week 10 lecture Flashcards
1
Q
What is the purpose of verifying co-morbidities in the preoperative assessment?
A
To ensure all health factors are considered before surgery
This includes understanding the patient’s overall health and potential complications.
2
Q
What should be confirmed regarding anesthesia consent?
A
It must be properly understood and signed
This ensures that the patient is aware of the risks and procedures involved.
3
Q
What is the importance of IV access in the preoperative phase?
A
To confirm functioning IV and have the correct fluid type ready
A backup plan should also be established for obtaining access if needed.
4
Q
What should be confirmed about labs and blood products before surgery?
A
Labs must be drawn and complete, and blood products should be available if needed
Understanding estimated blood loss for the procedure is also crucial.
5
Q
What is the recommendation for surgery timing after BMS implantation?
A
Class III: Harm — Delay surgery if <30 days since implantation; Class I: Proceed with surgery if ≥30 days
This indicates the risk associated with stopping DAPT.
6
Q
What should be done if a DES was implanted less than 3 months before surgery?
A
Class III: Harm — Delay surgery
Risks are considered for patient safety.
7
Q
When should DAPT be discontinued for DES?
A
If appropriate based on the timing of stent implantation
This depends on the duration since the procedure.
8
Q
List the key moments for hand hygiene in the OR.
A
- Before aseptic tasks
- After glove removal
- Before/after touching machines, carts, or patients
- Upon entering or leaving the OR
Hand hygiene is critical to prevent infection.
9
Q
What should be used for airway management in a high-risk aerosol-generating procedure?
A
N95 or higher respirators
If unavailable, a surgical mask may be used.
10
Q
What are the guidelines for safe injection practices?
A
- Single-dose vials = one patient only
- Never reuse syringes or needles
- Disinfect ports and vial tops before access
- Disinfect high touch surfaces routinely
These practices are essential to prevent infection.
11
Q
What are the additional responsibilities in the OR?
A
- Follow Standard + Transmission-Based Precautions
- Proper PPE donning/doffing
- Prevent SSIs: administer antibiotics, maintain normothermia, control glucose, maintain asepsis
These measures are critical for patient safety.
12
Q
What impact did COVID-19 have on OR practices?
A
- Use of HEPA filters
- More airborne PPE
- Increased use of disposable gear
- Enhanced environmental cleaning
These changes aim to improve safety in the surgical environment.
13
Q
What is the role of anxiolytics before entering the OR?
A
To reduce patient anxiety
Administering medications like Versed can help calm patients.
14
Q
What is the purpose of performing an airway and dental exam?
A
To identify potential difficulties for intubation or dental injury risks
This assessment is non-negotiable and must be performed regardless of prior evaluations.
15
Q
What is the goal of pre-oxygenation during induction?
A
To prevent hypoxemia by increasing oxygen reserve
This is essential during the apnea period.
16
Q
What factors should be considered when choosing an induction agent?
A
- Patient’s needs
- Hemodynamic stability
- Allergy history
- Comorbidities
Tailoring the agent to the patient ensures safety and effectiveness.
17
Q
What does the mnemonic P-A-T-I-E-N-T stand for in airway management?
A
- P – Patient
- A – Anesthesia
- T – Train-of-Four
- I – IV
- E – EtCO₂
- N – Narcotics
- T – Temperature
This mnemonic helps in assessing various aspects during anesthesia.
18
Q
What are common induction problems related to hypotension?
A
- Fluid Administration
- Vasopressors/Ephedrine
- Reduce Anesthetic Depth
- Positioning
Addressing these issues is critical for maintaining hemodynamic stability.
19
Q
What should be confirmed to address hypoxemia during induction?
A
- O₂ is on
- Effective Bag-Valve-Mask Ventilation
- Secure Airway
- Check Equipment
These steps are essential to ensure adequate oxygenation.
20
Q
What interventions are recommended for bronchospasm?
A
- Deepen Anesthesia
- Beta-2 Agonists
- Epinephrine
- Steroids
- Anticholinergics
These treatments help to alleviate bronchospasm effectively.
