Inhalational Agents + Vaporizers
Property of a substance/material that determines how fast it transmits heat (pertinent to the material of anesthetic vaporizers to reduce fluctuations in temperature)
thermal conductivity
FiO2 limit during procedures with a high airway fire risk
FiO2 should be <30%
Dibucaine number associated with homozygous atypical pseudocholinesterase and the effects of succinylcholine can be greatly prolonged by several hours
20-30
Most common type/classification of bellows because if a circuit disconnect occurs, the bellows will NOT be able to rise during expiration
ascending bellows
Two blood products that should NOT be administered through a fluid warming device
platelets + cryoprecipitate
In clinically equivalent doses, list the negative climate impacts of the inhalational agents (from most negative to least negative)
desflurane > N2O > isoflurane > sevoflurane
Components of the Fire Triad and one example of each
fuel - ETT, surgical drapes, alcohol preps
oxidizer - O2, N2O
ignition- electrocautery, lasers
Percentage of nicotinic acetylcholine receptors (nAChR) that may still be blocked by a nondepolarizing NMB with a train-of-four count (TOFC) of 4
70-75%
Essential safety feature of the anesthesia machine that prevents contamination of the OR with waste anesthetic gases
scavenging system
Name one valuable thing that you learned from this class and that you will remember forever
:)
Two properties of desflurane that cause it to require a special type of vaporizer
high vapor pressure + low boiling point
In the event of the line isolation monitor (LIM) alarming that faulty equipment is present, what action should be performed?
UNPLUG the last line that was plugged in***; continue to unplug lines until the alarm stop
Muscle monitored with a peripheral nerve stimulator that has the slowest recovery time from paralysis by nondepolarizing NMBs
adductor pollicis m.
Essential safety feature of the anesthesia machine that ensures a minimum concentration of oxygen is delivered to the pt, it links the flow of two medical gases
oxygen/nitrous oxide ratio controller
Etomidate induction dose
0.1-0.4 mg/kg
3 common characteristics of vaporizers (NOT for electronic vaporizers)
variable-bypss, temperature-compensated, agent-specific, flow over
Maximum current leakage allowed in OR equipment
10 µA
neostigmine + glycopyrrolate doses for reversal of neuromuscular blockade by nondepolarizing NMBs
neostigmine 40-80 mcg/kg
glycopyrrolate 0.2mg for every 1 mg of neostigmine
Two characteristics of a circle breathing system that make it more desirable than a Mapleson circuit
better control of anesthetic depth, ability to scavenge, conservation of heat + humidity, rebreathing of exhaled anesthetic gases (less waste)
Three indications for the use of a total intravenous anesthetic (TIVA)
Malignant hyperthermia susceptibility, neuromonitoring (use of motor evoked potentials (MEPs)), ENT procedures without a secured airway, intracranial procedures, hx of significant/severe PONV
Pressure + temperature at which an electronic vaporizer pressurizes and warms desflurane to
The electronic vaporizer pressurizes desflurane to ~1500 mmHg and warms it to ~40 ºC
Gauge reading on the line isolation monitor (LIM) that can indicate faulty equipment is present
> 5 mA
Two keys differences between myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS)
MG: autoimmune rxn againts post-synaptic AChR, muscle function worsens with repeated activity, symptoms start proximal and progress peripherally, resistance to succinylcholine + sensitivity to nondepolarizing NMBs
LEMS: autoimmune rxn against pre-synaptic calcium channels, muscle function improves with repeated activity, symptoms start distal and progress proximally, sensitivity to both succinylcholine + nondepolarizing NMBs
Components of a circle breathing system
•CO2 absorber
•Fresh gas inlet
•Inspiratory + expiratory unidirectional valves
•Inspiratory + expiratory breathing tubes
•Y-connector
•APL valve
•Reservoir bag
Epinephrine infusion rate range
0.01-0.1 mcg/kg/min