Anesthesia

Question 1

As a PT, why should you care about anesthetics?

Answer 1

Pts have used anesthetics, and the effects can last days after surgery; PTs can administer anesthetics (phonophoresis, iontophoresis)

Question 2

Patient is not conscious; Effect is on the whole body; Used for more extensive surgical procedures

Answer 2

General anesthesia

Question 3

Patient is conscious; used in surgery of relatively small, well defined area or surgery where pt needs to remain conscious

Answer 3

Local anesthesia

Question 4

Name 6 requirements that most general anesthetics meet

Answer 4

1. Loss of consciousness and sensation
2. Amnesia
3. Skeletal muscle relaxation
4. Inhibition of sensory and autonomic reflexes
5. Minimum of toxic side effects
6. Rapid onset, easy adjustment of dosage during use, and rapid, uneventful recovery

Question 5

Name the four stages of anesthesia

Answer 5

1. Analgesia
2. Excitement (delirium)
3. Surgical Anesthesia
4. Medullary Paralysis

Question 6

Loss of sensation of pain

Answer 6

Analgesia

Question 7

Using too much anesthesia; results in loss of cardiac HR, decreased breathing, etc.

Answer 7

Medullary paralysis

Question 8

What is the goal of anesthesia

Answer 8

To bring pt to stage III [surgical anesthesia] as quickly as possible

Question 9

What are the administration techniques for anesthesia?

Answer 9

1. Intravenous
2. Inhalation
3. Sequential combo of the two

Question 10

What is an advantage to intravenous administration?

Answer 10

Quick onset

Question 11

What is a problem with intravenous administration?

Answer 11

Lack of control if overdosed; once the drug is in the body, it cannot be removed quickly, so you must wait until the body metabolizes it

Question 12

What is the advantage to inhalation administration?

Answer 12

Easy to adjust dose

Question 13

What is the disadvantage to inhalation administration?

Answer 13

Slow onset

Question 14

What is the currently used for inhaled anesthetics? What older anesthetics were used previously?

Answer 14

Nitrous oxide; Ether [explosive] or chloroform [toxic]

Question 15

What are 5 IV anesthetics used?

Answer 15

1. Barbiturates
2. Benzodiazepines
3. Etomidate
4. Ketamine
5. Propofol

Question 16

General anesthetic that has fast onset; short-acting forms; relatively safe [respiratory and circulatory depressants, decrease intracranial pressure]; however little analgesic or muscle relaxant effect; Hepatic metabolism required for elimination (do not give to people with liver disease)

Answer 16

Barbiturates; Thiopental and methohexital

Question 17

General anesthetic that has a slower onset than barbiturates; longer duration of action; more often used as premedication; prolongs recovery period but produces amnesia; used to get pt to relax before surgery

Answer 17

Benzodiazepines

Question 18

Analgesics; usually not used alone to produce anesthesia but can produce anes. with higher doses; help maintain anes. at low doses; causes respiratory depression, post-op nausea and vomiting; can cause constipation, itching

Answer 18

Opioids

Question 19

General anestesia; patient not fully awake or asleep [analgesia, retrograde amnesia]; short procedures requiring some pt cooperation

Answer 19

Neuroleptanesthesia

• neuroleptic drug AKA dopamine blocker = droperidol
• opioid analgesic = fentanyl

Question 20

Induction of anesthesia (seconds); quick onset, quick recovery; combined with other drugs; adverse effects = no analgesic actions, involuntary movements, pain on injection, nausea and vomiting

Answer 20

Etomidate

Question 21

Dissociative anesthetic [catatonia, amnesia, analgesia]; poor muscle relaxant; mostly for short procedures; increases muscle tone, BP, HR, breathing rate; increase salivary and bronchial secretions; hallucinations or disturbed dreams - reduced by diazepam

Answer 21

Ketamine

Question 22

General anesthesia; Fast onset; antiemetic; lowers BP, ICP; little pain control, lethal metabolic acidosis and skeletal myopathy; dystonia and seizures

Answer 22

Propofol

Question 23

Term meaning “stops vomiting”

Answer 23

Antiemetic

Question 24

Term meaning “involuntary muscle contractions”

Answer 24

Dystonia

Question 25

Drug used to treat dystonia; anticholinergic drug

Answer 25

Benzotropine

Question 26

Prevents involuntary movements and make mechanical ventilation easier; block NMJ fxn

Answer 26

Neuromuscular blockers

Question 27

Competitive antagonists of muscle nicotinic receptor; similar in structure to curare; no muscle movement

Answer 27

Non depolarizing blockers

Question 28

Act like ACh ant NMJ, but not broken down; depolarized muscle is not responsive to further stimulation

Answer 28

Depolarizing blockers

Question 29

What are 5 special concerns of general anesthesia?