21
Q
What should be done in case of laryngospasm?
A
- Positive Pressure Ventilation
- Deepen Anesthesia
- Administer Neuromuscular Blocker
- Secure the Airway
These steps are critical in managing laryngospasm effectively.
22
Q
What is the immediate action for esophageal intubation?
A
Remove ETT immediately if misplacement confirmed
This action prevents further complications and ensures patient safety.
23
Q
What are the first-line treatments for anaphylaxis?
A
- Discontinue Trigger
- Epinephrine
- Secure airway
- Additional Medications
- Fluid Bolus
These steps are crucial for effective management of anaphylaxis.
24
Q
What should be monitored for cardiac arrhythmias?
A
- Call for Help
- Identify and Treat Cause
- Specific Treatment
- Electrolyte Correction
- Consult Cardiology
Monitoring and responding to arrhythmias is essential for patient safety.
25
What should be done immediately after identifying a dental or oral injury?
Document the injury
## Footnote
This ensures proper tracking and management of the injury.
26
What are key components of emergence from anesthesia?
* Reversal of Neuromuscular Blockade
* Pain Management
* Extubation Criteria
## Footnote
These components are vital for a safe recovery process.
27
What are the global criteria for extubation?
* Hemodynamic Stability
* Normothermia
* Airway Patency
* Return of laryngeal and cough reflexes
* Adequate consciousness
* Muscular Strength
* Metabolic Balance
* Hematologic Status
* Analgesia
## Footnote
Meeting these criteria is necessary for safe extubation.
28
What are signs and symptoms of hypoxia?
* Respiratory Signs: Tachypnea, Dyspnea, SpO₂ <90%
* Neurologic Signs: Anxiety, confusion
* Skin Signs: Diaphoresis, Cyanosis
* Cardiac Signs: Bradycardia, hypotension
## Footnote
Recognizing these signs is critical for timely intervention.
29
What are risk factors for postoperative nausea and vomiting (PONV)?
* Patient-Specific: Female gender, Age <50, Nonsmoker
* Anesthetic-Related: Use of volatile anesthetics
* Surgery-Related: Type of surgery, especially laparoscopic procedures
## Footnote
Identifying these factors helps in preventive strategies.
30
What is the typical target MAP for controlled hypotension in surgery?
50–60 mmHg or ≤20% below baseline
## Footnote
Adjusted based on patient risk to preserve organ perfusion.
31
What are the physiologic effects of pneumoperitoneum?
* ↑ MAP
* ↑ SVR
* ↓ Stroke Volume & Venous Return
* ↑ PaCO₂ and EtCO₂
## Footnote
These effects can impact patient management during laparoscopic surgery.
32
What are the entry techniques for laparoscopic surgery?
* Closed technique: Veress needle or trocar
* Open technique: Hasson approach
## Footnote
These techniques are used to gain access to the abdominal cavity.
33
What are rare but serious complications of laparoscopic surgery?
* Subcutaneous emphysema
* Gas embolism
* Visceral or vascular injury
## Footnote
Awareness of these complications is crucial for prevention and management.
34
What is gas embolism?
Rare but life-threatening condition characterized by sudden hypotension, hypoxia, and a 'mill wheel' murmur.
35
What can cause gas embolism during surgery?
Occurs during trocar or Veress needle entry.
36
What should be monitored for during laparoscopic surgery?
Unexpected bleeding or hemodynamic instability.
37
What anesthetic technique is preferred for laparoscopic surgery?
General anesthesia due to the need for ventilatory control.
38
What are common postoperative issues after laparoscopic surgery?
* PONV (Postoperative Nausea and Vomiting)
* Shoulder tip pain
* Visceral discomfort
39
What multimodal analgesia methods can be used for pain management after surgery?
* Opioids (e.g., fentanyl, morphine)
* NSAIDs (e.g., ketorolac)
* Dexamethasone
* Local anesthetic infiltration at port sites
40
What antiemetics should be considered for PONV prophylaxis?
