Anesthesia

Question 1

What is anesthesia?

Answer 1

Elimination of sensation

Question 2

What is analgesia

Answer 2

Elimination of pain

Question 3

What is sedation?

Answer 3

Is a decrease in activity, alertness, arousal and/or vigilance

Question 4

What is general anesthesia?

Answer 4

Drug-induced, reversible depression of the CNS that results in the loss of physiologic response and perception to all external stimuli

Question 5

What are the general actions of inhalation anesthetic agents?

Answer 5

CV
Resp
Brain
Renal
Hepatic
Malignant hyperthermia

Question 6

How do inhalation anesthetic agents affect CV?

Answer 6

Decreased MAP

Depression of myocardial function

Question 7

How do inhalation anesthetic agents affect respiratory?

Answer 7

Depress mucocilliary function

Question 8

How do inhalation anesthetic agents affect brain?

Answer 8

Decrease metabolic rate of the brain

Increase cerebral blood flow

Question 9

How do inhalation anesthetic agents affect renal?

Answer 9

Decrease renal blood flow and GFR

Question 10

How do inhalation anesthetic agents affect hepatic?

Answer 10

Decrease hepatic blood flow

Rarely causes permanent changes in liver enzymes

Question 11

What are the drugs that require special ventilation?

Answer 11

NO
Halothan
Isoflurane
Enflurane
Desflurane
Sevoflurane

Question 12

What is malignant hyperthermia?

Answer 12

Autosomal dominant genetic disorder

Question 13

What are the sx of MH?

Answer 13

Tachy
HTN
Muscle rigidity
Hyperthermia
Hyperkalemia
Acidosis

Question 14

What is the treatment of MH?

Answer 14

Dantrolene

Supportive treatment

Question 15

What are the IV agents for anesthesia?

Answer 15

Barbiturates
Benzos
Opioids
Propofol
Etomidate
Ketamine
Dexmedetomidine

Question 16

What are commonly used for IV induction of anesthesia?

Answer 16

Barbiturates

Question 17

What barbiturates are used for anesthesia?

Answer 17

Thiopental

Question 18

Why are benzos not used for anesthesia?

Answer 18

Inadequate depth of sedation for surgical anesthesia

Question 19

Why are benzos used for anesthesia?

Answer 19

Premedicate because of the sedative, anxiolytic and amnestic properties

Question 20

What is the most commonly used opioid for anesthetia?

Answer 20

Fentanyl

Question 21

What can the emulsion formulation of propofol cause?

Answer 21

Hypertriglyceridemia

Question 22

What do HD of propofol cause?

Answer 22

Propofol Infusion Related Syndrome can result in death

Question 23

What is etomidate used for?

Answer 23

Induction of anesthesia

Question 24

What are the AEs of etomidate?

Answer 24

Injection site pain
Myoclonic activity
Post-op n/v
Decreases plasma cortisol

Question 25

How does ketamine work?

Answer 25

Produces dissociative anesthetic state characterized by catatonia, amnesia, and analgesia e/ or e/o loss of consciousness

Question 26

What are the AEs of ketamine?

Answer 26

Produces CV stmiulation Increases cerebral blood flow, oxygen consumption and intracranial pressure Associated with post-op disorientation, illusions and vivid dreams

Question 27

Where is dexmedetomidine used?

Answer 27

ICU

Question 28

What are the indications of NMBAs?

Answer 28

``` Facilitate short procedures under general anesthesia Facilitate mechanical ventilation ARDS Manage increased ICP Treat muscle spasms Decrease oxygen consumption Surgery ```

Question 29

What are NMBAs?

Answer 29

``` Succinylcholine Pancuronium Vecuronium Rocuronium Atracurium Cisatracurium ```

Question 30

How does succinylcholine work?

Answer 30

Mimics acetylcholine at the NMJ and prolongs the repolarization phase

Question 31

How is pancuronium eliminated?

Answer 31

Renal

Question 32

What are the AEs of pancuronium?

Answer 32

Tachy HTN Increased CO

Question 33

Which NMBA is the fastest onset?

Answer 33

Rocuronium

Question 34

What drugs interact with NMBAs?

Answer 34

``` Diuretics Antiarrhythmics AG Mg Li ```

Question 35

What is the reversal agent for rocuronium and vecuronium?

Answer 35

Sugammadex

Question 36

What is the reversal agent for non-depolarizing agents?

Answer 36

Neostigmine | Pyridostigmine

Question 37

Where is sugammadex used?

Answer 37

In the OR only

Question 38

What is procedural sedation?

Answer 38

Creates a decreased level of awareness for a patient while maintaining protective airway reflexes and adequate spontaneous ventilation

Question 39

What medications are used for procedural sedation?

Answer 39

Ketamine and benzo Benzo and analgesic Propofol or etomidate and analgesic

Question 40

What type of patient can procedural sedation be used in?

Answer 40

Healthy

Question 41

How do we monitor sedation in OR?

Answer 41

BIS monitor - mini EEG | BIS < 60 = no recall

Question 42

How do we monitor sedation in ICU?

Answer 42

RASS RAMSEY CAM

Question 43

What are the 7 steps of rapid sequence intubation?

Answer 43

``` Preparation Pretreatment Premedication (induction) Paralyze after sedation Protection/positioning Post-intubation management ```

Question 44

What drugs are used for pretreatment?

Answer 44

Fentanyl IV* Lidocaine IV Atropine IV Esmolol IV

Question 45

What drugs do we use for premedication?

Answer 45

Midazolam, etomidate, propofol, ketamine

Question 46

What drug is the gold standard for paralyzation?

Answer 46

Succinylcholine

Question 47

What drugs are used to paralyze?

Answer 47

Succinylcholine | NMBAS (rocuronium, vecuronium)

Question 48

What is done in protection/placement step?

Answer 48

Trach placement