Anesthesia Flashcards
(19 cards)
- Used in general anesthesia
- mechanism of action not completely understood
- delivered to the patient using vaporizer and a carrier gas
Inhaled agents
physiologic effects of inhaled agents?
- cardiac (decreased contractility, decreased systemic vascular resistance, decreased mean arterial pressure)
- pulmonary
- CNS
CNS effects of anesthesia?
- Anesthetic Effects: Analgesia, amnesia, muscle relaxation , hypnosis
- increased cerebral blood flow
- decreased cerebral metabolic demand
- increased ICP
why would someone have a prolong reaction to medications?
- it is indicative of pseudocholinesterase deficiency
- Autosomal dominant inherited defect in the ryanodine receptor
- uncontrolled release of calcium causes- increased energy production, uncontrolled muscle contraction (heat, increased lactic acid)
- as progresses- acidosis, hyperkalemia, arrhythmia
Malignant hyperthermia
what do you see with MH?
- increased respiratory rate
- increased CO2
- increased HR
- increased temp
- rigidity
- acidosis
- hyperkalemia
how do you manage malignant hyperthermia?
- mix and give dantrolene (this prevents the release of calcium from the SR and stops the cascade of events that lead to the symptoms of MH
- Supportive care decrease temperature (ice bags, gastric lavage)
types of anesthesia?
General
- endotracheal
- laryngeal mask airway
Regional
- peripheral regional
- neuraxial
Sedation, or M.A.C (monitored anesthesia care)
- defined as the complete loss of consciousness
- patient is rendered insensate to surgical stimulus
- practical versus semantic defintion
General anesthesia
Components of general anesthesia?
Analgesia
- lack of pain
Hypnosis
- loss of consciousness
- amnesia
Muscle relaxant (in some cases)
what can be used to achieve GA?
- inhaled gases
- intravenous hypnotics
- intravenous analgesics
- muscle relaxants (paralytics)
ex. of inhaled anesthetic gasses?
- Sevoflurane
- isoflurane
- desflurane
ex. of intravenous hypnotics
propfol
ex. intravenous analgesics?
- narcotics
- NSAIDs
ex. of muscle relaxants (paralytics)
Succinylcholine, NDMR
Why is NPO necessary with GA? what are the guidelines for NPO?
NPO necessary to decrease risk for aspiration pneumonia
- 2 hours- clear liquid
- 4 hours- breast milk
- 6 hours- milk, “light” meal (toast and clear liquids), formula
- 8-12 hours- large meal, fried or fatty foods, meats
Common pretreatment medications
- Anxiolytics
- antiemetcs
- aspiration risk reduction- sodium bicarb, famotidine
- prokinetics
- bronchodilators
- antihypertensive
- topical anesthetics
what medications are commonly used as induction medications for GA?
Commonly used IV agents: propofol, etomidate
commonly used gas agent: Sevoflurane
what are some endotracheal tube advantages and disadvantages?
advantages
- secure airway
- if patient laryngospasms, you can still move air
- cuffed tubes can help prevent aspiration of gastric contents from reaching below
Disadvantages
- can cause hypertension and tachycardia on placement and removal
- can be technically difficult to place
- ETT is irritating to the trachea causing coughing, bronchospasm
