Module 9 Part 4

Question 1

Monitor core temperature with general anesthesia >___ minutes

Answer 1

> 30 minutes

Question 2

Maintain core temp of >___C

Answer 2

> 36C

Question 3

Hypothermia

Answer 3

<36C

Question 4

Hyperthermia

Answer 4

> 38C

Question 5

Normothermia

Answer 5

37C

Question 6

What drug can inhibit the sweating response?

Answer 6

Atropine

Question 7

The majority of heat loss in the preoperative setting occurs within the first ____ hour(s)

Answer 7

1 hour

Question 8

Hypothermia reduces the MAC of volatile anesthetic agents by __% per degrees C

Answer 8

5%

Question 9

Name 3 risks of hypothermia

Answer 9

• Increased O2 consumption through shivering
• Increased risk CV events & MI
• Increased risk sickling with sickle cell dz
• Impaired coagulation
• Increases surgical blood loss
• Decreased drug metabolism
• Reduced MAC of volatile anesthetic agents by 5% per C
• Increased wound infection and delayed healing
• Impaired immune function
• Prolonged PACU stay

Question 10

What method of heat transfer accounts for the majority of heat transfer in the OR?

Answer 10

Radiation

Question 11

2nd leading cause of heat loss?

Answer 11

Convection

Question 12

Keep OR at least >___C

Answer 12

> 23C

Question 13

1 unit of PRBCs or 1L of crystalloids can decrease temp by _____ degrees C

Answer 13

0.25C

Question 14

Benchmark for adequate neuromuscular recovery is an adductor pollicis (_____ nerve) Train of Four (TOF) ratio of >_____

Answer 14

Ulnar nerve

>0.9

Question 15

Device that uses electrical impulses transmitted from stimulator to superficial peripheral nerve by surface electrodes

Answer 15

peripheral nerve stimulator (PNS)

Question 16

The ________ is most resistant to NMB and it recovers more _______ than peripheral muscles

Answer 16

Diaphragm

Quickly

Question 17

Which nerve is the gold standard for PNS monitoring?

Answer 17

Ulnar nerve

Question 18

Contraction of the _______ muscle of the ______ via stimulation of the ulnar nerve is the preferred site for determining the level of neuromuscular blockade

Answer 18

adductor

thumb

Question 19

Out of the five clinical test types of neuromuscular function, the TOF and _______ stimulation are the most commonly used.

Answer 19

tetanic

Question 20

When is the most useful time to use single twitch PNS monitoring?

Answer 20

Induction

Question 21

Without a baseline for single twitch PNS measuring, if muscle movement is detected at all during stimulation, what does this simply mean?

Answer 21

NMB <100%

Question 22

Single twitch PNS monitoring involves a single twitch at ___ to ___ hertz (Hz) for ___ to ___ milliseconds (ms)

Answer 22

0. 1 - 1 Hz

0. 1 - 0.2 ms

Question 23

The TOF test delivers four separate stimuli every ___ seconds at a frequency of __ (Hz) for __ seconds.

Answer 23

every 0.5 seconds
2 Hz
2 seconds

Question 24

The most widely used means of stimulation is the ______

Answer 24

TOF

Question 25

With TOF stimulation what is the term for the decrement in twitch height

Answer 25

Fade

Question 26

Twitch suppression of 90% = TOF count of __ or less

Answer 26

1

Question 27

TOF stimulation is most sensitive between ___% and ___% paralysis

Answer 27

70-100%

Question 28

T1-T3 twitches are present. What is the percent NMB?

Answer 28

75-80% block

Question 29

T1 & T2 twitches are present. What is the percent NMB?

Answer 29

80-85% block

Question 30

Only T1 twitch is present. What is the percent NMB?

Answer 30

90-95% block

Question 31

No twitches are present with TOF. What is the percent NMB?

Answer 31

100% block

Question 32

What agent does not have a TOF fade?

Answer 32

Succinylcholine

Question 33

Intraoperatively, the ideal degree of paralysis necessary for any procedure with sufficient anesthetic depth is ___% to ___%.

Answer 33

85-95% (1-2 twitches)

Question 34

How many TOF twitches visible for ideal degree of paralysis intraop?

Answer 34

1-2 twitches visible

Question 35

___-__________ agents have a TOF fade.

Answer 35

Non-depolarizing

Question 36

What TOFR should be obtained before extubation?

Answer 36

0.9

Question 37

During onset of _______ block, each of the four twitches is decreased equally in size; there is no fade

Answer 37

depolarizing

Question 38

___-________ block → more fade = deeper block

Answer 38

Non-depolarizing

Question 39

Depolarizing block → no fade; if fade present = _______ block

Answer 39

Phase 2 block

Question 40

If larger doses of depolarizing agent are given, for example in techniques that require repeated bolus doses or infusions of succinylcholine, then a ________ block may develop

Answer 40

Phase 2

Question 41

_______ blocks with depolarizing agents mimic non-depolarizing blocks

Answer 41

phase 2

Question 42

Tetanus consists of continuous electrical stimulation for __ seconds at ___ or ___ Hz

Answer 42

5 seconds | 50 or 100 Hz

Question 43

With tetanus stimulation, if the muscle contraction produced is sustained for the entire 5 seconds of stimulation without fade, significant paralysis is ______.

Answer 43

unlikely

Question 44

This type of stimulation test is painful and should not be repeated too often in order to avoid muscle fatigue

Answer 44

Tetanus stimulation

Question 45

The adult brain comprises approximately __% to __% of body weight

Answer 45

2-3%

Question 46

The adult brain requires approximately __% to __% of cardiac output

Answer 46

15-20%

Question 47

The ______ monitoring system can monitor patient’s level of consciousness (LOC)

Answer 47

BIS (bispectral index)

Question 48

A BIS monitor uses the analysis and processing of ____ electrical signals

Answer 48

EEG

Question 49

What does BIS value of 0 mean?

Answer 49

No brain activity

Question 50

What does BIS value of 100 mean?

Answer 50

Pt awake and alert

Question 51

BIS values between ___ and ___ suggest adequate general anesthesia for surgery

Answer 51

40-60

Question 52

______ is a controversial marker of renal function

Answer 52

UO

Question 53

Try to keep UO >______

Answer 53

>0.5mL/kg/hr

Question 54

Increased response time and/or decrease in response rate to a clinical alarm as a result of too many alarms

Answer 54

Alarm fatigue

Question 55

“_________” phenomenon is a natural behavior to disregard signals that have been false in the past

Answer 55

"Cry wolf"