Anesthesia Assessment and Etomidate Quiz
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Questions and Answers

Which of the following conditions is associated with a high Mallampati score?

  • Low blood pressure
  • Difficult intubation (correct)
  • Normal oxygen saturation
  • Low heart rate

What does the Thyromental distance (TMD) assess?

  • The distance from the thyroid cartilage to the mental prominence (correct)
  • The length of the patient’s neck
  • The distance from the chin to the collarbone
  • The distance from the upper lip to the lower lip

Which air assessment predictor assesses the ability to bite the upper lip?

  • Modified Mallampati score
  • Upper lip bite test (correct)
  • Tracheal deviation test
  • Thyromental distance

What is the typical threshold for a normal Thyromental distance?

<p>7 cm (D)</p> Signup and view all the answers

What is the primary action of etomidate?

<p>Hypnotic (D)</p> Signup and view all the answers

What is the typical induction dose of etomidate?

<p>0.3 mg/kg (B)</p> Signup and view all the answers

In assessing a patient’s airway, which sign might indicate a difficult intubation?

<p>Loose or chipped teeth (A)</p> Signup and view all the answers

Which of the following factors is not typically included in a pre-anesthesia assessment?

<p>Type of clothing worn during surgery (D)</p> Signup and view all the answers

Which of the following is a significant adverse effect of etomidate?

<p>Transient inhibition of adrenal steroid synthesis (D)</p> Signup and view all the answers

What is the primary route of excretion for etomidate after administration?

<p>Urine (D)</p> Signup and view all the answers

What is the purpose of evaluating exercise tolerance during a pre-anesthesia assessment?

<p>To assess overall physical fitness and risks (A)</p> Signup and view all the answers

Which of the following could be a complication that needs to be documented in previous anesthesia assessments?

<p>PONV (Postoperative Nausea and Vomiting) (A)</p> Signup and view all the answers

What is the onset of action for etomidate after intravenous administration?

<p>30 to 60 seconds (B)</p> Signup and view all the answers

Why is etomidate no longer administered by continuous infusion?

<p>It risks sustained suppression of endogenous cortisol and aldosterone production (C)</p> Signup and view all the answers

Which statement about etomidate's metabolism is correct?

<p>It is rapidly metabolized by hepatic and plasma esterases. (B)</p> Signup and view all the answers

In which patients is etomidate particularly ideal for use during induction?

<p>Patients with significant cardiovascular disease (B)</p> Signup and view all the answers

What makes neonates and young infants obligate nasal breathers?

<p>Soft tracheal cartilages (A)</p> Signup and view all the answers

Which anatomical feature is the narrowest part of the airway in infants?

<p>Cricoid cartilage (D)</p> Signup and view all the answers

What is a significant physiological difference in the respiratory system of young children?

<p>Lower lung compliance (B)</p> Signup and view all the answers

What should be maintained to prevent airway obstruction in infants?

<p>Neutral or slightly extended head position (B)</p> Signup and view all the answers

Which condition is common in children aged 3 to 8 years that may lead to airway obstruction?

<p>Adeno-tonsillar hypertrophy (D)</p> Signup and view all the answers

What characterizes the tidal volume in infants?

<p>Relatively fixed volume (D)</p> Signup and view all the answers

What is a common complication in premature and ex-premature infants that requires monitoring post-surgery?

<p>Apnoeas (C)</p> Signup and view all the answers

What anatomical difference decreases the ease of airway management in young children?

<p>Long, U-shaped epiglottis (A)</p> Signup and view all the answers

Which of the following is a contraindication for the use of sevoflurane?

<p>Severe hypovolemia (B)</p> Signup and view all the answers

What property of sevoflurane contributes to its effectiveness in inhalational induction?

<p>Pleasant smell (D)</p> Signup and view all the answers

What effect does sevoflurane have on cardiovascular function?

<p>Decreases myocardial O2 demand (A), Reduces systemic vascular resistance (C)</p> Signup and view all the answers

What is a risk associated with the degradation of sevoflurane by soda lime?

<p>Compounds A formation (D)</p> Signup and view all the answers

Which characteristic makes sevoflurane particularly suitable for use in pediatric patients?

