Anesthesia

Question 1

Types of Anesthesia

Answer 1

General
Sedation
Regional

Question 2

Define General Anesthesia

Answer 2

Suppression of activity in the CNS

Unconsciousness & total lack of sensation

Question 3

Define Sedations

Answer 3

Inhibition of transmission of nerve impulses between higher & lower centers of the brain
Inhibition of anxiety & memory

Question 4

Define Regional Anesthesia

Answer 4

Use of local anesthetics to make a portion of the body insensate by blocking transmission of nerve impulses between a part of the body & the spinal cord

Question 5

Peripheral Anesthesia

Answer 5

Inhibits sensory perception within a specific location

Nerve blocks

Question 6

Central Anesthesia

Answer 6

Local anesthetic delivered around the spinal cord & removes sensation of the body below the level of the block

Question 7

Risks of Anesthesia

Answer 7

Death
MI
PE
Post op N/V

Question 8

ASA 1

Answer 8

Normal healthy patient

Question 9

ASA II

Answer 9

Patient with mild systemic disease

Smoking, pregnancy, obesity, well controlled DM or HTN, lung disease

Question 10

ASA III

Answer 10

Patient with sever systemic disease, not incapacitating
DM, poorly controlled HTN, hx of MI, CVA, TIA, cardiac stent; COPD, ESRD, hepatitis, pacemaker, EF less than 40%, congenital metabolic abnormalities

Question 11

ASA IV

Answer 11

Patient with severe systemic disease that is a constant threat to life
Recent MI, CVA, TIA, cardiac stent; ongoing cardiac ischemia or severe valve dysfunction; ICD; EF below 25%

Question 12

ASA V

Answer 12

Moribund patient who is not expected to survive

Ruptured AAA; intracranial bleed; ischemic bowel with significant cardiac path

Question 13

ASA VI

Answer 13

Delivered brain-dead

Organ donor for transplantation

Question 14

Regional/Local Anesthesia

Answer 14

Pain blocked from a part of the body using local anesthetics

Question 15

Types of Regional Anesthesia

Answer 15

Infiltrative
Peripheral nerve block
IV regional anesthesia
Central nerve blockage
Topical anesthesia
Tumescent anesthesia

Question 16

Infiltrative Regional Anesthesia

Answer 16

Local anesthetic injected in a small area to stop sensation

Question 17

Peripheral Nerve Block

Answer 17

Local anesthetic injected near a nerve that provides sensation to a portion of the body

Question 18

IV Regional Anesthesia

Answer 18

Dilute local anesthetic infused to a limb through a vein with a tourniquet placed to prevent the drug from diffusing out of the limb

Question 19

Central Nerve Blockage

Answer 19

Infusion or injection of local anesthetic in or around a portion of the CNS
Spinal or epidural

Question 20

Topical Anesthesia

Answer 20

Special formulation that diffuses through the skin or mucous membranes

Question 21

Tumescent Anesthesia

Answer 21

Large amount of dilute local anesthesia infiltrated into the subcutaneous tissue used in liposuction

Question 22

Indications for Neuroaxial Anesthesia

Answer 22

Surgery or pain

Appropriate distribution

Question 23

Contraindications to Neuroaxial Anesthesia

Answer 23

Patient refusal
Infection
Coagulopathy

Question 24

Benefits of Spinal Anesthesia

Answer 24

Decreased surgical time
Less blood loss
Less intraoperative transfusion requirements
Decrease the incidence of DVT or PE

Question 25

Benefits of Epidural Anesthesia & Analgesia

Answer 25

Less blood loss Reduced platelet aggregation Reduced stress response to surgery Decreased incidence of DVT Improved graft potency after LE revascularization Patients with general & epidural for aortic surgery had lower incidence of death & major complications

Question 26

Complications of Spinal/Epidural

Answer 26

Post procedural headahce | Spinal hematoma or abscess

Question 27

Drug Concentration (%) of Local Anesthetics

Answer 27

% x 10=mg/mL

Question 28

Epinephrine (g/mL)

Answer 28

1:200,000 | 5 ug/mL

Question 29

Why add epinephrine to local anesthetics?

Answer 29

Prolong surgical anesthesia time Decrease peak serum levels Intravascular marker Decrease surgical site bleeding

Question 30

When to not add epinephrine to lidocaine?

Answer 30

Fingers/toes Penis Ear/nose Skin flaps

Question 31

Scale of Local Anesthetic Toxicity

Answer 31

``` Dizziness Tinnitus Nystagmus, dysphoria, shivering Somnolence, muscle twitching Seizures Cardiac arrhythmias Cardiovascular instability & collapse ```

Question 32

Treatment of Local Anesthetic Toxicity

Answer 32

``` Stop injection Call for help Supportive care 20% intralipid 1.5 mL/kg IV bolus (may repeat 1-2 times) Cardiopulmonary bypass ```