Term
| Desflurane (Suprane) Anesthetic Gas |
|
Definition
Rapidly absorbed inhalation anesthetic which produces loss of perception of sensations and unconsciousness.
MAC 5.8% B/G 0.42 O/G 18.7
Fastest anesthetic gas, no analgesic properties, expensive, muscle relaxant properties, carbon mononxide in soda lime/baralyme, pungent odor. |
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Term
| Sevoflurane (Ultrane) Anesthetic Gas |
|
Definition
Rapidly absorbed inhalation anesthetic which produces loss of perception of sensations and unconsciousness.
MAC 2% B/G 0.6 O/G 50
5-7% metabolized and susceptible to free fluoride ion release which is storedin adipose tissues. Obese people store more fluoride ions. Fluoride is aasociated with nephrotoxity. Reacts with soda lime to form Compound A. A vinyl ether, inhalation induction, muscle relaxant properties, expensive. |
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Term
| Isuflurance (Forane) Anesthetic Gas |
|
Definition
Rapidly absorbed inhalation anesthetic which produces loss of perception of sensations and unconsciousness.
MAC 1.15% B/B 1.4 O/G 99
No analgesic properties, cheap, muscle relaxant properties, pungent odor. |
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Term
| Nitrous Oxide Anesthetic has (Inorganic) |
|
Definition
Odorless, nonexplosive gas with relatively lose anesthetic potency and muscle relaxant properties; however, the drug has strong analgesic properties. 70%=10-15mg Morphine
MAC 105% B/G 0.47 O/G 1.4
High risk of PONV, inhibits methioonine synthase, teratogenic: CONTRAINDICATED in pregnancy, causes expansion of closed spaces. No skeletal muscle relaxation, Does NOT trigger MH. |
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Term
Succinylcholine (Anectine) 1 0f 2
NMB (Depolarizing) |
|
Definition
Mechanism: Acts similiar to acetylcholine, produces depolarization of the myoneural junction.
Indication: Chemical Paralysis
Dosage:1-1.5mg/kg Standard dose 100mg
Onset:30-60sec
Duration 3-6min |
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Term
Succinylcholine (Anectine) 2 0f 2
NMB (Depolarizing) |
|
Definition
| Increased IOP, ICP, Hyperlipidemia, increased K by 0.5-1mEq/L, MH, Massteau spasm "Jaws of steel", prolonged block with Pseudocholinesterase defiencency (liver disease, pregnancy, sepsis_, Histamine release, fasiculations, muscle pain, myoglobinemia (Rhabdo) |
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Term
Veruronium (Norcuron)
NMB (Non-Depolarizing) |
|
Definition
Mechanism: Binds to cholinergic receptors antagonizing/blocking the effects of Ach.
Indication Chemical Paralysis
Dosage: 0.1mg/kg Induction
IV gtt: 1mcg/kg/min
Onset: 3-5 min
Duration 20-35min
Notes:Liver and renal metabolism. Normal histamine release.
Podiatries: 0.1-0.3 mg/kg induction |
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Term
|
Definition
Avoid barbiturates and etomidate in patients with porphyria.
Found to cause severe bradycardia that leads to death. Atropine doesnt work well. May need to use isoproterino or other beta agonist. |
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Term
Rocuronium (Zemuron)
NMBA (Non-dpolarizing) |
|
Definition
Mechanism: Binds to cholinergic receptors antagonizing the effects of Ach. Blocks neural transmission at myoneural junction.
Indication: Chemical inducing paralysis
Dosage:Induction 0.6-1.2 mg/kg, IV Gtt: 3-12mcg/kg/min
Onset: 90secs
Duration: 20-30minutes
Notes: No histamine release and no CV changes. Not for use in liver dysfunction. Increased sensitivity in Myasthenia Gravis paients. Resistance to blockage in burn patients. Longer acting that succinylcholine. |
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Term
Propofol (Diprivan)
Gabamimetic, General Anesthetic |
|
Definition
Mechanism: Mimics the inhibitory characteristics of GABA. Pumps chloride ions into the cell making the cellular charge more negative preventing neural firing.
