ANESTHESIA BOARD QUESTION OF THE DAY – Flashcards

skeletal muscle

alcohol abuse

omeprazole (prilosec)

bivalirudin

enoxaparin; Low molecular weight heparins (LMWH), such as enoxaparin, have greater activity against factor Xa than thrombin. As a result, the INR is not a reliable monitoring tool. The LMWHs cause less platelet inhibition and are associated with a lesser incidence of heparin induced thrombocytopenia. (Barash)

diffusion of succinylcholine away from the receptors. Because depolarizing muscle relaxants are not metabolized by acetylcholinesterase, they diffuse away from the neuromuscular junction and are hydrolyzed in the plasma by pseudocholinesterase. (Morgan and Mikhail, p 209

offers coverage if the policy was in place at the time of the incident, regardless of when the claim is filed; An occurrence policy offers coverage of an incident resulting in a claim, whenever that claim might be filed. The much more common claims-made policy covers claims that are filed only while the insurance is in force. Umbrella coverage is activated at the time of the need to pay a claim that exceeds the limits of coverage on the standard malpractice policy.

Droperidol: has antiarrhythmic activity Droperidol has mild alpha-blocking activity and causes vasodilation and has antiarrhythmic properties with prolongation of the QT interval. As a result of the prolongation of the QT interval, droperidol has been associated with torsades de pointes and should not be given to patients with QT intervals measuring more than 440 ms. Patients with pheochromocytoma should not receive droperidol because it can induce catecholamine release.

The phrenic nerves arise from the C3 - C5 nerve roots. Unilateral phrenic nerve palsy only modestly reduces most indices of pulmonary function (about 25%). Bilateral phrenic nerve palsies produce more severe impairment, but accessory muscles may maintain adequate ventilation. Cervical cord injuries above C5 are incompatible with spontaneous ventilation. pg. 542 Morgan, GE, Mikhail, MS, and Murray, MJ.

Factors associated with primary ALI are: excessive intravascular volume, high ventilation pressures, right pneumonectomy and preoperative alcohol abuse.

Radiation accounts for approximately 40% of intraoperative heat loss. Convection is the next most significant mechanism of loss accounting for 32%. (Morgan and Mikhail)

Sinus arrhythmia is a cyclic variation in heart rate that corresponds to ventilation, increasing with inspiration and decreasing with expiration. Sinus arrhythmia is a normal cardiac rhythm and is due to cyclic changes in vagal tone. Morgan and Mikhail p 420

Blood concentration of local anesthetic is dependent on the total volume and concentration injected. However, the intercostal block results in the highest blood levels of local anesthetic per volume injected of any block in the body.

The incidence of venous air embolism is highest during sitting crainotomies, with an incidence of 20 - 40%. Venous air embolization can occur during any procedure when the wound is above the level of the heart.

Because of its unique metabolism, the Hoffman elimination, the duration of action of atracurium may be prolonged by hypothermia or acidosis

Tumescent liposuction is commonly done with large volumes of tumescent solution consisting of normal saline with 1:1,000,000 epinephrine and 0.025 - 0.1% lidocaine. Peak serum levels of lidocaine occur 12 - 14 hours after injection and decline over the next 6 - 14 hours. (Barash)

Remifentanil is prepared in a solution of glycine, a known inhibitory neurotransmitter. Currently remifentanil is not approved for epidural or intrathecal use.

the intravenous administration of caffeine Both caffeine and theophylline have been shown to reduce the incidence of postoperatitive apnea in infants at increased risk. Caffeine is favored because of its wider therapeutic margin. The recommended loading dose is 10 mg/kg caffeine base. (barash)

: mu receptors The cardiovascular effects of narcotics appear to be mediated through the mu receptors. In addition, these receptors seem, at least in part, to be responsible for the ventilatory depression associated with narcotic admnistration.

1mAmp: perception threshold 15mAmp: let-go current 100 microAmp: microshock risk 200 mAmp: v-fib

Mortality after liposuction procedures most commonly is the result of: pulmonary embolism The mortality rate from liposuction procedures is approximately 0.02%. The most common cause of mortality is pulmonary embolism accounting for 23.1% of the deaths.

: decreased bronchial secretions The tracheobronchial tree receives sympathetic innervation form the T1 - T4 nerve roots. β2 stimulation causes bronchodilation and decreased secretions. α1 stimulation causes decreased bronchial secretions and possible bronchoconstriction. Both α- and β-adrenergic receptors are present in the pulmonary vasculature, but seem to have little effect on pulmonary vascular tone.

left ventricular subendocardium The subendocardium of the left ventricle is most vulnerable to ischemia since this is an area of greater systolic shortening. In addition, left ventricular subendocardium perfusion is almost entirely restricted to diastole, in contrast to the subendocardium of the right ventricle that receives most of its perfusion during systole.

valerian Both valerian and kava have been shown to have a GABA-mediated hypnotic effect and by this mechanism decrease MAC. Acute withdrawl after chronic use may result in an increase in MAC.