What are the components of the "physiologic beta blockade" seen in geriatric patients?
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, 1. Decreased receptor affinity
2. Decreased intracellular cAMP
These lead to a decreased maximal heart rate and decreased peak ejection
fraction.
6 major perioperative concerns for the patient undergoing radical neck dissection
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1. These patients are often heavy users of alcohol and tobacco and have
bronchitis, emphysema, and cardiovascular disease
2. They also present with weight loss, malnutrition, anemia, and electrolyte
imbalances
3. Difficult tracheal intubation, and after the case is going, it can be
mainstemmed by the surgeon
4. Manipulation of carotid baroceptors leads to vagal reflex bradycardia,
hypotension, or cardiac arrest. This is best prevented by blocking the
carotid sinus nerve with lidocaine!! Can also give atropine or glyco
5. Trauma to right stellate ganglion -> prolonged QT interval -> lower
threshold for V-fib
6. VAE
Why is isoflurane the only volatile agent recommended for deliberate hypotension, and
by the way, what is the goal of deliberate hypotension?
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Isoflurane only blunts the stress response evoked by deliberate hypotension.
The goal = maintain or reduce transmural pressure.
, TP = MAP - ICP
Three drugs for treating mitral valve prolapse
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1. Lidocaine
2. Esmolol
3. Amiodarone
What is an EXIT procedure and its anesthetic implications?
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Ex utero intrapartum procedure. It is surgery on the fetus so that it will survive
after separation from uteroplacental support. There are 2 anesthesia teams,
one for the fetus and one for the mother. PIA is used on Mom for uterine
relaxation, the surgery is done, the baby is delivered and uterotonics are
given for blood loss.
Which anesthetic technique is best for preventing autonomic hyperreflexia?
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Spinal
, What is Arnold-Chiari malformation?
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Herniation of the hindbrain through foramen magnum.
90% of kids with myelomeningocele also have Arnold-Chiari malformation.
What is the cause of pre-eclampsia?
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Unknown for sure, but the prevailing theory is abnormal placental
implantation -> inc. placental vascular resistance -> decreased oxygenation
of placenta -> release of way too much TXA2
If a patient is receiving PEEP and become hypotensive, what happens to your BP if you
switch to either CPAP or IRV (inverse ration ventilation, or switched I:E ratio)?
Give this one a try later!
CPAP = increases BP
IRV = further decreases BP because it probably will produce auto-PEEP
(breath stacking)
Give this one a try later!
, 1. Decreased receptor affinity
2. Decreased intracellular cAMP
These lead to a decreased maximal heart rate and decreased peak ejection
fraction.
6 major perioperative concerns for the patient undergoing radical neck dissection
Give this one a try later!
1. These patients are often heavy users of alcohol and tobacco and have
bronchitis, emphysema, and cardiovascular disease
2. They also present with weight loss, malnutrition, anemia, and electrolyte
imbalances
3. Difficult tracheal intubation, and after the case is going, it can be
mainstemmed by the surgeon
4. Manipulation of carotid baroceptors leads to vagal reflex bradycardia,
hypotension, or cardiac arrest. This is best prevented by blocking the
carotid sinus nerve with lidocaine!! Can also give atropine or glyco
5. Trauma to right stellate ganglion -> prolonged QT interval -> lower
threshold for V-fib
6. VAE
Why is isoflurane the only volatile agent recommended for deliberate hypotension, and
by the way, what is the goal of deliberate hypotension?
Give this one a try later!
Isoflurane only blunts the stress response evoked by deliberate hypotension.
The goal = maintain or reduce transmural pressure.
, TP = MAP - ICP
Three drugs for treating mitral valve prolapse
Give this one a try later!
1. Lidocaine
2. Esmolol
3. Amiodarone
What is an EXIT procedure and its anesthetic implications?
Give this one a try later!
Ex utero intrapartum procedure. It is surgery on the fetus so that it will survive
after separation from uteroplacental support. There are 2 anesthesia teams,
one for the fetus and one for the mother. PIA is used on Mom for uterine
relaxation, the surgery is done, the baby is delivered and uterotonics are
given for blood loss.
Which anesthetic technique is best for preventing autonomic hyperreflexia?
Give this one a try later!
Spinal
, What is Arnold-Chiari malformation?
Give this one a try later!
Herniation of the hindbrain through foramen magnum.
90% of kids with myelomeningocele also have Arnold-Chiari malformation.
What is the cause of pre-eclampsia?
Give this one a try later!
Unknown for sure, but the prevailing theory is abnormal placental
implantation -> inc. placental vascular resistance -> decreased oxygenation
of placenta -> release of way too much TXA2
If a patient is receiving PEEP and become hypotensive, what happens to your BP if you
switch to either CPAP or IRV (inverse ration ventilation, or switched I:E ratio)?
Give this one a try later!
CPAP = increases BP
IRV = further decreases BP because it probably will produce auto-PEEP
(breath stacking)
