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Flashcards in Anesthesia Deck (32):
1

Types of Anesthesia

General
Sedation
Regional

2

Define General Anesthesia

Suppression of activity in the CNS
Unconsciousness & total lack of sensation

3

Define Sedations

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

4

Define Regional Anesthesia

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

5

Peripheral Anesthesia

Inhibits sensory perception within a specific location
Nerve blocks

6

Central Anesthesia

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

7

Risks of Anesthesia

Death
MI
PE
Post op N/V

8

ASA 1

Normal healthy patient

9

ASA II

Patient with mild systemic disease
Smoking, pregnancy, obesity, well controlled DM or HTN, lung disease

10

ASA III

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

11

ASA IV

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%

12

ASA V

Moribund patient who is not expected to survive
Ruptured AAA; intracranial bleed; ischemic bowel with significant cardiac path

13

ASA VI

Delivered brain-dead
Organ donor for transplantation

14

Regional/Local Anesthesia

Pain blocked from a part of the body using local anesthetics

15

Types of Regional Anesthesia

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

16

Infiltrative Regional Anesthesia

Local anesthetic injected in a small area to stop sensation

17

Peripheral Nerve Block

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

18

IV Regional Anesthesia

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

19

Central Nerve Blockage

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

20

Topical Anesthesia

Special formulation that diffuses through the skin or mucous membranes

21

Tumescent Anesthesia

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

22

Indications for Neuroaxial Anesthesia

Surgery or pain
Appropriate distribution

23

Contraindications to Neuroaxial Anesthesia

Patient refusal
Infection
Coagulopathy

24

Benefits of Spinal Anesthesia

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

25

Benefits of Epidural Anesthesia & Analgesia

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

26

Complications of Spinal/Epidural

Post procedural headahce
Spinal hematoma or abscess

27

Drug Concentration (%) of Local Anesthetics

% x 10=mg/mL

28

Epinephrine (g/mL)

1:200,000
5 ug/mL

29

Why add epinephrine to local anesthetics?

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

30

When to not add epinephrine to lidocaine?

Fingers/toes
Penis
Ear/nose
Skin flaps

31

Scale of Local Anesthetic Toxicity

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

32

Treatment of Local Anesthetic Toxicity

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