Anesthesia

Question 1

Stage 1 Anesthesia

Answer 1

decreased awareness of pain and consciousness, sometimes w/ amnesia

consciousness may be impaired but its not lost

Question 2

Stage 2 Anesthesia

Answer 2

Disinhibition –> pt is delirious and excited; amnesia
Reflexes are enhanced and respiration is typically irregular
Possible retching and incontinence

Question 3

Stage 3 Anesthesia

Answer 3

surgical anesthesia:
regular respiration, skeletal muscle relaxation, decrease in eye reflexes and movements, fixed pupils
Loss of motor and autonomic responses to pain; BP is maintained

Question 4

Stage 4 Anesthesia

Answer 4

Medullary paralysis: depression of respiratory and vasomotor centers
*requires mechanical and pharmacologic support to prevent death

Anesthesiologist job for sure!

Question 5

Types of General Inhaled Anesthesia

Answer 5

Nitrous oxide, halothane, isoflurane, sevoflurane

Question 6

Types of General IV Anesthesia

Answer 6

Propofol, etomidate, ketamine, barbiturates

Question 7

Types of Local Ester Anesthesia

Answer 7

Procaine, Tetracaine

Question 8

Types of Local Amide Anesthesia

Answer 8

Lidocaine, Bupivacaine

Question 9

Goals of General Anesthesia

Answer 9

analgesia, unconsciousness/hypnosis, amnesia
Muscle relaxation or immobility (PRN for procedure)
Autonomic and sensory blockade of responses to noxious surgical stimulation

Question 10

Phases of Anesthesia

Answer 10

Induction
Maintenance
Emergence

Question 11

General Anesthetic Mechanisms and Effects

Answer 11

Neuronal depression in many regions
Decrease in BP
Respiratory depression
Bronchodilation
Impaired mucociliary clearance
decreased hepatorenal perfusion

Question 12

Types of Anesthesia

Answer 12

General, Neuraxial (spinal or epidural), peripheral nerve blocks, intravenous regional anesthesia, monitored anesthesia care (MAC), conscious sedation w/out anesthesia personnel

Question 13

Conscious sedation: how it is administered, pt state

Answer 13

Through IV to make pt sleepy/calm for procedure
**NOT expected to induce impairment of pt respiratory function or ability to maintain their own airway

Pt technically awake but groggy/unable to follow instructions

Question 14

Conscious sedation Drugs used

Answer 14

periprocedural anesthesia assessment of the patient’s coexisting med conditions and management of actual or anticipated physiological derangements during procedure

Question 15

MAC: what does it include

Answer 15

administration of sedatives and/or analgesics for conscious sedation (usually)

Question 16

What is provider focused on during MAC

Answer 16

exclusive and continuously on pt for attendant airway, hemodynamic and physiologic derangements

**must be ready/prepped to covert to general anesthesia AND intervene to rescue pt airway

Question 17

What is nitrous oxide?

Answer 17

laughing gas; weak anesthesia but good analgesic

**Used a lot as adjuvant

Question 18

What to give after NO tx

Answer 18

Oxygen

Question 19

what does pt population does NO not work well in

Answer 19

pt taking opiates

Question 20

Laughing gas SE

Answer 20

N/V, headache, increased sleepiness, diaphoresis BUT no resp depression

Question 21

Laughing Gas Contraindications

Answer 21

Respiratory Compromise (ie COPD)

Question 22

What causes malignant hyperthermia?

Answer 22

Inhaled anesthesia and succinylcholine

Genetic disorder –> caused by mutations of muscle ryanodine receptor leading to uncontrolled release of Ca from the sarcoplasmic reticulum

Question 23

symptoms of malignant hyperthermia

Answer 23

tachycardia, HTN, severe muscle rigidity, hyperthermia, hyperkalemia, acidosis

CAN BE FATAL!

Question 24

Tx of malignant hyperthermia

Answer 24

Dantrolene (block Ca release via ryanodine receptor)

Plus cooling, correction of acid-base disturbances

Question 25

IV Barbiturates Use and Names

Answer 25

Thiopental v. methohexital - redistribution, induction; significant respiratory depression à induction of anesthesia

Question 26

IV Benzos use and names

Answer 26

*midazolam (Versed®), lorazepam (Ativan®) *Can be given intranasally; perioperative amnesia, pre-procedure use; amnestic effects

Question 27

IV Propofol Use and SE

Answer 27

(This slide was not well described) Induction and maintenance; GABA- A; day surgery (rapid onset and recovery); potent respiratory depression, decreased inotropism, decreased PR, decreased cerebral BP

Question 28

IV fentanyl Use and SE

Answer 28

Induction and maintenance, conscious and deep sedation; respiratory depression

Question 29

Ketamine: what is it, Use, who is it used for

Answer 29

NMDA blocker Use: Dissociative anesthesia (catatonia, amnesia and analgesia without loss of consciousness) Used in children for short procedure

Question 30

Ketamine SE

Answer 30

increased HR and CO, increased ICP leading to hallucinations *not a significant resp depressant

Question 31

Short Acting Esters for Local anesthesia*

Answer 31

Procaine (Novocaine)

Question 32

Medium Acting Esters for Local anesthesia*

Answer 32

Cocaine

Question 33

Long Acting Esters for Local anesthesia*

Answer 33

Tetracaine (more lipophilic)

Question 34

Medium Acting Amides for Local anesthesia*

Answer 34

Lidocaine (xylocaine)

Question 35

Long Acting Amides for Local anesthesia*

Answer 35

Bupivacaine (Marcaine)

Question 36

All local anesthetics do what?*

Answer 36

block Na channels- failure of nerve conduction

Question 37

Why use adjuvant local anesthetics*

Answer 37

Decrease onset time, Increase duration, increase block intensity, or decrease toxicity

Question 38

options for adjuvant local anesthetics*

Answer 38

1) Epinephrine (Vasoconstrictor) --> hemostasis *However, cannot use on certain organs that can easily become ischemic (Fingers, toes, penis, and nose) 2) Sodium bicarbonate 3) Dexamethasone