Surgical test 1 – Flashcards
Unlock all answers in this set
Unlock answersquestion
What is the anesthetic for choice for abdominal cases in the United States?
answer
General, but balanced anesthesia provides excellent surgical anesthsia
question
How can General anesthesia compound effect on respiratory system?
answer
Airway resistance, shunt, and V/Q mismatch increase. ALL promoting hypoxia
question
How long does it take FRC to return to normal Post Op? What makes it worse?
answer
normally 7-10 days with obesity 10-14. Inadequate narcotics can cause splinting which worsens FRC
question
What are advantages of neuroaxial anesthesia
answer
Blocks stress response, no residual effect of GA, decreased suppression of cardia and respiratory systems unless a high block, Minimal systemic side effects
question
What is the blood supply to the liver?
answer
Hepatic artery and portal vein
question
Hepatic blood flow =
answer
SVR - hepatic splanchnic pressure
question
True or false: Increases in hepatic splanchnic pressure is directly proportional to proximity of surgical site to the liver
answer
True
question
What is normal renal blood flow?
answer
1100-1200 mL/minute
question
What is normal cardiac output
answer
5-6L/minute
question
How does abdominal surgery affect (effect?) RBF and GFR?
answer
decreases, also urine output decreases
question
How does abdominal surgery affect (effect?) splanchnic blood flow?
answer
decreases, GA also decreases- may explain PONV
question
What drugs do you give for the GI system when preforming an RSI?
answer
Metoclopramide 10 mg (5-10 mg) Famotide 20 mg (5-10 mg) Both IV 30-60 minutes pre op Sodium Citrate, bicitra 30 mg PO immediately prior to surgery
question
How long do you pre oxygenate a RSI patient?
answer
3-5 minutes
question
What maneuver do you preform during an RSI?
answer
Sellick's
question
What is the dose of propofol for a RSI?
answer
1.5-2.5 mg/kg
question
What is the dose of etomidate for an RSI?
answer
0.3 mg/kg
question
Can you use STP for an RSI?
answer
yes
question
What is the dose of succinylcholine for an RSI?
answer
1.5 mg/kg
question
What is the dose of rocuronium for an RSI?
answer
1.2 mg/kg
question
What are the peritoneal structures?
answer
JOG STUPID LASS Jejunum Ovaries Gallbladder Stomach Transverse Colon Uterus Pancreas (tail) Ileum Doudenum Liver Appendix Spleen Sigmoid Colon
question
What are the retroperitoneal structures?
answer
SAD PUCKER Suprarenal Glands Aorta&IVC Doudenum Pancreas (not tail) Ureters&bladder Colon Kidneys Espohagus Rectum
question
Where is a Kocher procedure? When is it used?
answer
RUQ for gallbladder or liver access
question
Where is a McBurney procedure? When is it used?
answer
RLQ, appendix access
question
Where is a Pfannenstiel procedure? When is it used?
answer
Transverse incision above pubis, C-section and uterus access
question
What are anesthetic considerations for Appendectomy
answer
RSI, Dehydration-fever and emesis, with perforation: Peritonitis-paralytic blues and Abcess-infection/sepsis
question
What is the duration of Appendectomy?
answer
15-30 minutes
question
Cholangiogram
answer
Dye injected into CBD and examined with flour to search for stones. Can be preformed intraoperativly
question
What comorbities can you expect with a patient requiring a cholecystectomy?
answer
cirrhosis, pancreatitis, or obesity
question
What is the duration of a cholecystectomy
answer
45-90 minutes, faster when laparoscopic compared to open
question
What is significant to anesthesia if a patient is having a colon resection for a disease like Crohn's?
answer
They likely have chronic steroid therapy
question
What are the extubation parameters in our notes about Colon resection?
answer
VC>15mg/kg and rate <24, ABGs appropriate for patient
question
What is normal blood loss for colon resection?
answer
400-500 mL
question
What is the duration of a colon resection?
answer
60 minutes without a colostomy, 90 mins with colostomy
question
What are some etiologies of a case that would require a small bowl resection?
answer
Obstruction, ischemic bowel, internal hernia, voluvlus, Chron's, or tumors. Consider RSI!
