AIRWAY ADVENTURES
This device is typically the first-line rescue tool when direct laryngoscopy fails but mask ventilation is still adequate
What is Laryngeal Mask Airway (LMA)?
These are 3 EARLY signs of LAST (Local Anesthetic Systemic Toxicity) + treatment
What are: Perioral paresthesia
Muscle twitching
Dizziness
Visual and auditory disturbances
Dysarthria
Agitation
Hallucinations
Altered mental status
TREATMENT:
Lipid emulsion 20% should be administered in cases of refractory seizures or cardiotoxicity associated with LAST.
According to ASRA guidelines, lipid emulsion dosing should be based on ideal body weight.
Dosing (per ASRA guidelines, based on ideal body weight:
>70 kg: Bolus 100 mL IV over 2–3 minutes, followed by a 250 mL IV infusion over 15 to 20 minutes
<70 kg: Bolus 1.5 mL/kg IV over 2–3 minutes, followed by an infusion of 0.25 mL/kg/min?
This nondepolarizing neuromuscular blocker undergoes Hofmann elimination and is therefore relatively independent of renal and hepatic function
What is Cisatracurium?
This effect describes the increased ability of blood to carry more CO2 as Hb offloads its O2
What is Haldane effect?
This phenomenon explains why sevoflurane uptake is accelerated when administered together with nitrous oxide.
What is Second gas effect?
This maneuver lifts the tongue off the posterior pharynx to improve airway patency during ventilation
What is Jaw thrust?
During a midline spinal anesthetic approach, the needle traverses multiple ligamentous and meningeal structures before entering the subarachnoid space. Name all layers in order from skin to cerebrospinal fluid.
What is skin → subcutaneous tissue → supraspinous ligament → interspinous ligament → ligamentum flavum → epidural space → dura mater → arachnoid mater → subarachnoid space (CSF)?
Induction agent of choice in hypovolemic trauma patients with bronchospastic disease
What is Ketamine?
This anticoagulant is commonly added to stored packed red blood cells and it can chelate ionized calcium during massive transfusion
What is Citrate?
According to standard U.S. anesthesia cylinder color coding, identify the gases associated with green, blue, and yellow cylinders
What is Oxygen - Green
Nitrous oxide - Blue
Medical air - Yellow ?
This technique provides oxygenation via a narrow catheter but requires special methods to assess ventilation because chest rise and pulse oximetry may not reliably reflect adequacy
What is Jet ventilation?
Neuraxial opioids bind to this receptor at this location of the spinal cord to exert their analgesic effects
What is Mu receptors on the substantia gelatinosa of the spinal cord (dorsal horn)?
These 5 drugs do NOT cross the placenta
Hint: He Is Going Nowhere Soon
What is Heparin
Insulin
Glycopyrrolate
NDMB
Succinylcholine?
The clotting factor with the shortest half life of ~ 6 hours and is primarily activated by TF in the extrinsic pathway of the clotting cascade
What is Factor 7?
This ventilation mode limits peak airway pressure by delivering breaths until a preset inspiratory pressure is reached, causing tidal volume to vary with compliance
What is Pressure controlled ventilation?
Aspiration risk becomes clinically relevant during these weeks in the second trimester
What is 18 - 20 weeks?
This is the order of systemic absorption of local anesthetics from highest to lowest based on injection site
Clue: BICEPS
What is Bier block (intravascular)
Intercostal
Caudal
Epidural
Perineural
Subcutaneous?
This opiate has increased clearance in neonates compared with children and adults
What is Remifentanil?
This coagulation factor complex concentrate contains factors II, VII, IX, and X and is commonly used for urgent warfarin reversal
What is Prothrombin complex concentrate (PCC)?
According to perioperative cardiac guidelines, elective surgery should be delayed for at least this long after:
Ballon angioplasty with no stent
Drug eluting stent
Metal stent placement
What is Ballon angioplasty with no stent: 14 days
Drug eluting stent: 6 months
Metal stent placement: 30 days ?
During volume-controlled ventilation, an increase in both peak and plateau pressures most strongly suggests worsening of this pulmonary property
What is Lung compliance?
Dr. Tischler is giving 39ml of Ropivacaine 0.2% to his 80kg patient going for TKA.
What's the maximum amount (ml) of Bupivacaine 0.25% you can administer for a nerve block?
What is 43 ml?
This alpha-2 adrenergic agonist produces analgesia by acting in the _________ of the spinal cord and produces sedation through action at the ________ in the brainstem.
What is Dexmedetomidine
Analgesia: Dorsal horn
Sedation: Locus ceruleous ?
Evidence of a prolonged K time and low Alpha angle on Thromboelastogram (TEG) is indication to give this product (name the components)
What is Cryoprecipitate: fibrinogen, factor VIII, factor XIII, von Willebrand factor, and fibronectin?
These 3 conditions shift the oxygen-hemoglobin dissociation curve to the right, facilitating oxygen unloading to tissues
What is Decreased pH (increased H)
Increased Carbon monoxide
Increased Carbon dioxide
Increased 2,3-DPG
Increased temperature
Increased Fetal Hb ?