* Ondansetron
* Dexamethasone
41
What are the patient benefits of robotic surgery?
* Decreased length of stay
* Decreased pain
* Decreased blood loss
42
What anesthetic challenges are associated with robotic surgery?
* Prolonged case duration
* Restricted access to patient
* Extreme positioning
43
What are the hemodynamic effects of Trendelenburg position in laparoscopic surgery?
Increases MAP, CVP, and PCWP, elevating intrathoracic and intra-abdominal pressures.
44
What is the risk of postoperative visual loss (POVL) associated with?
* Prolonged steep Trendelenburg
* Prone positioning
45
What are major risk factors for POVL?
* Hypotension
* Anemia
* Venous congestion
* Direct ocular pressure
46
What is ERAS in the context of surgery?
Enhanced Recovery After Surgery, aimed at improving outcomes.
47
What are key components of ERAS protocols?
* Opioid-sparing techniques
* Aggressive PONV prophylaxis
* Goal-directed fluid therapy
* Early ambulation and oral intake
48
What is TECAB?
Totally Endoscopic Coronary Artery Bypass requiring one-lung ventilation.
49
What is the effect of capnothorax during robotic thoracic surgeries?
Increases intrathoracic pressure and decreases venous return.
50
What are the major concerns during RALP (Robot-Assisted Laparoscopic Prostatectomy)?
* Postoperative visual loss (POVL)
* Venous air embolism
* Increased airway pressures
51
What defines a high-risk surgical procedure?
Procedures with potential for major blood loss, prolonged operative times, and complex hemodynamic demands.
52
What are examples of high-risk surgical procedures?
* Open Aortic Surgery
* Peripheral Vascular Surgery
* Neurosurgery
* Thyroid Surgery
* Prostatectomy
53
What characterizes moderate-risk surgical procedures?
Predictable outcomes, minimal blood loss, and shorter durations.
54
What is the typical daily fluid requirement for an adult?
30–35 mL/kg/day or about 2500 ml/day.
55
What fluid types are used for resuscitation?
* Isotonic solutions (e.g., 0.9% Normal Saline, Lactated Ringer's, Plasmalyte)
* Hypotonic solutions (e.g., 0.45% NaCl, D5W)
* Hypertonic saline (3% NaCl)
56
What are key components of Starling Forces?
* Capillary Hydrostatic Pressure (Pc)
* Interstitial Fluid Pressure (Pi)
* Plasma Oncotic Pressure (πc)
* Interstitial Oncotic Pressure (πi)
57
What does an increase in capillary hydrostatic pressure (Pc) cause?
Pushes fluid out of capillaries, leading to edema.
58
What is the effect of hypoalbuminemia on fluid balance?
Decreases plasma oncotic pressure (πp), leading to fluid leakage into tissues.
59
What is the Frank-Starling mechanism?
Describes the relationship between left ventricular end-diastolic pressure (LVEDP) and cardiac output (CO).
60
What are the types of crystalloid solutions?
* Normal Saline (NS)
* Lactated Ringer's (LR)
* Plasmalyte/Normosol
61
What is the risk associated with using Normal Saline (0.9% NaCl)?
Hyperchloremic metabolic acidosis.
62
What are the advantages of crystalloids?
* Inexpensive and widely available
* No allergenic potential
* Easily metabolized and renally cleared
63
What are the disadvantages of crystalloids?
* Dilution effect
* Require 3–4x more volume than colloids for the same effect
64
What is the risk associated with cerebral edema in BI?
Risk of cerebral edema from hypotonicity
## Footnote
This highlights the potential danger of using hypotonic solutions in patients with brain injuries.
65
What is a potential complication of blood transfusions?
Contains calcium, risk of clotting
## Footnote
Calcium in transfusions can lead to coagulation issues.
66
List advantages of crystalloids.
* Inexpensive and widely available
* No allergenic potential
* Easily metabolized and renally cleared
* Restore both intravascular and interstitial hydration
## Footnote
Crystalloids are a common choice for fluid resuscitation due to their availability and cost-effectiveness.
