Anesthesia ITE prep – Flashcards
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What causes right shift in O2 Hb curve?
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acidosis, hyperthermia, increased 2,3 DPG, hypercarbia, preggers, bad anemias (sickle cell, thalas) volatiles at 1 MAC
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What causes left shift in O2 Hb curve?
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alkalosis, hypothermia, low 2,3,dpg, hypocarbia, CO, methemoglobinemia, hypophos
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Mg effects
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V-asodilator A-nticonvulant S-edative, skeletal relaxant T-ocolytic potentiates local anes, and ND NMBs
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Mg effects cardiac
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decreases contractility
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what happens with acute smoking cessation
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CO decreases --> improves O2 delivery CN decreases less nicotine --> better vasodilation, improved wound healing
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how does smoking affect anesthesia
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wound infections respiratory/airway complications coughing decr coronary flow reserve, HTN, ischemia current smoker = 6x increase in post op pulm comp
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What factors help local anesthetics cross the placenta?
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lipid solubility size - <500kD degree of ionization maternal drug conc maternal and fetal pH
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Bupivicaine and placental transfer
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pKa = 8, and 95% protein bound. won't cross
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how do R-->L shunts affect rate of induction?
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SLOWS because it dilutes the anesthetic
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What factors affect rate of rise of Fa/Fi?
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blood gas solubility constant - less soluble --> faster CO - lower --> faster minute ventilation --> higher --> faster Alv-venous pp difference
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Poorly soluble agents don't really depend on alveolar ventilation (des, NO2, sev)
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SOLUBLE agents are VERY dependent on alveolar ventilation (iso, halo, enf)
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Epiglottitis: mechanism
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acute inflam disease of SUPRAGLOTIC structures --> complete airway obstruction, hypoxia, death. H flu (now obs w vax), staph aureus
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epiglottits px
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tripos, sore throat, fever, dysphagia, drool, inspiratory stridoe, respiratory distresss, TOXIC vs croup (subglottic)= barking cough, rx with O2 mist, racemic epi
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what enhance NMBs?
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volatiles, LA, Mg, Li, CCB, dantrolene, aminoglycosides, lasix
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when is succ contraindicated in eye surgeries?
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open anterior chamber
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SVR =
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MAP-CVP/CO*80
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Fick equation = CO =
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VO2/ CaO2-CvO2
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O2 content
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1.36HgbXO2 sat + PaO2x0.0003
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o2 tank psi and vol
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2200/660
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factors that affect fa/fi rate of rise
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solubility lower faster CO (lower,faster) MV higher faster alveolar to venous partial pressure difference
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how does r to l shunt affect inhalational fa/fi
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slows. dilutional effect
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max dose lidocaine, w epi
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500
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max dose w epi prilocaine
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600
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max dose bupiv w epi
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225
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max mepic w epi
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500
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what drugs cant cross placentA?
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Heparin Insulin Glyco Non depol NMbs suxx
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what is therapeutic level of mg?
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5-7 mEq
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side effects of mg (toxicity by level)
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EKG changes loss of dtrs respiratory paralysis cardiac failure Rex w cacl
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what factors decrease FRC
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Preggers Ascites Neonates GA Obesity Supine
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what factors increase FRC
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PEEP emphysema elderly
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how man mm of A-a gradient is proportional to 1% of shunt?
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20 or A-a gradient/20= %shunt
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what is normal Vd
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2cc/kg
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intrathoracic mass, which loop in flow iss flattened
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expiratory
