anesthesiathrunutrition.txt

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Author:
nsmallwood
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125465
Filename:
anesthesiathrunutrition.txt
Updated:
2011-12-31 15:16:14
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anest thru nutrition
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  1. how is speed of induction related to MAC
    • typically inversely
    • i.e Nitrous is fast acting but with a high MAC
  2. effects of inhalational agents
    • anesthesia
    • amnesia
    • +/- analgesia
  3. inhalation agent that can cause szs
    enflurane
  4. highest level of myocardial depression of all inhalation agents
    halothane
  5. continuous infusion of etomidate leads to
    adrenal suppression
  6. how is propofol metabolized
    liver and plasma cholinesterases
  7. why should you avoid propofol in children
    prolonged use has been associated with metabolic acidosis and death
  8. IV induction agent contraindicated in head injury
    ketamine
  9. s/e of ketamine
    • hallucinations
    • catecholamine release with increase pCO2, HR, airway secretions
  10. mcc of sudden increase ET CO2
    alveolar hypoventilation
  11. how do you tx myoclonus seen in serotonin syndrome
    • benzodiazepines
    • cyproheptadine for overall syndrome
  12. malignant hyperthermia is caused by
    a defect in the ryanodine receptor on SR
  13. mc s/e of pancuronium
    tachycardia
  14. s/e of cis atracurium
    histamine release
  15. lidocaine max dosage
    5mg/kg, 7 with epi
  16. bupivicaine max dosage
    2mg/kg, 3 with epi
  17. 2nd sx of lidocaine toxicity
    visual and auditory hallucinations
  18. what level epidural effects the heart
    T5
  19. decreased motor in legs after epidural
    mc is medication overdose so decrease and follow if no response then do w/u for hematoma
  20. categories for revised cardiac risk factors
    • high risk surgical procedures
    • histor of ischemic heart dz
    • hx of CHF
    • hx of Cerebrovascular dz
    • preop insulin need
    • preop Cr > 2
  21. largest risk factor for cardiac complication
    uncompensated CHF> recent MI
  22. when is no preop testing needed in a pt who has had a CABG or PTCA
    • if no return of sxs and
    • CABG with in 5 yrs
    • PTCA within 2 yrs
  23. how do you manage a pt who needs an emergency non cardiac procedure and has a hx of cardiac dz
    • maximize wedge pressure 15-20
    • beta blocker
    • nitropaste as pressure tolerates
    • Hct 30 and above
    • fi02 of 100%
    • inotropes for decrease CO
  24. tx for myasthenia gravis
    • pyridostigmine
    • steroids
    • plasmapharesis
    • azathioprine
    • IVIG
  25. when operating on a pt with myasthenia gravis what neuromuscular blocker should you use
    succ
  26. what is the blood supply to the thymus
    ima and inf thyroid
  27. what are the effects of cholinergic crisis
    depolarization blockade
  28. mc rxn to iodine
    nausea
  29. main determinant of intracellular and extracellular osmotic pressure
    Na
  30. composition of LR
    • Na 130
    • K 4
    • Ca 2.7
    • Cl 109
    • lactate 28
  31. calculate plasma osm
    2NA + (glucose/18) + (BUN/2.8)
  32. HD removes what ions
    • k
    • ca
    • mg
    • po4
  33. k requirement
    0.5 - 1 mEq/kg/day
  34. amt of insensible losses/day
    10cc/kg/day
  35. D51/2NS at 125 provides how much glucose/cal per day
    • 150gm of glucose
    • 525 cal
  36. type of secretion with the highest amount of K
    saliva
  37. calculate free water deficit
    (0.6 x weight) x [(Na/140) -1]
  38. tx of hyponatremia in DKA
    nothing just treat underlying illness
  39. top three drugs to treat hyperkalemia
    • 1 amp Calcium gluconate
    • 1 amp NaHCO3
    • insulin/dextrose
  40. mcc of hypermagnesium
    renal failure plus pt taking laxative/antacids or burn/trauma
  41. tx hypermagnesium
    • calcium
    • diuretics
    • dialysis
  42. MCC of hypophosatemia
    refeeding syndrome
  43. causes of anion gap met acidosis
    • methanol
    • uremia
    • DKA
    • propylene glycol
    • infxn/INH
    • Lactic acidosis
    • Ethylene glycol
    • Salicylates
  44. types of non gap met acidosis
    • gi loss of bicarb
    • over diuresis
    • dilutional
    • lactulose
    • hyperparathyroid
    • RTA
  45. tx of DKA
    • treat underlying precipitants
    • NS 10cc/kg/hr
    • insulin 10 U then 0.1 u/kg/hr until gap normal
    • add k to drip if <4.5
  46. amount of kcal needed per day
    25 kcal/kg/day
  47. calories/protein needed with burns
    • 25 + (30/day x % burn)
    • 1 + (3g x % burn)
  48. harris benedict equation uses what to calculate BMR
    • height
    • weight
    • age
    • gender
  49. what are micelles
    aggregates of bile salts, long chain FFAs, monoacylglyderides, and cholesterol
  50. major component of chylomicrons
    TAGs
  51. lipoprotein lipase are located where
    endothelium
  52. located on cell membrane and helps to transport FAs into cell
    fatty acid binding protein
  53. carry newly synthesized TAGs and cholesterol from liver to adipose tissue
    VLDL
  54. majority of total body cholesterol
    is synthesized
  55. what are two essential fatty acids
    linolenic linoleic
  56. obligate glucose users
    • peripheral nerves
    • adrenal medulla
    • rbcs
    • wbcs
  57. primary glycogen storage areas
    • #1 muscle
    • #2 liver
  58. what are the non essential aas
    those that begin with A G C + serine, proline, tyrosine, histidine
  59. what are the essential aas
    • leucine, isoleucine
    • valine
    • lysine
    • methionine
    • phenylalanine
    • threonine
    • tryptophan
  60. aas that can be metabolized by muscle outside liver
    branched chain leucine, isoleucine, valine
  61. site of urea cycle
    liver
  62. major fuel source is short chain FAs
    • heart
    • colon
  63. major fuel source is glutamine
    stomach, small bowel, pancreas, spleen
  64. neoplastic cells prefer what fuel source
    glutamine
  65. RQ = 0.8
    protein metabolism
  66. RQ that resembles balanced feeding
    0.825
  67. acute indicators of nutritional status
    • pre albumin
    • transferrin
    • retinal binding protein
    • total lymphocytes
  68. maximum glucose concentration in TPN
    3g/kg/hr
  69. composition of TPN
    • 20% protein
    • 30% fat
    • 50% dextrose
  70. FFA oxidation occurs where
    inner mitochondrial space
  71. precursors for gluconeogenesis
    • alanine
    • lactate
    • pyruvate
    • glycerol
  72. only amino acids to increase with stress
    • alanine
    • phenyl-alanine
  73. main cause of trace mineral def
    TPN
  74. vit E def leads to
    neuropathy, spinocerebellar ataxia
  75. szs, cheilitis, peripheral neuropathy
    pyridoxine def
  76. def of essential fatty acids causes
    • thrombycytopenia
    • dermatitis
    • poor wound healing
  77. often 1st manifestation of trace mineral def
    poor wound healing
  78. trace mineral def associated with cardiomyopathy
    selenium

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