General Anesthesia

Question 1

Define Anesthesia

Answer 1

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

Question 2

3 Phases of Anesthesia

Answer 2

Induction
Maintenance
Emergence

Question 3

Induction

Answer 3

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

Question 4

Propofol Effects in Induction

Answer 4

Drop in BP
Drop in cardiac output
Antiemetic properties

Question 5

When is ketamine used for induction?

Answer 5

Hemodynamic instability
Cardiac stimulant
Significant analgesia
Bronchodilation
Hallucinations

Question 6

Maintenance Phase of Anesthesia

Answer 6

Inhaled or IV anesthetics

Question 7

Inhalation Anesthetic Agents

Answer 7

Sevoflurane
Desflorane
Nitrous Oxide

Question 8

IV Anestetics

Answer 8

Propofol

Remifentanil

Question 9

Emergence Phase of Anesthesia

Answer 9

Waking up

Can result in autonomic hyper-responsiveness

Question 10

Autonomic Hyper-Responsiveness During Emergence

Answer 10

Tachycardia
Hypertension
Bronchospasm
Laryngospasm

Question 11

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

Answer 11

Short acting narcotics
Beta blockers
Lidocaine

Question 12

In what surgeries is Propofol used?

Answer 12

General surgeries
Cardiac surgery
Neurosurgery
Pediatric surgery

Question 13

How is propofol metabolized & cleared from the body?

Answer 13

Metabolized in the liver

Excreted in the urine

Question 14

SE of Propofol

Answer 14

Support rapid growth of microorganisms
Hypotension
Hypertonia & movement
Respiratory depression

Question 15

In what populations is ketamine used?

Answer 15

Pediatrics- IM shot
Geriatrics
Shock patients (cardiac stimulant)

Question 16

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

Answer 16

Soluble gasses
More soluble, longer
Less soluble, quicker

Question 17

How do inhaled anesthetics work?

Answer 17

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

Question 18

Isoflurane

Answer 18

Higher blood-gas solubility

Question 19

Effects of Isoflurane

Answer 19

Tachycardia
Peripheral vasodilation
Airway irritant
Coughing

Question 20

Desflurane

Answer 20

Requires heated-pressurized vaporizer for delivery

Question 21

Effects of Desflurane

Answer 21

Tachycardia
Peripheral vasodilation
Coughing
Bronchospasm
Not for mask induction

Question 22

Sevoflurane

Answer 22

NO tachycardia
Peripheral vasodilation
Well-tolerated for mask induction

Question 23

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

Answer 23

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

Question 24

Effects of Nitrous Oxide

Answer 24

Post op nausea

Analgesic properties

Question 25

Advantages of Nitrous Oxide

Answer 25

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

Question 26

Disadvantages of Nitrous Oxide

Answer 26

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

Question 27

Contraindications to Potent Inhaled Anesthetic Agents

Answer 27

Inability to tolerate physiologic alterations | Malignant hyperthermia

Question 28

Reasons for Neuromuscular Blocking Drugs (NMBDs)

Answer 28

Endotracheal intubation Surgical immobility/relaxation Mechanical ventilation

Question 29

2 Types of NMBDs

Answer 29

Depolarizing | Non-depolarizing

Question 30

Depolarizing NMBD Medication

Answer 30

Succinylcholine (Anectine)

Question 31

Non-depolarizing NMBDs Medication

Answer 31

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

Question 32

MOA of Depolarizing Agents

Answer 32

Brief twitching or fasciculations | Flaccid paralysis

Question 33

Succinylcholine (Anectine)

Answer 33

Depolarization at the motor end plate | Slowly dissociates from ACh receptors

Question 34

When is succinylcholine (Anectine) used most frequently?

Answer 34

RSI

Question 35

Disadvantages of Succinylcholine

Answer 35

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

Question 36

Long Acting Non-depolarizing Agents

Answer 36

Pancurounium

Question 37

Intermediate Acting Nondepolarizing Agents

Answer 37

Vecuronium Rocuronium Cistracurium

Question 38

Short Acting Non-Depolarizing Agent

Answer 38

Mivacurium

Question 39

4 Twitches Seen with NMBDs

Answer 39

0-75% of receptors blocked

Question 40

3 Twitches Seen with NMBDs

Answer 40

75% of receptors blocked

Question 41

2 Twitches Seen with NMBDs

Answer 41

80% of receptors blocked

Question 42

1 Twitch Seen with NMBDs

Answer 42

90% of receptors blocked

Question 43

No Twitches Seen with NMBD Use

Answer 43

100% of receptors blocked

Question 44

Reversal of NMBDs

Answer 44

Acetycholine esterase inhibitors

Question 45

Examples of Acetylcholine Esterase Inhibitors

Answer 45

Neostigmine Edrophonium Sugammeadex: vecuronium & rocuronium