question
What is the duration of a small bowel resection
answer
60-180 minutes
question
Describe ventral hernia repair
answer
Repair of a hernia in the ventral fossa-> usually incisional hernia, mesh is frequently inserted, closer with retention sutures. Think they will also have comorbities of the procedure they had that lead them to need the surgery
question
What is the duration of ventral hernia repair
answer
30-120 minutes
question
What are anesthetic consideration for a ventral hernia repair?
answer
LMA vs ETT, if extensive maybe post op analgesia with epidural or surgeon can perform a field block
question
What are anesthetic consideration for a patient with Hodgkin's disease getting a splenectomy?
answer
Chemo drugs: bleomycin, methotrexate, or cytarabine may cause pulmonary fibrosis
question
What is a pulmonary concern with splenectomy?
answer
23% risk of post-op pulmonary complications, due to splenomegaly may have LLL atelectasis
question
What is a regional anesthesia concern with splenectomy?
answer
low platelet count
question
What is the duration of a splenectomy?
answer
60-90 minutes
question
Estimated blood loss for splenectomy?
answer
50-100 mL unless coagulopathy
question
Pancreaticoduodenectomy (Kaush-Whipple) is the removal of
answer
Antrectomy (distal stomach), Choledochectomy (CBD), Duodenum, Regional lymph nodes, Cholecystectomuy (GB and Cystic duct), Head of pancreas, proximal jejunum
question
What is the mortality of a Pancreaticoduodenectomy (Kaush-Whipple)
answer
15%
question
What are some anesthetic considerations for a Pancreaticoduodenectomy (Kaush-Whipple)
answer
25% have malnutrition from delayed gastric emptying. Recommend GA/epidural. Large fluid loss! CVL necessary, PA cathter. Brittle diabetic post-op
question
What is the duration of a Pancreaticoduodenectomy (Kaush-Whipple)
answer
4-6 hours
question
Cystectomy Regional anesthesia considerations
answer
T4 level required due to peritoneal stimulation
question
Cystectomy estimated blood loss
answer
15oo mL
question
Duration of Cystectomy
answer
2-6 hours
question
True or false Cystectomy procedure requires a bowel prep
answer
True
question
What is post nephrectomy syndrome
answer
loss of L1 dermatome distribution secondary to retractor injury
question
What is a radical nephrectomy?
answer
Kidney and ureter
question
What position would you place a patient receiving a nephrectomy?
answer
Flank or prone
question
What is the EBL for a patient receiving a partial nephrectomy?
answer
1500 mL
question
What is the duration of a nephrectomy?
answer
2-4 hours
question
Rheumatoid arthritis and the pre op assessment
answer
Cervical Spine, Temporal-mandibular joint, and Larynx Chronic steroid use associated with pulmonary, cardiac and musculoskeletal involvement. Neck ROM Atlantoaxial instability with subluxation of the odontoid process-> spinal cord injury
question
What medication do you continue through the pre op period
answer
antihypertensives and chronic opioid therapy
question
What medication do you consider changing pre operatively?
answer
Hemostasis altering drugs? may start ASA or warfarin
question
What are 2 good question to ask patients with stents?
answer
What type? How long have you had them?
question
Do you hold or continue diuretics the day of surgery?
answer
Do not take
question
Routine laboratory testing (this contradicts Wrights lecture kinda)
answer
CBC, BMP, PT, PTT, INR, Blood type and screen (antibodies), blood donation
question
What should you prepare for when setting up for a cervical spine case?
answer
Neck stabilization (careful intubation), carefully document sensory and motor deficits pre op, Good IV access, consider a-line, type and screen, SSEP and EMG monitoring, TIVA/narcotic technique, precordial doppler, extubatne when fully awake
question
What test do you look at to prepare for a scoliosis surgery?
answer
CXR, ABG, PFT
question
What do the results show you from a PFT on a scoliosis patient?
answer
Vital capacity- restrictive problem >70% adequate respiratory reserve <40% post op ventilation may be required
question
What do you do for an air embolism?
answer
Flood field, left lateral position to move air to right side
question
What are the cardiovascular considerations for a patient with scoliosis surgery?
answer
High incidence of mitral valve prolapse and pulmonary hypertension. May preform ECG and ECHO
question
What part of the cord does the wake up test look at?
