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Anesthesia > Lessons 1 & 2 > Flashcards

Lessons 1 & 2 Flashcards

1
Q

True/False

Antecubital Veins are NOT usable for perioperative IV during prone spine surgery

A

True

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2
Q

Biggest “con” for antecubital IV

A

They can “infiltrate” like any other IV, but (unlike other IVs) the infiltration may be hard to detect (even more so on very muscular or obese patients)

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3
Q

What size IV for massive transfusion?

A

Two 16G IVs

If you want to look up the “Poiseuille relationship” go crazy

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4
Q

True/False

You CANNOT induce with a 22G IV

A

False

22G is fine to induce, but you will need a bigger IV after

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5
Q

4 Goals/A’s of General Anesthesia

A
  • Amnesia (w/ LOC)
  • Analgesia
  • Akinesia (skeletal muscle relaxation)
  • Autonomic and sensory reflex blockade
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6
Q

Define General Anesthesia

A

A state of reversible coma intentionally induced by drugs in which the patient is not arousable even with painful stimuli

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7
Q

Define Balanced Anesthesia

A

General anesthesia with several agents

(can be a mixture of inhalational and IV medications)

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8
Q

Define Regional Anesthesia

A

Use of local anesthetics (sometimes with other additives) applied to an anatomically-familiar nerve root(s) or peripheral nerve, to numb a particular region of the body

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9
Q

Define Combined Technique

A

Regional Anesthesia + General Anesthesia

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10
Q

What is Monitored Anesthetic Care?

A

Sedation provided by an Anesthesiologist or CRNA

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11
Q

ASA I

A

No medical problems

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12
Q

ASA II

A

One or more systemic diseases under good control

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13
Q

ASA III

A

One or more systemic diseases which are not in perfect control or limit function to some extent

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14
Q

ASA IV

A

A systemic condition which is a constant threat to life

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15
Q

ASA V

A

Expected to die within a day, surgery is a desperation measure

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16
Q

ASA VI

A

Dead patient (organ harvesting)

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17
Q

ASA E

A

E = emergency

(can be added to any ASA status)

18
Q

Types of IV Anesthetics

A
  1. Sedative-hypnotics (barbiturates, etomidate, propofol, benzodiazepines)
  2. Opioids
  3. Dissociative anesthetics (ketamine)
19
Q

Thiopental

A

Barbiturate

Crosses BBB rapidly

Short acting even though elimination half life is several hours

20
Q

Difference between barbiturate and benzodiazepine in terms of mechanism of action?

A

Barb = prolonged Cl channel opening (potentiates GABA)

BZ = increased frequency of Cl channel opening (potentiates GABA)

21
Q

What is Etomidate?

A

Carboxylated imidazole (simply put = GABA potentiator)

Pro: Minimal CV effects

Con: Potential adrenocortical suppression

22
Q

Onset of action for Etomidate

A

Onset: 30-60 seconds

Peak effect: 1 min

Duration: 3-5 min

Metabolized by hepatic and plasma esterases to inactive product

23
Q

Why is propofol a popular induction agent?

A

Compared to thiopental, propofol has:

  • Antiemetic and antiepileptic activity
  • Associated w/ faster and more complete awakening
  • Easier to store in anesthesia carts
  • Cheap
  • Treats alcohol detox
  • Does not “mask pain”
24
Q

When is propofol contraindicated?

A

History of:

  1. Propofol infusion syndrome (PRIS)
  2. Pancreatitis from hypertriglyceridemia
  3. HFrEF (or concern for “soft pressures”)
25
Propofol's mechanism of action
- Decreases dissociation of GABA from the receptor (increasing duration) - At supraclinical concentrations, it may directly activate the receptor’s chloride channel * Very similar to Etomidate in terms of MOA*
26
Most popular benzodiazepine in anesthesia
Midazolam (primarily used as an anxiolytic or for amnestic effect) Short half-life, water soluble (not painful on injection), coverts to highly lipid soluble form in blood pH
27
Prototype Opioid Agent
Morphine Synthetic agents = fentanyl, sufentanil, remifentanil
28
Fentanyl vs Morphine
Fentanyl is: * 100x more potent * More liphophilic (crosses BBB faster) * **Unlikely to cause hypotension**, even with rapid administration of a relatively large dose\* *\*Morphine can cause hypotension via the release of histamine (especially with rapid administration)*
29
Side effect unique to fentanyl
Chest wall rigidity (especially when given as a rapid bolus)
30
How if Fentanyl excreted?
Oxidized by hepatic microsomal cytochrome P450 into norfentanyl, an inactive metabolite that is then renally excreted
31
What are the volatile liquids?
Halothane Isoflurane Desflurane Sevoflurane
32
Ideal Anesthetic Gas
Low blood solubility (i.e., faster onset) Minimal metabolism Compatible w/ Epi Not irritating to the airway No myocardial depression
33
Blood Solubility
AKA partition coefficient The distribution ration between 2 phases at equilibrium Blood is an inactive reservoir (high blood solubility = decreased speed of onset)
34
Blood Solubility for Inhalational Anesthetics (from fastest time of onset to slowest)
Des (0.42) \> N2O (0.47) \> Sevo (0.69) \> Iso (1.4) \> Hal (2.5) "**D**o **N**ot **S**hit **I**n **H**ere"
35
Define MAC
The steady state concentration of an inhalational agent that maintains immobility in 50% of subjects exposed to a noxious stimulus
36
True/False MAC values are additive
True Ex: 1 MAC of Iso + 0.5 MAC N2O = 1.5 MAC
37
MAC 0.25 MAC 0.5 MAC 1 MAC 1.5 MAC 2
0. 25 = 50% experience anterograde amnesia 0. 5 = 50% unconscious 1 = 50% will not move at incision 1.5 = 95% will not move at incision 2 (aka MAC-BAR) = 50% blocked autonomic reflexes at incision
38
Which Inhalational Agent is used for induction?
Sevo The other agents cause airway irritation and bronchospasm
39
Stages of Anesthesia
Stage 1: Analgesia Stage 2: Excitement (Delirium) Stage 3: Surgical Anesthesia Stage 4: Medullary Depression
40
How does cardiac output affect the speed of induction?
Increased CO = decreased rate of rise of arterial anestheic gas = **slower induction** **Low CO = faster induction**
41
Rare, inherited, potentially lethal syndrome almost exclusive to anesthesiology
Malignant Hyperthermia Due to mutations in the ryanodine receptor 1 gene Hypermetabolic state, Marked CO2 production, Altered skeletal muscle tone, Mixed respiratory & metabolic acidosis

Anesthesia (7 decks)

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