<p>Rapid and smooth induction characteristics (C)</p> Signup and view all the answers

How does sevoflurane affect respiratory function?

<p>Induces bronchodilatation (B)</p> Signup and view all the answers

What is a notable neurological effect of sevoflurane?

<p>Reduces intraocular pressure (D)</p> Signup and view all the answers

Which effect is commonly associated with sevoflurane during emergence from anesthesia?

<p>Emergence agitation (B)</p> Signup and view all the answers

What is the most common initial sign of cardiac toxicity associated with local anesthetics?

<p>Hypotension (C)</p> Signup and view all the answers

Which class of drugs is recommended for the immediate management of seizures in local anesthetic systemic toxicity?

<p>Benzodiazepines (C)</p> Signup and view all the answers

What can be administered if benzodiazepines are not available during seizure management?

<p>Propofol or thiopental (B)</p> Signup and view all the answers

What is the primary focus of management during local anesthetic-induced cardiac arrest?

<p>Restoring cardiac output (C)</p> Signup and view all the answers

How is lipid emulsion therapy theorized to help in cases of local anesthetic toxicity?

<p>By drawing the anesthetic out of cardiac tissue (A)</p> Signup and view all the answers

What is the recommended initial bolus amount of 20% lipid emulsion for treatment in suspected toxicity cases?

<p>1.5 mL/kg (B)</p> Signup and view all the answers

Which of the following is NOT a sign of cardiac toxicity from local anesthetics?

<p>Fever (A)</p> Signup and view all the answers

What should be done if hemodynamic stability is not achieved after the initial lipid emulsion bolus?

<p>Increase infusion rate to 0.5 mL/kg per minute (D)</p> Signup and view all the answers

What is one of the primary uses of nitrous oxide in medical practice?

<p>Pain relief during childbirth (C)</p> Signup and view all the answers

Which of the following is a known characteristic of nitrous oxide?

<p>It rapidly enters enclosed air-containing spaces (A)</p> Signup and view all the answers

What condition may result from the use of nitrous oxide at the end of surgery?

<p>Diffusion hypoxia (C)</p> Signup and view all the answers

What is a notable effect of prolonged use of nitrous oxide?

<p>Megaloblastic anemia (A)</p> Signup and view all the answers

How does nitrous oxide affect the cardiovascular system?

<p>It mildly depresses myocardial function (C)</p> Signup and view all the answers

What percentage of xenon mixed with oxygen is considered to induce general anesthesia without side effects?

<p>70% xenon and 30% oxygen (C)</p> Signup and view all the answers

What is a significant drawback of nitrous oxide exposure?

<p>Interferes with DNA synthesis (D)</p> Signup and view all the answers

Which statement about nitrous oxide is inaccurate?

<p>It is highly soluble in blood (A)</p> Signup and view all the answers

Flashcards

Difficult intubation

A situation where endotracheal intubation (placing a tube into the trachea) is challenging due to factors like a narrow airway.

Mallampati classification

A method used to assess the ease of intubation by visually examining the oral cavity in a patient.

Thyromental distance (TMD)

The distance between the thyroid cartilage (Adam's apple) and the chin, used to predict intubation difficulty in a person.

Anesthesia awareness

A rare and serious complication where a patient undergoing anesthesia may retain some awareness during the procedure despite being under anesthesia

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PONV

Postoperative nausea and vomiting, nausea or vomiting occurring after surgery or a medical procedure.

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Regular Medications

Medications that a patient takes regularly on a daily basis.

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Mallampati class I

The easiest intubation; soft palate, uvula, fauces, pillars are visible.

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Mallampati class IV

The most difficult intubation; only hard palate is visible.

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Etomidate's action

Etomidate is a hypnotic intravenous anesthetic.

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Etomidate's administration

Administered intravenously only, not in a continuous infusion.

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Etomidate's hemodynamic profile

Minimal blood pressure drop during induction.

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Etomidate's major adverse effect

Transient inhibition of adrenal steroid synthesis.

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Etomidate's metabolism

Primarily metabolized in the liver by ester hydrolysis.