answer
anterior part of the cord
question
Scoliosis patients my have muscular dystrophy which alerts you to the risk of_____
answer
Malignant hyperthermia
question
What are hematologic consideration for scoliosis surgery
answer
Avoid platelet inhibiotors for 2-3 weeks pre op encourage autologous blood donation controlled hypotension, cell saver devices, and volume expanders Tests: CBC, clotting profile, clot to blood bank, type and cress for 2-4 units for PRBCs
question
What does SSEP monitor?
answer
SomatoSensory Evoked Potential Posterior (dorsal/sensory) cord function. Indicates spinal cord ischemia. Very sensitive to volatile.
question
What does MEG monitor?
answer
Magnetoencephalography. Anterior cord function
question
What are the effects of the prone position?
answer
Pooling of blood in extremities, compressed abdominal muscles (decreased preload, cardiac output, and blood pressure), decreased total lung compliance, increased work of breathing, decreased cerebral venous drainage and CBF from extreme head rotation
question
What are effects of the lateral decubitus position?
answer
Cardiac output is not changed unless there is venous return obstruction, decreased volume in dependent lung and increased perfusion of the dependent lung
question
What are effects of the sitting position?
answer
Pooling of blood in lower extremities decreases the central blood volume, cardiac output and blood pressure decrease the compensatory increase in HR & SVR, Lung volumes and RC increase, cerebral blood flow decreases
question
Which frame is most likely to cause post op blindness?
answer
Wilson frame- only modifiable factor to prevent
question
What are factors that lead to blindness?
answer
Male, obesity, non-colloid fluid replacement, increased blood loss, anesthetic duration
question
Intraoperative management of a patient with scoliosis surgery
answer
Controlled hypertension to decrease blood loss, SSEP & MEG
question
What do you do when the SSEP monitor shows ischemia?
answer
restore normal blood pressure, release cord traction, No muscle relaxation (during testing of instrumentation or with EMG monitoring unless requested by the surgeon and should be documented on the anesthesia record
question
Wake up test
answer
Provides information reguarding the anterior (motor) spinal cord but does not test function of the dorsal volume (sensory) No longer routine-do not leave patient- various level of stimulation and blood loss, have blood products ready, frequent ABG, H/H, and electrolytes
question
What type of blocks can be used in a shoulder arthroscopy/rotator cuff repair?
answer
Interscalene nerve block and brachial plexus catheters
question
Hypertensive bradycardic episodes
answer
a decrease in heart rate of at least 30 beats per minute within a 5 minute interval, any heart rate less than 50 beats permute, and/or a decrease in systolic blood pressure of more than 30 mmHg within a 5-minute interval or any systolic pressure below 90mmHg
question
Bezold-jarish reflex
answer
inhibitory reflex mediated through cardiac sensory receptors with a vagal efferent limb
question
Beach chair position
answer
Enhanced venous pooling occurs due to dependent extremities, leading to subsequent increase in sympathetic tone and a low-volume hyper contractile ventricle
question
Treatment of bezold-jarish reflex
answer
Prophylaxis- prevent HBE by aggressive treatment of fluid deficits and blood loss, minimize venous pooling-support stockings, avoid the use of local anesthetics containing epinephrine and consider use of beta blocker (different from what you would think)
question
There is a tension pneumothorax risk with arthroscopy. What are the signs of a tension pneumothorax?
answer
Sudden hypoxemia, elevated CVP, Tachycardia, absent breath sounds on affected side, tracheal shift, agitation, hypotension, jugular vein distention, increased airway pressures
question
How wide should the pneumatic tourniquet be
answer
50% of the extremity
question
How much do you inflate an pneumatic tourniquet?
answer
upper- Do not exceed 300 mmHg Lower- SBP+100mmHg= effective bleeding control Do not exceed 500 mmHg
question
Esmarch bandage
answer
used prior to tourniquet inflation to exsanguinate limb. Bandage applied, t. inflated, then removed
question
How long can a tourniquet be on before it produces tourniquet pain, hypertension, and underlying nerve injury
answer
60 minutes
question
What kind of pain do patients experience when the tourniquet has been on for 45-60 minutes? What fibers are mediating that pain?
answer
Unmylenated C fibers. Aching>burning> excrutiating pain
question
What nerve fibers cause tingling post deflation?
