anesthesia pre-clinical med review
Terms
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- What is the b:g of n2o?
- .47
- What is the mac of n2o?
- 105%
- svp of halo
- 245 mmHg
- svp of iso
- 238 mmHg
- svp of des
- 669 mmHg
- svp of sevo
- 170 mmHg
- b:g of halo
- 2.4
- b:g of iso
- 1.4
- b:g of des
- .42
- b:g of sevo
- .65
- mac of halo
- .75
- mac of iso
- 1.17
- mac of des
- 6.0
- mac of sevo
- 2.0
- Dose of edrophonium and atropine for reversal
-
1mg/kg + .01mg/kg
(70/0.7 for 70 kg pt) - Onset and duration of edrophonium/atropine reversal
- 1 min, lasts 60 min
- Dose of neostigmine/glyco reversal
- 3mg/.6mg
- onset and duration of neo/glyco reversal
- 10min, lasts 60 min
- dose for pyridostigmine reversal with atropine or glyco
-
pyrido .25mg/kg
plus .015mic/kg atropine
or .2mg glyco for every 5 pyrido
*so 20mg/1mg pyrido/atro
or 20mg/.8mg pyrido/glyco - onset and duration of pyridostigmine reversal (with atropine or glyco)
- 10min, lasts 90 min
- dose of glycopyrolate for tx secretions preop
- .1-.2mg, may repeat if needed.
- o/d of glycopyrolate iv
-
2min onset
vagal effects last 2 hours,
salivation decreased for ~7h - dose of scopalimine patch
- 1.5mg patch, place behind ear
- o/p/d scopalimine patch
- 30min/3h/3d
- hydralizine action
- vasodilator, art>veins
- hydralizine dose
- 5-10mg q15min
- o/d hydralizine
- 15m/4h
- nitro action
- venodilator, preload reducer
- iv bolus dose of ntg
- 25-50mcg
- iv gtt of ntg formula and rates
-
50mg in 250 d5w
start at 5 mic/min and titrate up - o/d of ntg gtt
- 1m/5m
- nitroprusside action
-
arterio and venous dilator, afterload reducer
probably via NO which is a potent vasodilator - nitroprusside o/d
- 1m/5m (same as NTG)
- nitroprusside bolus dose
- 25-50mic bolus (same as ntg)
- nitroprusside gtt and rates
-
50mg in 250 d5w = 200mic/cc
(same as ntg)
start at 0.5 mic/kg/min and increase in 0.5 mic/kg/min increments until effect - name the ester local anesthetics
- procaine, chloroprocaine, tetracaine
- name the amide local anesthetics
- lido, prilo, mepiva, etido, ropiva, bupiva
- what is the condition that precludes pts from getting ester anesthetics?
- atypical plasma cholinesterase
- morphine action
- acts as agonist at mu,kappa, delta receptors in the CNS
- morphine iv dose
- 1-4 mg usually
- what is the metabolite of morphine and why is it important
- morphine-6 glucoronide is an active metabolite
- does morphine release histamine
- yes
- o/p/d of morphine
- 1m/10m/4h
- meperidine action
- a synthetic atropine-like opioid. agonist at mu, kappa and delta receptors in cns. Also stops shivering via kappa receptors.
- what is the relative potency of meperidine to mso4
- 1/10th
- dose of meperidine for shivering and pain
-
shivering ~25mg iv
pain 25-100 mg slow iv - o/p/d meperidine
- 1m/10m/4h (same as mso4)
- what is the metabolite of meperidine and why do we care
- normeperidine is an active CNS stimulant and can cause seizures
- What is a SE unique to meperidine (different than other opioids)
- tachycardia due to atropine-like structure
- what is action of fentanyl
- agonist at mu, kappa and delta receptors in CNS
- what is iv dose of fentanyl
- 25-100 mic bolus
- o/p/d of fentanyl
- 0.5m/6m/45m
- does fentanyl stimulate histamine release
- no
- what is the relative potency of fentanyl
- 100x more potent than ms04
- what is the action of sufenta
- same as other opioids
- what is the dose of sufenta
-
2-10 mic/kg for induction
(150-700 mics)
10-40 mic maintenance boluses - o/p/d of sufenta
- 1/6/45
- what is the relative potency of sufenta
- 1000x more potent than ms04
- does sufenta release histamine
- no
- what is the action of alfentanil
- same as others
- what is the dose of alfentanil
-
50-75 mic/kg pre-intubation load
pain: 10-75 mic/kg (must watch resps at doses >50 mic/kg) - o/p/d of alfentanil
- 1/2/15m
- what is the relative potency of alfentanil
- 25x potency of mso4
- what are 2 benefits of alfentanil
-
1. small Vd leads to rapid elimination (short action)
2. lower incidence of PONV than other opioids - what is action of remifentanyl
- same
- what is dose of remi
-
induction: 1-3 mic/kg/min
maint: 0.05-2 mic/kg/min - o/p/d of remi
- 0.5/5/10m
- what is unique about remi
- ester hydrolysis
- what is the relative potency of remi
- 250x more potent than mso4
- what are the classic SE of all opioids?
- cns depression, resp depression, n/v, pruritis, biliary spasm, urinary retention, bradycardia, hypotension
- what is action of naloxone
- competative pure mu, kappa and delta ANTAGONIST
- how would you mix and administer naloxone
-
dilute the 0.4mg ampule into 10cc of nss. This makes 0.04mg/cc.
then give 1-2cc at a time to reverse resp depression/sedation while preserving analgesia - o/p/d of naloxone
- 1/10/120m
- who must naloxone be used cautiously with
- opioid addicts (may precipitate withdrawl) and cardiac pts (it increased myocardial contractility and may precipitate angina
- what is another caution to observed with naloxone
- the action of naloxone may be shorter than the opioid and rebound resp depression/sedation may occur.
