Risks
Local
Pre-op
Anesthetic Agents
Fun Drugs & Facts
100
Name two HIGH risk surgeries (> 5% cardiac risk)
Aortic and other major vascular surgeries
Peripheral vascular surgery
Cardiac surgery
100
Local Anesthetics work on what channel and where?!
Block voltage gated sodium channels in neuron (along axon) to stop depolarization of the membrane
100
Left ventricular failure is found to _____ the risk of 30-day cardiovascular morbidity and _________ the risk of long term mortality...
DOUBLED
QUADRUPLED
100
Midazolam works on what receptor and what kind of channel is this?
GABAa receptor - GABA mediated Cl current.
100
PCP (angle dust) is most common in structure to what anesthetic agent used in hospitals?
Ketamine!
It is a hallucinogenic agent. PPL arent really sure how it works, but truckers do.
200
Name 4 surgeries that are LOW risk (<1% cardiac risk)
Prostate Surgery
Endoscopic procedures
Superficial surgeries (us)
Cataract Surgery
Breast Surgery
Ambulatory Surgery
200
Max dose of lido with and without epi?
With Epi: 7mg/kg
Without: 4.5mg/kg
200
Submental space (hyomental / thyromental legnth) should be what if you have a normal (not short) neck?
> 6 cm!
200
Whut is Propofol infusion syndrome (PRIS)?
Rare and often fatal complication with refractory bradycardia leading to asystole (first sign is RBBB). Must have MA, rhabdomyolysis, HLD, enlarged liver.
More common in children. Can see in adults undergoing longterm infusion >48 hours at rate of >66mcg/kg/min
200
Heavy marijuanna usage in teens has been associated with this anesthesia complication….
Emergence Delirium
300
What are the 6 independednt risk factors for major cardiac complications
(Revised Lee Cardiac Risk Index = RCRI)
- High Risk Surgery
- History of Ischemic heart disease
- Heart Failure
- Cerebrovascular Disease
- Diabetes requiring Insulin
- Creatinine greater than 2
300
Max dose of Bupivicane 0.25% plain
2.5mg/kg = ~ 1cc/kg (roughly)
300
Baby has infant forumla, how long till they are NPO
6 hours
300
Where is propofol metabolized?
Rapidly in the liver = 70%
Extra-hepatic (mostly lungs) = 30%
300
Which US president overdosed on Methamphetamine?
JFK in 1962. His doctor prescribed it
400
Roughly give me ASA guidelines….
400
Treatment of Local Anesthesia Systemic Toxicity (LAST) involves avoiding which medications?
Calcium channel blockers and alpha-adrenergic receptor blockers as well as vasopressin.
Things to give/do: Benzos, lipid emulsion, protect and maintain airway. Prevent hypoxia and acidosis. Amio for arrhythmias.
400
How long must a patient be OFF of injectable gliptide medications for them to be NPO at midnight?
2 weeks prior to procedure, then NPO midnight
400
What is Etomidate and how does it work?
Rapid induction and recovery agent that potentiates GABAa receptors. Minimal hemodynamic effects
400
Cocaine was initially derived from coco leaves and helped make local anesthetics….
…..BORING!
Tell me what country has the highest rate of cocaine abuse
Scotland = 2.4% of the population
500
Give me 3 absolute contraindications to spinal anesthesia
Infection at site
Refusal (lol)
Coagulopathy or other bleeding diathesis
Severe Hypovolemia
Increased intracranial pressure
Severe aortic stenosis
Severe mitral stenosis
500
Go through the phases of Local Anesthetic Systemic Toxicity (LAST)...
[must be in order]
1. CNS excitement (agitation, auditory changes, metallic taste)
2. Seizures then CNS depression (drowsiness, coma, respiratory arrest)
3. Cardiac toxicity
*1. HTN, TACHY, Ventricular arrythmias
THEN...
*2. Cardiac Depression Bradycardia, conduction blocks, asystole, decreased contractility.
500
Class I evidence supports preop coronary revascularization in 5 patients
1. Patients with stable angina who have significant L main coronary stenosis
2. Pts with stable angina and 3-vessel disease
3. Pts with stable angina who have 2-vessel disease with significant LAD stensosis and EF less than 50%
4. Patients with high-risk unstable angina or non-ST segment elevation
5. Patients with acute ST-elevation MI
500
What is PROPOFOL made of?
10% soybean oil
2.25% glycerol
1.2% Lecithin
500
Bayer pharma has derived two drugs of abuse. One of them was made 11 days after synthesizing aspirn for the first time. What are they?!
1. Heroin (11 days after ASA)
2. TRANQ!!!! (1962)