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WorksheetsSurgical Problems & Procedures: General Surgery Anesthesia
Total questions: 63
Worksheet time: 32mins
Fi (inspired gas concentration) is determined by?
Free gas flow rate
Breathing Circuit + Volume
Circuit Absorption
CO2 Intake
FA (alveolar gas concentration) is determined by?
Uptake
Ventilation
Concentration Effect
Secondary Gas Effect
What is anesthesia?
Partial/Complete loss of sensation with or without LOC as a result of disease, injury or administration of anesthetic agent
lidocaine 1%
lidocaine 2%
Bupivacaine 0.5%
Fa = arterial gas concentration, is affected by?
Ventilation/Perfusion Mismatching
Free gas flow rate
Breathing Circuit Volume
What are the 3 basic end points of anesthesia?
Pure Analgesia
Numbing only
Hypnosis, Muscle Relaxation, Analgesia
During general anesthesia, what could be used to treat hypotension?
Lisinopril
Metoprolol Tartrate
Ephedrine
Atropine
What happens with general anesthesia (state and administration)?
Controlled state of consciousness, unarousable and loss of airway control
IV drugs with rapid onset
Uncontrolled state of consciousness, with symptoms of Mania followed by anhedonia
Oral
Propofol is what kind of medication?
Anesthetic
Vasopressor
Hypnotic
MOA for Atracurium and its use?
Antagonizes Ach by binding cholinergic receptor sites on motor end plate
Used for neuromuscular blocks
Agonist of Ach by binding cholinergic receptor sites on motor end plate
used for thyroid storms
Reversal of neuromuscular block/antagonism inhibition examples? (Acetylcholinesterase inhibitors)
Neostigmine
Edrophonium
Pyridostigmine
Atenolol
Robinul is an antimuscarinic agent. What is its purpose in general anesthesia?
Decrease secretions
Increase Secretions
Raise HR
Spinal anesthesia, what is it and what is it used for?
anesthetic into subarachnoid space, bathes nerves and numbs.
good for lower abdomen, pelvis and lower extremity surgery
anesthetic into dead space of resp tract, bathes nerves and numbs.
good for tooth extraction
Advantages of spinal anesthesia?
Effective alternative
Avoid Polypharmacy
Avoid severe allergic Rxn
Patient can remain awake
Disadvantages to spinal anesthesia?
Limited scope
Anticoagulants
Bleeding Disorders
Increased Failure Rate
Epidural anesthesia, what does it do and what is used?
Sympathetic, sensory and motor blockade
Needle only goes as far as epidural space/Not into CSF
Uses the LOR syringe (loss of resistance)
Local anesthetics typically produce?
Necrosis
Pain interruption but is a process that is completely reversible = no residual effect
Fibrosis
Why use epinephrine with local anesthetic?
to prevent respiratory failure
constrict blood vessel (decrease bleeding)
Increase time of duration for Local anesthetic
reduce time duration
Local infiltration anesthesia can be used for?
Lacerations and bedside procedures
Percutaneous coronary intervention
Brain sugery
Topical blocks can be used on?
amputations
Mucous membranes
Respiratory tract procedures
Surface anesthesia, what is it and when is it used?
Local anesthesia to skin or mucous membranes
Can be used for surface, burning, and surface pain
Minor sunburns, eye procedures, and superficial debridement.
Digital blocks are used for?
anesthetize an entire digit
longer duration than local + no distortion
MAC anesthesia consists of?
IV Sedation/Analgesia with monitoring of vital signs and supplemental O2
xx
MAC or General Anesthesia + Regional Block can be used for?
Preop Pain control
Post Op Pain Control
Factors that influence anesthesia selection?
Age/Physical Status
Type of Surgery
Skills
Patient wishes and Surgical Needs
IV placement/sedation are what part of the anesthesia plan?
Post Op
Operative
Pre-Op
Elderly with comorbidities preferred anesthesia plan?
Local Anesthetic
MAC w/Regional Block
General Anesthesia
What makes up the post op anesthesia plan?
Pain control and hemodynamic stability
Surgical Needs
Uncooperative patients, such as the pediatric patient does better with what type of anesthesia?
MAC
General Anesthesia
Regional Block
What type of anesthesia is preferred for c-sections and why?
Regional Block
Spinal/Epidural because general has increased mortality rate
MAC
General
Increased risk of thrombosis patients that take chronic anticoagulants should be switched to?
Plavix
Dabigatran
IM LMWH (Lovenox) or IV Heparin
Guidelines regarding ACS and surgeries (anesthesia)?
Wait 1 month post coronary intervention
If surgery iminent, don't use drug eluting stent
Phases of general anesthesia?
Induction
Maintenene
+/- paralytic
recovery
Goals of general anesthesia?
Loss of pain, memory, consciousness, muscle function/contraction, and abolition of autonomic response
Loss of memory
Amnesia
McIntosh blade curve goes into what structure?
Vellecula
Trachea
Bronchus
What is a bispectral index monitor used for?
measures brain waves and relates info to numeric levels
measures heart rate on both hands to compare rates
What is pulmonary capillary wedge pressure?
Indirect RIght Atrial Pressure
Indirect Left Atrial Pressure
When would you use a bispectral index monitor?