Indication: Rapid sequence intubation, MAC
Dosage: 1.5mg-2.5mg/kg for induction.
MAC: 25-100mcg/kg/min gtt
GA:100-300mcg/kg/min gtt
Onset: Rapid
Duration 3-10 minutes
Notes: Egg and soybean allergy risk, significant CV effects, pain on injection, lactic acid risk. Discard unused syringes after 6 hrs. Myoclonus, mildly anti-emetic |
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Term
Midazolam (Versed)
Gabamimetic, Benzodiazepine |
|
Definition
Mechanism: Mimics the inhibitory characteristics of GABA. Pumps chloride ions into the cell making the cellular charge more negative preventing neural firing.
Indication: Anxiolysis, sedation
Dosage: 1-4mg Preop
Onset: 60 seconds
Duration: 15-60min. Amnestic about 60min after injection.
Notes: Use reduced dose in elderly. Water soluble. |
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Term
| Ketamine (Ketalar) NMDA antagonist |
|
Definition
Mechanism: NMDA receptor antagonist are a class of anesthetics that work to inhibit the action of N-methyl d aspartate receptor. Referred to as "dissociative anesthesia".
Indication: Adjunct Anesthetic
Dosage: 0.5-2mg/kg Induction
IV gt:5-20 mcg/kg/min
Onset: 30-60 seconds
Duration: 5-15 min
Notes: Bronchodilator, analgesic, increases HR, B/P, salvation, maintain airway reflexes, PONV, hallucinations
Pediatrics: 0.5-1mg/kg induction. |
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|
Term
Etomidate (Amidate)
Gabamimetic. Short acting hypnotic. |
|
Definition
Mechanism: Mimics the inhibitory characteristics of GABA. Pumps chloride ions into the cell making the cellular charge more negative preventing neural firing.
Indication: Rapid sequence intubation
Dosage: 0.2-0.4mg/kg for induction.
Onset: 30-60 Seconds
Duration: 4-10 minutes
Notes: Produces EEG Burst suppresion, decreases icp, used in patients with diminished cardiac function.
50-80% Show myoclonus
Pediatrics: 0.3mg/kg Intubation/RSI |
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|
Term
Lidocaine
Local Anesthetic |
|
Definition
Mechanism: Prevents transmission of nerve impulses by inhibiting passage of Na ions through Na channels in nerve membranes slowing the rate of depolarization until threshold is no longer reached and AP ceases to fire.
Indication: Pain on injection
Dosage: 0.5 -1mg/kg
Onset: <30 seconds
Duration: 60 minutes
Notes: 300mg Max single dose, toxic plasma concentration >mcg/ml |
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Term
| Fentanyl (Sublimaze) Opiod Agonist |
|
Definition
Mechanism: Pure opiod agonist. Provides analgesia, anxiolysis, euphoria, relaxation, respiratory depression, constipation, miosis, and cough suppresion.
Indication: Intraoperative pain
Dosage: 0.5-1.5 mcg/kg
Onset: Immediate
Duration: 30-60 minutes
Notes: Phenylpiperdine synthetic opiod, 100x more potent than morphine, associated muscle chest wall rigidity, PONV.
Pediatrics: 1mcg/kg
Indication: Post oper |
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|
Term
|
Definition
Mechanism: Pure opiod agonist
Indication: Post-operative pain
Dosage: 2-10mg
PCA: 1-2mg bolus, 0.2-0.3 demand. every 5-10 min (6min)
Onset: 5 min
Duration 4-5 hrs
Notes: Phenathrene opiod. Gold standard. Histamine release, allergies common.
Pediatrics: 0.1mg/kg |
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Term
Hydromorphone (Dilaudid)
Opiod Agonist |
|
Definition
Mechanism: Pure opiod agonist
Indication: Post operative pain
Dosage: 0.2-1mg
PCA: 0.05-0.4MG (O.2) demand, every 5-10 min (5 min)
Onset: 10-15 minutes
Duration 4-5 hours
Notes: Phenanthrene semi-synthetic opiod, 10x more potent that morphine, PONV, may have cross sensitivity to morphine/codeine allergy.
