Anesthesia

Question 1

what is the role of sedation?

Answer 1

facilitation of painful procedures

Question 2

List the spectrum of sedation (lowest to highest)

Answer 2

1. Anxiolysis
2. Moderate sedation
3. Deep sedation
4. Anesthesia (requires intubation)

Question 3

Dissociative sedation is done with:

Answer 3

Ketamine

Question 4

Dissocative sedation is not on a:

Answer 4

spectrum (on and off switch)

Question 5

The patient is disscosiated from what is going on around them:

Answer 5

dissociative sedation

Question 6

List the neurophysiological effects produced by anesthetics:

Answer 6

1. unconsciousness
2. amnesia
3. analgesia
4. inhibition of autonomic reflexes
5. skeletal muscle relaxation

Question 7

List the aspects of the PERFECT anesthetic:

Answer 7

1. optimize procedure performance
2. minimize patient movement
3. maximize patient comfort
4. no side effects
5. provide sedative/hypnotic effect, analgesia, amnesia
6. minimal cardiovascular and respiratory effects
7. rapid onset, short acting, or reversible

Question 8

What is the most frequently used (historically), IV sedative?

Answer 8

Etomidate

Question 9

What effect is Etomidate missing from “ideal anesthetics?”

Answer 9

no analgesia

Question 10

What quality of “ideal anesthetics” does Etomidate provide?

Answer 10

1. Hypnotic
2. Rapid onset
3. Short duration of action

Question 11

What is the dosing of Etomidate?

Answer 11

0.3 mg/kg IV

Question 12

Etomidate has a neutral hemodynamic profile meaning:

Answer 12

It will not increase or decrease BP and has neutral effect on the HR as well

Question 13

Etomidate can cause ____ which was originally confused as causing a seizure:

Answer 13

myclonic activity (muscle spasms)

Question 14

What type of activity is increased with Etomidate?

Answer 14

EEG activity (clinically insignificant with intubations unless a patient is actively seizing)

Question 15

Etomidate is emetogenic meaning:

Answer 15

may cause vomiting in some patients

Question 16

• Neutral hemodynamic profile
• Myoclonic actiity
• EEG activity increased
• Emetogenic
• Short acting
• Rapid onset
• 0.3 mg/kg
• Hypnotic

Answer 16

Etomidate

Question 17

What are the negative aspects of etomidate:

Answer 17

1. inhibits 11-B Hydroxylase
2. Adrenal suppresion

Question 18

What 11-B hydroxylate responsible for?

Answer 18

Converting cholesterol into cortisol

Question 19

What is one way to avoid adrenal suppression when giving etomidate?

Answer 19

Only allowed to give 1 dose

Question 20

Used more commonly as an anxiolytic to “take the edge off”:

Answer 20

Benzodiazepines

Question 21

A benzodiazepine that is most frequently used for sedation in the setting:

Answer 21

Midazolam

Question 22

The most lipid soluble benzodiazepine:

Answer 22

Midazolam

Question 23

What is the brand name of Midazolam?

Answer 23

Versed

Question 24

What is significant about Midazolam (Versed) being the most lipid soluble benzodiazepine?

Answer 24

It has the most rapid onset of action (anything that is lipid soluble tends to work faster)

Question 25

What is a downfall of Midazolam (Versed)?

Answer 25

slower offset of action, and the effect is very unreliable, making it a very difficult drug to titrate

Question 26

If a patient comes in with a higher baseline need of GABA (like someone who drinks a case of beer per day), what would the dosing of Midazolam (Versed) look like:

Answer 26

Would require a lot more to have an effect

Question 27

For a patient who just needs the edge taken off, Midazolam is an appropriate drug choice:

Answer 27

True

Question 28

For a patient who is undergoing a lengthy procedure, Midazolam is an appropriate drug choice:

Answer 28

False

Question 29

Describe the amnesia and analgesia effects of benzodiazepines:

Answer 29

Great amnesia and NO analgesia

Question 30

Reversal agent for Benzodiazapines:

Answer 30

Flumazenil

Question 31

If you have a patient that has OD on Xanax (oversedated) what could you give them and why or why not would this be a good idea?

Answer 31

You could give them Flumazenil which would reverse the effects of the benzodiazepine however would put hyper-excitatory state which would increase the risk of seizures If they have a seizure we typically would give them Ativan (A benzodiazepine) which now has nowhere to bind and therefore no effect on stopping the seizure. The next best thing for a seizure would be an anti-epileptic which takes 20 minutes to work and now are patient is probably brain dead

Question 32

How does flumazenil work to reverse benzos?

Answer 32

Binds up with the benzodiazepine receptor site, antagonizing the effects by kicking the benzodiazepines off, so the benzodiazepines can no longer bind, so GABA can no longer bind

Question 33

Propofol is classified as:

Answer 33

GABA Agonist

Question 34

Propofol is a ____ emulsion meaning it works ____

Answer 34

Lipid emulsion; quick onset quick off

Question 35

Describe the timeliness of Propofol:

Answer 35

Quick onset; Quick offset (Quick onset because it gets in the brain quickly (lipid), and quick off because it gets distributed throughout the body pretty quickly)

Question 36

Describe the analgesic effects of Propofol:

Answer 36

No analgesia

Question 37

- GABA agonist - Quick on, Quick off - Lipid Emulsion - No Analgesia - No definitive dose response with this

Answer 37

Propofol

Question 38

Procedural sedation dose for Propofol: Anesthesia dosing for Propofol:

Answer 38

1mg/kg IV followed by 0.5mg/kg IV 2-3mg/kg indication then max 200 mcg/kg/min for maintenance

Question 39

Sedation for mechanical ventilation with propofol:

Answer 39

Max 75mcg/kg/min

Question 40

What are three things to keep in mind when administering Propofol?

Answer 40

1. Burns on administration 2. Negative inotrope (meaning it will drop BP) 3. Respiratory Depression

Question 41

What is a contraindication for propofol use?

Answer 41

Due to it being a negative inotrope (causes a drop in BP), we would not want to give it to a hypotensive person