Anesthetics

Question 1

IV anesthetics (4)

Answer 1

Barbiturate- Methohexital
Propofol
Ketamine
Etomidate

Question 2

two uses of methohexital?

Answer 2

used with opioid analgesics to supplement inhaled anesthetic agents for longer procedures AND inducing hypnotic state

Question 3

use of propofol

Answer 3

quick ambulatory/outpatient procedures

Question 4

why is Propofol better than methohexital?

Answer 4

Propofol is out of the system within an hour and patients have less N/V compared to other anesthetics

Question 5

2 uses of etomidate

Answer 5

use if BP is low before surgery (has minimal cardiac and resp depression) OR rapid induction of general anesthesia during short procedures

Question 6

4 uses of ketamine

Answer 6

pediatric procedures (shock or short painful procedures), short procedures in general, induction of anesthesia, in pts at risk for hypotension or bronchospasm (NO hypotension)

Question 7

use of inhaled anesthetics

Answer 7

produce reversible loss of consciousness before and during surgery

Question 8

main side effect of inhaled anesthetic

Answer 8

takes a bit longer to recover- coordination and concentration problems for up to a few days

Question 9

types of inhaled anesthetics

Answer 9

Nitrous oxide (not used much anymore), desflurane, isoflurane, sevoflurane

Question 10

what can occur when using local anesthetics

Answer 10

tachyphylaxis- repeated injections lose effectiveness

Question 11

how do local anesthetics work?

Answer 11

block nerve conduction of sensory impulses from periphery to CNS

Question 12

drugs of local anesthetics

Answer 12

all end in AINE (some topical, some injectable)

Question 13

esters of local anesthetics

Answer 13

PCCT

procaine (SA), chloroprocaine (SA), cocaine, tetracaine (LA)

Question 14

amides of local anesthetics

Answer 14

LMBR
lidocaine (IA), mepivacaine (IA)
, bupivacaine, ropivacaine (both LA)

Question 15

what enzyme breaks down esters?

Answer 15

plasma cholinesterase

Question 16

local anesthetics don’t work as well in what type of tissue?

Answer 16

infected or injured tissue bc pH is lowered (more acidic) and different ionization is present

Question 17

what are local anesthetics paired with? why?

Answer 17

epi- vasoconstricts blood supply to injection site so longer duration of action, less systemic absorption, and less toxicity

Question 18

should use epi with local anesthetics where on the body?

Answer 18

sites where vasoconstriction could cause permanent tissue damage (fingers, toes, nose, ear, penis)

Question 19

what is it called when local anesthetics are injected into the vicinity of nerve endings to numb the areas fed by that nerve?

Answer 19

infiltration

Question 20

whats it called when a local anesthetic is injected into a major nerve trunk

Answer 20

nerve block

Question 21

local anesthetic is administered by what?

Answer 21

inotophoresis

Question 22

what two ways can midazolam be given?

Answer 22

IV/IM drug of choice for preop sedation, anxiety, amnesia OR IV sedation for diagnostic, therapeutic or endoscopic procedures

Question 23

what opioids are used for anesthetics?

Answer 23

fentanyl, RS nyl’s, morphine

Question 24

when are anticholinergics more likely used for surgeries?

Answer 24

when you need to prevent GI secretions during longer surgeries

Question 25

when is local anesthesia with sedation used?

Answer 25

use local for more involved sedative procedure (breast biopsy or cataract) OR eye/ENT/cosmetic procedures

Question 26

what type of procedure is conscious sedation used in?

Answer 26

colonoscopy

Question 27

what is regional anesthesia often combined with?

Answer 27

conscious sedation

Question 28

if regional anesthesia fails, what do you do?

Answer 28

convert pt to general anesthesia