Answer 29

1. Drowsiness 2. Confusion or delirium 3. Weakness 4. May last several days if a patient has difficulty eliminating the drug 5. Lung concerns

Question 30

Anesthetics decrease ______________ in airways, which increases risk of infection and atelectasis

Answer 30

Mucociliary clearance (move things out from lungs)

Question 31

How can PTs help with residual lung concerns produced by using general anesthesia?

Answer 31

Encourage patients to cough and breath deeply to: 1. Eliminate anesthesia 2. Mobilize secretions 3. Breathing exercises 4. Postural drainage

Question 32

Characterized by a loss of sensation in a specific body part or region

Answer 32

Local anesthesia

Question 33

What two environments would you use local anesthetics?

Answer 33

1. Surgery; no post op effects of general anes.; doesn't interfere with CV, resp. or renal fxn 2. Non-surgical; short- or long-term pain relief; block sympathetic pathways; iontophoresis or phonophoresis

Question 34

Name 3 local anesthetics

Answer 34

1. Benzocaine (Américaine) 2. Lidocaine (Xylocaine) 3. Procaine (Novocain)

Question 35

What is local anesthetics often administered with? Why?

Answer 35

A vasoconstricting agent such as epinephrine; slows down removal of the drug and to reduce entering the bloodstream

Question 36

How are anesthetics metabolized?

Answer 36

Hydrolysis by liver or enzymes in plasma

Question 37

How are anesthetics excreted?

Answer 37

Metabolite secreted by kidneys

Question 38

Local anesthetic applied directly to skin, mucous membranes, cornea, etc.; drug is for the thing its being applied to

Answer 38

Topical administration

Question 39

Local anes. applied to skin, absorbed into underlying structures; iontophoresis, phonophoresis, transdermal patch

Answer 39

Transdermal administration

Question 40

Local anes. injected into a region and saturates it; diffuses to sensory nerve endings; used in dental procedures

Answer 40

Infiltration anesthesia

Question 41

Local anes. injected into a nerve trunk so that transmission in peripheral nerve is blocked; prolonged administration into skeletal m. can produce localized m. pain and necrosis

Answer 41

Peripheral nerve block

Question 42

Local anes. injected into spaces surrounding the spinal cord; too high of dosage has a risk for neurotoxicity, resulting in nerve damage; used whenever anesthesia is needed for large region

Answer 42

Central neural blockade

Question 43

Central neural blockade injected in space between vertebra and dura mater; safer and easier of the 2 blockades

Answer 43

Epidural nerve blockade

Question 44

Central neural blockade injected in subarachnoid space (intrathecal anesthesia); faster and more effective, but higher risk for neurotoxicity

Answer 44

Spinal nerve blockade

Question 45

Can occur during peripheral and central nerve blocks; can be used for specific treatment - CRPS; tend to work better in beginning of disorder rather than later

Answer 45

Sympathetic block

Question 46

What is Complex Regional Pain Syndrome (CRPS)? How is a block used to treat this?

Answer 46

Affects a region of the body, thought to be due to dysfunction of symp. NS; injections into the region surrounding the sympathetic ganglion

Question 47

Injected into peripheral vein; drug diffuses into body region; tourniquet restrict blood flow so anesthetic stays in the region

Answer 47

IV regional anesthesia

Question 48

Inhibit of sodium ion channels [blocks action potential]; blockage at one point blocks all forward progression of action potential; smaller diameter axons affected the most

Answer 48

MOA (mechanism of action, inhibitor)

Question 49

Drugs meant to have a local effect; if absorbed into general circulation, can affect nervous and CV systems; happens when a blood vessel is hit instead of a nerve

Answer 49

Systemic effects

Question 50

What are anesthetic systemic effects of the CNS?

Answer 50

Initially stimulates the brane [somnolence, confusion, agitation, excitation, seizures]; followed by CNS depression [respiratory depression, cardiac depression]

Question 51

What are anesthetic systemic effects of the cardiac system?

Answer 51

Decreased excitation, HR, force

Question 52

What causes systemic actions due to anesthesia?

Answer 52

1. Long-acting and excessive dose 2. Increased absorption rate 3. Injected into systemic circulation