Pediatrics: 10-15mg/kg |
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Term
Narcan (Naloxone)
Opiod antagonist |
|
Definition
Mechanism: Competitively binds at Mu, Kappa, and Delta opiod receptors.
Indication: Reversal of respiratory depression or symptoms associated with narcotic overdose.
Dosage: 1-4mcg/kg (usually 40mcg at a time)
Onset: 90 Seconds
Duration 30-45 minutes
Notes: Rapid reversal results in excitation, nausea, vomiting, puritis, tachycardia that can lead to VT. Give slowly.
Pediactrics 0.1mg/kg <20kg, 2mg >20mg |
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|
Term
|
Definition
First generation cephalosporins
Reactions:
CNS: SEIZURES (High doses)
GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps.
Derm: STEVEN JOHNSON SYNDROME, rash, pruritis, uticaria
Hemat: Leukopenia, neutropenia, thrombocytopernia.
Local: Pain at Im site, Phlebitis at IV site.
Misc: Allergic reactions including anaphylaxis and serum sickness, superinfection.
CAPITALS indicates life threatening. |
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Term
Nalbuphine (Nubain)
Opiod Agonist |
|
Definition
Mechanism: Opiod with binding affinity to Mu, Kappa, and Delta receptors. Acts primarily as a Kappa agonist and partial Mu antagonist.
Indication: Post operative pain
Dosade: 0.2-3mg/kg IV, 10mg SQ (usual dose)
Onset 2 min IV, <15min SQ
Duration 3-6 hours
Notes: Ewuipotent to morphine, synthetic phenanthrene opiod, Provides pain releif without Mu receptor side effects (Itching) fetal bradycardia in pregnancy, PONV
Pediatrics: Not established |
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Term
Sufentanil (Sufonta)
Opiod Agonist |
|
Definition
Mechanism: Pure opiod agonist
Indication: Intraoperative pain
Dosage: 0.5-8mcgs/kg (usual dose 10-20mcg)
MAX: 30mcg/kg/procedures IV gtt 1mcg/kg/hour
Onset: 1 minute
Duration: 36 minutes
Notes:Phenylpiperdine synthetic opiod, 1000x more potent, associated muscle chest wall rigidity, PONV, High doses can cause a dose related reduction of catecholamine release especially norepinephrine |
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Term
Ramifentanil (Ultiva)
Opiod Agonist |
|
Definition
Mechanism: Pure opiod agonist.
Indication: Intraoperative pain. Infuson.
Dosage: 1mcg/kg (Induction)
IV gtt: 0.05-2mcg/kg min
Onset: Immediate
Duration: 3-10 minutes
Notes: Water soluble dose by IBW, Phenylpiperdine synthetic opiod, 100x more potent than morpine, associated muscle wall rigidity, PONV, hydrolyzed in the plasma by esterases enzymes. |
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|
Term
|
Definition
Mechanism: Blocks the inflammatory effects of the COX enzyme.
Indication: Pain, inflammation, fever
Dosage: 15-30mg (>65/<65yrs)
Onset: 45-60 minutes
Duration: 4-5 hours
Notes: Potentiates opiods, increases bleeding, may cause bronchospasm in asthmatics, potential for renal toxicity, inhibits bone osteogenesis.
Pediatrics: Not established |
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|
Term
Albuterol (Proventil)
Beta2 Agonist |
|
Definition
Mechanism: Stimulates B2 receptors leading to bronchodilation, symppathomimetic.
Indication: Bronchospasm, bronchoconstriction
Dosage: 100mcg puff x2, Neb 2.5-5mg
Onset: Rapid
Duration: 3-6 hours
Notes Tachycardia, hypokalemia |
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Term
Dexmedetomidine (Precedex) 1 of 2
Alpha 2 agonist |
|
Definition
Mechanism: Alpha 2 Agonist, act through endogenous sleep promoting pathways to exert sedative effect.
Dosage: IV gtt: 0.2-0.7mcg/kg/hr
Onset: 30 minute
Duration: 4 hours
Notes: Analgesic properties, bradycardia, hypertension (loading dose), hypotension (gtt), expensive, used primarily as an adjunct.
