Surgical: anesthetics Flashcards
general anesthesia: what are the most common inhaled/volatile anesthetics ?
(4)
-Sevoflurane, Isoflurane, Desflurane, Nitrous Oxide*
general anesthesia: what are the most common IV anesthetics
TIVAs; total IV anesthetics) ? (3
-Propofol, Dexmetatomadine,
Remifentanyl
5 different types of anesthesia administration
- Sedation - ex/ propofol, fentanyl, versed
- MAC – monitored anesthesia care
- General - inhalational, TIVA
- Neuraxial – ex/ epidural, spinal
- Regional – ex/ femoral block
what is a “MAC” case? - monitored anesthesia care
a case that requires anesthesia providers there in order to conduct the required …
- anesthesia assessment and mgmt
- continual assessment of level of consciousness and mgmt of cardiac, respiratory function
- ability to manage airway and ventilation
- ability to convert to general anesthesia
what is “MAC”- minimum alveolar conc. ? what would a lower MAC mean?
indicator of potency: level at which 50% pts do not respond to sx stimulation
- lower MAC = more potent agent
PKs of anesthesia: uptake and distribution
- uptake in the lungs: passive diffusion
- higher ratio = more soluble in blood
- distribution + uptake in the brain: blood- brain partition coefficient
- higher coeff = higher brain solubility
PKs of anesthesia: onset of effect and elimination
ONSET OF EFFECT – *the lower the blood – gas partition coefficient, the faster the onset/induction
ELIMINATION – via lungs: *the lower the blood-gas partition coefficient, the quicker the recovery
how does obesity effect the elimination of inhaled anesthetics
prolonged exposure with high solubility ->prolonged recovery
3 phases of anesthesia
Pre-Operative – pre-op evaluation, testing, clearance
Peri-operative –
–Induction
–Maintenance
–Emergence
Post-operative - PACU, discharge, first 24 hours out
monitoring requirements: ASA standards (2 )
1 – Anesthesia provider shall be present in room for all GA, MAC, and regional anesthetics.
2 –Continual monitoring:
-oxygenation
-ventilation: observation, end-tidal CO2 verification
-circulation: EKG, HR, BP
-temperature
PCP role in pre-op clearance (3)
To address chronic and acute medical issues
To consider perioperative challenges (especially Cardiac Risk)
To optimize patient for surgery
3 Main Factors in determining risk for non-cardiac surgery and need for further perioperative testing (kinda weeds)
- Clinical presentation of the patient
- Inherent cardiac risk of the procedure
- The patient’s functional capacity
5 parts of determining cardiac risk of surgery (kinda weeds)
- Is the surgery emergent?
- Are there active cardiac conditions?
- What is the level of risk of the surgery?
- Does the patient have good functional capacity without symptoms?
- Does the patient have clinical risk factors?
airway classification (kinda weeds)
based on how much of the back of the throat/airway you can visualize
Class 1: soft palate, uvula, pillars (open)
Class 2: soft palate, portion of uvula
Class 3: soft palate, base of uvula
Class 4: hard palate only (more closed)
3 phases of intra-op
- Induction (“take-off”)
- Maintenance
- Emergence (“landing”)
