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Periop 101 > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Devices used to secure and manage patient’s airways:

A

Laryngeal mask airways (LMAs)

Laryngoscopes

Video laryngoscopy devices

Fiberoptic bronchoscopes

Endotracheal tubes (ET tubes)

Oral and nasopharyngeal airways

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2
Q

Types of anesthesia (5)

A

General

Regional

Monitored Anesthesia care (MAC)

Moderate sedation

Local anesthesia

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3
Q

General anesthesia:

A

Drug-induced reversible state of unconsciousness

Amnesia, analgesia, loss of responsiveness, decreased stress response, loss of skeletal muscle reflexes (varying degree)

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4
Q

Regional anesthesia:

A

Injection of local anesthetics near nerve fibers to cause reversible loss of sensation over an area of the body.

Spinal, epidural, peripheral nerve blocks

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5
Q

Monitored anesthesia care (MAC):

A

Anesthesiologist monitors the patient, administers sedatives and other agents needed

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6
Q

Moderate sedation:

A

Administration of sedative, analgesic, and/or anxiolytic (benzos) agents by a MD or under MD supervision.

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7
Q

Local anesthesia:

A

Infiltration of topical administration of agents to anesthetize a part of the body. Typically used for minor procedures, does not involve a MD or sedation.

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8
Q

3 Phases of anesthesia

A

Induction (Phase 1)

Maintenance (Phase 2)

Emergence (Phase 3)

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9
Q

Anesthetics used in IV induction

A

Propofol

Etomidate

Methohexital and ketamine

  • Narcotics (fentanyl) and/or sedatives (midazolam) are often given during induction or as premedication
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10
Q

Inhalational induction

A

Patient breathes in anesthetic by face mask

Sevoflurane with or without nitrous oxide is a common choice

Patients receiving an inhalation induction may become agitated and thrash as they lose consciousness

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11
Q

Muscle relaxants:

A

Often given during induction and maintenance of anesthesia. Used to facilitate intubation and/or optimize surgical conditions

Succinylcholine: SHORT ACTING muscle relaxant agent that causes muscle twitches (fasiculations)

Intermediate- acting: Cistracurium, atracurium, rocuronium, vecuronium

Long-acting: Pancuronium

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12
Q

Options for maintaining the airway

A

Mask ventilation

Supraglottic airway device (LMA)

ET tube

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13
Q

Inhalational maintenance:

A

Sevoflurane, isoflurane, desflurane- used for inhalational maintenance

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14
Q

TIVA:

A

Total intravenous anesthesia is a technique for maintaining anesthesia using infusions or short acting IV agents without inhalational anesthetics

Propofol and remifentanil commonly used

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15
Q

Succinycholine reversal agent

A

NONE!

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16
Q

Muscle relaxants can be reversed with

A

neostigmine or edrophonium

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17
Q

Reversal agent for Rocuronium, vecuronium and pancuronium

A

Sugammadex

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18
Q

Benzodiazepine (Midazolam) reversal agent

A

Flumazenil

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19
Q

Narcotics (fentanyl) can be reversed with

A

Naloxone

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20
Q

NPO Guidelines for clear liquids

A

2 hours

21
Q

NPO guidelines for breast milk

A

4 hours

22
Q

NPO guidelines for infant formula

A

6 hours

23
Q

NPO guidelines for nonhuman milk

A

6 hours

24
Q

NPO guidelines for light meal (toast and a clear liquid)

A

6 hours

25
Q

NPO guidelines for fried foots, fatty foods, meat

A

8 hours

26
Q

Local anesthetics commonly used for regional anesthesia include:

A

Lidocaine

Bupivacaine

Ropivacaine

Additional drugs such as epinephrine (increase density and duration of regional block) and bicarbonate (added to reduce the acidity of local anesthetic and speed the onset of block) can be added to local anesthetic

27
Q

Signs of LAST (Local Anesthetic Systemic Toxicity)

A

Ringing in ears

Tingling around the lips

Metallic taste in mouth

Dizziness

LAST can progress to SEIZURES 222377and respiratory or cardiac arrest

28
Q

Complications that can occur during anesthesia

A

Difficult airway

Laryngospasm

Cardiac problems

Hemorrhage

Anaphylaxis

Hypo/Hyperthermia

29
Q

Initial signs of malignant hyperthermia

A

Tachycardia and hypertension- common initial signs

Increased end-tidal carbon dioxide is the most specific sign of MH

Muscle rigidity

Mottling of skin

Ventricular dysrhythmia

Hyperthermia, myoglobinuria

30
Q

Drug used to treat MH

A

Dantrolene!

Dilute with sterile water for injection

31
Q

Adverse effects of hypothermia in surgery

A

vasoconstriction

Coagulation/platelet function impairment

Prolonged time for medications to take effect

Surgical site infection

Myocardial ischemia

Increased length of stay

32
Q

ASA Class 1:

A

Normal healthy patient

33
Q

ASA 2:

A

Patient with mild systemic disease

34
Q

ASA 3:

A

Patient with severe systemic disease

35
Q

ASA 4:

A

Patient with severe systemic disease that is a constant threat to life

36
Q

ASA 5:

A

Moribund patient who is not expected to survive without the operation

37
Q

ASA 6:

A

Declared brain-dead patient whose organs are being removed for donor purposes

38
Q

Phase 1:

A

Induction

anesthetic agents are administered to “put the patient to sleep” IV agents (most adults) or inhalational agents (many small children) can be used

39
Q

Phase 2:

A

Maintenance

Provider continues to administer inhalational and/or IV agents to keep the patient anesthetized

40
Q

Phase 3:

A

Emergence

Anesthetic agents are discontinued and/or reversed and the patient is allowed to “wake up”

41
Q

Spinal anesthesia

A

subarachnoid space is entered and local anesthetic is injected directly into the spinal canal

42
Q

Potential complications of spinal anesthesia

A

hypotension may be caused by vasodilation

high spinal can compromise respiration

spinal headache may occur postop. Younger patients more susceptible, size of needle and design of the needle’s point affect incidence

43
Q

Epidural anesthesia

A

Space between the ligamentum flavum and dura

Space is ID’d by a loss of resistance as the needle is advanced. single dose of anesthetic can be injected or a catheter can be placed

Complications:
dura puncture
subarachnoid injection
intravascular injection

44
Q

Bier blocks can be used for

A

procedures on the hand, wrist or forearm

anesthetic effect lasts until the tourniquet is deflated.

45
Q

Most specific sign of MH is

A

Increased end-tidal carbon dioxide

46
Q

Most common signs of MH that are not specific

A

Tachycardia and hypertension are most common initial signs but not specific to MH

47
Q

Drug used to treat MH

A

Dantrolene

48
Q

Protocol for treatment of MH

A

Stopping the surgery is possible and DC inhalational agents and succinylcholine

Getting the MH cart and dantrolene

Calling for help

Hyperventilating with 100% oxygen at a flow of 10L/min

Give 2.5mg/kg dantrolene rapidly by IV. repeat as needed until patient responds. Consider alternate diagnosis if more than 10mg/kg given without response

obtain ABG’s

Cooling the patient if core temp is greater than 39 Celsius. Stop cooling if temp decreased to less than 38 Celsius

Provide appropriate treatment for dysrhythmias and abnormal electrolytes

Periop 101 (15 decks)

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