Pediatrics 0.2-1mcg/kg/hr |
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Term
Dexmedetomidine (Precedex) 2 of 2
Alpha 2 agonist |
|
Definition
| IV (Adults). Loading infusion 1mcg/kg (0.5mcg/kg for opthalmic surgery or patients >65yr)over 10 min followed by maintenance infusion of 0.6 mcg/kg/hr; rate is adjusted to acheive desired level of sedation (usual range 0.2-1mcg/kg/hr)(Maintenance infusion of 0.7 mcg/kg/hr recommended for fiberoptic intubation until endotracheal tube secured). |
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Term
Dexamethasone (Decadron)
Adrenocorticoical Steroid |
|
Definition
Mechanism: Potent anti-inflammatory effects and increases endorphins.
Indications: Surgical and airway inflammation, PONV.
Dosage: 4mg
Onset: 4-8hrs
Duration: >24hrs
Notes: Administered at the beginning of the case or in pre=op for patients at high risk for PONV. Multimodal approach to PONV, not be used as sole preventative.
Pediactrics: 0.15mg/kg |
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|
Term
Diphenhydramine (Benadryl)
Antihistamin |
|
Definition
Mechanism: Histamine antagonist at H1 receptor site in GI tract, respiratory system and blood vessels.
Indication: Symptomatic releif of allergic symptoms, itchi8ng, nighttime sleep aid, motion sickness, antitussive, PONV.
Dosages: 25-50mg
Onset: 10-30 minutes
Duration: 4-7 hours
Notes: Anticholinergic effects (tachycardia, dry mouth). Mat cause photosensitivity, avoid direct exposure to sunlight.
Pediatrics: 1-2mg/kg Q 6-8 hours |
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|
Term
Droperidol (Inapsine)
Dopamine antagonist |
|
Definition
Mechanism: Alpha adrenergic and dopaminergic receptor blockade at CTZ.
Indication: PONV
Dosage: 0.625-1.25mg
Onset: <10 minutes
Duration: 2-4 hours
Notes: "Black Box" warning for QT prolongation, torsades de pointes, extrapyramidal symptoms, contraindicated in Parkinsons Disease. |
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|
Term
Esmolol (Brevibloc)
Selective Beta1 Blocker |
|
Definition
Mechanism: Binds to Beta adrenergic receptors blocking the catecholamines from provoking beta responses. Short acting.
Indication: Htn, Tachycardia
Dosage: 10-80mg
IV gtt: 50-300 mcg/kg/min
Onset: 60 seconds
Duration: 10-30 minutes
Notes: Hepatic clearance. Do not give to patients with severe CHF (decreases contractility), may inhibit B2 at higher doses and excacerbate bronchoconstriction in asthmatics. |
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|
Term
Ephedrine
Nonselctive sympathomimetic |
|
Definition
Mechanism: Stimulation of alhpa and beta receptors resulting n vasoconstriction. Increases B/P and afterload. Stimulates the release of norepinephrine.
Indication: Hypotension
Dosage: 5-25mg
Onset: Rapid
Duration: 5-10 minutes
Notes: First line treatment for hypotension without tachycardia.
Pediatrics: 0.2-0.3 mg/kg. |
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|
Term
Famotidine (Pepcid)
H2 Receptor Antagonist |
|
Definition
Mechanism: Blocks histamines ability to induce secretion of gastric acid, increased PH.
Indication: Increase gastric PH, decrease gastric acid, RSI.
Dosage: 20-40mg
Onset: 30 minutes
Duration 10-15 hours
Notes: Use caution in asthmatics due to unopposed H1 mediated bronchoconstriction, may develop tolerance, may prolong the half life of some drugs (benzos, lidocaine, propranolol), prolonged QT.
Pediatrics: 0.25-0.5mg/kg |
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|
Term
Glycopyrrolate (Rubinol)
Anticholingergic |
|
Definition
Mechanism: Inhibits the acetylcholine activity on smooth muscles and structures innervated by postganglionic nerves. This results in control of excessive pharyngeal, tracheal and bronchial secretions, increases HR.
