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Flashcards in Anesthesia Deck (55):
1

What is anesthesia?

Loss of sensation/pain

2

What is local anesthesia?

Anesthesia of a small confined area of the body (e.g. lidocaine for an elbow laceration)

3

What is epidural anesthesia?

Anesthetic drugs/narcotics infused into epidural space

4

What is spinal anesthesia?

Anesthetic agents injected into the thecal sac

5

What is regional anesthesia?

Blocking of the sensory afferent nerve fibers from a region of the body (e.g. radial nerve block)

6

What is general anesthesia?

1. Unconsciousness/amnesia
2. Analgesia
3. Muscle relaxation

7

What is GET or GETA?

General EndoTrachael Anesthesia

8

What are common local anesthetics?

Lidocaine, bupivacaine (Marcaine)

9

What are common regional anesthetics?

Lidocaine, bupivacaine (Marcaine)

10

What are common general anesthetics?

Isoflurane, enflurane, sevoflurane, desflurane

11

What is a common dissociative agent?

Ketamine

12

What is cricoid pressure?

Manual pressure on cricoid cartilage occluding the esophagus and thus decreasing the chance of aspiration of gastric contents during intubation.
Also called Sellick's maneuver.

13

What is rapid-sequence anesthesia induction?

1. Oxygenation and short-acting induction agent
2. Muscle relaxant
3. Cricoid pressure
4. Intubation
5. Inhalation anesthetic

14

What are common induction agents?

Propofol, midazolam, sodium thiopental

15

What are contraindications of the depolarizing agent succinylcholine? Why?

Patients with burns, neuromuscular diseases/paraplegia, eye trauma, increased ICP.
Depolarization can result in life-threatening hyperkalemia and also increases intra-ocular pressure.

16

Why doesn't lidocaine work in an abscess?

Lidocaine does not work in an acidic environment

17

Why does lidocaine burn on injection and what can be done to decrease the burning sensation?

Lidocaine is acidic, which causes the burning.
Add sodium bicarbonate to decrease the burning sensation.

18

Why does some lidocaine come with epinephrine?

Epinephrine vasoconstricts the small vessels, resulting in a decrease in bleeding and blood flow in the area.
This prolongs retention of lidocaine and its effects.

19

In what locations is lidocaine with epinephrine contraindicated?

Fingers, toes, penis because of the possibility of ischemic injury or necrosis resulting from vasoconstriction

20

What are the contraindications to nitrous oxide?

Nitrous oxide is poorly soluble in serum and thus expands into any air-filled body pockets.
Avoid in patients with middle ear occlusions, PTX, SBO, etc.

21

What is the feared side effect of bupivacaine?

Cardiac dysrhythmia after intravascular injection leading to fatal refractory dysrhythmia

22

What are the side effects of morphine?

Constipation, respiratory failure, hypotension (from histamine release), spasm of sphincter of Oddi (use Demerol in pancreatitis and biliary surgery), decreased cough reflex

23

What are the side effects of meperidine (Demerol)?

Similar to those of morphine but causes less sphincteric spasm and can cause tachycardia and seizures

24

What is the limit to the duration of meperidine (Demerol) postoperatively?

Build up of the metabolites (normeperidine)

25

What medication is a contraindication to meperidine (Demerol)?

Monoamine oxidase inhibitor

26

What metabolite of Demerol breakdown causes side effects?

Normeperidine

27

What is the treatment of life-threatening respiratory depression with narcotics?

Narcan IV (naloxone)

28

What are the side effects of epidural analgesia?

Orthostatic hypotension, decreased motor function, urinary retention

29

What is the advantage of epidural analgesia?

Analgesia without decreased cough reflex

30

What are the side effects of spinal analgesia?

Urinary retention, hypotension

31

What is the side effect of inhalational (volatile) anesthesia?

Halothane: hypotension (cardiac depression, decreased baroreceptor response to hypotension, peripheral vasodilation), malignant hyperthermia

32

What is malignant hyperthermia?

Inherited predisposition to an anesthetic reaction, causing uncoupling of the excitation-contraction system in skeletal muscle, which in turn causes malignant hyperthermia.
Hypermetabolism is fatal if untreated.

33

What is the incidence of malignant hyperthermia?

Very rare

34

What are the causative agents of malignant hyperthermia?

General anesthesia, succinylcholine

35

What are the signs and symptoms of malignant hyperthermia?

Increased body temperature; hypoxia; acidosis; tachycardia; increased PCO2

36

What is the treatment for malignant hyperthermia?

IV dantrolene, body cooling, discontinuation of anesthesia

37

What are some of the non-depolarizing muscle blockers?

Vecuronium, pancuronium

38

What are the antidotes to the non-depolarizing neuromuscular blocking agents?

Edrophonium, neostigmine, pyridostigmine

39

How do antidotes to the non-depolarizing neuromuscular blocking agents work?

They inhibit anticholinesterase

40

Which muscle blocker is depolarizing?

Succinylcholine

41

What is the duration of action of succinylcholine?

42

What is the antidote to reverse succinylcholine?

Time.
Endogenous blood pseudocholinesterase (patients deficient in this enzyme may be paralyzed for hours).

43

What is the maximum dose of lidocaine with epinephrine?

7 mg/kg

44

What is the maximum dose of lidocaine without epinephrine?

4 mg/kg

45

What is the duration of lidocaine local anesthesia?

30-60 minutes (up to 4 hours with epinephrine)

46

What are the early signs of lidocaine toxicity?

Tinnitus, perioral/tongue numbness, metallic taste, blurred vision, muscle twitches, drowsiness

47

What are the signs of lidocaine toxicity with large overdose (> 10 ug/mL)?

Seizures, coma, respiratory arrest, LOC, apnea

48

When should the Foley catheter be removed in a patient with an epidural catheter?

Several hours after the epidural catheter is removed (to prevent urinary retention)

49

What is a PCA pump?

Patient-Controlled Analgesia:
A pump delivers a set amount of pain reliever when the patient pushes a button.

50

What are the advantages of a PCA pump?

Better pain control; patients actually use less pain medication with a PCA.
If given a moderate dose without a basal rate, patients should not be able to overdose.

51

What is a basal rate on the PCA?

Steady continuous infusion rate of the narcotic (e.g. 1-2 mg of morphine) continuously infused per hour.
Patient can supplement with additional doses as needed.

52

What is used to reverse narcotics?

Naloxone (Narcan)

53

What is used to reverse benzodiazepines?

Flumazenil

54

What is fentanyl?

Very potent narcotic

55

What is a common IV NSAID?

Ketorolac (Toradol)