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Areviewbook > New Book Anesthesia > Flashcards

New Book Anesthesia Flashcards

(108 cards)

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1
Q

ARDS

A

Acute onset
PAOP<18
Diffuse bilateral opacities
Pa02:Fi02<200 if 300 it is ALI

Mechanical ventilation is not a requirement

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2
Q

No hypercarbia not good with

A

Increased ICP

Pulmonary HTN

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3
Q

Thiopental

A

Large volume of distribution and insignificant hepatic metabolism

Therefore same duration in patient with liver disease

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4
Q

Factor 7 first to become deficient in

A

Liver disease
Vitamin K deficiency
Warfarin therapy

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5
Q

Liver disease

A

Thrombocytopenia
Low levels factor 2 5 7 9 10 11
Vitamin k deficiency
Increased tPA levels

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6
Q

Clinical uses factor 7

A

Hemophilia
Congenital missing factor 7
Reverse warfarin
Reversal of direct factor 10 inhibitors

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7
Q

ALP not raised by

A

Osteoporosis

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8
Q

Low albumin is indicator of

A

Poor hepatic function

Not good in acute disease due to long half life

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9
Q

Low SAAG

A

Malignancy
Nephrotic syndrome
Infection

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10
Q

AST/ALT ratio<1 in

A

Viral hepatitis

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11
Q

ALP

A

Excreted in bile

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12
Q

ALP is high but GGT is low in various

A

Bone diseases

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13
Q

Liver disease see increase in

A

CO
Decrease SVR
Increased O2 in mixed venous
Decreased portal vein/hepatic blood flow

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14
Q

Relieving ascites May lead to greater venous capacitance and thus

A

Hypotension

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15
Q

Hyperinflation with emphysema thus lose elastic recoil of alveoli by loss of elastic tissue and surfactant

A

Read it

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16
Q

Reasonable maneuvers to minimize PEEPi include

A

Low tidal volume
Reduce respiratory rate
Low I:E
Increase insporatory flow to delivery tidal volume in short time to reduce I:E and increase expiratory time

