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Residency Anesthetics Flashcards

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1
Q

Pre-anesthesia history

A

Patient - PMHx inc cardiorespiratory health, DM. Meds, allergies, smoking, alcohol, drugs
Surgery - risk of complications, positioning
Anesthesia - PONV, emergence reaction, adverse effects

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2
Q

SAMPLE hx

A 
S+S
Allergies 
Meds 
PMHx 
Last oral intake 
Events leading up to injury/ illness
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3
Q

What is good exercise tolerance?

A

4 METs (metabolic equivalents) - able to climb a flight of stairs

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4
Q

Screening for sleep apnea

A 
STOP BANG 
Snoring 
Tired 
Observed (apnea) 
Pressure (HTN)
BMI >35
Age >50 
Neck large 
Gender (male)
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5
Q

Acronym for identifying difficult BVM pts

A 
BONES 
Beard 
Obese 
No teeth 
Elderly 
Snoring
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6
Q

ASA ratings

A 
1 = normal healthy 
2 = mild systemic disease inc smoker, pregnancy, obesity, social alcohol use 
3 = severe systemic disease
4 = severe disease, threat to life 
5 = not expected to survive without operation 
6 = brain-dead
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7
Q

Maintenance anesthesia

A

Usually inhalation + IV - goal of reducing dose of any one agent

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8
Q

NMBA

A

Neuromuscular blocking agent

Used for muscle relaxation

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9
Q

What to prepare in anesthetics (acronym)

A 
MS MAIDS
Machine check 
Suction 
Monitors 
Airway equipment 
IV
Drugs 
Special equipment
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10
Q

Indications for tracheal intubation (5 Ps)

A 
Patency 
Protection from aspiration 
Positive pressure ventilation 
Pulmonary toilet 
Paralysis (GA or injury)
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11
Q

Damage to recurrent laryngeal nerve causes…

A

Hoarseness

Stridor

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12
Q

How to assess an airway

A

Assess TMJ (open mouth wide, space between TMJ + tragus should be 1 fingerbreadth)
Assess mouth opening (>3 FB is normal)
Assess pharyngeal view using Mallampati classification
Assess thyromental distance - extend neck back, measure from chin to border of thyroid (>3 FBs)
Assess ROM of cervical spine

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13
Q

Acronym for difficult laryngoscopy

A 
LEMON 
Look - obese, short neck 
Evaluate 3-2-1 rule (3 FBs for TMD, 2 for mouth opening and 1 FB for TMJ to ear) 
Mallampati 
Obstruction 
Neck mobility
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14
Q

How to pre-oxygenate

A

4 vital capacity breaths or 3 mins of tidal vol breaths

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15
Q

Complications of intubation

A

Airway trauma
Improper positioning of ETT
Laryngospasm
Malfunction

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16
Q

Factors that shift O2-Hb curve to right

A

Increased acidity
Increased PaCO2
Increased 2,3-DPG
Increased body temperature

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17
Q

What does a shift to the right mean in O2-Hb curve?

A

Decreased affinity of O2 to Hb

Favors unloading of o2 to peripheral tissues

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18
Q

What states inreased 2,3-DPG?

A

Chronic anemia

Hyperthyroidism

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19
Q

What is hypoxemia?

A

Decreased partial pressure of O2 in arterial blood (decreased arterial oxygen tension)

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20
Q

Causes of hypoxemia

A 
Ventilation perfusion mismatch 
Decreased alveolar ventilation 
Right to left shunt 
Decreased diffusion across alveolar-capillary membrane 
Decreased PiO2
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21
Q

What is hypoxia?

A

Low content of O2 in blood or tissues

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22
Q

What is oxygen content reliant on?

A

Oxygen saturation
Hb concentration
Partial pressure of O2

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23
Q

PaO2 compared to saturation

A

Pa02 100 = Sa02 100%
Pa02 60 = Sa02 90%
Pa02 40 = Sa02 75%

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24
Q

Commonest cause for V/Q mismatch in perioperative setting, and other causes

A

Atelectasis

Other causes: PE, intubation with only one lung being ventilated, low cardiac output

