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Section I, Surgical Recall Sixth Edition > Anesthesia, C31 P190-195 > Flashcards

Anesthesia, C31 P190-195 Flashcards

1
Q

Define the following terms:
Anesthesia
P190

A

Loss of sensation/pain

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2
Q

Define the following terms:
Local anesthesia
P190

A

Anesthesia of a small confined area of
the body (e.g., lidocaine for an elbow
laceration)

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3
Q

Define the following terms:
Epidural anesthesia
P190

A

Anesthetic drugs/narcotics infused into

epidural space

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4
Q

Define the following terms:
Spinal anesthesia
P190

A

Anesthetic agents injected into the thecal

sac

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5
Q

Define the following terms:
Regional anesthesia
P190

A

Blocking of the sensory afferent nerve
fibers from a region of the body
(e.g., radial nerve block)

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6
Q

Define the following terms:
General anesthesia
P191

A

Triad:

  1. Unconsciousness/amnesia
  2. Analgesia
  3. Muscle relaxation
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7
Q

Define the following terms:
GET or GETA
P191

A

General EndoTracheal Anesthesia

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8
Q

Give examples of the following terms:
Local anesthetic
P191

A

Lidocaine, bupivacaine (Marcaine®)

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9
Q

Give examples of the following terms:
Regional anesthetic
P191

A

Lidocaine, bupivacaine (Marcaine®)

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10
Q

Give examples of the following terms:
General anesthesia
P191

A

Isoflurane, enflurane, sevoflurane,

desflurane

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11
Q

Give examples of the following terms:
Dissociative agent
P191

A

Ketamine

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12
Q

What is cricoid pressure?

P191

A 
Manual pressure on cricoid cartilage
occluding the esophagus and thus
decreasing the chance of aspiration of
gastric contents during intubation
(a.k.a. Sellick’s maneuver)
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13
Q

What is “rapid-sequence”
anesthesia induction?
P191

A 
1. Oxygenation and short-acting
    induction agent
2. Muscle relaxant
3. Cricoid pressure
4. Intubation
5. Inhalation anesthetic (rapid: boom,
    boom, boom S to lower the risk of
    aspiration during intubation)
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14
Q

Give examples of induction
agents.
P191

A

Propofol, midazolam, sodium thiopental

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15
Q

What are contraindications
of the depolarizing agent
succinylcholine?
P191

A

Patients with burns, neuromuscular
diseases/paraplegia, eye trauma, or
increased ICP

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16
Q

Why is succinylcholine
contraindicated in these
patients?
P191

A

Depolarization can result in life-threatening
hyperkalemia; succinylcholine also
increases intraocular pressure

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17
Q

Why doesn’t lidocaine work
in an abscess?
P191

A

Lidocaine does not work in an acidic

environment

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18
Q 
Why does lidocaine burn
on injection and what can
be done to decrease the
burning sensation?
P192
A

Lidocaine is acidic, which causes the
burning; add sodium bicarbonate to
decrease the burning sensation

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19
Q

Why does some lidocaine
come with epinephrine?
P192

A

Epinephrine vasoconstricts the small
vessels, resulting in a decrease in bleeding
and blood flow in the area; this prolongs
retention of lidocaine and its effects

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20
Q

In what locations is lidocaine
with epinephrine contraindicated?
P192

A

Fingers, toes, penis, etc., because of the
possibility of ischemic injury/necrosis
resulting from vasoconstriction

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21
Q

What are the contraindications
to nitrous oxide?
P192

A

Nitrous oxide is poorly soluble in serum
and thus expands into any air-filled body
pockets; avoid in patients with middle ear
occlusions, pneumothorax, small bowel
obstruction, etc.

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22
Q

What is the feared side effect
of bupivacaine (Marcaine®)?
P192

A

Cardiac dysrhythmia after intravascular
injection leading to fatal refractory
dysrhythmia

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23
Q

What are the side effects of
morphine?
P192

A 
Constipation, respiratory failure,
hypotension (from histamine release),
spasm of sphincter of Oddi (use
Demerol® in pancreatitis and biliary
surgery), decreased cough reflex
24
Q

What are the side effects of
meperidine?
P192

A

Similar to those of morphine but causes
less sphincteric spasm and can cause
tachycardia and seizures