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17
Q

FEV1 less than 30% sign of

A

Very severe COPD

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18
Q

Stop smoking

A

6 to 8 wks before surgery is best

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19
Q

Neuraxial can preserve

A

FRC
Preserve RR
Hypotension

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20
Q

General anesthesia

A

Lower FRC

Atelectasis

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21
Q

Venovenousbypass

A

Pulmonary or air embolus and thrombosis possible

Rarely used

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22
Q

OSA leads to

A

Difficult mask ventilation

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23
Q

Lipophilic drugs

A

Higher volume of distribution

Longer to clear from body

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24
Q

For succ and cisatracurium use

A

TBW

Not broken down by organs so not IBW

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25
Roc/Vec use
IBW
26
Obese individuals
Blood volume Stroke volume Cardiac output increase to provide circulation to adipose tissue Left ventricular hypertrophy Increased incidence of hypotension on induction
27
Decreased FRC in obese due to
Reduction in ERV and chest compliance! DLCO is preserved in obese
28
Propofol maintenance dosing by
TBW
29
Kidney is autoregulation for
MAP 60 to 160 | Renal system gets 20% of blood flow
30
Diabetes inspidus common after
Head injury
31
Mannitol leads to
Hyponatremia associated with high serum osmolality
32
Reversal agents same dosage in those with
Kidney disease Morphine and meperidine have metabolites dependent on kidney for excretion
33
Best preserved mechanism for temperature regulation with general anesthesia
Sweating
34
Conduction lowest form of
Heat loss | Highest is radiation
35
Vasodilation from epidural leads to heat loss due to
Redistribution from core to periphery
36
More wound infections and coagulopathy with
Hypothermia
37
Postop hypothermia increases
Sympathetic nervous system activity
38
Hypothermia causes MAC to
Decrease
39
Thyroid storm is
Life threatening
40
Too much thyroid hormone increases
RR and TV Increased CO Increase basal metabolic rate up to 60 to 100%
41
MH vs thyroid storm
MH has metabolic acidosis, profound hypercarbia and muscle rigidity not found in thyroid storm CPK is increased in MH but decreases in thyroid storm
42
Thyroid storm treatment start with
Restoring intravascular volume, glucose, and electrolytes
43
Don’t use ASA with
Thyroid storm
44
Propranolol is best for
Thyroid storm
45
Do surgical decompression for a
Hematoma
46
Airway obstruction immediately after Extubation after thyroidectomy due to
Bilateral recurrent laryngeal nerve injury
47
After 24 hours of thyroidectomy respiratory obstruction due to
Hypocalcemia
48
Thyroid storm can occur during intraop
Thyroidectomy
49
Most pheo
Solitary tumors at a single adrenal gland usually the right side
50
Pheo is part of
MEN type 2a or 2b
51
Alpha blocker therapy improves mortality in patients with
Pheo
52
Phenoxybenzamine is
Long acting 24-48 hours Non competitive pre and post synaptic alpha blocker Give 10mg q8
53
Orthostatic hypotension is an affect of
Alpha blockers
54
Don’t need to use steroids for
Pheochromocytoma
55
Labetalol
Alpha blocker and beta blocker
56
Hypotension or hypertension possible post
Pheo removal HTN if some of the pheo is still present Hypoglycemia is also possible but not hyperglycemia
57
Recurrence of signs of MH post dantrolene mean you need additional dose of
Dantrolene
58
Dantrolene vials contain
Mannitol
59
Most specific early sign of MH is
Muscle rigidity
60
Most sensitive sign of MH is
Hypercarbia
61
Dantrolene blocks
Calcium release from SR Drug of choice in treatment of MH
62
MH hyperventilate with C02
Hyperventilate with 100% oxygen at flows of 10 L/min
63
Cocaine blocks reuptake of
Norepinephrine serotonin dopamine
64
Don’t give just beta blocker to patient with
Cocaine abuse
65
Restoration of p50 of Hgb within a few days of quitting
Smoking prior to surgery Will also reduce carboxyhemoglobin levels
66
Opioids given before to asthma patients can prevent
Bronchospasm
67
Management of intraop bronchospasm
Deepen anesthesia with volatile agent Beta agonists Minimize barotrauma Epinephrine especially if anaphylaxis triggered bronchospasm
68
Young adult post Extubation male think
Negative pressure pulmonary edema
69
Post Extubation pulmonary edema
Bilateral fluffy infiltrates Don’t do diuresis
70
Aortic dissection first steps include
Aggressive blood pressure control with nitroprusside and labetalol infusions
71
Profound systemic hypotension likely to occur after removal of
Aortic cross clamp
72
Decreased arterial pH or worsening acidemia leads to
Activation of chemoceptors
73
Cerebral hyperperfusion syndrome
When blood flow to brain exceeds metabolic demand
74
Baroceptor leads to decreased
Heart rate BP Cardiac output and increase in venous dilation
75
Downregulation of beta receptors
CHF
76
Decreased blood viscosity improves
Systemic blood flow
77
Higher hematocrit leads to
Reduction in peripheral blood flow
78
Hematocrit
Percentage composition of whole blood composed of erythrocytes
79
CPP=
MAP-ICP
80
Dobutamine is not a good choice of pressor without evidence of heart failure bc it predisposes to
Arrhythmia
81
Tricuspid valve insuffiency with
PE
82
Nitroprusside inhibits
HPV this lowering Pa02
83
ADH released in response to
Surgical stress
84
SBP goes up as you travel further from
Aorta
85
FFP indicated for
Treatment of micro vascular bleeding for inr>1.5 Don’t give preventatively or as volume expander
86
Bleeding into closed space such as brain eye or spine demands immediate reversal of
Antucoagulation If on ASA or clopidogrel give platelets to reverse Usually if < 50000 you transfuse
87
DDAVP for
Central diabetes insipidus | Helps uremic renal failure patients prevent bleeding
88
Hetastarch
Impairs renal function | Can cause coagulopathy leading to increased surgical blood loss
89
Von wildebrand can affect
PTT but not PT
90
PT
Normal 11 to 14 seconds 5 7 10 factors are a part of it
91
Warfarin affects
PT time
92
VWD
If you just found out delay the surgery and get a hematology consult
93
VWD type 3 is severe
Treat by giving vWf and factor 8
94
Dextran has
Anticoagulant properties
95
Check for TRALI by
Sending a specimen to blood bank for antibody antigen cross match
96
All blood products carry
Infectious risks
97
Most common noninfectious adverse reaction from blood product transfusion
Transfusion related immunomodilatoon
98
Leukoreduction
Remove wbcs from red blood cells
99
Isovolumetric relaxation
After closure of aortic valve until mitral valve opens associates with lowest ventricular volume
100
Late stages of phase 4 of SA node action potential
ICaT
101
L type Calcium channels open and cause depolarization during
Phase 0 of SA node action potential
102
Slowest rate of conduction of all cardiac tissues is
AV node
103
Starling law compares
Cardiac output to LVEDP If no other variables it should be linear, the heart pumps what it gets
104
Increase in contractility shifts frank starling curve to the
Left
105
Increase in afterload causes Frank starling curve to go
Down and to the right
106
Preload affects
Same line on frank starling curve Afterload and contractility form new lines
107
Most myocardial oxygen consumption during
Isovolumetric contraction phase
108
Lambert Eaton affects both
Depolarizing and no depolarizing blockers and makes you more sensitive to them

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