Anesthesia, C31 P190-195 Flashcards Preview

Surgery 🤓 > Anesthesia, C31 P190-195 > Flashcards

Flashcards in Anesthesia, C31 P190-195 Deck (56)
1

Define the following terms:
Anesthesia
P190

Loss of sensation/pain

2

Define the following terms:
Local anesthesia
P190

Anesthesia of a small confined area of
the body (e.g., lidocaine for an elbow
laceration)

3

Define the following terms:
Epidural anesthesia
P190

Anesthetic drugs/narcotics infused into
epidural space

4

Define the following terms:
Spinal anesthesia
P190

Anesthetic agents injected into the thecal
sac

5

Define the following terms:
Regional anesthesia
P190

Blocking of the sensory afferent nerve
fibers from a region of the body
(e.g., radial nerve block)

6

Define the following terms:
General anesthesia
P191

Triad:
1. Unconsciousness/amnesia
2. Analgesia
3. Muscle relaxation

7

Define the following terms:
GET or GETA
P191

General EndoTracheal Anesthesia

8

Give examples of the following terms:
Local anesthetic
P191

Lidocaine, bupivacaine (Marcaine®)

9

Give examples of the following terms:
Regional anesthetic
P191

Lidocaine, bupivacaine (Marcaine®)

10

Give examples of the following terms:
General anesthesia
P191

Isoflurane, enflurane, sevoflurane,
desflurane

11

Give examples of the following terms:
Dissociative agent
P191

Ketamine

12

What is cricoid pressure?
P191

Manual pressure on cricoid cartilage
occluding the esophagus and thus
decreasing the chance of aspiration of
gastric contents during intubation
(a.k.a. Sellick’s maneuver)

13

What is “rapid-sequence”
anesthesia induction?
P191

1. Oxygenation and short-acting
induction agent
2. Muscle relaxant
3. Cricoid pressure
4. Intubation
5. Inhalation anesthetic (rapid: boom,
boom, boom S to lower the risk of
aspiration during intubation)

14

Give examples of induction
agents.
P191

Propofol, midazolam, sodium thiopental

15

What are contraindications
of the depolarizing agent
succinylcholine?
P191

Patients with burns, neuromuscular
diseases/paraplegia, eye trauma, or
increased ICP

16

Why is succinylcholine
contraindicated in these
patients?
P191

Depolarization can result in life-threatening
hyperkalemia; succinylcholine also
increases intraocular pressure

17

Why doesn’t lidocaine work
in an abscess?
P191

Lidocaine does not work in an acidic
environment

18

Why does lidocaine burn
on injection and what can
be done to decrease the
burning sensation?
P192

Lidocaine is acidic, which causes the
burning; add sodium bicarbonate to
decrease the burning sensation

19

Why does some lidocaine
come with epinephrine?
P192

Epinephrine vasoconstricts the small
vessels, resulting in a decrease in bleeding
and blood flow in the area; this prolongs
retention of lidocaine and its effects

20

In what locations is lidocaine
with epinephrine contraindicated?
P192

Fingers, toes, penis, etc., because of the
possibility of ischemic injury/necrosis
resulting from vasoconstriction

21

What are the contraindications
to nitrous oxide?
P192

Nitrous oxide is poorly soluble in serum
and thus expands into any air-filled body
pockets; avoid in patients with middle ear
occlusions, pneumothorax, small bowel
obstruction, etc.

22

What is the feared side effect
of bupivacaine (Marcaine®)?
P192

Cardiac dysrhythmia after intravascular
injection leading to fatal refractory
dysrhythmia

23

What are the side effects of
morphine?
P192

Constipation, respiratory failure,
hypotension (from histamine release),
spasm of sphincter of Oddi (use
Demerol® in pancreatitis and biliary
surgery), decreased cough reflex

24

What are the side effects of
meperidine?
P192

Similar to those of morphine but causes
less sphincteric spasm and can cause
tachycardia and seizures

25

Limit to the duration of
Demerol® postoperatively?
P192

Build up of the metabolites
(normeperidine)

26

What medication is a
contraindication to
Demerol®?
P192

Monoamine oxidase inhibitor

27

What metabolite of Demerol®
breakdown causes side effects
(e.g., seizures)?
P192

Normeperidine

28

What is the treatment of
life-threatening respiratory
depression with narcotics?
P193

Narcan® IV (naloxone)

