3, 9, 9, 10 protein C and protein S

Coumadin inhibits epoxide recuctase - diminihing available vitamin K in the caroxylation reaction.  ac

1. battery backup for 30 minutes
2. alarms - high, low and medium priority
3. various monitors
4. breathing circuit limited to 125 cm of water
5. nondetachable electrical supply cord or a cord resistant to detachment,
6. cylinder supplies
7. flowmeters
8. an oxygen flush capable of 35-75 liters flow that does not go through an vaporizers
9. vaporizers
10. only one common gas outlet 22 mm od, 15 mm id
11. pipeline gas supply
12. checklist must be provided - electronic or paper
13. digital interface

list 8 required monitors on the AGM

1. exhaled volume
2. inspired oxgyen - with high priority alarm of 30 seconds of oxygen falling below 18%
3. oxygen supply failure alrm
4. hypoxic gaurd system that must protect againt less than 21% inspired oxyugen in use if N2O is present
5. anesthetic vapor concentration
6. pulse oximetery
7. blood pressure monitoring
8. ECG

1. one cylinder attached to the machine
2. hanger yoke must have PIS index
3. hanger yoke must have a clamping device that resists leaks
4. hanger youke must have a filter
5. hanger yoke must have a check valve to prevent transfilling
6. hanger yoke must have a cylinder pressure gauge
7. cylinder pressure regulators

1. single control for each flow for each gas
2. each flow control must be next to a flow indicator
3. oxygen flow control knob must be uniquely shaped
4. valve stops are required such that excessive rotaion will not damage the flowmeter
5. oxygen flowmeter is to the right of the flowmeter bank
6. oxygen enters the common manfiold downstream of other gases
7. an auxilaiary oxygen flow meter is strongly recommended

1. concentration calibrated
2. must have interlock
3. must indicate the liquid level to prevent overfilling
4. should use key filler devices
5. must not discharge liquid from the vaporaizer even at maximum fresh gas flows

1. pressure gauge must be present
2. inlets for atleast oxygen and nitrous oxide
3. protected DIS
4. inine filter
5. check valve

1. proceeds to teh fresh gas flow meter
2. powers the oxygen flush
3. activates fail safe mechanism
4. activates oxygen low pressure alarm
5. compresses the bellows of mechanical ventilators

1. explicit or consocius memor and implicit or unconscious memore., 
2. explicit memory refers to the conscoius recollection of previous experiences and is equivalent to remembering
3. awareness during anestehsia describes conscious recall (explicit memory) of intraoperative events.  many more anestehtized pts may respond to commands, yet lack the conscious recall of intraoperative events

1. unsafe to administer sufficient anesthesia - high risk
2. mistake / failure in anesthesia delivery
3. anesethetic technique tha tresults in inadeuqate anesthesia
4. pts needs are under appreciated

CPB

trauma

OB emergency

1. inhaltion not turned on/empty vaporizer
2. use of NMB that leads to underappreciation of light anesthesia
3. difficult airway with prolonged intubation attemps
4. TIVA

pharmacodynamic resistance - opioid benzo tolerance

altered P450 metabolism

increased P450 activty

mutations of melancortin-1-gene assoicated with red hair type

Brice Questionnarire developed in 1970 is an accepted tool for detecty postoperative awarnesss.  the modificed interveiw comprises 5 questions: 

1. what is the last thing you rember before going to sleep?
2. what is the first thing yoiu remember after waking up?
3. do you remember anyting going to sleep adn waking up?
4. did you dream during your procedure?
5. what was the worst thing about your procedure?

control postoperative pain, comparable to ASA with codient of ibuprofen.  tramadol mixed with acetaminopehn is the only treatment of fibromyalgia -

good to give this drug with regional

1-2 mg gluagon

naloxine

nalbuphine

atropine

robinal

NTG

VA

despite their name, neither gabapentinoids (gabapentin and pregabalin) has activity in the GABA neuron transmission system.   Gabapentinoids do not bind to the GABA receptors and do not affect the uptake or metabolism of GABA. Gabapeninoids exhibit anticonvulsant, anxiolytic and central antihyperalgesia effects.  teh exact MOA of gabapentinoids is unertian,, but both drugs have high binding affinities for presynaptic VG-Ca channels in the CNS.  Gabapentoids appear to exert their analgesic effects by reducing the hyperexcitability of the dorsal horn neurons caused by tissue damage.  the anlagesic mechanism of gabapentinoids may invovle 3 distinct processes:  decrease releae of NT via presynaptic binding of Ca recetpor, redistribution of the Ca channel away from its functional membrane bound site to its nonfunctional cystolsolic site and inhbition of activation of the transcription factor KB, which reduce gen transcription of COX23 and interlukin 6

what are the therapuetic uses of babapentinoids, gabapentin and pregablain?

1. direct visulaization of nerves and adjacent anatomic structures
2. observing local anesethtic spread in real time
3. detecting variations in anatomy
4. faster onset times
5. improvement in block quality
6. use of lower more precise doses of local
7. possible increase in safety
8. less painful administration compared with nerve stimulatr
9. high pt satisfaction

knowing where the tip of the needle is in reatlion to antaomoical structurs and being able to see the spread of local is the best thing about URGA

1. a sound wave is defined by a specific wave length- meaured in units of distance, amplitude
2. meaure in decibels dB- a logarithmic measure
3. frequcny - meausured by hertz or cycles per second