[216B] Anesthesia (Zoom Lec)

Question 1

Define anesthesia.

Answer 1

Sedation of a pt for a medical procedure/intervention.

Question 2

List the 4 types of anesthesia. Which are systemic?

Answer 2

1. Local anesthesia.
2. Regional anesthesia.
3. General anesthesia: systemic.
4. Monitored anesthesia care (MAC): systemic.

Question 3

Is it possible to administer regional anesthesia systemically?

Answer 3

Yep :)

Question 4

MAC is sedation at ____ levels to maintain the pt’s ___ without __________ them.

Answer 4

low; vitals; intubating.

Question 5

Local anesthetics are also known as:

Answer 5

Sodium channel blockers.

Question 6

Describe the mechanism of action for local anesthetics.

Answer 6

Block Na+ influx into neurons > no action potential/depolarization = no communication of sensory info to brain.

Question 7

Do local anesthetics affect the efferent or afferent nervous system?

Answer 7

Both c:< but depending on the drug, it may have more affinity for one pathway vs the other.

Question 8

Local anesthetics are lipo_____, meaning they have a:

Answer 8

lipophilic = high VD.

Question 9

Which now-street drug was the original local anesthetic?

Answer 9

Cocaine :D

Question 10

Cocaine ________ dopamine, resulting in:

Answer 10

increases = CNS stimulation.

Question 11

Which 3 routes of admin may be used with local anesthetics?

Answer 11

1. Topical.
2. Infiltration (SC injection into tissue).
3. Nerve block (SC injection near a large nerve bundle).

Question 12

List 3 adjunct medications for local anesthesia.

Answer 12

1. Epinephrine (adrenalin).
2. Sodium bicarbonate.
3. Opioids.

Question 13

Why is epinephrine a good adjunct medication for local anesthesia? (2)

Answer 13

1. Localized vasoconstriction = bleeding control.

2. Increased duration of action for the anesthetic.

Question 14

Why is sodium bicarbonate a good adjunct medication for local anesthesia?

Answer 14

Alkalization of tissue in case of bacterial environment.

Question 15

Epidurals are a form of _______ anesthesia.

Answer 15

Local.

Question 16

How do we verify the location of our epidural injection?

Answer 16

Check that there is no CSF return in the needle.

Question 17

If a pt has had an epidural, we should assess their ______ & ______ ability before mobilizing them.

Answer 17

Sensory & motor.

Question 18

Onset of epidural: __-__ mins.

Answer 18

20-30 mins.

Question 19

Spinals (“intrathecals”) are a type of _______ anesthesia.

Answer 19

Local.

Question 20

In a spinal, the drug is delivered directly to the ______ in the _________/_________ space.

Answer 20

CSF; intrathecal/subarachnoid space.

Question 21

How many doses can we give in a spinal? Why?

Answer 21

Only 1 to prevent infection - need sufficient anesthetic in that one dose.

Question 22

We should always inject spinals below ___ to:

Answer 22

L2 to avoid spinal cord damage

Question 23

Why does the tonicity of our injection matter in a spinal?

Answer 23

The higher the tonicity, the lower it will stay (because it’s “heavier” than its surroundings). We need it to stay at or below the injection site, so the tonicity of the injection will be site-dependent.

Question 24

Spinals are often used for procedures being done in the ____________ region.

Answer 24

Abdominopelvic.

Question 25

With spinals, there is a risk of _______ ________ if the ________ is accidentally affected.

Answer 25

Respiratory depression; diaphragm.

Question 26

Epidurals continuously infuse via an ________ _________. What should we monitor while using this device?

Answer 26

Indwelling catheter. | Monitor placement of catheter for potential migration.

Question 27

Which requires a higher dose of anesthetic: spinal or epidural? Why?

Answer 27

Epidural, because spinals are directly into the CSF, so a lower dose is needed to be effective.

Question 28

The 2 goals of general anesthesia are:

Answer 28

1. Analgesia. | 2. Unconsciousness.

Question 29

Which analgesic class might we use in general anesthesia? Which drug specifically?

Answer 29

Opioids (ex: morphine, fentanyl). | Fentanyl is fairly common: very potent = lower dose needed = decreased side effects.

Question 30

List the 2 steps in achieving unconsciousness in general anesthesia.

Answer 30

1. Induction: beginning of the loss of consciousness. | 2. Maintenance.

Question 31

General anesthetics causing unconsciousness may be: (2 routes)

Answer 31

1. Inhaled. | 2. IV.

Question 32

General anesthetics ________ GABA.

Answer 32

increase.

Question 33

List 3 meds that may be used as inhaled general anesthetics.

Answer 33

1. NO ("laughing gas"). 2. Halothane. 3. Isoflurane.

Question 34

Which drug is a commonly used IV general anesthetic? What drug class is it similar to?

Answer 34

Propofolol (Diprivan) - barbituate-like.

Question 35

List 4 considerations when using propofol (Diprivan).

Answer 35

1. Rapid onset. 2. Short t1/2. 3. Intubation required. 4. Monitor vitals (hypotension).

Question 36

Paralytics block ___ (neurotransmitter) binding at _______ receptors.

Answer 36

Ach at nicotinic receptors.

Question 37

Nicotinic receptors are found in: (3)

Answer 37

1. The SNS. 2. The PNS. 3. Skeletal muscle junctions.

Question 38

Do paralytics help with sedation?

Answer 38

No :0 they don't cross the BBB.

Question 39

Do pts on paralytics need to be intubated?

Answer 39

Yes -- drugs will paralyze all muscles, including the diaphragm.

Question 40

Name 5 paralytics.

Answer 40

1. Vecuronium. 2. Rocuronium. 3. Pancuronium. 4. Succinylcholine. 5. Botox.

Question 41

What class of drugs is used for MAC?

Answer 41

CNS depressants: ketamine, benzos (ex: midazolam (Versed).