25
Q

Limit to the duration of
Demerol® postoperatively?
P192

A

Build up of the metabolites

normeperidine

26
Q

What medication is a
contraindication to
Demerol®?
P192

A

Monoamine oxidase inhibitor

27
Q

What metabolite of Demerol®
breakdown causes side effects
(e.g., seizures)?
P192

A

Normeperidine

28
Q

What is the treatment of
life-threatening respiratory
depression with narcotics?
P193

A

Narcan® IV (naloxone)

29
Q

What are the side effects of
epidural analgesia?
P193

A

Orthostatic hypotension, decreased

motor function, urinary retention

30
Q

What is the advantage of
epidural analgesia?
P193

A

Analgesia without decreased cough reflex

31
Q

What are the side effects of
spinal anesthesia?
P193

A

Urinary retention

Hypotension (neurogenic shock)

32
Q

What is the side effect of
inhalational (volatile)
anesthesia?
P193

A

Halothane—hypotension (cardiac
depression, decreased baroreceptor
response to hypotension, and peripheral
vasodilation), malignant hyperthermia

33
Q

MALIGNANT HYPERTHERMIA
What is it?
P193

A

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

34
Q

MALIGNANT HYPERTHERMIA
What is the incidence?
P193

A

Very rare

35
Q

MALIGNANT HYPERTHERMIA
What are the causative agents?
P193

A

General anesthesia, succinylcholine

36
Q

MALIGNANT HYPERTHERMIA
What are the signs/symptoms?
P193

A

Increased body temperature; hypoxia;
acidosis; tachycardia, ↑ PCO(2) (↑ end tidal
CO(2))

37
Q

MALIGNANT HYPERTHERMIA
What is the treatment?
P193

A

IV dantrolene, body cooling, discontinuation

of anesthesia

38
Q 
MISCELLANEOUS
What are some of the
nondepolarizing muscle
blockers?
P193
A

Vecuronium

Pancuronium

39
Q 
MISCELLANEOUS
What are the antidotes to
the nondepolarizing neuromuscular
blocking agents?
P194
A

Edrophonium
Neostigmine
Pyridostigmine

40
Q

MISCELLANEOUS
How do these agents work?
P194

A

They inhibit anticholinesterase

41
Q

MISCELLANEOUS
Which muscle blocker is
depolarizing?
P194

A

Succinylcholine

42
Q

MISCELLANEOUS
What is the duration of
action of succinylcholine?
P194

A

< 6 minutes

43
Q

MISCELLANEOUS
What is the antidote to
reverse succinylcholine?
P194

A

Time; endogenous blood pseudocholinesterase
(patients deficient in this enzyme
may be paralyzed for hours!)

44
Q

MISCELLANEOUS
What is the maximum dose of lidocaine:
With epinephrine?
P194

A

7 mg/kg

45
Q

MISCELLANEOUS
What is the maximum dose of lidocaine:
Without epinephrine?
P194

A

4 mg/kg

46
Q

MISCELLANEOUS
What is the duration of
lidocaine local anesthesia?
P194

A

30 to 60 minutes (up to 4 hours with

epinephrine)

47
Q

MISCELLANEOUS
What are the early signs of
lidocaine toxicity?
P194

A

Tinnitus, perioral/tongue numbness,
metallic taste, blurred vision, muscle
twitches, drowsiness

48
Q 
MISCELLANEOUS
What are the signs of
lidocaine toxicity with large
overdose ( > 10 mcg/mL)?
P194
A

Seizures, coma, respiratory arrest
Loss of consciousness
Apnea

49
Q 
MISCELLANEOUS
When should the Foley
catheter be removed in a
patient with an epidural
catheter?
P194
A 
Several hours after the epidural catheter
is removed (to prevent urinary retention)
50
Q

MISCELLANEOUS
What is a PCA pump?
P194

A

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)

51
Q

MISCELLANEOUS
What are the advantages of
a PCA pump?
P195

A

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!)

52
Q

MISCELLANEOUS
What is a “basal rate” on the PCA?
P195

A 
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
53
Q

MISCELLANEOUS
What is used to reverse
narcotics?
P195

A

Naloxone (Narcan®)

54
Q

MISCELLANEOUS
What is used to reverse
benzodiazepines?
P195

A

Flumazenil

55
Q

MISCELLANEOUS
What is fentanyl?
P195

A

Very potent narcotic (#1 drug of abuse by

anesthesiologists)

56
Q

MISCELLANEOUS
Name an IV NSAID.
P195

A

Ketorolac (has classic side effects of

NSAIDs: PUD, renal insufficiency)

Section I, Surgical Recall Sixth Edition (33 decks)

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