answer
Mylenated A-delta fibers
question
With tourniquet usage how do you prevent injury
answer
Keep inflation<2 hours, Avoid excessive pressures (359 mmHg), keep extremity well padded and free from wrinkles, cuff should properly fit extremity, keep pressure well displayed, document application of the tourniquet and ischemic time: inflation and deflation
question
What position do you place a patient having hip arthroplasty?
answer
lateral decubitus position
question
How do you set up the bed for a patient with a hip/femur fracture?
answer
Fracture table, maintenance of traction on the fractured extremity for closed reduction and fixation, access to fracture site for radiography in several planes, general or regional anesthesia, pad perineal post, place ipsilateral arm on arm board or sling to keep it from obstructing fluoroscopy
question
What happens vascularly when prosthetic component is secured with methylmethacrylate
answer
PVR and SVR decreases, decreases CO
question
What are the risk factors for a fat embolus
answer
Male, age 20-30, hypovolemic shock, intramedullary instrumentation, rheumatoid arthritis, total hip arthroplasty involving cemented femoral stem, bilateral total knee surgery
question
What is the occurrence of Fat Embolism?
answer
12-40 hours after surgery. multiple traumatic injuries and surgery involving long bone fractures, incidence 3-4% with mortality of 10-20%.
question
What are the symptoms of a fat embolus?
answer
axillary/subconjunctival petechiae, hypovolemia CNS depression disproportiante to hypoxemia, pulmonary efema, tachycardia, hyperthermia, retinal fat emboli on fundoscopic exam, urinary fat globules, sputum fat globules, unexplained decrease in platelets and hematocrit
question
How do you treat a fat emboli
answer
early surgical stabilization of fracture, aggressive respiratory support, reversal of affirmation factors such as hypovolemia, early recognition
question
What are the 1st 3 branches off the aorta?
answer
Brachiocephalic artery, left common carotid, left SCA
question
What come off the thoracic descending aorta
answer
intercostals, subcostals, bronchials, and supply to mediastinum and diaphragm
question
Arteries that supply the Visceral area
answer
celia trunk, superior mesenteric aretery, inferior mesentaric artery, renal arteries, suprarenal arteries
question
Celiac trunk (1st below diaphragm)
answer
liver, stomach, abdominal esophagus, spleen and the superior half of both duodenum and pancreas
question
Superior mesenteric artery
answer
investing from duodenum to 2/3 of transverse, pancrease
question
Inferior mesenteric artery
answer
from splenic flexure to recur; communicates with SMA
question
Radicularis Magna (artery of adamkiewicz)
answer
Flow to spinal cord, compromise results in anterior spinal artery syndrome-preservation of sensory function with loss of motor skin and urinary/fecal control 83% arise from left between T8 and L1 (from left intercostal artery)
question
What is the etiology of aortic aneurysms
answer
Medial cystic necrosis (familial), syphilis (ascending AA), RA, ankylosing spondylitis, trauma. Most often atherosclerosis
question
If an aortic aneurysm is >6cm then there is a __ chance of rupture in 1 year
answer
50%
question
What size of an aneurysm is surgery usually preformed?
answer
4 cm
question
When can an endovascular repair be preformed when
answer
larger than 3 cm but smaller than 6 cm
question
What is mortality for an aortic aneurysm repair?
answer
2-5% with no leak, 50%+ with leak or rupture
question
What is an intimate tear? What can happen if you have one?
answer
Allows blood to flow into the vessel wall into media. Can disrupt the intimate and rupture the vessel. Can occlude tributary branches or disrupt aortic valve
question
Type I aneurysms
answer
Surgical, involves the ascending aorta, aortic arch, and descending aorta
question
Type II aneurysm
answer
Surgical, confined to the ascending aorta
question
Type III aneurysm
answer
managed medically, confined to the descending aorta distal to the left subclavian artery
question
How do you treat aortic aneurysm pre operatively
answer
after load reduction (nitroprusside) and beta blocker (esmolol infusion). Trimethaphan or labetalol commonly used
question
Leriche's syndrome
answer
Thrombosis forms in forty usually at area of most turbulent flow. Treated with aortobifemoral bypass graft, endarterectomy possible
question
Bentall procedure
answer
graft replacement of aortic valve, aortic root, and preimplantation of coronary arteries into graft. get a L radial art line or femoral or doornails pedis or a combo of 2
question
Hypothermic circulatory arrest
answer
Cerebral protection provided with deep anesthesia, circulatory arrest, and induced systemic hypothermia, core temperature decreased to 15 C, barbiturate infusion to flatline EEG, Dexamethasone or methylprednisalone are frequently given, phenytoin common, rearming period will be time consuming, large blood loss
question
Descending thoracic aneurysm
answer
Left thoracotomy with no bypass, may need one lung ventilation, Right radial art line, PA catheter, large blood loss
question
What are poor outcomes of Thoracic aneurysm repair? death, stroke, MI and...
