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Anesthetics > Residency Anesthetics > Flashcards

Residency Anesthetics Flashcards

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
Q

Which cause of hypoxemia would not respond to supplemental O2?

A

Right to left shunt

26
Q

Impact of DM on perioperative pt

A

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
Q

How to manage DM in periop pt

A

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
Q

Impact of HTN on periop pt

A

Risk of hemodynamic instability

29
Q

Management of HTN pt

A

Stop ACE-i 24 hrs before
Continue BB
Art line is useful to monitor beat to beat BP

30
Q

Smoking impact on pt

A

Increased risk of CAD, impairs wound healing + immune response

31
Q

Management of smoking periop

A

Smoking cessation 4-8 wks before surgery ideal

12-24 hrs before surgery improves most effects

32
Q

What does the right coronary artery supply?

A

RV
Inferior aspect of heart
SA and AV nodes

33
Q

What does the left coronary artery supply?

A

2 branches: LAD + circumflex
LAD = septum + wall of LV
CX = lateral + posterior wall of LV

34
Q

What is coronary dominance?

A

Artery which supplies posterior descending artery

Usually RCA

35
Q

When to hold aspirin?

A

3 days pre op, start 8-10 days after surgery

36
Q

Rules for statins periop

A

Continue

37
Q

Monitoring needed periop

A

ABC
Airway - pulse oximetry
Breathing - capnography
Circulation - 3 lead heart monitor, NIBP

38
Q

Monitoring needed periop

A 
ABCD
Airway - pulse oximetry 
Breathing - capnography
Circulation - 3 lead heart monitor, NIBP or art line 
Drug - nerve stimulator
39
Q

What is a central line?

A

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
Q

What is a pulmonary artery catheter?

A

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
Q

Contraindications for spinal

A 
Coagulopathies (thrombocytopenia)
CNS tumor 
Infection at the site of entry 
Relative: 
Systemic infection 
CNS disease such as MS 
Aortic stenosis
42
Q

Landmarks for needle placement for spinals

A

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
Q

Spinal anesthetic factors

A

Baracity - hypo, iso or hyper. Will rise, stay put or descend from point of injection
Pt position

44
Q

Complications of regional anesthesia

A

Misplacement of needle
Block failure
Damage to nerve
Injection of LA into artery can cause seizures

45
Q

Causes of shock

A

CHOD
Cardiogenic - dysrhythmia, MI
Hypovolemic - hemorrhage
Obstructive - tension pneumo, PE, cardiac tamponade
Distributive - spinal shock, sepsis, anaphylaxis

46
Q

What is the lethal triad of trauma?

A

Acidosis
Hypothermia
Coagulopathy

47
Q

What is blood typing vs screening?

A

Typing - identifies antigens present - classifies into ABO + Rh groups
Screening looks for most common non-ABO abs present such as Duffy, Kell

48
Q

What is the universal donor?

A

O negative - no antigens on surface

O positive can be used in men

49
Q

Types of immune mediated acute transfusion reactions

A 
Acute hemolytic transfusion reaction 
Febrile non-hemolytic transfusino reaction 
Urticarial 
Anaphylaxis 
Transfusion related acute lung injury
50
Q

Types of non-immune mediated acute transfusion reactions

A

Transfusion associated circulatory overload

Transfusion related sepsis

51
Q

What is an acute hemolytic transfusion reaction + how does it present + how is it managed?

A

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
Q

What is a febrile non-hemolytic transfusion reaction + how does it present + how is it managed?

A

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
Q

What is an urticarial transfusion reaction + how does it present + how is it managed?

A

IgE reaction with mast cell activation
Causes itching, urticaria, flushing
Slow transfusion, give antihistamines IV

54
Q

What is an anaphylactic transfusion reaction + how does it present + how is it managed?

A 
Ab reaction against donor IgA 
Causes itching, urticaria, flushing, bronchospasm, hypotension, shock 
Stop transfusion 
Epinephrine 0.5mg IV 
IV fluids 
Bronchodilators 
Corticosteroids
55
Q

What is a transfusion related acute lung injury + how does it present + how is it managed?

A

Reaction of ab to leukocyte antigens causing pulmonary edema
Hypoxemia, SOB, cyanosis, fever, tachy, hypotension
Stop transfusion
Supportive care (may need mechanical ventilation)

56
Q

What is a transfusion associated circulatory overload + how does it present + how is it managed?

A

Overload causing pulmonary edema
SOB, hypoxemia, CHF, HTN
Slow transfusion, give diuretics + O2

57
Q

What is a transfusion related sepsis reaction + how does it present + how is it managed?

A

Contamination of blood products with bacteria
Fever, chills, hypotension
Stop transfusion
Sepsis resus

58
Q

Characteristics of propofol

A

Decreases BP

Decreases myocardial contractility

59
Q

Characteristics of ketamine

A

Increase HR + BP

60
Q

Key points of pediatric airways

A 
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
Q

Fluid management in kids

A

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
Q

Why do we use TIVA in kids?

A

Decreased airway reactivity
Less frequent emergency delirium
TIVA is weight based

Anesthetics (6 decks)

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