Anesthetics I

Question 1

Anesthesia

Answer 1

partial or complete loss of sensation with or without loss of consciousness

Question 2

General Anesthesia:

Answer 2

anesthesia that produces complete loss of consciousness. “medically controlled coma”

loss of protective reflexes, cessation of respiration

Question 3

Analgesia

Answer 3

insensitivity to pain

Question 4

sedation

Answer 4

the process of allaying nervous excitement

Question 5

conscious sedation

Answer 5

a minimally depressed level of consciousness during which he patient retains the ability to maintain a patent airway and respond appropriately to physical or verbal commands

Question 6

Phases of Anesthesia

Answer 6

Induction
Maintenance
Recovery

Question 7

depth of anesthesia

Answer 7

Stage 1 - Analgesia
Stage 2 - Excitement
Stage 3 - Surgical Anesthesia
Stage 4 - Medullary paralysis

Question 8

Most popular agent for the induction of anesthesia

Answer 8

PROPOFOL

Usually given with lidocaine to prevent injection pain from venous irritation

Question 9

Newer version of propofol

Answer 9

Fospropofol (Lusedrea)

less venous irritation

Question 10

Maintenance of anesthesia is done how?

Answer 10

inhalation agents

Intravenous agents

Question 11

Inhalation agents

Answer 11

Halogenated hydrocarbons

Nitrogen Oxide

Question 12

Halogen Adverse Effects

Answer 12

Hepatic Toxicity
Decreased Cardiac Output
Malignant Hyperthermia

Question 13

Malignant Hyperthermia

Answer 13

Rare but life threatening
Usually seen in conjucntion with use of succinylocholine
Dantrolene is main treatment choice

Question 14

Nitrous Oxide

Answer 14

Strong analgesic but weak anesthetic

Frequently used as adjunct

Question 15

MAC - minimal alveolar concentration

Answer 15

Concentration needed to suppress movement in response to standard incision

Question 16

IV Anesthetics

Answer 16

Opiods
FENTANYL

Benzodiazepines
MIDLAZOPAM (conscious sedation)

KETAMINE

DEXMEDETOMIDINE

Question 17

Ketamine

Answer 17

Dissociative agent
One of few agents which increase cardiac output
May cause post-op hallucinations

Question 18

Neuromuscular blockade agents

Answer 18

Nondepolarizing agents
Depolarizing agents

to paralyze patients

Question 19

Neuromuscular blockade agent utilization

Answer 19

facilitate endotracheal intubation

relax abdominal musculature to enhance surgical exposure

Question 20

Depolarizing agent

Answer 20

Succinylcholine

fast acting short duration

Question 21

Non depolarizing agent

Answer 21

Longer duration of action

Question 22

Local anesthetic agents

Answer 22

Inhibit sensory nerve conduction via block of sodium ion channels

Pain nerves more sensitive
can block motor nerves at higher doses

Question 23

Chemical types of local anesthetics

Answer 23

Esters

Amides

Question 24

Amides

Answer 24

Lidocaine
Mepivicaine
Bupivicaine
Ropivacaine

Question 25

popular ester

Answer 25

chloroprocaine

Question 26

Duration of action for topical anesthetics

Answer 26

Lidocaine 15-30 min Chloroprocaine 30-40 min Mepivacaine: 60-90 min Bupivacaine & Repivacaine: 120 min or more

Question 27

adding epinepherine to topical anesthetics

Answer 27

extends duration of action, reduces bleeding bad news: increases heart rate, increased anxiety

Question 28

Adverse effects of local anesthetics

Answer 28

``` Allergic reactions Cardiac Toxicity (bupivacaine) Systemic effects are variable altered CNS function Cardiac changes ```

Question 29

allergy considerations in topical anesthetic

Answer 29

True allergy is rare Allergic to one ester, usually means allergic to all esters Amides or usually OK in patients allergic to esters Allergic to one amide DOES NOT mean allergic to all amides

Question 30

Insensitivity to local anesthetics

Answer 30

Insensitivity is usually rare

Question 31

Conscious sedation

Answer 31

very frequently utilized | especially for endoscopic procedures

Question 32

Elements of conscious sedation

Answer 32

``` Intravenous access Patient monitoring Variable medicaiton "cocktail" sedative analgesic Anesthetic ```

Question 33

Conscious sedation medications

Answer 33

Most common: Benzodiazepine esp midlazopam (versed) Next: Fentanyl (short acting opiod) Sometimes: propofol

Question 34

Conscious sedation dangers

Answer 34

respiratory depression | adverse drug reactions