answer
Paraplegia- usually anterior spinal artery syndrome (transient 11% paraplegia 6%) Renal failure- give mannitol prior to cross clamp, fendoldpam infusion
question
What do you give to protect the kidney's prior to cross clamp
answer
Mannitol 0.5 g/kg prior to cross clamp Fenoldopam infusion
question
What should be done when the surgeon releases the cross clamp
answer
bolus 1L colloid IVF, decrease depth, vasopresson (phenylephrine), NaHCO3 and CaCl
question
True or false AAA patients can be extubated in OR
answer
True, it is common for TAA patients to remain intubated
question
How do you preform anesthesia for an endovascular AA repair? What are special considerations?
answer
MAC, Spinal, or general. When ballooning there is massive increase in BP so deepening is helpful. Thoracic is more hemodynamically significant
question
Where does the right common carotid come from?
answer
brachiocephalic
question
Where does the left common carotid come from?
answer
branch of the aorta
question
Does the internal or external carotid have more branches in the neck?
answer
External
question
What forms the circle of willis?
answer
internal carotid 80%, most of the circle of willis are actually branches of the internal carotid arteries. Also the 2 vertebrals make up 20% of flow
question
Reversible ischemic neurologic deficit
answer
24 hours-2 weeks
question
What is indication for surgical correction of carotid stenosis?
answer
>70% usually >90%
question
What is operative mortality of carotid endarterectomy?
answer
1-4% mostly from cardiac complications MI
question
What is preoperative morbidity of Carotid endarterectomy
answer
4-10% primary neurological
question
How does hicks like us to maintain MAP in a CEA
answer
at baseline or up to 15% above baseline
question
What are good induction agents for a CEA?
answer
Opioids, barbiturates, and hypnotics are safe
question
Benzodiazepines and Carotid Endarterectomy
answer
don't use because interferes with neuro assessment
question
Low molecular weight dextran
answer
given in CEAs to decrease blood viscosity and decrease microemboli
question
How do you prevent bradycardia during a CEA? Why would it happen
answer
Inject 1% lidocaine/atropine. Induced by manipulation of C baroreceptor
question
At what rate of flow does the EEG signal become diminished
answer
<15 mL/100g
question
At what flow is there cortex ischemia
answer
below 12 mL/100g
question
With an EEG is there a high false positive or false negative?
answer
False positive
question
Transcranial dopper
answer
detect emboli in cerebral circulation
question
Stump pressure
answer
needle connected to transducer placed in artery proximal to clamp that measures pressure in Circle of Willis. Minimal between 25-70 mmHg depending on literature
question
Cerebral oximetry
answer
Very similar to pulse ox, 2 sided, check baseline with no supplemental O2, want to maintain values at or within 20% of baseline on room air,
question
What forms of anesthesia can be used during a femoral popliteal bypass?
answer
General anesthesia, Subarachnoid block, lumbar epidural anesthesia
question
What is the expected blood loss during a femoral popliteal bypass?
answer
250-500 mL
question
What is the duration of a fem pop bypass?
answer
45-120 minutes
question
FEV1
answer
Forced expiratory volume measured in one second
question
What is the mortality in pulmonary resection cases?
answer
4%
question
What is the percentage of patients that suffer resp. complications with a pulmonary resection?
answer
21%
question
What is the percentage of patients that suffer cardiac complication with a pulmonary resection?
answer
15%
question
How many segments are there in the lung?
answer
42
question
How many segments are in the right upper lobe?
answer
6
question
What is the most common cardiac complication post thoracotomy?