29

What are the side effects of
epidural analgesia?
P193

Orthostatic hypotension, decreased
motor function, urinary retention

30

What is the advantage of
epidural analgesia?
P193

Analgesia without decreased cough reflex

31

What are the side effects of
spinal anesthesia?
P193

Urinary retention
Hypotension (neurogenic shock)

32

What is the side effect of
inhalational (volatile)
anesthesia?
P193

Halothane—hypotension (cardiac
depression, decreased baroreceptor
response to hypotension, and peripheral
vasodilation), malignant hyperthermia

33

MALIGNANT HYPERTHERMIA
What is it?
P193

Inherited predisposition to an anesthetic
reaction, causing uncoupling of the
excitation–contraction system in skeletal
muscle, which in turn causes malignant
hyperthermia; hypermetabolism is fatal
if untreated

34

MALIGNANT HYPERTHERMIA
What is the incidence?
P193

Very rare

35

MALIGNANT HYPERTHERMIA
What are the causative agents?
P193

General anesthesia, succinylcholine

36

MALIGNANT HYPERTHERMIA
What are the signs/symptoms?
P193

Increased body temperature; hypoxia;
acidosis; tachycardia, ↑ PCO(2) (↑ end tidal
CO(2))

37

MALIGNANT HYPERTHERMIA
What is the treatment?
P193

IV dantrolene, body cooling, discontinuation
of anesthesia

38

MISCELLANEOUS
What are some of the
nondepolarizing muscle
blockers?
P193

Vecuronium
Pancuronium

39

MISCELLANEOUS
What are the antidotes to
the nondepolarizing neuromuscular
blocking agents?
P194

Edrophonium
Neostigmine
Pyridostigmine

40

MISCELLANEOUS
How do these agents work?
P194

They inhibit anticholinesterase

41

MISCELLANEOUS
Which muscle blocker is
depolarizing?
P194

Succinylcholine

42

MISCELLANEOUS
What is the duration of
action of succinylcholine?
P194

43

MISCELLANEOUS
What is the antidote to
reverse succinylcholine?
P194

Time; endogenous blood pseudocholinesterase
(patients deficient in this enzyme
may be paralyzed for hours!)

44

MISCELLANEOUS
What is the maximum dose of lidocaine:
With epinephrine?
P194

7 mg/kg

45

MISCELLANEOUS
What is the maximum dose of lidocaine:
Without epinephrine?
P194

4 mg/kg

46

MISCELLANEOUS
What is the duration of
lidocaine local anesthesia?
P194

30 to 60 minutes (up to 4 hours with
epinephrine)

47

MISCELLANEOUS
What are the early signs of
lidocaine toxicity?
P194

Tinnitus, perioral/tongue numbness,
metallic taste, blurred vision, muscle
twitches, drowsiness

48

MISCELLANEOUS
What are the signs of
lidocaine toxicity with large
overdose ( > 10 mcg/mL)?
P194

Seizures, coma, respiratory arrest
Loss of consciousness
Apnea

49

MISCELLANEOUS
When should the Foley
catheter be removed in a
patient with an epidural
catheter?
P194

Several hours after the epidural catheter
is removed (to prevent urinary retention)

50

MISCELLANEOUS
What is a PCA pump?
P194

Patient-Controlled Analgesia; a pump
delivers a set amount of pain reliever
when the patient pushes a button
(e.g., 1 mg of morphine every 6 minutes)

51

MISCELLANEOUS
What are the advantages of
a PCA pump?
P195

Better pain control
Patients actually use less pain medication
with a PCA!
If given a moderate dose without a basal
rate, patients should not be able to
overdose (They will fall asleep and not
be able to push the button!)

52

MISCELLANEOUS
What is a “basal rate” on the PCA?
P195

Steady continuous infusion rate of the
narcotic (e.g., 1–2 mg of morphine)
continuously infused per hour; patient
can supplement with additional doses
as needed

53

MISCELLANEOUS
What is used to reverse
narcotics?
P195

Naloxone (Narcan®)

54

MISCELLANEOUS
What is used to reverse
benzodiazepines?
P195

Flumazenil

55

MISCELLANEOUS
What is fentanyl?
P195

Very potent narcotic (#1 drug of abuse by
anesthesiologists)

56

MISCELLANEOUS
Name an IV NSAID.
P195

Ketorolac (has classic side effects of
NSAIDs: PUD, renal insufficiency)