Indication: Reversal, excessive secretions
Dosage: 0.2mg (secretions)0.2mg per 1mg of Neostigmine to offset parasympathomimetic response, does not cross the BBB, decreases LES tone (reflux). |
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|
Term
Granisetron (Kytril)
5-HT3 receptor antagonist |
|
Definition
Mechanism: Antagonists of 5-HT3 receptors present peripherally on vagal nerve terminals and centrally in the CTZ. Cinding results in blockade of serotonin and subsequent vomiting.
Indication: PONV
Dosage: 1-2mg (usual dose)
Onset: Rapid
Duration: 24hrs
Notes: "Big Guns" of antiemetic class, 2.5 times longer acting than zofran, expensive.
Pediatrics: Not established. |
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|
Term
Labetalol (Normodyne)
Non-selective Beta Blocker |
|
Definition
Duration:PO, onset 1-4hr, Peak 8-12hr
IV, onset 5min, peak 16-18hr
Notes: Orthostatic hypotension, nonselective can cause bronchospasm, bradycardia, can exacerbate CHF. |
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Term
Metoprolol (Lopressor)
Selective Beta blocker, B1 |
|
Definition
Mechanism: Binds to beta adrenergic receptors blocking the cathecholamines from provoking beta responses.
Indication: Tachycardia, hypertension
Dosage: 1-15mg (Usual: 5mg)
Onset: Rapid
Duration: 4-6 hours
Notes: Hepatic clearance, no metabolites, do not give to patients with severe CHF r/t decreases in contractility. |
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Term
Hydralazine (Apresoline)
Direct-acting peripheral arteriolar vasodilator. |
|
Definition
Antihypertensive with unknown mechanism of action.
Apparently decreases blood pressure by exhibiting a peripheral-vasodilating effect through a direct relaxation of vascular smooth muscle. |
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|
Term
Metoclopramide (Reglan)
Dopamine receptor antagonist |
|
Definition
Mechanism: Stimulates gi motility, increases gastroesophageal sphincter tone, relaxes pylorus/duodenum.
Indication: Full stomach, emergency surgery, RSI
Dosage: 5-20mg
Onset:<30 minutes
Duration: 1-2 hours
Notes: GIVE SLOW to decrease gastric cramping and confusion. Treatment of diabetic gastroparesis, GERD, nausea. Do not give to Parkinson's patients, prolongs succinylcholine.
Pediatrics: 0-6yr 0.1mg/kg, 6-14 2.5-5mg, >14 adult dosing |
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Term
| Prostigmine (Neostigmine) |
|
Definition
Mechanism: Inhibits acetylcholinesterase at neuromuscular junction, facilitating buildup of acetylcholine.
Indication: Reversal of NMBA
Dosage: 0.05mg/kg MAX: 5mg
Onset: 50% reversal in 3 min, 100% in 7 min
Duration: 1-2 hours
Notes: Also used to treat glaucoma, alzheimers and Myasthenia Gravis, used concurrently with Robinul or atropine to offset parasympathetic response. |
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Term
Odansetron (Zofran)
5-HT3 Receptor antagonist |
|
Definition
Mechanism: Antagonists of 5-HT3 receptors present peripherally on vagal nerve terminals and centrally in the CTZ. Binding results in blockade of serotonin and subsequent vomiting.
Indication:PONV
Dosage: 4-8mg
Onset: <1hr
Duration: 6-12hrs
Notes: QT prolongation, may mask signs of gastric distension. Do not use in patients with liver dysfunction.
Pediatrics: Not established. |
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|
Term
Omeprazole (Prilosec)
Proton pump inhibitor |
|
Definition
Mechanism: Inhibits activity of the proton pump of the parital cell, decreasing gastric acid secretion.
Indication: Increase gastric PH, decrease gastric acid secretion.
