ANESTHESIA

Question 1

ASA class breakdown

Answer 1

1 = healthy
2 = mild systemic disease (HTN, DM), active smoker, pregnancy
3 = severe systemic disease (stable angina, CHF, hx MI, CKD), morbid obesity
4 = severe systemic disease that is constant threat to life (unstable angina, mod-severe COPD)
5 = not expected to survive wo operation (MOF, sepsis, coagulopathy)

Question 2

Succinylcholine should be avoided in which pts?

Answer 2

• burn pts
• massive tissue trauma (rhabdo)
• upper and lower motor neuron lesions (spinal cord injuries)
• NM disorders

Question 3

C/I to nitrous oxide administration includes…

Answer 3

• pneumothorax
• SBO
• w/ air-filled cavity (ie. pneumoperitoneum, increased middle ear pressure)

**bc can diffuse into any air-filled cavity to displace nitrogen

Question 4

Which inhalation agent has highest incidence of postop nausea and vomiting (PONV)?

Answer 4

prolonged use of nitrous oxide

Question 5

ACC-AHA cardiac risk stratification for non-cardiac surgery

Answer 5

high risk >5% = any vascular surgery (except CEA)
intermediate 1-5% = CEA, head/neck/C/A surgery, ortho
low <1% = hernia, endoscopic, breast

Question 6

1 predictor of post-op hospital mortality

Answer 6

renal failure

Question 7

Steps of RSI

Answer 7

1. oxygenation + short-acting induction agent
2. muscle relaxant
3. cricoid pressure
4. intubation
5. inhalational analgesic

Question 8

MCC sudden rise ETCO2…? But should also be concerned for…?

Answer 8

hypoventilation.

malignant hyperthermia.

Question 9

MCC sudden drop ETO2…? But should also be concerned for…?

Answer 9

tubing malfunction.

CO2 emboli.

Question 10

Mgmt CO2 emboli

Answer 10

1. stop CO2 insufflation, reduce pneumoperitoneum
2. Trendelenburg + left lateral decub
3. 100% FiO2
4. aspirate off central line from RA
5. pressors/inotrope + prolonged CPR, if necessary

Question 11

What is MAC?

Answer 11

minimal alveolar concentration; smallest concentration of gas in which 50% pts will not move to painful stimuli

Question 12

Low MAC means…?

Answer 12

• more lipid soluble
• more potent
• slow speed induction

Question 13

High MAC means…?

Answer 13

• less lipid soluble
• less potent
• fast induction

Question 14

Highest MAC agent is…?

Answer 14

nitrous oxide

Question 15

Side effect: halothane

Answer 15

• hepatitis
• high degree cardiac depression
• arrhythmia

Question 16

Best agent for mask-induction for kids

Answer 16

Sevoflurane

Question 17

Best agent for NSGY procedures

Answer 17

Isoflurane

Question 18

Side effect: propofol

Answer 18

• metabolic acidosis
• hyperTG
• rhabdo
• propofol infusion syndrome

Question 19

Best IV anesthesia agent in pts with angina or HF

Answer 19

etomidate (few hemodynamic and cardiac effects)

Question 20

Which IV anesthesia agent can cause adrenal cortical suppression?

Answer 20

etomidate

Question 21

Which IV anesthesia agent has no respiratory depression effects?

Answer 21

ketamine

Question 22

Order of paralysis of muscles vs. recovery from paralysis with paralytic agent

Answer 22

paralyzed from head -> diaphragm.

recovers from diaphragm -> head.

Question 23

Tx malignant hyperthermia

Answer 23

dantrolene

Question 24

Paralytic agent that undergoes Hoffman elimination? Best used for pts w/…?

Answer 24

Cisatracurium.

For pts with liver or renal failure.

Question 25

Rocuronium is metabolized by?

Answer 25

liver

Question 26

Pancuronium is metabolized by?

Answer 26

kidney

Question 27

How to reverse non-depolarizing paralytic agents?

Answer 27

ACh-esterase inhibitors

Question 28

How do local anesthetics work?

Answer 28

blocks transmission signals by stabilizing Na-channels -> increase AP threshold (increases amount of Na needed to create AP)

Question 29

Longest lasting local anesthetic by longest > shortest

Answer 29

Bupivacaine > lidocaine > procaine

Question 30

Max dose lidocaine wo epi vs. w epi? How long do they last?

Answer 30

wo epi: 5 mg/kg (up to 60-min) | w/ epi: 7 mg/kg (up to 4-hr)

Question 31

Max dose bupivacaine? How long does it last?

Answer 31

3 mg/kg (up to 15-hrs)

Question 32

If give morphine via epidural, can cause...?

Answer 32

respiratory depression

Question 33

If give lidocaine via epidural, can cause...?

Answer 33

hypotension + bradycardia

Question 34

Which benzo is C/I pregnancy?

Answer 34

midazolam