Positioning
Correct arm placement in supine position
What is either adducted or abducted (< 90 degrees to prevent brachial plexus injury). Hands / forearms in neutral position, either supinated or palms toward body?
Norepinephrine's primary effect is on this receptor
What is alpha-1 stimulation?
The two NMBs appropriate for rapid sequence intubation
What are succinylcholine and rocuronium?
The amount of water in the intracellular and extracellular compartments
What is 400-450 mL/kg (intra) and 150-200 mL/kg (extra)? (Total body water = 600 mL/kg or 40 L)
The effects of opioids on ventilation
What is respiratory depression? (Increase in PaCO2, decreased in stimulant effects of CO2, decrease in the hypoxic ventilatory drive)
The reason a supine patient may wake up with a backache.
What is loss of normal lumbar lordosis? (Can avoid with hip / knee flexion)
Name two vasoconstrictors that stimulate alpha and beta receptors
What are ephedrine and epinephrine?
The most reliable means of monitoring the effects of NMBs
What is a peripheral nerve stimulator?
Current recommendation for pre-operative fasting of clear fluids
What is up to 2 hr prior to procedure?
Dosing of opioids in obese patients
What is by lean body mass?
Correct placement of an axillary roll
What is caudal to the axilla?
Two life-threatening conditions treated with epinephrine
What are cardiac arrest, cardiovascular collapse and anaphylaxis?
Three patient populations at risk for hyperkalemia after succinylcholine
What are patients with burns, trauma and spinal cord injury?
Three balanced salt solutions
What are Lactated Ringers, Plasma-Lyte and Normosol? (Electrolyte composition similar to extracellular fluid)
The active metabolite of codeine
What is morphine? (10% of white population lack CYP2D6 and do not exhibit a therapeutic effect from codeine)
Correct position to zero arterial line in patient in reverse Trendelenburg position.
What is at the external auditory meatus? (To optimize cerebral perfusion)
Two effects of muscarinic antagonists
What is increase in heart rate, sedation and dry mouth?
An electrical stimulus of 50 Hz for 5 sec
What is tetanus?
Reason Lactated Ringer's should not be used to dilute packed red cells
What is its calcium content? (Use PlasmaLyte or normal saline)
Two effects of opioids on the cardiovascular system
Minimal cardiovascular effects, fentanyl decreased vagal tone leads to bradycardia. Nonetheless, in patients with high sympathetic tone (CHF) opioids can decrease blood pressure.
The most common neuropathy in the ASA closed claims database
What is ulnar neuropathy (28%)? Followed by brachial plexus (20%), lumbosacral nerve root (16%), and spinal cord (12%). LS nerve root and spinal cord are usually associated with regional anesthesia.
Results of the POISE trial
What is increased mortality in the beta blocker group (started on the day of surgery and continued for 30 days)?
The train-of-four ratio before the administration of an NMBs.
What is 1.0?
The conclusions of the SAFE trial
What is no difference in outcomes? RCT of 7000 critically ill ICU patients (SAFE = Saline vs Albumin Fluid Evaluation); a subset of traumatic brain injury pts had increased mortality with albumin
The definition of context-sensitive half-time
What is the time required for a 50% decrease in effect site concentration after stopping a steady-state infusion?