Dosage: 20-60mg
Onset: <1hr
Duration: >72hrs
Notes: Osteoporosis related bone fractures with greater than 1 year of use, hypomagnesemia with long term use. |
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|
Term
Promethazine (Phenergan)
H1 Antagonist |
|
Definition
Mechasim: Blocks histamine h1 receptors without blocking the secretion of histamine. The drug has sedative, antiemetic, and anticholinergic effects. Antimuscarinic action at CTZ.
Indication: PONV, motion sickness
Dosage: 12.5-25mg
Onset: 3-5 minutes
Duration: 4-6 hrs
Notes: Tissue injury if infiltrates, bone marrow depression, NMS, lowers seizure threshold, sulfite sensitivity; injection contains sodium metabisulfite.
Pediatrics:12.5-25 >2yrs. <2yrs contraindicated. |
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|
Term
Ranitidine (Zantac)
H2 receptor antagonist |
|
Definition
Mechanism: Blocks histamine's ability to induce secretion of acidic gastric fluid, increasing gastric fluid PH.
Indication: Increase gastric PH
Dosage: 50-200mg
Onset: 1 hr
Duration: 9-13 hr
Notes: Use cautiously in asthmatics due to unopposed H1 mediated bronchoconstriction, more potent and longer acting. May prolong 1/2 life of some drugs (benzodiazepines, lidocaine, propranolol, potent opiod analgesics)
Pediatrics: 2-4mg/kg/day in 3-4 doses. |
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Term
Phenylephrine (Neosynephrine)
Alpha-Adrenergic Agonist |
|
Definition
Mechanism: Stimulation of Alpha receptors resulting in vasoconstriction. Increases BP and afterload.
Indication: Hypotension
Dosage: 40-500 mcg
IV gtt: 50-300 (max)mcg/min
Onset: Rapid
Duration: Short
Notes: Can be given thru peripheral IV.
Pediatrics: 5-20mcg/kg/dose Q10-15min |
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Term
Emend (Aprepitant)
Neurokinin Antagonist |
|
Definition
Mechanism: Acts as a selective antagonist at substance P/neurokinin receptors in the brain
Indication: PO: PONV
IV: Nausea and vomiting due to initial and repeated courses of highly emetogenic chemotherapy.
Onset: PO: 1hr IV:Rapid
Duration: 24hr
Notes: Concurrant use with pimozide (life-threatening adverse cardiovascular reactions), may cause unwanted effects in nursing infants.
Pediatrics: Not established. |
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Term
|
Definition
Dobutamine(500mg/250)
Beta 1 agonist, increaes contractility and stroke volume.
IV gtt: 2-10mcg/kg/min
Milrinone (20mg/100ml)
PDE3 inhibitor, Inc. cAMP,Inc. intracellular ca2+, Dec. PHTN, Inc. CL, SV
Load: 50mcg/kg
IV gtt: 0.375-0.75mcg/kg/min |
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Term
|
Definition
Nicardipine
Class IV Anti-arrhythmic; vasodilator to prevent spasm.
0.625-2.5mg bolus, IV gtt: 0.5-5mg
Nitroprusside (50mg/250ml)
Direct arterial & venous dilator, profound HTN, Cyanide tox.
0.5-10mcg/kg/min
Nitroglycerin (50mg/250ml)
Direct venous dilator
5-200mcg/min |
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Term
|
Definition
(400mg/250)
Dopaminergic stimulation: Renal arterial vasodilator.
Dopaminergic > Beta > Alpha |
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Term
|
Definition
1mg/250ml
Direct Alpha/Beta stimulation
Beta > Alpha
1-5mcg/min
0.05-1mcg/kg/min |
|
|
Term
|
Definition
4mg/250
Direct Alpha/Beta stimulation
Alpha>Beta
1-20mcg/min |
|
|
Term
|
Definition
10mg/250ml
Direct Alpha 1 stimulation
5-150mcg/min |
|
|
Term
|
Definition
100u/100ml
Inc, cAMP, dec urine, volume and inc. osmolarity.
