Anesthesia

Question 1

2 major types of anesthesia:

Answer 1

1) general anesthetics

2) local anesthetics

Question 2

general anesthesia: goal

Answer 2

absence of all perceived sensations

Question 3

general anesthesia: purpose

Answer 3

allow detailed surgical procedures, with minimal harm to patient

Question 4

anestheia before 1846: unconsciousness from what?

Answer 4

strangulation or blow to head

Question 5

date of anesthesia breakthrough

Answer 5

Oct. 17, 1846

Question 6

anesthesia after 1846: first use of ( )

Answer 6

ether

Question 7

general anesthesia requirements: loss of ( )

Answer 7

consciousness; perceived sensations

Question 8

general anesthesia requirements: amnesia- yes or no?

Answer 8

yes

Question 9

general anesthesia requirements: inhibition of ( )

Answer 9

reflexes

Question 10

general anesthesia requirements: ( )relaxation

Answer 10

skeletal muscle

Question 11

general anesthesia requirements: safe, transient, ( )

Answer 11

predictable

Question 12

stages of general anesthesia:

Answer 12

1) analgesia
2) excitement/delirium
3) surgical anesthesia
4) medullary paralysis

Question 13

types of general anesthetics: inhalation agents

Answer 13

1) halogenated liquids
2) nitrous oxide
3) other gases

Question 14

types of general anesthetics: IV agents

Answer 14

1) barbiturates
2) Benzos
3) opioids

Question 15

choice of anesthetic: often use more than 2 agents to provide what?

Answer 15

“balanced” anesthesia

Question 16

choice of anesthetic: traditional method

Answer 16

injected followed by inhaled

Question 17

inhalation or IV: halothane

Answer 17

inhalation

Question 18

inhalation or IV:

Answer 18

thiopental

Question 19

general anesthetics- mechanism of action: direct effect on ( )

Answer 19

lipid bilayer

Question 20

general anesthetics- mechanism of action: direct effect on ( ) receptors

Answer 20

neuronal

Question 21

general anesthetics- mechanism of action: combo of ( )effects

Answer 21

lipid and receptor

Question 22

anesthetic adjuvants: ( ) patients prior to surgey

Answer 22

relax and sedate

Question 23

anesthetic adjuvants: reduce post-op ( )

Answer 23

nausea and vomiting (PONV)

Question 24

anesthetic adjuvants: reduce other problems related to ( )

Answer 24

anesthesia

Question 25

NMJ blockers: used to ( ) skeletal muscles to facilitate positioning on table, prevent spasms, allow easier mechanical ventilation

Answer 25

paralyze

Question 26

NMJ blockers: depolarizing

Answer 26

succinylcholine

Question 27

NMJ blockers: nondepolarizing

Answer 27

tubocurarine, rocuronium, others

Question 28

NMJ short duration (minutes to about an hours) but some paitents may lack ( ) which make them remain in paralyzed state at end of surgery

Answer 28

metabolizing enzymes

Question 29

NMJ blocker effects can be reversed somewhat with what?

Answer 29

cholinesterase inhibitors (neostigmine, edrophonium) OR sugammadex (inactivates rocuronium, veruronium)

Question 30

dissocitative anesthesia: patient may remain conscious but ( )

Answer 30

indifferent to surroundings

Question 31

dissocitative anesthesia: achieved by use of ( )

Answer 31

ketamine OR combo of antipsychotic with opioid

Question 32

general anesthetics rehab concerns: use in ( )

Answer 32

burn debridement, dressing changes, etc

Question 33

general anesthetics rehab concerns: dealing with residual effects of

Answer 33

respiratory hygience, short term confusion/lethargy due to redistribution of anesthesia, possible long term effects on cognition/intellect

Question 34

local anesthesia: goal

Answer 34

interrupt nerve conduction at site of application

Question 35

local anesthesia: purpose

Answer 35

prevent or relieve pain w/o loss of consciousness or systemic effects

Question 36

typical local anesthetics

Answer 36

"-caine" drugs: lidocaine, procaines, bupivicaine, etc.

Question 37

local anesthetics mechanism:bind to ( ) in nerve membrane

Answer 37

sodium (Na+)

Question 38

local anesthetics mechanism: inactivate ( ); prevent action potential conduction

Answer 38

Na+ channel

Question 39

clinical use and administration: applied to surface of skin

Answer 39

topical

Question 40

clinical use and administration: pain relief...minor burns, abrasions

Answer 40

topical

Question 41

clinical use and administration: also used prior to IV insertion, injections

Answer 41

topical

Question 42

clinical use and administration: movement through skin enhaced by electricity, ultrasound, other cehmicals

Answer 42

transdermal

Question 43

clinical use and administration: lidocaine patch

Answer 43

transdermal

Question 44

clinical use and administration: injected subQ

Answer 44

infiltration

Question 45

clinical use and administration: commonly used before suturing wounds

Answer 45

infiltration

Question 46

clinical use and administration: allowed to penetrate into selected area

Answer 46

infiltration

Question 47

clinical use and administration: injected close to nerve or nerve plexus

Answer 47

peripheral nerve block

Question 48

clinical use and administration: commonly used for dental procedures, other minor surgeries

Answer 48

peripheral nerve block

Question 49

clinical use and administration: administration outside of durs

Answer 49

epidural

Question 50

clinical use and administration: administration into subarachoid space

Answer 50

spinal block

Question 51

clinical use and administration: CRPS

Answer 51

sympathetic block

Question 52

clinical use and administration: local anesthetic injected into venous system of affected arm/leg

Answer 52

intravenous regional anesthesia (Bier Block)

Question 53

clinical use and administration: tourniquet placed proximally to keep drup in limb

Answer 53

intravenous regional anesthesia (Bier block)

Question 54

clinical use and administration: used for some surgical procedures or to treat CRPS/RSDS

Answer 54

intravenous regional anesthesia (Bier block)

Question 55

continuous nerve block: small catheter is implanted near ( )

Answer 55

peripheral nerve(s) to a specific region

Question 56

continuous nerve block: ( ) dripped slowly/continuously onto nerve

Answer 56

local anesthetic

Question 57

continuous nerve block: excellent ( ) pain control

Answer 57

post-op

Question 58

differential nerve block: which fibers affected first?

Answer 58

smallest, unmyelinated fibers

Question 59

differential nerve block: which fibers affected last?

Answer 59

largest myelinated fibers

Question 60

differential nerve block: typical order of functional loss

Answer 60

pain, temp, touch, proprioception, motor

Question 61

local anesthetics implications for rehab: transdermal administration for tx of pain via ( )

Answer 61

ionto- and phonophoresis

Question 62

local anesthetics implications for rehab: use in ( )

Answer 62

RSDS/CRPS; other acute and chronic conditions

Question 63

local anesthetics implications for rehab: be alter for possible ( )

Answer 63

absorption into systemic circulation (can cause "local anesthetic systemic toxicity" (LAST)