Anesthesia Board flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

MAC

Minimum alveolar concentration at one atmosphere that prevents movement in 50% of patients given a standard surgical stimulus; a potency measure inversely related to lipid solubility.

Hofmann elimination

Spontaneous non-enzymatic degradation at physiologic pH and temperature; explains the organ-independent clearance of atracurium and cisatracurium, whose duration is unaffected by renal or hepatic failure.

Context-sensitive half-time

Time for plasma concentration to fall by 50% after an infusion stops; lengthens with infusion duration for lipophilic drugs such as thiopental and fentanyl but remains short for remifentanil.

Arterial oxygen content

CaO2 = (1.34 × Hb × SaO2) + (0.003 × PaO2), reported in mL O2 per dL; hemoglobin-bound oxygen dominates, so dissolved oxygen contributes little.

Cerebral perfusion pressure

Mean arterial pressure minus intracranial pressure; typical adult target is roughly 60–70 mmHg, and cerebral blood flow is autoregulated between MAP 50 and 150 mmHg.

Depolarizing block

Succinylcholine holds the nicotinic channel open, causing fasciculations then flaccid paralysis; Phase I block is not reversed by anticholinesterases and is actually potentiated by them.

Ion trapping

A weak base crosses membranes only in its uncharged form; in acidic compartments it becomes protonated and cannot exit, prolonging drug effect in fetal or infected tissue.

Turbulent flow

Occurs when the Reynolds number exceeds about 2000, at high flow or gas density or low viscosity; flow then varies with the square root of the pressure gradient.

ASA physical status

I healthy; II mild systemic disease; III severe systemic disease; IV constant threat to life; V moribund; VI brain-dead organ donor; the E suffix denotes emergency surgery.

Mallampati classification

Airway assessment with the patient seated, mouth open, tongue protruded: class I shows soft palate, uvula, and fauces; class IV shows only hard palate. Higher classes predict difficult laryngoscopy.

Rapid sequence induction

Preoxygenation, prompt induction with a fast-acting agent, and neuromuscular blockade without positive-pressure ventilation to limit aspiration; cricoid pressure is traditional but evidence is mixed.

Sugammadex

Modified gamma-cyclodextrin that encapsulates rocuronium and vecuronium, reversing even deep blockade within minutes; doses range from 2 to 16 mg/kg and it does not reverse succinylcholine.

Post-dural puncture headache

Fronto-occipital headache worsened by upright posture and relieved by lying flat, caused by CSF leak after dural puncture; conservative therapy first, epidural blood patch if persistent.

Malignant hyperthermia

Hypermetabolic crisis from uncontrolled skeletal muscle calcium release triggered by volatile anesthetics and succinylcholine; treat with dantrolene 2.5 mg/kg boluses, stop triggers, cool, and treat hyperkalemia.

Laryngospasm management

Remove the stimulus, give 100% oxygen with CPAP and jaw thrust, and deepen anesthesia; if persistent, give propofol or succinylcholine 0.5–1 mg/kg IV and prepare to reintubate.

Apfel score

Predicts postoperative nausea and vomiting from female sex, nonsmoking status, prior PONV or motion sickness, and postoperative opioids; each factor adds roughly 20% risk.

Uncuffed endotracheal tube size

For children older than 1 year, internal diameter in mm equals age in years divided by 4 plus 4; a cuffed tube is typically chosen half a size smaller.

Left uterine displacement

After 20 weeks' gestation the gravid uterus compresses the inferior vena cava when supine; manual displacement or a wedge maintains venous return and cardiac output during neuraxial anesthesia.

Lipid emulsion therapy

For local anesthetic systemic toxicity, give 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min infusion; continue CPR and avoid vasopressin, calcium channel blockers, and beta blockers.

One-lung ventilation hypoxemia

First verify tube position and hemodynamics, then apply CPAP to the non-dependent lung or PEEP to the dependent lung, and reduce tidal volume to limit volutrauma.

Awake fiberoptic intubation

Airway topicalization with light sedation preserves spontaneous ventilation and is indicated for anticipated difficult airways; an antisialagogue improves the view and oxygen is supplied throughout.

Pulmonary artery catheter

Flow-directed catheter measuring right atrial, pulmonary artery, and occlusion pressures plus thermodilution cardiac output; used in complex cardiac and shock states without routine mortality benefit.

Informed consent elements

Requires patient capacity, adequate disclosure of risks and alternatives, comprehension, and voluntariness; anesthesia discussion covers awareness, nausea, sore throat, dental injury, and nerve injury.

Anesthesia billing units

Total units equal ASA base units for the procedure plus one unit per 15 minutes of anesthesia time, multiplied by a contracted conversion factor; modifiers cover physical status and qualifying circumstances.

EMTALA

Federal law requiring Medicare-participating hospitals with emergency departments to provide a medical screening examination and stabilizing treatment regardless of insurance status or ability to pay.

Medical malpractice elements

The plaintiff must prove an established duty of care, a breach of the standard of care, causation linking the breach to injury, and compensable damages; all four elements are required.

WHO surgical safety checklist

Three phases: sign in before induction of anesthesia, time out before skin incision, and sign out before the patient leaves the operating room; use reduces surgical morbidity and mortality.

Operating room fire triad

Requires an oxidizer such as oxygen or nitrous oxide, a fuel such as drapes or the endotracheal tube, and an ignition source such as electrocautery; management is stopping gas, removing burning material, and saline.

Alarm fatigue

Desensitization caused by frequent false or nonactionable alarms leads to delayed clinician response; mitigation uses individualized limits, correct lead placement, and fewer unnecessary audible alarms.

Donabedian model

Frames quality assessment in three categories: structure (resources and staffing), process (what is done to the patient), and outcome (results), each with distinct measures and limitations.

Plan-Do-Study-Act

Iterative improvement cycle: plan a change, test it on a small scale, study the results, and act by adopting, adapting, or abandoning it; repeated rapid cycles drive local improvement.

Failure mode and effects analysis

Prospective team-based method that maps a process, identifies ways it can fail, and scores severity, occurrence, and detectability to prioritize preventive actions before harm occurs.