0.01-1U/min
0.04U/min (sepsis) |
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Term
| Anaphylaxis Signs + Symptoms 1 of 2 |
|
Definition
Hypotension, tachycardia, bronchospasm, inc. airway pressure, cardiovascular collapse, flushing, urticaria, angioedema, abd pain, nausea/vomiting
Triggers*
#1 Muscle relaxants (70%)
Antibiotics, heparin, latex, protamine, morphine |
|
|
Term
| Anaphylaxis Treatments 2 of 2 |
|
Definition
| Call for help, notify surgeon, 100% O2, Discontinue/limit anesthetics, volume expansion, Epi 5-10mcg bolus, IV gtt: 1-5mcg/min or 0.05-1mcg/kg/min, Benadryl (H1) 25-50MG, Zantac (H2) 150mg, albuterol, hydrocortisone 1-5mg/kg, Methylene Blue 1-2mg/kg, ACLS |
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|
Term
| Laryngospasm Signs + Symptoms 1 of 2 |
|
Definition
Stridor, difficult breathing, mouse squeak, absent breath sounds, desaturation, tachycardia/bradycardia
Triggers*
Light planes of anesthesia
irritants, secretions |
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Term
| Laryngospasm treatment 2 of 2 |
|
Definition
Jaw thrust, chin lift, 100% 02, hold positive pressure till spasm breaks.
What if it doesn't break?
Succinylcholine 0.1mg/kg IV
Still not helping, what now?
Reintubation after full dose of Succ. Reattempt extubation. |
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Term
| Bronchospasm Signs + Symptoms 1 of 2 |
|
Definition
Increased airway pressure, prolonged expiration on ETCO2, FEV1 <80%, desaturation, increased ETCO2
Triggers*
Irratating volatiles: use Sevo for known asthmatics.
Histamine releasing drugs (Morphinem Atracurium, Succ.) |
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Term
| Pt. w/kwn Malignant Hyprthrmia 1 of 2 |
|
Definition
Patient should be firt case of the day.
Know exactly where the MH box is located.
Lock Succ in bottom drawer.
Set up TIVA. Consider adjunts.
Propofol 100-300mcg/kg/min
Remifentinil 0.05-2mcg/kg/min
Sufentanil 0.5-1.2mcg/kg/hr
Ketamine 0.5mg/kg
N2O is okay!!! |
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|
Term
| Pt. w/kwn Malignant Hyprthrmia 2 of 2 |
|
Definition
Anesthetic Gas Machine (AGM) Preparation
Replace all tubing analyzers and bag.
Take xtra 3L bag and place on the elbow of the Ins/Exp tubing. Run AGM on auto with TV of 1000 for 30 mins at 10L of flow.
Remove vaporizers. Keep them far away from the AGM.
Tape vaporizer dial in off position. |
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Term
| Malignant Hyperthermia 1 of 2 |
|
Definition
Triggering agents induce increased calcium in the muscle cells leading to hypermetabolic state.
What will it look like?
Sudden incease in metabolic oxygen demand. Desaturations or requiring more 02.
Sudden increase in ETC02, Hyperthemia, myoglobinuria, tachycardia, tachypnea, acidosis, electrolyte imbalance |
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|
Term
| Malignant Hyperthermia 2 of 2 |
|
Definition
Triggers*
Succinylcholine
Al volatiles ex. N20
Treatment
Early recognition/suspicion
Turn off all volatiles. 100% 02
Dantrolene 2.5mg/kg bolus x2 1mg/kg Q6hrs for 24hrs. Max dose 10mg/kg.
Active patient cooling.
Treat acidosis, NaHCO3, UOP >2ml/kg/hr, Lasix, IVF |
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|
Term
|
Definition
HR: Maintain or decrease
SVR: Avoid decreasing
Volume: Maintain
Hypertrophy: Concentric |
|
|
Term
|
Definition
HR: Maintain or increase
SVR: Avoid increasing
Volume: Maintain or keep elevated
Hypertrophy: Eccentric |
|
|
Term
|
Definition
HR:Maintain or decrease
SVR: Avoid decreasing
Volume: Maintain
Hyptertrophy: Concentric |
|
|
Term
|
Definition
HR: Maintain or increase
SVR: Avoid increases
Volume: Maintain or keep elevated
Hypertrophy: Eccentric |
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