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Etomidate's excretion

75% excreted in urine in the first day, bile also involved.

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Etomidate's protein binding

Highly protein-bound (77%).

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Etomidate's induction dose

0.3mg/kg standard dose.

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Nitrous Oxide Properties

A colorless, odorless gas stored as a liquid under high pressure (51 bar at 20°C) in blue cylinders, used as an anesthetic.

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Nitrous Oxide Use in Anesthesia

Used for rapid induction and recovery, strong pain relief (analgesia), and minor surgeries, especially in obstetrics.

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Nitrous Oxide Diffusion

Diffuses quickly into enclosed air spaces, potentially causing volume expansion and air emboli.

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Diffusion Hypoxia

Temporary oxygen deficiency after surgery, potentially caused by rapid nitrous oxide diffusion.

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Nitrous Oxide Respiratory Effects

Slightly depresses respiration but isn't irritating. Diffusion hypoxia is a potential issue at the end of the procedure.

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Nitrous Oxide Cardiovascular Effects

Mild myocardial depression but also has sympathetic effects that compensate for this reduction in the heart. No big change in heart rate or blood pressure generally.

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Nitrous Oxide CNS Effects

Slightly increases brain metabolism, blood flow, and intracranial pressure.

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Xenon as anesthetic

A noble gas with an anesthetic effect. It is a nearly ideal anesthetic agent. Isolated from the air.

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Sevoflurane Uses

Sevoflurane is commonly employed in neurosurgery and is widely used globally, particularly for children. Its rapid onset and smooth recovery make it suitable for various procedures.

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Sevoflurane Properties

Sevoflurane is a colorless liquid with a pleasant smell. It is non-flammable, non-corrosive, and stable at room temperature. It has a low blood-gas partition coefficient, leading to quick onset and offset of action.

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Sevoflurane and Soda Lime

When Sevoflurane interacts with soda lime (a common absorbent in anesthesia machines), it can produce Compound A, a potentially harmful substance that may cause kidney damage.

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Sevoflurane Respiratory Effects

Sevoflurane is well-tolerated by the respiratory system, causing minimal irritation. It acts as a respiratory depressant, increasing breathing rate while reducing the amount of air inhaled in each breath. It can also widen airways, improving breathing.

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Sevoflurane Cardiovascular Effects

Sevoflurane minimally impacts heart rate and strength but can cause a decrease in blood pressure by dilating blood vessels. It lowers the heart's oxygen demand and is unlikely to cause heart rhythm problems.

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Sevoflurane CNS Effects

Sevoflurane offers smooth and rapid induction and recovery from anesthesia. It can enhance the risk of agitation after waking up and provides some pain relief after surgery. It can reduce brain activity and pressure.

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Sevoflurane Muscle Relaxation

Sevoflurane provides adequate muscle relaxation, particularly useful for intubation in children. It enhances the effects of muscle relaxant drugs.

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Sevoflurane Advantages for Intubation

Sevoflurane is favored for inhalational induction in children because of its rapid and smooth effects. Its properties are well-suited for difficult airway situations, including obstructions.

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Neonate breathing

Newborn babies primarily breathe through their nose until around 5 months of age.

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Airway obstruction in infants

Infants are susceptible to airway obstruction due to their soft tracheal cartilages, which can easily collapse.

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Infant larynx position

The larynx in infants sits higher than in adults, at the level of C3-4 compared to C5-6.

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Infant airway's narrowest point

The narrowest part of an infant's airway is at the cricoid cartilage, below the vocal cords.

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Adeno-tonsillar hypertrophy

Enlarged tonsils and adenoids are common in children between 3 and 8 years old, potentially causing airway obstruction.

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Infant respiratory rate

Infants have a faster respiratory rate compared to adults.

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Infant lung compliance

Infants have lower lung compliance, meaning their lungs are less easily expandable.

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Infant tidal volume

Infants have a relatively fixed tidal volume, averaging 5-7 ml per kilogram of body weight.

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Cardiac Toxicity and Local Anesthetics

The potential for potent local anesthetics to cause heart problems like arrhythmias and bradycardia, often appearing alongside seizures or even preceding them.