answer
arrhythmias, mostly a fib
question
Myasthenic syndrome (Eaton Lambert Syndrome)
answer
muscular weakness seen with bronchial carcinomas, caused by decreased Ach release, no improvement after AChe, usually proximal muscles of limb, may be seen in pts with thyroid disease and SLE (lupus), marked sensitivity to depolarizers and nondepolarizers, may have temporary improvement when cancer is removed
question
What is the best ventilator mode for one lung ventilation?
answer
pressure control
question
What is the goal for one lung ventilation?
answer
same minute ventilation 8-10 cc/kg and EtCO2 35-40
question
What are absolute indications for one lung ventilation?
answer
Avoid contamination, control the distribution of ventilation (bronchopleural fistula, lung cyst, tracheobronchial disruption), or to preform unilateral bronchopulmonary lavage
question
What are relative indications for one lung ventilation?
answer
Surgical exposure, High priority- thoracic aortic anerysm, upper lobecotmy, pneumonectomy Low priority- esophageal resection and middle and lower lobectomy
question
What do you hear when placing a double lumen ETT when you clamp tracheal lumen with both cuffs inflated AND the tube is in too far on the left side? R lung and left lung
answer
Left- breath sounds Right- no breath sounds
question
What do you hear when placing a double lumen ETT when you clamp tracheal lumen with both cuffs inflated AND the tube is out too far? In the left lung? Right lung?
answer
Left- breath sounds Right- breath sounds
question
What do you hear when placing a double lumen ETT when you clamp tracheal lumen with both cuffs inflated AND the tube is in too far on the right side? In the left lung? Right side?
answer
Left- no breath sounds Right- breath sounds
question
Is it safer to use a Right or Left sided double lumen tube? Why?
answer
Left because the left side has a greater margin for saftey
question
What 2 sizes of double lumen tube would you use for a woman?
answer
35 and 37
question
What 2 sizes of double lumen tubes would you use for a male?
answer
39 and 41
question
How much CPAP should you start with during One lung ventilation?
answer
begin with 5-10 cm of CPAP to non ventilated lung
question
How do you progress when adding PEEP to the ventilated lung during one lung ventilation?
answer
start with 5-10 cm H2O then 10-15 cmH2O. If that does not work you can place ligature around PA of the non ventilated lung to reduce shunt
question
What happen to the cardiovascular system when the patient is in lateral decubitus position?
answer
decreased venous return and decreased cardiac output
question
What happen to the respiratory system when the patient is in lateral decubitus position?
answer
decreased pulmonary compliance and increase V/Q mismatch, hypoxia, alveolar collapse, interstitial pulmonary edema
question
Do volatile anesthetics or TIVA decrease HPV more?
answer
Volatile anesthetics
question
At what predicted post op FEV1 do you plan staged weaning from mechanical ventilation and only consider extubation if >20% and they have thoracic epidural analgesia
answer
<30%
question
Trocar
answer
cannula through which cameras and instruments are inserted into abdomen
question
What type of camera is used during laparoscopic surgery?
answer
all digital using fiber optic
question
What is the Veress needle technique for insufflation of the abdomen?
answer
needle connected to high flow gas to allow insufflation
question
What is the Hassan technique for insufflation of abdomen?
answer
insertion of initial tracer with high flow gas connected which is more common among newer surgeons
question
What is the most common insufflation pressure?
answer
10-15 mmHg
question
What 5 gases can be used for pneumoperitoneum? Which is most common?
answer
CO2- most common, Air N2O Argon Helium Oxygen
question
What happens when insufflation pressures are greater than 18 mmHg
answer
Vena cava collapse
question
How does an increased PaCO2 change blood flow to the brain? (during pneumoperitoneum)
answer
increases cerebral bloodflow
question
What is the sympathetic innervation of the ureter?
answer
originate from T10-L2 and synapse with the postganglionic fibers in the aorticorenal and superior and inferior hypogastric plexuses.
question
Parasympathetic innervation of the ureter
answer
S2-S4
question
What is the pain somatic distribution of the ureter?
answer
T10-L2
question
What is the sympathetic innervation of the bladder and urethra
answer
T12-L2. through superior hypogastric plexus and supply bladder by R&L hypogastric nerves
question
What is the parasympathetic innervation of the bladder and urethra?