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25
Which cause of hypoxemia would not respond to supplemental O2?
Right to left shunt
26
Impact of DM on perioperative pt
End organ damage due to chronic vascular disease Good glycaemic control needed to prevent micro and macrovascular complications Hypergylcaemia leads to poor wound healing, infections + mortality
27
How to manage DM in periop pt
Blood glucose kept at <10 Hold oral hypoglycaemic meds on day including metformin (due to lactic acidosis) Reduce dose of insulin day before/ of
28
Impact of HTN on periop pt
Risk of hemodynamic instability
29
Management of HTN pt
Stop ACE-i 24 hrs before Continue BB Art line is useful to monitor beat to beat BP
30
Smoking impact on pt
Increased risk of CAD, impairs wound healing + immune response
31
Management of smoking periop
Smoking cessation 4-8 wks before surgery ideal | 12-24 hrs before surgery improves most effects
32
What does the right coronary artery supply?
RV Inferior aspect of heart SA and AV nodes
33
What does the left coronary artery supply?
2 branches: LAD + circumflex LAD = septum + wall of LV CX = lateral + posterior wall of LV
34
What is coronary dominance?
Artery which supplies posterior descending artery | Usually RCA
35
When to hold aspirin?
3 days pre op, start 8-10 days after surgery
36
Rules for statins periop
Continue
37
Monitoring needed periop
ABC Airway - pulse oximetry Breathing - capnography Circulation - 3 lead heart monitor, NIBP
38
Monitoring needed periop
``` ABCD Airway - pulse oximetry Breathing - capnography Circulation - 3 lead heart monitor, NIBP or art line Drug - nerve stimulator ```
39
What is a central line?
Measures central venous pressure Rough estimate of right atrial + ventricular pressures Used in cardiopulmonary disease + shock, when vasoactive or inotropic drugs need to be administered, or TPN
40
What is a pulmonary artery catheter?
Measure pulmonary arterial pressure Estimate left atrial pressure Allow calculations of cardiac output, systemic vascular resistance and provide info on oxygen delivery + consumption Used in cardiac surgery or critically ill pts Trans esophageal echoes provide same info
41
Contraindications for spinal
``` Coagulopathies (thrombocytopenia) CNS tumor Infection at the site of entry Relative: Systemic infection CNS disease such as MS Aortic stenosis ```
42
Landmarks for needle placement for spinals
Intrathecal space between spinous processes Spinal cord ends at L1/L2 Needle introduced at L3/L4 Line between 2 anterior superior iliac spines is L4 - space above that is good
43
Spinal anesthetic factors
Baracity - hypo, iso or hyper. Will rise, stay put or descend from point of injection Pt position
44
Complications of regional anesthesia
Misplacement of needle Block failure Damage to nerve Injection of LA into artery can cause seizures
45
Causes of shock
CHOD Cardiogenic - dysrhythmia, MI Hypovolemic - hemorrhage Obstructive - tension pneumo, PE, cardiac tamponade Distributive - spinal shock, sepsis, anaphylaxis
46
What is the lethal triad of trauma?
Acidosis Hypothermia Coagulopathy
47
What is blood typing vs screening?
Typing - identifies antigens present - classifies into ABO + Rh groups Screening looks for most common non-ABO abs present such as Duffy, Kell
48
What is the universal donor?
O negative - no antigens on surface | O positive can be used in men
49
Types of immune mediated acute transfusion reactions
``` Acute hemolytic transfusion reaction Febrile non-hemolytic transfusino reaction Urticarial Anaphylaxis Transfusion related acute lung injury ```
50
Types of non-immune mediated acute transfusion reactions
Transfusion associated circulatory overload | Transfusion related sepsis
51
What is an acute hemolytic transfusion reaction + how does it present + how is it managed?
ABO/Rh incompatibility Presents during transfusion or up to 6 hrs post, fever, chills, chest/ flank pain, hypotension, DIC Manage by stopping transfusion, supportive
52
What is a febrile non-hemolytic transfusion reaction + how does it present + how is it managed?
Reaction between donor leukocyte antigens + recipient ab Presents during transfusion or up to 6 hrs post, mild fever, myalgia, flushing, NV Slow transfusion + give acetaminophen
53
What is an urticarial transfusion reaction + how does it present + how is it managed?
IgE reaction with mast cell activation Causes itching, urticaria, flushing Slow transfusion, give antihistamines IV
54
What is an anaphylactic transfusion reaction + how does it present + how is it managed?
``` Ab reaction against donor IgA Causes itching, urticaria, flushing, bronchospasm, hypotension, shock Stop transfusion Epinephrine 0.5mg IV IV fluids Bronchodilators Corticosteroids ```
55
What is a transfusion related acute lung injury + how does it present + how is it managed?
Reaction of ab to leukocyte antigens causing pulmonary edema Hypoxemia, SOB, cyanosis, fever, tachy, hypotension Stop transfusion Supportive care (may need mechanical ventilation)
56
What is a transfusion associated circulatory overload + how does it present + how is it managed?
Overload causing pulmonary edema SOB, hypoxemia, CHF, HTN Slow transfusion, give diuretics + O2
57
What is a transfusion related sepsis reaction + how does it present + how is it managed?
Contamination of blood products with bacteria Fever, chills, hypotension Stop transfusion Sepsis resus
58
Characteristics of propofol
Decreases BP | Decreases myocardial contractility
59
Characteristics of ketamine
Increase HR + BP
60
Key points of pediatric airways
``` Head is large compared to adults, causing neck flexion Epiglottis is long, narrow and floppy Vocal cords are angled anteriorly Narrowest part is cricoid cartilage BVM can be difficult Short tracheas ```
61
Fluid management in kids
4-2-1 rule 4ml/kg up to 10kg 2 ml/kg up to 20kg 1 ml/kg over 20kg Cheat: if kid is over 20kg, take weight minus 20. Add to 60. E.g. 47kg kid = 47 - 20 = 27 + 60 = 87ml/hr
62
Why do we use TIVA in kids?
Decreased airway reactivity Less frequent emergency delirium TIVA is weight based

Anesthetics (6 decks)

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