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Signs of Cardiac Toxicity

The symptoms of cardiac toxicity from local anesthetics can include hypotension, bradycardia, hypertension, dyspnea, pain, wide QRS complex, ST segment changes, asytole, tachycardia, and ventricular ectopy, tachycardia, or fibrillation.

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Management of Local Anesthetic Toxicity

Focuses on airway management, circulatory support, and reducing systemic side effects. This includes ventilation, oxygenation, immediate seizure control with benzodiazepines, and potentially lipid emulsion therapy.

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Lipid Emulsion Therapy for Local Anesthetic Toxicity

A treatment option for local anesthetic-induced cardiac arrest, arrhythmias, or prolonged seizures, aiming to improve cardiac conduction, contractility, and coronary perfusion by drawing the anesthetic out of cardiac tissue.

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Lipid Emulsion Therapy Dosage

A bolus of 1.5 mL/kg of 20% lipid emulsion followed by an infusion of 0.25 mL/kg per minute, maintained for 10 minutes after hemodynamic stability.

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Benzodiazepines for Seizures

The recommended treatment for seizures caused by local anesthetic toxicity. Benzodiazepines like diazepam or lorazepam help to control seizures.

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Propofol or Thiopental

Alternative medications for seizure control if benzodiazepines are unavailable, but be cautious as they may worsen hypotension or cardiac depression.

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Succinylcholine for Seizures

Small doses can be used intermittently to stop muscular activity and acidification during prolonged seizures if other medications fail.

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Study Notes

Anesthesia 3rd Stage Study Notes

  • This is a teaching package for anesthesia techniques, 3rd stage, for the academic years 2023-2024.
  • The course covers preoperative assessment and premedication.

Preoperative Assessment and Premedication

  • Preoperative assessment identifies comorbidities that may cause complications during and after surgery.
  • Elective procedures typically have a preoperative assessment 2–4 weeks before surgery.
  • Premedication involves medications to prepare the patient for anesthesia and optimize surgery conditions.
  • Specific patient needs depend on the patient and procedure.

Goals of Preoperative Assessment

  • Establish a strong doctor-patient relationship
  • Plan the anesthetic technique
  • Screen and manage comorbidities
  • Assess and minimize anesthetic risks
  • Identify the need for specialized techniques
  • Identify the need for advanced postoperative care
  • Prepare the patient
  • Determine perioperative risk
  • Reduce patient anxiety
  • Obtain informed consent
  • The ASA physical classification (American Society of Anesthesiologists) helps assess patient risk before surgery.

Minimum Preoperative Visit Components (ASA)

  • Medical, anesthetic, and medication history
  • Complete physical examination
  • Review of diagnostic data (ECG, labs, X-rays)
  • Assessment of ASA physical status
  • Formulation and discussion of the anesthetic plan

ASA Physical Classification

  • ASA 1: Normal healthy patient
  • ASA 2: Mild systemic disease, no impact on daily life
  • ASA 3: Severe systemic disease, significant impact on daily life
  • ASA 4: Severe systemic disease, constant threat to life
  • ASA 5: Moribund, not expected to survive without surgery
  • ASA 6: Declared brain-dead patient—organ donor
  • E: Emergency surgery

History

  • Medical problems (current and past)
  • Regular medications
  • Previous surgeries (date)
  • Family anesthesia history
  • Anesthesia problems in the family
  • Type of anesthesia
  • Pseudocholinesterase deficiency and malignant hyperpyrexia

Physical Examination

  • Airway assessment
  • Heart and lungs assessment
  • Vital signs, including O2 saturation
  • Blood pressure, resting pulse, rate, rhythm
  • Respiration, rate, depth, and pattern at rest
  • Body temperature
  • Height and weight (BMI)
  • Other specific examinations depending on the individual patient and procedure

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Related Documents

Anesthesia 3rd Stage Lecture Notes PDF

Description

Test your knowledge on anesthesia assessments and specifically etomidate's pharmacology. This quiz covers key concepts like airway predictors, Thyromental distance, and the adverse effects of etomidate. Perfect for those studying anesthesiology or preparing for exams!

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