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(Neuraxial)
(Neuraxial)
BLOCK It Like Its Hot
(Neuromuscular Blockade)
(Neuromuscular Blockade)
LASTing Impressions
(Local Anesthetics)
(Local Anesthetics)
Passing Gas
(Inhaled Anesthetics)
(Inhaled Anesthetics)
Ounce of Preparation
(Perioperative Planning)
(Perioperative Planning)
100
What are the doses of the two medications in 3 mL of the epidural "test dose" mixture?
Lidocaine: 45mg
Epinephrine: 15 mcg
100
What neuromuscular blocking agents can be reversed with sugammadex?
Rocuronium and Vecuronium
100
What is the approximate upper limit of lidocaine dosing for intraoral application (topicalization for awake intubation)?
~ 9mg/kg
100
What is the effect of sevoflurane alone on minute ventilation?
Decreased minute ventilation due to increased upper airway resistance and GABAergic effects on pre-motor neurons.
100
How long should a patient hold their empagliflozin (SGLT-2 inhibitor) prior to major noncardiac surgery?
3-4 days to prevent onset of euglycemia ketoacidosis in the setting of surgical stress and recovery.
200
If an epidural catheter is placed in the intrathecal space and a test dose is given, how long will it take to see the effects of a lidocaine spinal?
At least 5 minutes
200
Why are the facial nerve, tibial nerve, and ulnar nerve routinely used for train of four testing?
They are some of the only peripheral motor nerves that innervate muscles that don't contain them. This avoids direct stimulation of the muscle whose twitch response is being measured.
200
Which is most likely to cause an allergic reaction?
Bupivacaine, Chloroprocaine, Lidocaine, or Ropivacaine
Chloroprocaine
(Esther local anesthetics tend to cause more allergic reactions)
200
Which is closest the 90% decrement time of sevoflurane after a 6 hour case?
10 minutes
30 minutes
60 minutes
90 minutes
60 minutes
200
A patient is taking suboxone 8-2mg BID for OUD maintenance and is planned for an ex-lap for bowel cancer resection. What should the patient do with their suboxone dosing leading up to the surgery?
Continue as prescribed
300
What clinical signs have the strongest positive predictive value for detecting an intravascular epidural catheter after a test dose is given?
Absence of ST depression in lead II of an EKG.
(T wave amplitude decreased by >25%)
300
What do the ASA 2023 guidelines list as standard of care for monitoring for full recovery after reversal of neuromuscular blockade?
Quantitative train of four with ratio of 1st to 4th twitch less than 0.9 on the ulnar nerve.
300
You are taking care of a 2 month old infant with an epidural in place for post-operative analgesia? What is the best choice for local anesthetic in this epidural?
Chloroprocaine (due to underdeveloped liver function)
300
When mean arterial pressure (MAP) is held constant, what is the effect of sevoflurane on cerebral blood flow (CBF)?
CBF is unchanged with sevoflurane as long as MAP is held constant.
300
What is the minimum amount of time a patient should abstain from smoking leading up to surgery in order to have a benefit in wound healing?
3-4 days
400
Name these types of spinal needles:
400
According to the FDA filing for sugammadex, what is the binding ratio for sugammadex and rocuronium?
1:1 molar ratio
180mg of sugammadex to 50mg rocuronium
400
What are the earliest EKG changes seen in LAST?
PR and QTc prolongation
Progressing to QRS abnormalities (bundle branch block, ST interval changes)
Then tachy/brady arrhythmias
400
Which inhaled anesthetic has the greatest global warming potential (GWP)?
Desflurane, Isoflurane, Nitrous Oxide, Sevoflurane
Desflurane
400
Which of the following is most likely to be decreased when an institution effectively and correctly implements an ERAS protocol?
Operation times
Rates of acute kidney injury
Length of hospital stay
Mortality
Length of hospital stay is decreased. Other are statistically unchanged.
500
At what vertebral levels do the cardiopulmonary sympathetic nerve fibers arise?
T1 - T5
500
What is a Phase II block? What does the train of four look like? What is occurring at the acetylcholine receptor to cause this behavior?
AchR is repolarized, but desensitized to the effects of acetylcholine binding. TOF will have fade (typically ratio <0.3). This is the effect of long-tern succinylcholine being bound.
500
When is giving intralipid contraindicated or at least must be done with extreme caution?
Hypertriglyceridemia
Acute pancreatitis
Severe hepatic dysfunction
Pre-existing ARDS
ECMO/CRRT (clogs filters)
500
What variables affect vapor pressure of an inhaled anesthetic?
Temperature
Intermolecular forces
Molecular size
External pressure
500
What is the minimum time to wait after a major ischemic stroke before having an elective surgical procedure?
9 months
