ANESTHESIA.txt

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Author:
dohertys
ID:
162200
Filename:
ANESTHESIA.txt
Updated:
2012-07-12 00:45:35
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anesthesia drugs meds
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anesthesia
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  1. ANESTHESIA
  2. Typical indications in a rural emergency room for intubation?
    • Head trauma
    • Drug overdose
    • Respiratory failure
  3. What equipment do you want for intubation?
    • ET tubes
    • Laryngoscope
    • Suction
    • Ambu bag (with reservoir)
    • Stethoscope
    • IV access
    • Taping for tube
    • Monitoring system - ECG, pulse oximetry, end tidal O2 monitor
    • Syringe (to inflate the cuff)
    • Stylet
    • Lubricant and Xylo spray
    • Rescue airways (LMA, etc)
    • Oral airway and nasal airway
    • Glide scope
    • Kit available for cricothyroidotomy
  4. Physical features difficult intubation?
    • Short, thick muscular neck
    • Fracture, receding or immobile mandible
    • Prominent incisor teeth
    • Rigid cervical spine
    • Neck trauma
    • Mallampati III or IV
  5. What does each class of Mallampati mean?
    • Structures that can be seen with mouth open, seated
    • I: soft palate, uvula, fauces and pillars visible
    • II: soft palate, uvula, fauces visible but not pillars
    • III: soft palate only visible
    • IV: hard palate only
  6. What is another score for predicting laryngoscopic view?
    • Hussain Khan (Upper Lip bite) class
    • I - lower incisors can hide mucosa of upper lip
    • II - lower incisors partially hide mucosa of upper lip
    • III - unable to touch mucosa of upper lip
  7. Dose of succhinylcholine for induction?
    • 1 - 1.5 mg/kg
    • 100mg in 70kg man
  8. What kind of drug is Succinylcholine (SCH)?
    Depolarizing muscle relaxant - made up of 2 ACh molecules bound together
  9. Onset and duration of succinylcholine?
    • Onset 30-45s (fastest)
    • Duraiton - 4-5 min
  10. Contraindications of SCH (succinylcholine)?
    • burns, crush injuries
    • pseudocholinesterase deficiency
    • malignant hyperthermia
    • open eye injuries
  11. Dose of Thiopental (Pentothal) for induction?
    Thiopental 2.5-4 mg/kg IV = 200mg in 70kg man
  12. What is the class of Thiopental?
    Barbiturate
  13. Properties of sodium thiopental?
    • barbiturate - for induction/sedation
    • direct myocardial depressant
    • peripheral vasodilation --> lowers MAP
    • Reflex tachycardia
  14. Speed of onset and duration of thiopental?
    • Onset 10-20s
    • Duration 10 minutes
  15. What is Rocuronium?
    A non-depolarizing muscle relaxant
  16. Dose of Rocuronium for induction?
    • 0.6 - 0.8 mg/kg as intubating dose for short-acting (30 min duration) (2-3 min onset)
    • Or
    • 1.2mg/kg for longer acting (60 min) with quicker onset (1 min)
    • Typical dose in 70kg man:
    • 50 mg intubation dose, 80mg for longer action
  17. Properties of Etomidate?
    • Imidazole derivative - for induction/sedation
    • Acts on GABA Rc
    • Hemodynamic stability
    • mild decrease in MAP
    • s/e - adrenal suppression, pain on injection, n/v
  18. Properties of propofol?
    • Substituted phenol - for induction/sedation
    • myocardial depression, peripheral vasodilation - drop in MAP
    • (moreso than STP/thiopental)
    • Minimal effect on HR
  19. Propofol dose?
    2-3mg/kg IV
  20. Propofol onset and duration?
    • <1 min
    • duration 10-15 min
  21. Contraindications to propofol?
    hypotension, shock
  22. Properties of Ketamine?
    • Phencyclidine derivative - induction/sedation
    • Sympathomimetic - increased CO, MAP and HR
  23. Ketamine dose?
    1 - 2.5 mg/kg IV
  24. Onset of Ketamine and duration?
    • < 1 min onset
    • 10-20 min
  25. Contraindications to ketamine?
    • head trauma (relative)
    • hypertension
    • ischemic heart disease
  26. Midazelam dose?
    • 0.02 mg/kg (sedation range)
    • 0.3 mg/kg (induction range)
  27. Contraindications to Midazolam?
    • Hypotension
    • Disadvantage is its unpredictability
  28. Properties of midazolam?
    • Benzodiazepine - induction/sedation
    • anxiolysis, sedation, amnesia
    • No effect on MAP or CO.
  29. Properties of opioids?
    • For induction/sedation
    • vagolytic effect - bradycardia
    • (except meperidine - tachy)
    • decreased MAP
  30. Contraindications of thiopental (STP)?
    • sulfa allergy - contains sulfa
    • porphyria - induces porphyrin synthesis - abdo pain, weakness, autonomic dysfxn
    • caution in hypovolemia or poor systolic fxn
    • advance age, hepatic dysfxn, obesity (prolonged effects)

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