Hodge Podge
Referred to as the "Mother of OB Anesthesia", this obstetric anesthesiologist taught at Einstein, practiced at Jacobi and is the namesake of a commonly used pencil-point spinal needle.
Who is Gertie Marx?
This drug, a favorite of Dr. Shlez, uniquely preserves airway reflexes and has sympathomimetic properties but may worsen myocardial ischemia.
What is ketamine?
(Bonus : MOA?)
A 2-month-old premature infant born at 30 weeks gestation is scheduled for an inguinal hernia repair. Which of the following preoperative findings would BEST predict an increased risk of postoperative apnea? A. Hemoglobin 7 gm/dL B. Glucose 61 mg/dL C. Room air SpO2 92%
What is A?
Dr. Jaconia would be remiss if everyone did not know that the narrowest point of the pediatric airway is this area.
What is cricoid cartilage (~C4)?
Wha is the appropriate size cuffed ETT in an 4 year old for elective surgery?
What is 5? (age/4 + 4)
Developed in a Montefiore lab, this medication containing acetaminophen, caffeine, and butalbital (a low-dose barbiturate) is a standard first line therapy for post-dural puncture headaches
What is fioricet?
This phenomenon occurs when a large volume of one gas accelerates uptake of a companion gas.
What is second gas effect?
During a thyroidectomy, a surgeon asks you to monitor for damage to a nerve that provides sensory input to the glottis and motor function to the cricothyroid muscle. You are mostly worried about injury of this nerve which can be particularly insidious
What is the external branch of the superior laryngeal nerve? Injury results in subtle voice changes due to impaired tensioning of the vocal cords, often going undiagnosed.
What is 5? (age/4 +4)
This reflex originates from inhibitory mechanoreceptors in the left ventricle wherein stmulation of these receptors by stretch (poorly filled ventricle), causes increased renin and vasopressin release and parasympathetic activity and inhibits sympathetic activity, which promotes reflex bradycardia, vasodilation and hypotension.
What is the Bezold Jarisch reflex?
Dr. Romanelli's favorite medication to use neuraxially has antihypertensive, analgesic, and anxiolytic properties. It has also been used as treatment for drug withdrawal, postop shivering, and ADHD, and works via this mechanism of action.
What is alpha-2 agonism?
After extubation, your patient is unable to phonate. You confirm that both vocal cords are paralyzed in the paramedian position, making you believe that an injury or transection could have occurred. You confer with Dr. Straker and determine the patient is obstructing and needs to be reintubated, reinforcing that this was the most likely etiology.
What is bilateral RLN injury?
Your patient in the PICU on mechanical ventilation has persistently low plateau pressures but high peak airway pressures. You suspect large airway obstruction as evidenced by this ventilator waveform
What is an increased difference between peak and plateau pressures on the flow-volume loop, indicating elevated airway resistance?
In LAST, cardiac arrest is often resistant to standard ACLS treatments due to this key electrophysiologic mechanism.
What is inhibition of cardiac sodium channels, leading to prolonged depolarization and conduction blockade?
Your vascular patient with CAD/PAD/PVD/COPD/OSA/ESRD undergoing AAA repair received 10 units of packed RBCs and is becoming progressively acidotic and hemodynamically unstable. After ruling out other causes, you and Dr. Aquino look at the EKG and decide that this electrolyte disturbance is most likely to blame for the hypotension.
What is hypocalcemia 2/2 citrate toxicity (causing QT prolongation)
After a prolonged nitroprusside infusion, a patient develops profound metabolic acidosis with a normal anion gap and rising mixed venous oxygen saturation. You determine this as the culprit, and propose this as the antidote.
What is cyanide toxicity? Treat with hydroxocobalamin or sodium thiosulfate.
After an uneventful carotid endarterectomy, your patient cannot shrug their shoulder or rotate their head against resistance. You determine that this nerve was likely injured via this type of surgical mistake.
What is the spinal accessory nerve (CN XI), likely injured during dissection of lymph nodes or the internal jugular vein?
A 2-month-old premature infant born at 30 weeks gestation is scheduled for an inguinal hernia repair. Which of the following preoperative findings would BEST predict an increased risk of postoperative apnea? A. Hemoglobin 7 gm/dL B. Glucose 61 mg/dL C. Room air SpO2 92%
What is A?
A 30-year-old healthy woman receives a local anesthetic for a dental procedure. Two hours later, she arrives at the ER with cyanosis and a pulse oximeter reading of 85% that does not improve with 100% FiO2, making you believe this medication was the culprit and prompting this specific treatment.
What is prilocaine (causing Methemoglobinemia) ? Treat with methylene blue 1 mg/kg IV, which restores normal hemoglobin function by reducing Fe³⁺ back to Fe²⁺.
A patient with a traumatic brain injury is hyperventilated in the ICU. Over the next hour, their intracranial pressure initially improves but then paradoxically worsens. Dr. Osborn is quick to tell you all about this biphasic effect of hyperventilation on cerebral blood flow that has occurred..
What is initial vasoconstriction reducing cerebral blood volume, followed by compensatory cerebral metabolic acidosis leading to vasodilation?
You are the lucky PACU doctor working with Dr Kiyatkin and there is an ECT to be done! The psychiatrist decides that since we are on shortage of this "gold standard" induction drug, that we should use this one to promote the longest seizure duration
What is Methohexital (barbiturate that stimulates GABA does not affect seizure threshold and, compared to propofol, does not shorten seizure length, causes moderate cardiac depression, which helps counteract the sympathetic discharge
Etomidate produce a longer seizure does not cause cardiac depression, so sympathetic discharge tends to be elevated
You’re performing an awake craniotomy when the patient suddenly develops asystole. The neurosurgeon insists they haven’t touched the brainstem. You are working with Jinu Kim who tells you this central structure was clearly stimulated.
What is the insular cortex? (plays a key role in autonomic regulation, and its stimulation can trigger profound parasympathetic activation leading to asystole.)
Children with these 3 disease processes are at highest risk for MH susceptibility..
King Denbouragh Sydrome, central core disease, multi minicore disease
While managing LAST, Dr. Gritseno advises that high-dose epinephrine should be avoided for this reason ..
What is high-dose epinephrine worsens arrhythmias and impairs lipid resuscitation by reducing cardiac output? (Use ≤1 mcg/kg epinephrine.)