67
What are the disadvantages of crystalloids?
* Dilution effect
* Require 3–4x more volume than colloids for the same intravascular effect
* Transient plasma expansion
* Only 15–25% stays intravascularly
* Intravascular half-life: 20–30 minutes
* Tissue edema risk
* Hyperchloremic metabolic acidosis
## Footnote
These disadvantages make crystalloids less effective in certain clinical scenarios.
68
What are colloids?
High-molecular-weight substances that exert plasma oncotic pressure
## Footnote
Colloids help retain fluid intravascularly, making them effective for plasma volume expansion.
69
What is the intravascular half-life of colloids compared to crystalloids?
Colloids: 3–6 hours; Crystalloids: 20–30 minutes
## Footnote
This difference underscores the longer-lasting effects of colloids.
70
What is the 4-2-1 Rule used for?
To calculate maintenance IV fluid requirements per hour based on body weight
## Footnote
This rule is essential for determining fluid needs in patients.
71
What is the recommended fluid administration protocol for NPO deficits?
* 1st Hour: Administer 50% of the total NPO deficit
* 2nd Hour: Administer 25% of the deficit
* 3rd Hour: Administer the remaining 25%
## Footnote
This structured approach helps in effective fluid management.
72
What are the consequences of under-resuscitation during fluid administration?
* Hypovolemia
* Decreased microvascular perfusion
* Reduced tissue perfusion
* End-organ complications
* Postoperative nausea and vomiting
* Renal dysfunction
* Myocardial ischemia
* Hemoconcentration
## Footnote
These factors can lead to serious complications in patient recovery.
73
What are the risks associated with over-resuscitation?
* Vascular overload
* Microvascular congestion
* Endothelial glycocalyx disruption
* Altered coagulation
* Hemodilution effects
## Footnote
Over-resuscitation can be just as harmful as under-resuscitation.
74
What does Goal Directed Fluid Therapy (GDFT) aim to optimize?
Tissue perfusion and oxygen delivery
## Footnote
GDFT is designed to balance fluid administration based on real-time monitoring.
75
What are some dynamic parameters used in GDFT?
* Plethysmography Variability Index (PVI)
* Stroke Volume Variation (SVV)
* Pulse Pressure Variation (PPV)
## Footnote
These parameters help assess fluid responsiveness.
76
What is the estimated blood volume (EBV) for a term newborn infant?
80–90 mL/kg
## Footnote
Understanding EBV is crucial for managing fluid and transfusion needs in infants.
77
What is the shelf life of whole blood?
Up to 35 days with CPDA-1
## Footnote
This shelf life allows for storage and use in transfusion protocols.
78
What is a critical indication for platelet transfusion?
Transfuse if PLT < 50,000/µL
## Footnote
Maintaining adequate platelet levels is essential for preventing excessive bleeding.
79
What are the complications associated with platelet transfusions?
* Febrile non-hemolytic reactions
* TRALI
* Alloimmunization
* Bacterial contamination
## Footnote
Awareness of these complications is important for patient safety.
80
What is the expected increase in platelet count from one unit of WB-derived platelets?
↑ PLT count by 5–10K/µL
## Footnote
This helps gauge the effectiveness of platelet transfusions.
81
What is the main purpose of using leukocyte-reduced PRBCs?
Reduces risk of febrile non-hemolytic transfusion reactions
## Footnote
This is particularly important for patients with a history of transfusion reactions.
82
What is the risk of using synthetic colloids like HES?
Renal injury, coagulopathy, increased mortality
## Footnote
These risks have led to restrictions on the use of synthetic colloids.
83
What is the advantage of using packed red blood cells (PRBCs)?
To increase oxygen-carrying capacity
## Footnote
PRBCs are essential for treating anemia and surgical blood loss.
84
What is purpura?
85
What is the risk associated with alloimmunization?
Risk of platelet refractoriness
86
What can cause bacterial contamination of blood products?
