Complete Solutions
Altered Mental Status/Delayed Emergence Correct Answers
*a. ABCs*
• Hypoxia
• Hypercarbia (C02 narcosis)
• Hypocarbia (insufficient C02 stimulus)
*b. Medication effect*
• Premedications (sedatives, scopolamine, droperidol,
benzodiazepines)
•Central anticholinergic syndrome (atropine, scopolamine,
organophosphates, TCA)
• Neuromuscular blocker
•Anesthetic (inhaled, intravenous)
• Usual medications (narcotics, sedatives, tranquilizers, lithium,
reserpine, clonidine, alpha-methyldopa, steroids, amphetamines,
etc.)
• Substance abuse (alcohol, cocaine, LSD, heroin, etc.)
*c. Endocrinologic/metabolic*
• Hyponatremia
• Hypocalcemia
• Hypoglycemia
• Hypermagnesemia
• Hypothermia
• DKA
• Hepatic encephalopathy
• Renal encephalopathy
• Hypothyroidism
,• Addison's Disease
• Cushing's Disease
*d. Neurologic*
• Ictal or post-ictal state
• CVA (ischemic, thrombotic, embolic, hemorrhagic)
• Cerebral edema
*e. Baseline condition*
Aortic Insufficiency Correct Answers Goals (fast, full &
forward)
-keep HR high
-keep preload high to maintain SV
-low SVR to reduce regurgitation fraction
Aortic Stenosis Correct Answers Symptom triad: angina,
syncope, CHF
Severe AS: pressure gradient>50 mm Hg, valve area <0.7 cm^2
Aortic Stenosis: Goals of Anesthetic Management Correct
Answers 1) Avoid tachycardia (and severe brady)
2) Normal SR (defibrillate if AF or SVT occurs)
3) Avoid and aggressively treat hypotension
Assessment of Pulmonary Function Correct Answers Evaluate
with hx and exam.
-smoking history
-use of inhalers
-productive cough
-baseline symptoms
, BP Correct Answers CO x SVR
CO is dependent on preload, afterload, contractility and HR.
SVR determined by arteriolar tone and blood viscosity
CAD-Preop History Correct Answers -chest pain
-exercise tolerance
-syncope
-palpitations
-orthopnea
-episodes of CHF
-hospitalizations
-medications
-old records
Cardiac Arrest (H's & T's) Correct Answers 1. hypoxia
2. hypovolemia
3. hypothermia
4. hyper/hypokalemia
5. hypoglycemia
6. hydrogen ions (acidosis)
1. Toxins (inhalational agents!)
2. Trauma
3. Tension PTX
4. Thrombosis: coronary, pulmonary
5. Tamponade-cardiac
Cardiac Complications: Predictive Criteria Correct Answers 1)
High risk surgery (major vascular, abdominal, thoracic or ortho
surgery)