Anesthetics Flashcards
(55 cards)
1
Q
Chloroprocaine
trade name
A
Nesacaine
2
Q
Chloroprocaine
onset
A
6-12 mins
3
Q
Chloroprocaine
duration of action
A
0.5-1 hr
4
Q
Chloroprocaine
max dose w/o Epi
A
800mg
5
Q
Chloroprocaine
max dose w/ Epi
A
100mg
6
Q
Procaine
Trade name
A
Novocaine
7
Q
Procaine
onset
A
2-5 mins
8
Q
Procaine
duration of action
A
1 hr
9
Q
Procaine
max dose w/o Epi
A
750 mg
10
Q
Procaine
max dose w/ Epi
A
1000 mg
11
Q
Lidocaine
trade name
A
Xylocaine
12
Q
Lidocaine
onset
A
3-5 mins
13
Q
Lidocaine
duration of action
A
1.5-2 hrs
14
Q
Lidocaine
Max dose w/o Epi
A
300 mg
15
Q
Lidocaine
max dose w/ Epi
A
500 mg
16
Q
Mepivacaine
trade name
A
Carbocaine, polocaine
17
Q
Mepivacaine
onset
A
3-5 mins
18
Q
Mepivacaine
duration of action
A
0.75-1.5 hrs
19
Q
Mepivacaine
max dose w/o Epi
A
300 mg
20
Q
Mepivacaine
max dose w/ Epi
A
not available
21
Q
Bupivacaine
trade name
A
Marcaine, sensorcaine
22
Q
Bupivacaine
onset
A
5 mins
23
Q
Bupivacaine
duration of action
A
2-4 hrs
24
Q
Bupivacaine
max dose w/o Epi
A
175 mg
25
Bupivacaine
| max dose w/ Epi
225 mg
26
Examples of esters (2)
| metabolization?
Chloroprocaine, procaine
| metabolized in blood by pseudocholinesterase
27
Examples of amides (3)
| metabolization?
lidocaine, mepivacaine, bupivacaine
| metabolized by liver
28
MOA of local anesthetics
anesthetic interferes with sodium and potassium currents in the nerve to inhibit depolarization and prevent signal transmission
29
order of how nerve function is affected
pain > temp > touch > proprioception
30
Why is epinephrine added to anesthetics?
causes vasoconstriction which decreases bleeding, shortens the onset of anesthesia, and prolongs effect by slowing the absorption
31
conversion of concentration from % to mg
(% x 10) (# of mL used)
| ex: 5 cc of 0.5% lidocaine = (0.5 x 10)(5)= 25mg of lidocaine
32
examples of how a person can get systemic toxicity with local anesthetics (3)
inadvertent intra-arterial or IV injection
administration of excessive doses
rapid absorption from a highly vascular area
33
symptoms of systemic toxicity of a local anesthetic
sensory disturbance, tongue numbness, twitching, vertigo, slurred speech, convulsions, hypotension, decreased cardiac output, cardiac collapse
34
pts might have an allergic reaction to ____ in ___ local anesthetics
PABA
| ester
35
Hallux/digital blocks
- used for procedures involving the hallux or other digits
- types: Mercado (2 point), 'V', 'H', ring, triangle block
- blocks adjacent proper plantar digital nerves and adjacent proper dorsal digital nerves
36
- used for procedures involving the hallux or other digits
- types: Mercado (2 point), 'V', 'H', ring, triangle block
- blocks adjacent proper plantar digital nerves and adjacent proper dorsal digital nerves
Hallux/digital blocks
37
Mayo (ring) block
- frequently used for bunion surgery
- provides anesthesia proximal to the surgical site to preserve surgical tissue planes
- targets: saphenous, deep peroneal, medial plantar, medial dorsal cutaneous nerves
- may need to administer more local anesthetic at the distal interspace
38
- frequently used for bunion surgery
- provides anesthesia proximal to the surgical site to preserve surgical tissue planes
- targets: saphenous, deep peroneal, medial plantar, medial dorsal cutaneous nerves
- may need to administer more local anesthetic at the distal interspace
Mayo (ring) block
39
Ankle block
- used for procedures distal to ankle
- targets: tibial, saphenous, deep peroneal, superficial peroneal & sural
- also in ring form (instead of targeting specific nerve sites)
40
- used for procedures distal to ankle
- targets: tibial, saphenous, deep peroneal, superficial peroneal & sural
- also in ring form (instead of targeting specific nerve sites)
Ankle block
41
Tibial nerve (popliteal) block
- used for TAL, gastroc recession, repain of Achilles tendon rupture, extensive clubfoot release
- targets tibial nerve right after it branches from the sciatic nerve
42
- used for TAL, gastroc recession, repain of Achilles tendon rupture, extensive clubfoot release
- targets tibial nerve right after it branches from the sciatic nerve
Tibial nerve (popliteal) block
43
How is a tibial nerve block administered?
| adult vs pediatric
- adult pts should be prone with knee flexed 30 degrees, wheal administered 7 cm proximal to the popliteal crease and 1 cm lateral to the midline, between the tendons of semitendinosus and biceps femoris
- pediatric pts may be supine if assistance is available to lift leg
44
infiltration block
- injection of anesthetic directly at the procedure site
| - most frequently used in biopsy or excision of a lesion
45
- injection of anesthetic directly at the procedure site
| - most frequently used in biopsy or excision of a lesion
infiltration block
46
American society of Anesthetists Physical status classification (level 1-6)
1 - normal health pt
2 - pt with mild systemic disease
3 - pt with severe systemic disease
4 - pt with severe systemic ds that is a constant threat to life
5 - moribund pt who is not expected to survive w/o the operation
6 - declared brain-dead pt whose organs are being removed for donation
47
```
conscious sedation
(commonly used med and dose)
```
drug-induced depression or consciousness, during which pts continue to respond to physical and verbal stimuli
48
goal of conscious sedation
relieve anxiety and relax pt w/o depressing consciousness to the point that the airway is compromised
49
MAC
(monitored anesthesia care)
similar to conscious sedation, but pts are more deeply sedated - they are not easily aroused, but still respond purposefully to repeated or painful stimulation
- able to administer local anesthetic at operative site w/o pt discomfort
- pt is comfortable, airway is maintained, vitals are continuously monitored
- short recovery time and reduced incidence of nausea
50
conscious sedation
| commonly used med and dose
- IV sedation and an analegesic/amestic
| 2 mg IV midazolam and 2 mg IV morphine
51
MAC
| commonly used med and dose
- 1-2 mg of IV midazolam, repeated as needed for sedation
- 30-80mg bolus of IV propofol for induction, then 25-100ug/kg/min for maintenance
- 25-100ug of IV fentanyl by titration for analgesia
52
general anesthetics
pt loses consciousness and ability to purposefully respond
53
5 components of general anesthetics
```
loss of consciousness
analgesia
amnesia
muscle relaxation
blunting of autonomic reflexes
```
54
phases of general anesthetics
induction - pt goes from awake to unconscious, need adequate airway and ventilation
maintenance - unconscious state is continued for duration of surgery
emergence - awakening of pt
55
general anesthetics
| commonly used med and doses
- combination of IV and inhalational agents
induced with IV push of 2mg/kg propofol (150-200mg in most adults)
maintained with isoflurane or sevoflurane, administered by vaporizer