Room temperature storage
87
What type of platelets should be used for patients with alloimmunization?
Single donor platelets
88
What are the platelet thresholds for very-high-risk procedures?
75,000–100,000/µL
89
List some very-high-risk procedures.
* Neurosurgery
* Ocular surgery (except cataract extraction)
* Thyroid surgery
* Prostatectomy
90
What is the platelet threshold for moderate-risk procedures?
≥50,000/µL
91
Give examples of moderate-risk procedures.
* Liver biopsy
* Dental extraction
* Most general surgical procedures
92
What is the platelet threshold for low-risk procedures?
≥30,000/µL
93
List examples of low-risk procedures.
* Endoscopy
* Bronchoscopy
* Lumbar puncture (with scrupulous technique)
94
What procedures are classified as very-low-risk?
No platelet transfusion needed
95
Provide examples of very-low-risk procedures.
* Bone marrow biopsy
* Cataract extraction
96
What components does Fresh Frozen Plasma (FFP) contain?
* All clotting factors
* Albumin
* Globulins
* Complement proteins
97
What is the recommended storage temperature for Fresh Frozen Plasma?
–18°C for up to 1 year
98
What clinical indications warrant the use of Fresh Frozen Plasma?
* Multiple clotting factor deficiencies
* Warfarin reversal (if PCC unavailable)
* Coagulopathy due to liver disease
* TTP (as part of plasmapheresis)
* Massive transfusion protocols
99
What is the dosing recommendation for Fresh Frozen Plasma?
10 to 15 mL/kg
100
What is the goal of administering Fresh Frozen Plasma?
Achieve ≥30% normal factor activity for hemostasis
101
What is Cryoprecipitate derived from?
Thawed Fresh Frozen Plasma (FFP) at 1 to 6°C
102
What contents are found in Cryoprecipitate?
* Fibrinogen
* Factor VIII
* Factor XIII
* von Willebrand Factor (vWF)
* Fibronectin
103
What is the dosing for Cryoprecipitate?
1 unit per 10 kg body weight
104
What are the indications for administering Cryoprecipitate?
* Hypofibrinogenemia (fibrinogen <80–100 mg/dL)
* Massive transfusion protocols when fibrinogen levels fall critically
* Congenital fibrinogen disorders (e.g., afibrinogenemia)
* Von Willebrand disease (if unresponsive to DDAVP)
* Factor XIII deficiency
105
What does Prothrombin Complex Concentrate (PCC) contain?
* Vitamin K–dependent clotting factors (II, VII, IX, X)
106
What is the primary use of Prothrombin Complex Concentrate (PCC)?
Urgent reversal of warfarin anticoagulation
107
What is Recombinant Factor VIIa (rFVIIa) used for?
Last-resort agent for uncontrolled, life-threatening bleeding
108
What is the dose for Recombinant Factor VIIa (rFVIIa)?
15–20 µg/kg
109
What is a Fibrinogen Concentrate used for?
Rapidly corrects hypofibrinogenemia
110
What is the purpose of donor screening procedures?
Identifies conditions that may endanger the donor or recipient
111
What is the purpose of antibody screening in blood donation?
Detects non-ABO antibodies that could cause hemolytic transfusion reactions
112
What are the mandatory infectious disease screenings in blood donation?
* Hepatitis B & C
* Syphilis
* HIV (anti-HIV-1 and anti-HIV-2 antibodies)
113
What is the purpose of ABO and Rh typing in blood safety measures?
Ensures compatibility and reduces the risk of hemolytic reactions
114
What does bacterial contamination monitoring focus on?
Critical for platelets, which are stored at room temperature and more susceptible to contamination
115
What is the purpose of leukocyte reduction in blood products?
* Lower risk of febrile non-hemolytic reactions
* Reduce immunosuppression
* Prevent CMV transmission
116
Who should receive CMV-negative blood units?
Immunocompromised patients (e.g., transplant recipients, neonates)
117
What is the function of a Cell Saver Machine?
Collects, filters, and washes shed surgical blood
118
What is the purpose of blood salvage systems?
