General Anesthesia Flashcards Preview

Surgery > General Anesthesia > Flashcards

Flashcards in General Anesthesia Deck (45):
1

Define Anesthesia

Combination of amnesia, analgesia, & muscle relaxation to allow the performance of surgery or other procedures

2

3 Phases of Anesthesia

Induction
Maintenance
Emergence

3

Induction

Putting to sleep
Most common: propofol
Alternatives: etomidate, ketamine

4

Propofol Effects in Induction

Drop in BP
Drop in cardiac output
Antiemetic properties

5

When is ketamine used for induction?

Hemodynamic instability
Cardiac stimulant
Significant analgesia
Bronchodilation
Hallucinations

6

Maintenance Phase of Anesthesia

Inhaled or IV anesthetics

7

Inhalation Anesthetic Agents

Sevoflurane
Desflorane
Nitrous Oxide

8

IV Anestetics

Propofol
Remifentanil

9

Emergence Phase of Anesthesia

Waking up
Can result in autonomic hyper-responsiveness

10

Autonomic Hyper-Responsiveness During Emergence

Tachycardia
Hypertension
Bronchospasm
Laryngospasm

11

What medications can block the autonomic hyper-responsiess during emergence?

Short acting narcotics
Beta blockers
Lidocaine

12

In what surgeries is Propofol used?

General surgeries
Cardiac surgery
Neurosurgery
Pediatric surgery

13

How is propofol metabolized & cleared from the body?

Metabolized in the liver
Excreted in the urine

14

SE of Propofol

Support rapid growth of microorganisms
Hypotension
Hypertonia & movement
Respiratory depression

15

In what populations is ketamine used?

Pediatrics- IM shot
Geriatrics
Shock patients (cardiac stimulant)

16

Which types of gasses take longer to eliminate from the body?

Soluble gasses
More soluble, longer
Less soluble, quicker

17

How do inhaled anesthetics work?

Interfere with release of neurotransmitters
Alter re-uptake of neurotransmitters
Change the binding of neurotransmitters to the post-synaptic receptor sites

18

Isoflurane

Higher blood-gas solubility

19

Effects of Isoflurane

Tachycardia
Peripheral vasodilation
Airway irritant
Coughing

20

Desflurane

Requires heated-pressurized vaporizer for delivery

21

Effects of Desflurane

Tachycardia
Peripheral vasodilation
Coughing
Bronchospasm
Not for mask induction

22

Sevoflurane

NO tachycardia
Peripheral vasodilation
Well-tolerated for mask induction

23

Which spaces can increase in size when nitrous oxide is used?

Bowel
Middle ear
Pneumothorax
Pneumocranium
Pneumo-peritoneum
Cuffs of ET tubes

24

Effects of Nitrous Oxide

Post op nausea
Analgesic properties

25

Advantages of Nitrous Oxide

Inexpensive
Readily available
Odorless/slightly sweet
Limited effect
No special equipment
Sympathomimetic
No malignant hypertension

26

Disadvantages of Nitrous Oxide

High MAC/limits FIO2
Sympathomimetic
Methionine syntheses inhibitor
Expands air-filled spaces

27

Contraindications to Potent Inhaled Anesthetic Agents

Inability to tolerate physiologic alterations
Malignant hyperthermia

28

Reasons for Neuromuscular Blocking Drugs (NMBDs)

Endotracheal intubation
Surgical immobility/relaxation
Mechanical ventilation

29

2 Types of NMBDs

Depolarizing
Non-depolarizing

30

Depolarizing NMBD Medication

Succinylcholine (Anectine)

31

Non-depolarizing NMBDs Medication

Rocuronium (Zemuron)
Vecuronium (Norcuron)
Pancuronium (Pavulon)
Cistracurium (Nimbex)

32

MOA of Depolarizing Agents

Brief twitching or fasciculations
Flaccid paralysis

33

Succinylcholine (Anectine)

Depolarization at the motor end plate
Slowly dissociates from ACh receptors

34

When is succinylcholine (Anectine) used most frequently?

RSI

35

Disadvantages of Succinylcholine

Cardiac dysrhythmias
Sinus bradycardia
Myalgias
Myoglobinuria
Hyperkalemia
Patient restrictions (children)
Masseter spasm
Malignant hyperthermia trigger
Possible intraocular, gastric, & ICPs

36

Long Acting Non-depolarizing Agents

Pancurounium

37

Intermediate Acting Nondepolarizing Agents

Vecuronium
Rocuronium
Cistracurium

38

Short Acting Non-Depolarizing Agent

Mivacurium

39

4 Twitches Seen with NMBDs

0-75% of receptors blocked

40

3 Twitches Seen with NMBDs

75% of receptors blocked

41

2 Twitches Seen with NMBDs

80% of receptors blocked

42

1 Twitch Seen with NMBDs

90% of receptors blocked

43

No Twitches Seen with NMBD Use

100% of receptors blocked

44

Reversal of NMBDs

Acetycholine esterase inhibitors

45

Examples of Acetylcholine Esterase Inhibitors

Neostigmine
Edrophonium
Sugammeadex: vecuronium & rocuronium