Anesthesia

Question 1

local anesthetics act by

Answer 1

blocking sodium channels of axon causing reversible blockade of neural conduction

Question 2

what can decrease effectiveness of drug

Answer 2

weakly basic-acidic environment

Question 3

local anesthetics can be either…

Answer 3

amides (liver) or esters (hydrolysis)

Question 4

amides in local anesthetics

Answer 4

lidocaine, bupivicaine, ropivicaine

Question 5

esters in local anesthetics

Answer 5

benzocaine, cocaine, chloroprocaine, procaine, tetracaine

Question 6

pain pumps used for

Answer 6

long acting local anesthetic to minimize post-op pain and the need for narcotics

Question 7

regional anesthesia includes

Answer 7

spinal, epidural anesthesia, and peripheral nerve block

Question 8

difference between spinal vs. epidural anesthesia

Answer 8

spinal- CSF obtained. epidural- No CSF obtained.

Question 9

Local anesthetic (lidocaine or bupivacaine) plus EPI plus Opiate. CSF obtained=

Answer 9

spinal anesthesia

Question 10

“sympathectomy” can occur from cephalic spread in spinal anesthesia resulting in

Answer 10

hypotension and bradycardia

Question 11

complications from spinal anesthesia

Answer 11

spinal headache, hypotension and bradycardia, urinary retention

Question 12

where is needle placed in epidural?

Answer 12

between ligamentum flavum and dura

Question 13

epidural complications

Answer 13

slower onset, hemi-block, urinary retention, CV effects, misplacement in subarachnoid space

Question 14

useful for surgery on extremity

Answer 14

peripheral nerve block. UE- brachial plexus block. LE- Lumbar plexus block

Question 15

moderate vs. deep conscious sedation

Answer 15

moderate- patient opens eyes to voice or pain. deep- patient does not respond to voice or open but maintains their own airway

Question 16

anesthetic agents

Answer 16

IV anesthetics, inhalation anesthetics, amnestics, narcotic

Question 17

what is good for inducing children?

Answer 17

inhalation anesthetics

Question 18

use inhalation anesthetics if preggo?

Answer 18

NO- TERATOGENIC

Question 19

inhalation anesthetics examples

Answer 19

“fluranes”- isoflurane, sevoflurane, nitrous oxide, halothane

Question 20

IV anesthetic agents

Answer 20

ketamine, propofol, etomidate, barbiturates

Question 21

phecycyclidine derivative, diisopropylphenol, and carboxylated imidazole

Answer 21

ketamine, propofol, etomidate

Question 22

IV anesthetic used a lot in kids and burn patients. causes dissociative amnesia, hallucinations, emergence delerium

Answer 22

ketamine

Question 23

IV anesthetic that has rapid onset and rapid awakening. Lipid soluble, looks like mild. Side effects are resp and CV depression, seizures

Answer 23

propofol

Question 24

IV anesthetic that has short half life (acts for about 30 seconds). MINIMAL CV effects. causes involuntary muscle movement, seizures (SE)

Answer 24

etomidate

Question 25

barbiturates MOA

Answer 25

suppresses reticular activating system

Question 26

amnestics

Answer 26

diazepam (valium), midazolam (versed), lorazepam (ativan)

Question 27

reversal agent for benzos

Answer 27

flumazenil 0.2-0.4 mg

Question 28

sedation accomplished by

Answer 28

benzo plus narcotic, nitrous oxide, or propofol

Question 29

reversal agent of narcotics

Answer 29

narcan 2 mg every 3 minutes (max of 10 mg)

Question 30

depolarizing muscle relaxant/paralytic

Answer 30

succinylcholine

Question 31

non depolarizing muscle relaxants/paralytics

Answer 31

"curonium" or "curium" (mivacurium, pancuronium)

Question 32

CI to paralytics

Answer 32

history of malignant hyperthermia, NM problems, allergy, lack of sedation

Question 33

succinylcholine can cause...

Answer 33

malignant hyperthermia

Question 34

twitches check in paralytics

Answer 34

if 4 twitches seen, 0-75% of receptors blocked, 3 twitches seen-75% of receptores blocked, 2 twitches seen, 80% of receptors blocked, 1 twitch- 90% of receptors blocked. no twitches- all receptors blocked

Question 35

if patient is going for urgent/emergent surgery, and last po was less than 4 hours ago...

Answer 35

need NG tube to empty stomach

Question 36

airway managed by

Answer 36

oral airway, nasal trumpet, LMA, endotracheal tube

Question 37

post op pain control

Answer 37

oral analgesics (codeine), pain patches, IV narcotics, PCA pumps, epidural catheter

Question 38

vicodin vs narco in oral analgesic for pain

Answer 38

norco- tylenol stays constant. Vicodin- tylenol dose escalates with each dose (toxic to kidneys)

Question 39

tylenol in pain preparation

Answer 39

no more than 4 g for first few days, then no more than 2 g/day

Question 40

pain patches are NOT indicated for post-op pain. for Long-term management of pain. apply every..

Answer 40

72 hours

Question 41

IV narcotics

Answer 41

morphine, dilaudid, fentanyl, demerol

Question 42

morphine dose per hour

Answer 42

0.5-1 mg/hour

Question 43

lockout morphine

Answer 43

6-10 minutes

Question 44

morphine one hour max dose

Answer 44

5 mg

Question 45

morphine basal dose/continuous

Answer 45

0-1 mg

Question 46

morphine breakthrough dose

Answer 46

1-3 mg q 2 hours prn

Question 47

If using IV morphine BASAL dose

Answer 47

always place pulse ox if ordering basal dose