Function similarly to Cell Saver devices
119
What is the role of a platelet agitator?
Maintains continuous motion during room temperature storage
120
What are the storage temperatures for RBCs?
1–6°C
121
What are the storage temperatures for FFP and cryoprecipitate?
≤ –18°C
122
What are the storage temperatures for platelets?
20–24°C with agitation
123
What is the purpose of transfusion tubing with a 170-μm filter?
Removes clots, aggregates, and debris from blood products
124
What is the purpose of a blood warmer?
Heats blood to 37°C to avoid transfusion-induced hypothermia
125
What are rapid infusion devices used for?
Deliver large fluid or blood volumes quickly
126
What should be included in a preoperative assessment?
* Risk identification
* Medication management
* Anemia optimization
127
What should be addressed in anemia optimization?
* Address iron deficiency
* Consider erythropoiesis-stimulating agents (ESAs)
128
What are the considerations for patients with sickle cell disease?
* Ensure hydration
* Infection control
* Hemoglobin optimization
* Use partial exchange transfusion if indicated
129
What surgical techniques can help with blood conservation?
* Employ meticulous, blood-sparing methods
* Autologous blood strategies
130
What does ANH stand for in blood conservation strategies?
Acute Normovolemic Hemodilution
131
What is the role of temperature and fluid management in blood conservation?
* Maintain normothermia to preserve coagulation function
* Use balanced crystalloids and goal-directed fluid therapy
132
What are topical hemostatics used for?
Promote local clotting
133
What should be prevented in sickle cell considerations during surgery?
* Hypoxia
* Low-flow states
* Prolonged tourniquet use
134
What are antifibrinolytics used for?
Used in high-risk or bleeding-prone surgeries and trauma
135
What is the mechanism of action for antifibrinolytics?
Inhibits fibrinolysis, thereby preserving clot integrity
136
What does desmopressin (DDAVP) enhance?
Platelet adhesion by stimulating release of von Willebrand factor and factor VIII
137
What should be monitored in standard monitoring for coagulopathy?
* Hemoglobin
* Hematocrit
* INR
* aPTT
* Fibrinogen levels
* Platelet count
138
What tools can be used for advanced monitoring of coagulopathy?
* TEG (Thromboelastography)
* ROTEM (Rotational Thromboelastometry)
139
What is the target range for Mean Arterial Pressure (MAP) in controlled hypotension?
50–60 mmHg
140
What should be considered for patients with chronic hypertension during controlled hypotension?
These patients may need higher MAPs to maintain adequate cerebral and coronary perfusion
141
What is hyponatremia defined as?
Serum sodium < 135 mEq/L
142
What are the classifications of hyponatremia based on volume status?
* Hypovolemic
* Euvolemic
* Hypervolemic
143
What are the clinical signs of hyponatremia?
* Neurologic symptoms due to cerebral edema
* Ranges from nausea to seizures, coma, or death
144
What is the treatment for hypovolemia in hyponatremia?
Isotonic saline
145
What is hypernatremia defined as?
Serum sodium > 145 mEq/L
146
What are the classifications of hypernatremia based on volume status?
* Hypovolemic
* Euvolemic
* Hypervolemic
147
What are the clinical signs of hypernatremia?
* Neurologic symptoms from cellular dehydration
* Restlessness, lethargy, seizures, coma
148
What is the treatment for hypernatremia?
Correct gradually over ≥48 hours to prevent cerebral edema
149
What is hypokalemia defined as?
Serum potassium < 3.5 mEq/L
150
What are the clinical manifestations of hypokalemia?
* Muscle weakness
* Hyporeflexia
* Ileus
* ECG changes: flattened T waves, U waves, arrhythmias
151
What is hyperkalemia defined as?
Serum potassium > 5.5 mEq/L
152
What are the clinical manifestations of hyperkalemia?
* Neuromuscular weakness
* Cardiac arrhythmias: ECG shows peaked T waves, widened QRS
153
What is hypocalcemia defined as?