answer
S2-S4. Main motor supply to bladder (with the exception of the trigone)
question
What is the sympathetic innervation of prostate, penile, urethra, & penis innervation?
answer
T11-L2
question
What is the parasympathetic innervation of prostate, penile urethra, & penis?
answer
S2-S4
question
What nerve supplies pain sensation to the penis?
answer
Pudendial nerve via dorsal nerve of the penis
question
How is the scrotum innervated anteriorly and posteriorly
answer
Anteriorly- ilioinguinal and genitofemoral nerves (L1-L2) and posteriorly- perineal branches of the pudendal nerve (s2 and S4)
question
What block do you use for urethral procedures?
answer
sacral block
question
What block do you use for bladder procedures?
answer
T9-T10
question
What block do you use for urthral procedures?
answer
up to T8
question
How much cardiac output do the kidney's receive? How many L/min
answer
20-25% of CO and 1-1/5 L/minute via renal arteries
question
What part of the kidney is more vulnerable to ischemia?
answer
Medulla of the kidney because it only receives 5% of cardiac output
question
What % of GFR is end stage renal disease?
answer
5-10%
question
How much of the % of GFR is lost when you see an increase in BUN?
answer
75% of normal
question
What medications should you be careful with in Chronic Renal Failure?
answer
Succs, demerol, morphine, aminoglycosides, vancomycin, digoxin, pancuronium, sevo, barbs
question
What are the signs and symptoms of common peroneal/fibular nerve?
answer
Loss of dorsiflexion of the foot
question
What are the signs and symptoms saphenous nerve injury?
answer
numbness along medial calf
question
what causes the damage to obturator and femoral nerve during surgery?
answer
damage is caused by flexion of thigh against the groin
question
What is the cause of sciatic nerve injury intro?
answer
flexion of thigh, stretches sciatic
question
What level of block should be used for a cystoscopy?
answer
T10, SAB over LEA
question
Autonomic Hyperreflexia and anesthesia
answer
in paraplegics and quadriplegics when noxious stimuli below the level of spinal cord injury. S&S flushing, headache, and nasal stuffiness
question
How high should a block go for a TURP?
answer
T9-T10
question
What is the average blood loss in a TURP? mL/minute?
answer
200-300 mL or 2-5 mL/minute
question
What are the S&S of TURP syndrome?
answer
headache, restlessness, confusion, cyanosis, dyspnea, dysrhythmias, hypotension, seizures, hyponatremia, fluid overload, solute toxicity
question
What 3 solutions (all hypotonic) can be used in a TURP?
answer
Glycine 1.5%, Sorbitol 2.7%, and Mannitol 0.54%
question
During a TURP what can Glycine 1.5% cause?
answer
Hyperglycemia which contributes to circulatory depression and CNS toxicity. Glycine is an inhibitory neurotransmitter in CNS and has been implicated in transient blindness following a TURP
question
During a TURP what can Sorbitol 2.7% cause?
answer
hyperglycemia- caution in diabetics
question
How can you calculate Sodium Deficit?
answer
Na deficit = TBW x (sodium Desired- Sodium current)
question
What is obturator nerve reflex?
answer
external rotation and adduction of tight when cautery contacts lateral wall of bladder. Can cause bladder perforation, Regional won't block but muscle relaxant will
question
Is regional preferred for extracorporeal shockwave lithotripsy?
answer
No, general is better because T4-T6 would be needed and no control over diaphragm. GA with LMA is very common
question
During an ESWL when the patient is immersed in water what happens?
answer
Vasodilation-> ABP rises as venous blood is redistributed centrally due to the hydrostatic pressure of the water on legs and abdomen. SVR increases and CO decreases. Increase in venous return and SVR may be problem with CHF patient. FRC reduced due to increase in intrathoracic blood volume.
question
What is removed in the simple cystectomy?
answer
removal of bladder only
question
What is removed in the partial cystectomy?
answer
removal of only the part of the bladder containing the pathology (rare)
question
What is removed in the radical cystectomy?
answer
removal of the bladder, lower ureters, pelvic lymph nodes and reproductive organs
question
Radical Orchiectomy
answer
Initial treatment for testicular tumors patients usually 15-35 years old
question
How do you diagnose Radical Nephrectomy
answer
Hematuria, flank pain, palpable mass (10%)
