Flashcards in E's intro to Anesthetics Deck (82)
what type of anesthesia provides numbness to a small area limited to where local anesthetic is injected?
What type of anesthesia provides numbness to a much larger areas, such as epidurals, spinals, and peripheral nerve blocks?
What type of anesthesia uses sedatives and other agents, but the patient is responsive and can breathe on their own?
MAC- monitored anesthesia care
What type of anesthesia is a deep state of sleep where the patient loses consciousness and sensation and usually (not always) requires assisted ventilation?
What type of anesthesia can be referred to as "IV sedation"?
Monitored anesthesia care
What is the major difference between monitored anesthesia care and general anesthesia?
MAC patient can still move (like for bronchoscopy and EGD; sedative)
General anesthesia the patient CANT MOVE/ no longer responds to stimulus
Distinguish the effects of Minimal sedation (vs moderate, deep, and general anesthesia)
(anxiolysis) patient can respond to verbal commands; cognitive function and coordination may be impaired; CV and Ventilatory functions are UNaffected
Distinguish the effects of moderate sedation/ analgesia (vs. minimal, deep, and general anesthesia)
(Conscious Sedation) patient responds purposefully to verbal commands, either alone or with tactile stimulation; adequate spontaneous ventilation; CV usually maintained. easily aroused
Distinguish the effects of deep sedation (vs. minimal, moderate, and general anesthesia)
NOT easily aroused; respond purposefully to repeated PAINFUL stimuli; ventilatory function and patent airway may be impaired; CV function usually maintained
Distinguish the effects of General anesthesia (vs. minimal, moderate, and deep sedation)
NOT arousable even with painful stimuli; IMPAIRED ventilatory function-->requires ventilatory assistance for patent airway; PPV may be required; CV function may be impaired (elderly may have CV issues, vasodilated...etc)
What is General Anesthesia?
generalized, reversible CNS depression
-NO sensory perception (all senses are gone)
-Loss of consciousness
-No recall of events
What are other potential effects of general anesthetics and adjuncts? (4)
-suppression of autonomic reflexes (good and bad: decreases the stress response, but knocks out ability to compensate BP etc.)
-Analgesia (NOT ALWAYS with general Anesth. ie. with EGD dont need pain relief)
What are the steps of General Anesthesia with an ETT template? (7)
- Pre-op medications/ sedation
- Induction Drug
- Neuromuscular blockade
- inhalation drug
- opioids/ local anesthetics etc.
- Neuromuscular Blockade reversal agent
What is the purpose of pre-op medication/sedation in the GA with an ETT template? (4)
patient comfort, reduce anxiety, prevent aspiration, antibiotics per surgeon request (usually benzos/versed)
What is the purpose of the induction drug in the GA with an ETT template?
to induce anesthesia (DUH!!!)--> can be IV (usually) or inhaled
What is the purpose of the neuromuscular blockade in the GA with ETT template?
to facilitate intubation and optimize surgical conditions (remember, you dont have to!! like you could give propofol)
What is the purpose of the inhalational drug in the GA with ETT template?
to maintain general anesthesia (can also be IVV gtt agent like propofol)
What is the purpose of opioids/local anesthetics etc. in the GA with ETT template?
to minimize physiological effects of pain and to promote comfort at emergence (ppl can feel pain on anesthetics! so give them the juice!)
What is the purpose of the antiemetic in the GA with ETT template?
to prevent nausea likely with opioids/inhalational agents "ain't nobody got time for that"
Whats the purpose of giving a neuromuscular blockade reversal agent?
to reverse the paralyzing effects of neuromuscular blockade (dont have to with the half-times of drugs....)
What are the 5 pharmacologic effects of Benzodiazepines?
-Anxiolysis**** especially with major surgeries like CV
-Anterograde Amnesia (From when you give it until its gone, so introduce yourself before!)
-Muscle Relaxation (Spinal Level)-- decreases muscle spasms
What is the prototype benzodiazepine?
What is the MOA of Benzodiazepines?
Potentiates binding of GABA to GABAa receptor; Increases GABA potency times 3 at the site
What happens due to the binding of GABA to GABAa receptors with respect to ions (3)....for benzodiazepines?
-increases chloride influx
-Decreased neuronal excitability
What are the uses of Benzodiazepines in anesthesia? (5)
-GA induction (rare)
-GA maintenance (rare)
What are the adverse effects and precautions of benzodiazepines?
-Dose dependent decrease in ventilation
-Hypoxemia and hypoventilation enhanced in presence of opioid
-decreases in SVR at induction dosage (only with large doses)
-BP consequently decreases especially with hypovolemia (BP generally stable except in large doses!)
-contraindicated in pregnancy
What are the pharmacological effects of opioids in supraspinal and spinal analgesia?
activation of endogenous pain suppression system
What are the opioid receptors and where does it act at the synapse?
agonist acts at the mu receptors- activates pain modulating systems
-acts at pre and post synaptic sites
What happens with neurotransmission when opioids bind to the receptor?
-increased K conductance-- hyperpolarization
-Ca2+ channel inactivation
-Immediate decrease in neurotransmitter release (Substance P)