-premedicated adults
24
Q
Factors that increase MAC
A
- infancy
- hyperthermia
- hyperthyroidism
- chronic alcohol/opioid use
- acute amphetamine use
- hypernatramia
25
Indications for muscle relaxants
```
Patient factors (risk of aspiration)
Anaesthetic factors (control of ventilation, facilitates ETT,abnormal positioning)
Surgical factors (microsurgery, laparotomyis, orthos, ECT, cardiac surgery)
```
26
Indications for muscle relaxants
```
Patient factors (risk of aspiration)
Anaesthetic factors (control of ventilation, facilitates ETT,abnormal positioning)
Surgical factors (microsurgery, laparotomyis, orthos, ECT, cardiac surgery)
```
27
Where are nicotinic receptors found?
Autonomic ganglia
| Skeletal muscles
28
Where are muscarinic receptors found?
heart
smooth muscle (bronchi and GIT)
glands
29
Management of LA toxicity
- stop injecting
- call for help
- ABCS
- maintain airway (intubate if necessary)
- 100% oxygen
- may need to hyperventilate
- ensure IV access
- control convulsions with diazepam/midazolam/propofol
- manage hypotension with vasopressors
- use adrenaline if necessary
- if arrested: start CPR
- may need magnesium and intralipid for bupivicaine toxicity
- intralipid (20%) 1.5ml/kg over 1 minute
- start infusion at 0.25ml/kg (max 8ml/kg)
30
Factors that reduce FRC
- Supine position
- lithotomy and trendelenbury
- muscle relaxants
- intubation
- abdominal distension
- pregnancy
- abdominal pain
31
Causes of hypoxia
- stagnant (thrombosis, embolism, arrest)
- anaemic hypoxia (not enough Hb)
- hypoxaemic (no O2)
- cytotoxic (cyanide)
32
MOA of ephedrine
Releases noradrenaline from sympathetic terminals (a-adrenergic and B effects), direct effect on alpha and B recepors (vasoconstruction and increase CO)
33
MOA of PEP
selective A1 receptor agonist, vasoconstricts to raise the SVR
34
Management of anaphylaxis
- ABCs
- call for help
- adrenaline (1mg in 20ml and give 0.5-1ml at a time)
- aggressive IV fluid replacement
- hydrocort 100mg IV/ promethazine 25mg IV
- bronchodilator
- glucagon 1-2mg slow IV
35
What to give for malignant hyperthermia
Dantroleme (2.5mg/kg)
36
Spinal volumes in obstetrics
2ml 0.5% bupivicaine with 8% dextrose and fentanyl 10ug (0.2ml)
37
Standard minute volume
70ml/kg/minute