Emergency surgery
Stat C-sections
Open heart Surgery
Inhaled anesthetic examples? (NO FLUR-ANE)
Nitric Oxide (laugh!)
Isoflurane
Sevoflurane
Desflurane
Halothane
IV agents (nonopioids) examples? MOA?
Barbiturates = Pentothal (thiopental)
Non-Barbiturates = Propofol, Etomidate
Barbiturates = bind to GABA post synaptic receptors causing LOC
Non-Barbiturates = act as opioid agonists = hypnotic state + LOC
What class of medications are "tranquilizers"?
Opioids
Benzodiazepines
Barbiturates
General anesthesia drug of choice?
Propofol *great for PONV
Pentothal
Etomidate
Propofol effect on Cardiovascular system?
Decreases SVR and BP
Increases SVR and decreases Bp
Propofol vs. Etomidate?
Etomidate has no analgesic effect and may cause PONV
Propofol has no analgesic effect and may cause PONV
MOA for Non-Depolarizing Neuromuscular Agents? Example?
Competitive ANTAGONISTS for Ach receptors
Rocuromium
Competitive AGONIST for Ach receptors
Suxamethonium Chloride
MOA for Depolarizing neruomuscular blocking agents? Examples?
Suxamethonium Chloride
Competitive AGONIST for Ach receptors
Rocuromium
Competitive ANTAGONISTS for Ach receptors
What is malignant hyperthermia?
Follows exposure to potent inhalation anesthetics with critical temperature elevation
Increases metabolism = rhabdo + increased temperature w/Hyperkalemia
King Denborough Syndrome?
Congenital Myopathy
RYR1 gene mutation
Pathophysiology of malignant hyperthermia?
Defective calcium channel on sarcoplasmic reticulum of skeletal muscle cells
Hypermetabolism of muscles, uncoordinated contraction and metabolism, O2 consumption and lactic acid production=metabolic acidosis = heat generation and CO2
Treatment of malignant hyperthermia?
Ice Packs, Dantrolene(skeletal muscle relaxant by decreasing Ca++ inflow)
If dantrolene is used, Prep for ETT
Acetylcholinesterase inhibitors?
Neostigmine
Physostigmine
Edrophonium
Lorazepam
Anticholinergics examples?
Atropine
Glycopyrrolate
Adenosine
Amiodarone
A 48-year-old male had surgery under general anesthesia. Etomidate was one of the used
agents. At the PACU labs report the following Na 120, K 5.2, Cl 100, HCO3 25, Glucose 46, Ca 19.
Which of the following could be a side effect of the anesthetic agent?
Acute renal insufficiency
Acute adrenocortical suppression
Post anesthesia nausea and vomiting
Acute heart failure
Which of the following is a depolarizing muscle relaxant?
Atracurium
Pancuronium
Succinylcholine
Vecuronium
A 24-year-old-male undergoing and elective shoulder surgery under general anesthesia. He is
being monitored during the procedure. During trans operative the patient is noted to have
increased muscle rigidity, temperature raised to 104.3 F, and end-tidal CO2 is elevated. Heart
rate of 172bpm. Which of the following could have prevented this?
Twelve lead EKG monitoring
Chest imaging preoperative
Pulmonary function tests preoperative
Thorough family history preoperative evaluation
An 18-year-old male is being evaluated for a laparoscopic appendectomy due to appendicitis.
He has a history of good health. Which of the following is the correct classification for this
patient?
E-ASA III
E-ASA I
E-ASA II
E-ASA V
A 62-year-old man is scheduled for prostatectomy under general endotracheal anesthesia. A
surgical admission history and physical and pre-anesthesia evaluation are performed. The
patient's personal and family history of problems with anesthesia (i.e., malignant hyperthermia or
pseudocholinesterase deficiency), her NPO status, the presence or absence of gastric reflux, and
medications taken on the day of surgery are elicited. Which of the following should also be
included in his preoperative management?
An abdominal examination, noting any tenderness and/or rebound.
An electrocardiogram and chest x-ray
Mallampati score and neck range of motion
A prescription for postoperative analgesics
An uncontrolled diabetes mellitus type 2 patient with morbid obesity is scheduled for elective
surgery. Which of the following classified this patient?
ASA II
ASA I
ASA III
ASA IV
Which of the following is considered a trigger agent for malignant hyperthermia?
Halothane
Vecuronium
Etomidate
Propofol
You are assessing the airway access in a patient and you have found visualization of hard palate
only. Which of the following is the correct Mallampati score?
Mallampati II
Mallampati III
Mallampati I
Mallampati IV
Which of the following is an absolute contraindication to neuroaxial blockade?
Increased intracranial pressure
Hypertrophic obstructive cardiomyopathy
Complicated surgery
Uncooperative patient
Which of the following is considered a disadvantage for spinal anesthesia?
Better pain control than intravenous narcotics
Less need for systemic opioids (narcotics)
Headache always develop following the block procedure
Limited Scope
Which of the following is used to reverse non-depolarizing muscle relaxants?
Naloxone
Flumazenil
Neostigmine
Propofol
Which of the following is the mechanism of action of local anesthetics on nerve conduction?
Inhibition of acetylcholinesterase
Inhibition of stage III calcium channels
Inhibition of voltage-gated sodium channels
Decreasing intracellular acetylcholine
