Anesthesiology board review by Kerri M. Robertson, David J Lubarsky, Sudharma Ranasinghe

By Kerri M. Robertson, David J Lubarsky, Sudharma Ranasinghe

Why waste time guessing at what you must comprehend for anesthesia in-service and board examination? Maximize your examination instruction time with this quick-hit query and resolution evaluate. the original query and single-answer structure gets rid of the guesswork linked to conventional multiple-choice Q&A stories and reinforces simply the right kind solutions you will have to understand on examination day. Emphasis is put on distilling key proof and medical pearls crucial for examination good fortune. This high-yield overview is ideal for severe, streamlined evaluation within the days and weeks ahead of your examination.

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If more than two units of type O Rh-negative uncrossmatched whole blood have been administered, the blood bank must determine that transfused anti-A and anti-B antibodies have fallen to levels that permit transfusion of typespecific blood. There is a risk of a major transfusion reaction if the patient has received enough anti-A or anti-B antibodies in type-O blood to cause hemolysis if A, B or AB blood is subsequently given. It takes significantly more PRBC units to potentially transfuse enough plasma containing anti-A, anti-B antibodies to prevent switching to type specific blood.

Recommended infusion rate is 2-10 mg/min to clinical response. A dose of 3 µg/kg/min is too high. 43 44 ANESTHESIOLOGY BOARD REVIEW  A parkinsonian patient requires urgent coronary artery bypass graft surgery while he is taking selegiline (selective inhibitor of monoamine oxidase type B). Should the patient stop taking MAO inhibitors prior to surgery? Although controversial, MAO inhibitors may be continued perioperatively. Decreased presynaptic metabolism of catecholamines and serotonin by MAOIs may be responsible for hemodynamic instability, hyperpyrexia and death when these patients are exposed to stress and anesthesia.

Epidural and other regional techniques appear to have no adverse effect.  A patient arrests 10 minutes after induction of spinal anesthesia. What do you do? The most likely cause is a high spinal, and supportive therapy is the treatment including airway control and BP support. However, unexpected cardiac arrest during spinal anesthesia has been described. Sudden severe bradycardia and asystolic arrest can develop without evidence of high spinal respiratory depression or hypoxemia and hypercarbia.

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