What is the treatment of life-threatening respiratory depression with narcotics?
What are the side effects of epidural analgesia?
What is the advantage of epidural analgesia?
What are the side effects of spinal anesthesia?
What is the side effect of inhalational (volatile) anesthesia?
Chapter 31 / Anesthesia 193
Narcan® IV (naloxone)
Orthostatic hypotension, decreased motor function, urinary retention
Analgesia without decreased cough reflex
Urinary retention
Hypotension (neurogenic shock)
Halothane—hypotension (cardiac depression, decreased baroreceptor response to hypotension, and peripheral vasodilation), malignant hyperthermia
MALIGNANT HYPERTHERMIA
What is it? |
Inherited predisposition to an anesthetic |
|
reaction, causing uncoupling of the |
|
excitation–contraction system in skeletal |
|
muscle, which in turn causes malignant |
|
hyperthermia; hypermetabolism is fatal |
|
if untreated |
What is the incidence? |
Very rare |
What are the causative |
General anesthesia, succinylcholine |
agents? |
|
What are the signs/symptoms? |
Increased body temperature; hypoxia; |
|
acidosis; tachycardia, c PCO2 (c end tidal |
|
CO2) |
What is the treatment? |
IV dantrolene, body cooling, discon- |
|
tinuation of anesthesia |
MISCELLANEOUS |
|
|
|
What are some of the |
Vecuronium |
nondepolarizing muscle |
Pancuronium |
blockers? |
|
194 Section I / Overview and Background Surgical Information
What are the antidotes to the nondepolarizing neuromuscular blocking agents?
How do these agents work?
Which muscle blocker is depolarizing?
What is the duration of action of succinylcholine?
What is the antidote to reverse succinylcholine?
What is the maximum dose of lidocaine:
With epinephrine?
Edrophonium
Neostigmine
Pyridostigmine
They inhibit anticholinesterase
Succinylcholine
6 minutes
Time; endogenous blood pseudocholinesterase (patients deficient in this enzyme may be paralyzed for hours!)
7 mg/kg
Without epinephrine? |
4 mg/kg |
What is the duration of lidocaine local anesthesia?
What are the early signs of lidocaine toxicity?
What are the signs of lidocaine toxicity with large overdose ( 10 mcg/mL)?
When should the Foley catheter be removed in a patient with an epidural catheter?
What is a PCA pump?
30 to 60 minutes (up to 4 hours with epinephrine)
Tinnitus, perioral/tongue numbness, metallic taste, blurred vision, muscle twitches, drowsiness
Seizures, coma, respiratory arrest Loss of consciousness
Apnea
Several hours after the epidural catheter is removed (to prevent urinary retention)
Patient-Controlled Analgesia; a pump delivers a set amount of pain reliever when the patient pushes a button
(e.g., 1 mg of morphine every 6 minutes)
What are the advantages of a PCA pump?
Chapter 32 / Surgical Ulcers 195
Better pain control
Patients actually use less pain medication with a PCA!
If given a moderate dose without a basal rate, patients should not be able to overdose (They will fall asleep and not be able to push the button!)
What is a “basal rate” on the PCA?
Steady continuous infusion rate of the narcotic (e.g., 1–2 mg of morphine) continuously infused per hour; patient can supplement with additional doses as needed
What is used to reverse narcotics?
What is used to reverse benzodiazepines?
What is fentanyl?
Name an IV NSAID.
Naloxone (Narcan®)
Flumazenil
Very potent narcotic (#1 drug of abuse by anesthesiologists)
Ketorolac (has classic side effects of NSAIDs: PUD, renal insufficiency)
C h a p t e r 32 |
Surgical Ulcers |
Define the following terms: |
|
Peptic ulcer |
General term for gastric/duodenal ulcer |
|
disease |
Gastric ulcer |
Ulcer in the stomach |
196 Section I / Overview and Background Surgical Information
Curling’s ulcer |
Gastric ulcer after burn injury (Think: |
|
Curling’s—curling iron burn—burn) |
OUCH!
Cushing’s ulcer |
Peptic ulcer after neurologic insult |
|
(Think: Cushing—famous neurosurgeon) |
Dieulafoy’s ulcer |
Pinpoint gastric mucosal defect |
|
bleeding from underlying arterial |
|
vessel malformation |
Marjolin’s ulcer |
Squamous cell carcinoma ulceration |
|
overlying chronic osteomyelitis or burn |
|
scar |
Aphthous ulcer |
GI tract ulcer seen in Crohn’s disease |
Marginal ulcer |
Mucosal ulcer seen at a site of GI tract |
|
anastomosis |
Decubitus ulcer |
Skin/subcutaneous ulceration from |
|
pressure necrosis, classically on the |
|
buttocks/sacrum |
Venous stasis ulcer |
Skin ulceration on medial malleolus |
|
caused by venous stasis of a lower |
|
extremity |
LE arterial insufficiency |
Skin ulcers usually located on the toes/feet |
ulcer |
|
|
Chapter 33 / Surgical Oncology 197 |
|
|
C h a p t e r 33 |
Surgical Oncology |
Define: |
|
Surgical oncology |
Surgical treatment of tumors |
XRT |
Radiation therapy |
In situ |
Not invading basement membrane |
Benign |
Nonmalignant tumor—does not invade |
|
or metastasize |
Malignant |
Tumors with anaplasia that invade and |
|
metastasize |
Adjuvant RX |
Treatment that aids or assists surgical |
|
treatment Chemo or XRT |
Neoadjuvant RX |
Chemo, XRT, or both BEFORE surgical |
|
resection |
Brachytherapy |
XRT applied directly or very close to the |
|
target tissue (e.g., implantable adioactive |
|
seeds) |
Metachronous tumors |
Tumors occurring at different times |
Synchronous tumors |
Tumors occurring at the same time |
What do the T, M, and N |
T-Tumor size |
stand for in TMN staging? |
M-Mets (distant) |
|
N-Nodes |
What tumor marker is |
CEA |
associated with colon cancer? |
|
What tumor marker is |
-Fetoprotein |
associated with hepatoma? |
|
What tumor marker is |
CA 19-9 |
associated with pancreatic |
|
carcinoma? |
|
198 Section I / Overview and Background Surgical Information
What is paraneoplastic syndrome?
What are the most common cancers in women?
What are the most common cancers in men?
What is the most common cancer causing death in both men and women?
Syndrome of dysfunction not directly associated with tumor mass or mets (autoimmune or released substance)
1.Lung
2.Breast
3.Colorectal
1.Prostate
2.Lung
3.Colorectal
Lung!