Flashcards in Week 8&9 - Dr. White Deck (61)
• Respiratory Changes seen in steep trendelenburg
End-tidal carbon dioxide (ETCO2)
Upper airway edema
Vital capacity (VC)
Forced Expiratory Volume in 1 second (FEV1)
• Cerebrovascular Changes seen in steep trendelenburg
Hydrostatic pressure gradient
Cerebral vascular resistance
Cerebral venous drainage
Regional cerebral oxygenation
Cerebral perfusion pressure
what is a rare but devastating complication following surgery (robotic):
Postoperative visual loss
• The most important goal in managing the hyperthyroid patient is before surgery, if possible, make the patient
What is best to avoid during induction of a hyperthryoid patient?
It is best to avoid using ketamine for induction, even when a patient is clinically euthyroid.
• The complications after thyroidectomy include :
*recurrent laryngeal nerve (RLN) damage,
-tracheal compression secondary to hematoma or tracheomalacia, and
• Unilateral nerve injury is more common and is often
• Unilateral damage to the RLN is characterized by
hoarseness and a paralyzed vocal cord,
whereas bilateral injury causes aphonia.
The normal total serum calcium concentration is 8.8 to 10.4 mg/dL.
In general, an increase or decrease in albumin of 1 g/dL is associated with a parallel change in total serum Ca2+ of .
Hypercalcemia (in hyperparathyroid) is responsible for a broad spectrum of signs and symptoms. The most common manifestation, occurring in 60% to 70% of patients is:
(Polyuria and polydipsia are also common complaints. 20-50% of patients are also HTN)
The anesthetic consideration for the hyperparathyroid/ hypercalemic patient regarding NMBD:
There is an increased requirement for vecuronium,
and probably all nondepolarizing muscle relaxants, during onset of neuromuscular blockade
the duration of safe tourniquet inflation is generally considered:
Tourniquet pain can become significant over time and can be mitigated with inhalational agents, opioids and/or hypnotics. Definitive management is:
deflation of the tourniquet.
Changes that can be expected with tourniquet deflation and are generally well tolerated in healthy patients (3):
1.) Transient systemic metabolic acidosis,
2.) increased arterial carbon dioxide levels,
3.) A drop in systemic blood pressure
The mechanical effects of peritoneal insufflation impair ventilation. Insufflation of the peritoneum displaces the diaphragm in a cephalad direction resulting in: (3)
1. decreases FRC,
2. decreases VC,
3. in turn induces collapse of the dependent regions of the lungs.
Studies show that recruitment maneuvers that use the combination of PEEP 10 cm H2O and intermittent positive airway pressure (40 cm H2O) for 40 seconds was most effective in improving end-expiratory lung volumes, lung compliance, and arterial oxygenation in both healthy weight and
obese patients than either intervention alone.
Postoperative nausea and vomiting is a major concern for patients undergoing
laparoscopic surgical procedures.
The incidence of PONV in the laparoscopic population has been reported to be as high as 72% and is known to be associated with significant postoperative complications such as
surgical wound dehiscence,
unanticipated hospital admission.
the etiology of PONV is
prior to cardioversion, what should the anesthesia provider ensure to review?
most recent EKG
Cardiovascular stimulation also occurs with ECT because
The sympathetic and parasympathetic nervous systems are stimulated sequentially.
COPD cannot be definitively diagnosed without
-Results of PFTs in COPD reveal a decrease in the FEV1:FVC ratio.
-An FEV1:FVC less than 70% of predicted that is not reversible with bronchodilators confirms the diagnosis.
-Other spirometric findings of COPD include an increased FRC and TLC.
CT is a much more sensitive test compared to simple chest radiography at diagnosing
the first step in treating COPD.
Smoking cessation should be
the two important therapeutic interventions that can alter the natural history of COPD.
Smoking cessation and long-term oxygen administration are
In COPD, the goal of supplemental oxygen administration is to achieve a PaO2 greater than
60 mm Hg
Diuretic-induced chloride depletion may produce a hypochloremic metabolic alkalosis that depresses the ventilatory drive and may aggravate
chronic carbon dioxide retention.
Strategies to Decrease Incidence of Postoperative Pulmonary Complications – Preoperative include:
- Encourage cessation of smoking for at least 6 weeks.**
- Treat respiratory infection with antibiotics. **
- Treat evidence of expiratory airflow obstruction.
- Initiate patient education regrading lung volume expansion maneuvers.
Strategies to Decrease Incidence of Postoperative Pulmonary Complications – Intraoperative include:
- Use minimally invasive surgery (endoscopic) techniques when possible. **
- Consider regional anesthesia**
- Avoid surgical procedures likely to last longer than 3 hours. **