Ionized Ca²⁺ < 4.0 mg/dL or Total Ca²⁺ < 8.5 mg/dL
154
What are the clinical manifestations of hypocalcemia?
* Paresthesias
* Tetany
* Seizures
* Cardiac: prolonged QT interval, hypotension
155
What is hypercalcemia defined as?
Ionized Ca²⁺ > 5.3 mg/dL or Total Ca²⁺ > 10.5 mg/dL
156
What are the primary causes of hypercalcemia?
* Hyperparathyroidism
* Malignancy (PTHrP, bone mets)
157
What are the clinical manifestations of hypercalcemia?
* Nausea
* Vomiting
* Weakness
* Confusion
* Cardiac signs: shortened QT, bradycardia
158
What is a primary cause of hypercalcemia?
hyperparathyroidism
## Footnote
Hyperparathyroidism is a condition characterized by excessive secretion of parathyroid hormone (PTH), leading to increased calcium levels in the blood.
159
What malignancies are associated with hypercalcemia?
PTHrP, bone mets
## Footnote
PTHrP refers to parathyroid hormone-related peptide, and bone metastases are cancer cells that spread to the bone, both causing increased calcium levels.
160
Name other causes of hypercalcemia.
* granulomatous disease
* vitamin D toxicity
* immobilization
* milk-alkali syndrome
* drugs (thiazides, lithium)
## Footnote
These causes illustrate various mechanisms by which calcium levels can be elevated in the body.
161
What does ionized calcium reflect?
true severity
## Footnote
Ionized calcium is the biologically active form of calcium and provides a more accurate assessment of calcium status than total calcium levels.
162
List common clinical manifestations of hypercalcemia.
* nausea
* vomiting
* weakness
* polyuria
* confusion
* coma
## Footnote
These symptoms indicate the systemic effects of elevated calcium levels.
163
What cardiac signs may be observed in hypercalcemia?
* shortened QT
* bradycardia
* AV block
* ventricular dysrhythmias
## Footnote
These cardiac manifestations can lead to serious complications if not addressed.
164
What complications can arise from hypercalcemia?
* renal failure
* pancreatitis
* hypertension
## Footnote
These complications highlight the serious nature of untreated hypercalcemia.
165
What is the first step in diagnosing hypercalcemia?
Confirm ionized Ca²⁺
## Footnote
Confirming ionized calcium levels is critical for accurate diagnosis and management.
166
What evaluations should be done in diagnosing hypercalcemia?
* renal function
* PTH
* vitamin D
* malignancy
## Footnote
These evaluations help identify the underlying cause of hypercalcemia.
167
How should total calcium be corrected?
for albumin
## Footnote
Correcting total calcium for albumin levels ensures a more accurate assessment of calcium status.
168
What is the first-line treatment for hypercalcemia?
IV saline hydration + loop diuretics
## Footnote
This approach helps to increase renal excretion of calcium.
169
What treatments are used for moderate to severe hypercalcemia?
* bisphosphonates
* calcitonin
## Footnote
These treatments help to decrease calcium levels by different mechanisms.
170
What should be done in refractory cases of hypercalcemia?
hemodialysis
## Footnote
Hemodialysis can effectively remove excess calcium from the body in severe cases.
171
What anesthetic consideration should be taken with significant hypercalcemia?
Delay surgery
## Footnote
Delaying surgery helps to mitigate the risks associated with high calcium levels.
172
What should be monitored during anesthesia in a patient with hypercalcemia?
* ionized calcium
* volume status
## Footnote
Monitoring these parameters helps ensure patient safety during anesthesia.
173
What fluid management strategy should be used in hypercalcemia during anesthesia?
goal-directed fluids, avoid acidosis
## Footnote
This approach helps to maintain hemodynamic stability and acid-base balance.
174
True or False: Responses to anesthesia and neuromuscular blockers in hypercalcemia can be predictable.
False
## Footnote
Hypercalcemia can lead to unpredictable responses to anesthesia and neuromuscular blockade.