- action of succs
- depolarizing NMB
- dose of succs
- 1mg/kg
- o/p/d of succs
- 0.5/1/5-10m
- what happens if you give a cholinesterase inhibitor after giving succs
- prolongs the block possibly to a phase 2 block
- what happens if you give succs and then give more a few minutes later
- can lead to a phase 2 block
- what are contraindications to succs
- MH, APC, myopathies, acute denervation injuries
- what is action of atracurium
-
blocks Ach at motor endplate.
Benzylisoquinoline. - what is dose of atracurium for bolus and drip
-
0.5 mg/kg
3-15 mic/kg/min - how is atra elim
- ester AND hofmann elim
- o/p/d of atra
- 3/5/30m
- what are 2 problems with atra
-
1. laudanosine toxicity (rare)
2. histamine release (minimal) - what is action of cisatracurium
- non-depol NMBA, benzylisoquinoline
- what is dose of cisatracurium as bolus and drip
-
0.2 mg/kg bolus
1-3 mic/kg/min gtt - o/p/d of cisatracurium
- 2/5/30m
- how is cisatracurium metab
- hofmann elim
- what are benefits of cisatracurium over atracurium
-
1. no histamine release (very good CV stability)
2. virtually no laudanosine toxicity risk - what is action of doxacurium
- non-depol nmba
- what is dose of doxacurium
-
0.05 mg/kg
(3.5 mg) - o/p/d of doxacurium
- 5/10/60m
- what are some key facts about doxacurium
-
1. the most potent nmba and very costly
2. excellent CV stablility
3. no histamine release - what is action of mivacurium
- non-depol nmba
- what is dose of mivacurium for bolus and gtt
-
0.2 mg/kg bolus
(~14 mg) bolus
gtt is 5-12 mcg/kg/min - o/p/d of mivacurium
- 2/3/15m
- how is mivacurium metab
- pseudocholinesterase, so do not use in pts with APC
- is mivacurium associated with histamine release
- yes, give in divided doses to limit histamine release
- what is action of pipecuronium
- non-depol nmba
- what is dose of pipecuronium
-
0.1 mg/kg
(7 mg) - what is o/p/d of pipecuronium
- 3/5/60m
-
what is important to know about pipecuronium
(what is it similar to and why are the SE less) -
1. a derivative of pancuronium, but minimal binding to cardiac muscarinic receptors leads to minimal CV SE.
2. no histamine release - what is action of pancuronium
- non-depol nmba
- what is dose of pancuronium, bolus and gtt
-
0.1 mg/kg bolus
(~7 mg)
gtt: 1-15 mic/kg/min - o/p/d of pancuronium
- 3/5/60m
- what is a key SE of pancuronium
- tachycardia via blockade of cardiac muscarinic receptors
- what is action of vec
- non-depol nmba
- what is dose of vec, bolus and gtt
-
0.2 mg/kg (~14mg)
gtt: 0.8-1.2 mic/kg/min - o/p/d of vec
- 3/5/30m
- what effects will liver or renal failure have on vec
-
slight prolongation with liver failure.
Effect will be prolonged with renal failure. - what is vec similar to
- it is a derivative of vec with improved SE profile.
- what is action of roc
-
non-depol nmba
(aminosteroid) -
what is dose of roc
bolus and gtt -
1 mg/kg bolus (use 1.2-1.5mg/kg for RSI)
5-12 mcg/kg/min - o/p/d roc
- 1.5/3/30m
- how does renal and hepatic disease effect roc
- block is prolonged by liver failure but NOT by renal failure.
- Which nmba's are prolonged with renal failure
- pan and vec
- which nmba's are prolonged with hepatic failure
- pan, roc and vec
- which nmba's are prolonged with APC
- succs and mivacurium
- which nmba's are not affected by renal or hepatic status
-
atracurium and cisatracurium.
Also to a certain extent succs and mivacurium unless the hepatic failure is so severe as to impair plasma cholinesterase production. - What is action of epi
- A1, B1, B2 agonist
- What is dose for epi gtt
-
1-2 mic/min = B2
4-6 mic/min = B1
10-20 mic/min = mostly A1 with some B1 - How do you mix an epi gtt
-
1mg epi in 250 NSS or D5W
= 4mcg/cc - o/p/d of epi gtt
-
immediate onset
lasts a few minutes max - What is action of norepi
- A and B1 with no effect on B2.
- What is dosage of norepi gtt
-
start at 1 mic/min
(avg dose is 2-12 mic/min) - How do you mix a norepi gtt
- 4mg of norepi in 250 cc D5W
- What is action of phenylephrine?
- pure alpha1 agonist. No effect on Beta
- What is dose of phenylephrine as bolus and gtt?
-
100 mic bolus
or 20-50 mic/min gtt - o/d of phenylephrine
-
IV instant onset
lasts 15 min - what is a problematic SE of phenylephrine?
- reflex bradycardia
- How do you mix a phenylephrine drip
-
10mg in 250cc NSS or D5W
= 40mic/cc - What is action of ephedrine
- indirect alpha and beta agonist
- what is dose of ephedrine
- 5-10mg
- what is improtant to remember about ephedrine dosing
- tachyphylaxis, so larger doses are required with redosing